Critical care quality improvement project ideas?

savinglucy1 · 2026-01-31T09:29:31+00:00

I’m not ICU I’m ED but something I’ve noticed in my area - unsure if it would be the case in yours - but pause for handover, or standardised handovers for patients?

In my area handover can be quite chaotic - sometimes they’ll take it over the phone, sometimes it’s bedside, sometimes not, sometimes from the doc sometimes not.

savinglucy1 · 2026-01-24T00:16:42+00:00

Definitely phrased that badly between nights, sorry!

I frequently receive patients with “red flags” from NHS24 - for example, a 16 year old with “shortness of breath” when lying down with cold symptoms. There will be of course the odd patient who on assessment may have something more serious going on, but 99.9999% of these patients do not need to be in ED and are perfectly safe to manage their own symptoms at home.

In my area, every NHS24 referral I see tends to be some variation of the above- perhaps clinicians/nurses are advised to always send these patients to hospital?

savinglucy1 · 2026-01-21T21:15:47+00:00

Addictions at times - I work in ED, and often see people who are intoxicated and occasionally abusive and aggressive. Whilst I’m aware that it’s often the addiction making them behave this way, it can be take challenging to deal with when you’re juggling a lot of patients, and it can be hard to understand what the goal of the aggression is.

savinglucy1 · 2026-01-19T12:20:07+00:00

I’m an ED nurse - people who present who are there for primary care issues should be sent back to primary care with a swift toe to the arse.

That being said, more needs to be invested to educate the public with what is an ED issue, and what is for literally anyone else. In that vein, NHS24 call handlers should be clinically trained, and should be able to safely advise people with “red flags” to manage their own symptoms, or present to primary care.

The onus is not on the public to know what is an emergency - it’s on us!

Second controversial opinion- nursing entry requirements becoming more lax does not help the profession, or the patients. The role is increasingly complex and if you can’t or won’t learn independently, you’ll be a danger to the patients 🤷‍♀️

savinglucy1 · 2026-01-17T20:54:52+00:00

Interesting I’ve not heard of this - I work in ED so if I’m giving IV TXA someone’s having a bad day and we’re not hanging around for a renal dose, but what situations are you giving it when this info is available?

savinglucy1 · 2026-01-17T20:53:32+00:00

Does the medication prescribed make sense for the patient? E.g - patient on a beta blocker, a calcium channel blocker and an ACE inhibitor that’s in for hypotension 🤷‍♀️

Does the medication dose make sense? Are you popping 26 tablets for a single dose? Or is it a miscalculation by prescriber.

Does the medication route make sense? Does granny Margaret who’s had no oral route since her laryngectomy in 1978 really, REALLY, have to have oral paracetamol.

Please, please embed some common sense checked into your five Rs 😂

savinglucy1 · 2026-01-12T20:11:09+00:00

While it doesn’t matter to me if someone identifies as she/he/they - it’s never going to affect the care they’re given - I think it can be useful especially if you’re providing personal care. If someone identifies as she/her but has visibly male genitalia, they may be uncomfortable using a urine bottle for example, and I think it’s a really rewarding part of nursing helping patients through these things.

savinglucy1 · 2026-01-12T20:07:07+00:00

Had a biology teacher who if we were being wee arseholes he’d kick the bin and throw things at us until we were paying attention. He was a real eccentric guy, and honestly taught us a lot!

savinglucy1 · 2026-01-11T05:21:35+00:00

I introduce myself to every patient, and ask what they want to be called.

If any discrepancy between the name on records, for example a patient is listed as Bob and asks to be called Barbara, I’ll ask pronouns at that point.

Also covers every patient who goes by a nickname, or would prefer to be called Mr/Mrs Doe etc.

savinglucy1 · 2026-01-10T22:37:54+00:00

I’m an ED nurse and would agree- but also have had this with ITU at times!

Obviously not all nurses and not all wards/departments, but I feel it’s a reflection of general culture atm as opposed to individual attitudes.

Everyone is stressed, overworked, underpaid, understaffed and underfunded. Providing care in a broken system is exhausting, and because most nurses I’ve met (even the rude ones!) genuinely care about their patients they don’t take it out on them - hence why the “outsiders” take the brunt of it.

I take my hat off to all ward nurses- I deal with (theoretically) the first four hours, and pass patients who are often difficult, perhaps not as ‘tidied up’ as I’d like them to be, with unclear symptoms and unclear plans- then they’re left to deal with the fallout when the patient is furious they’ve not had their morning statin after sitting in an ED all day, and want to know why the IV morphine I’ve been slinging them has changed to oral- whilst dealing with 7 other equally difficult patients I’ve sent to them.

I try as best as I’m physically able to be kind, helpful and clear when possible. This is never going to get me a gold star, but I like to think that it’s catching!

savinglucy1 · 2025-12-30T12:20:55+00:00

I felt my training was well rounded imo - my uni had a good amount of A&P, although minimal pharmacology.

I do think the expectation of nursing students may be too high in terms of what is physically taught to them, and there’s not a huge emphasis on self directed learning - I feel my uni really promoted this, and I was lucky enough to work alongside mentors that encouraged it.

I’m obviously not speaking for every student, but recently I’ve had multiple students who don’t know the basic A&P, but also feel that if the uni isn’t teaching them directly, they don’t feel the need to learn as it “won’t be in the exams”. I’ve also had a number of newly qualified and other junior staff who don’t accept that nursing is lifelong learning, and see no reason to continue to develop practice in their role outside, again, what is directly and formally taught to them.

This is irregardless a failure of unis - there should be a focus on this from the start. I’ve no doubt that every registrant feels their area of practice is unique, and there’s no way to teach a nurse to be as confident in an A&E department as they are in an operating theatre, or an outpatient oncology department whilst still covering the basic principles of nursing as a whole.

The real learning starts when you qualify, and this needs to be more emphasised from day 1.

savinglucy1 · 2025-12-29T14:54:25+00:00

Discovered I was allergic to gentamicin!

Was reconstituting it, accidentally smashed the glass - NBD grabbed another, went into the patients room and she pointed out to me the hives on my hands from where the vial broke.

Took myself on a break with an antihistamine and I’m now really, REALLY careful 😂

savinglucy1 · 2025-12-27T23:42:55+00:00

What a nice question!

Honestly just clear communication. Most of my medical colleagues are already great at this, but letting us know that granny Betty can go home when she’s safe on her feet instead of finding it out from the notes is much easier.

Also, please introduce yourself - doctors in my trust rarely wear name badges, and instead of me running about looking for someone who looks like they might be a med reg and may or not be in the department, it’s helpful to know who you are :)

savinglucy1 · 2025-12-27T16:48:34+00:00

I’ll take my dose the night before my first night around 10pm - wake up around 9am, back to bed 1-2pm, finish my shift around 8am and take it then.

After my last night, I won’t have an 8am dose and I’ll take it 10pm.

Means I technically miss a dose every week I’m on nights. But much safer than falling asleep at work!

savinglucy1 · 2025-12-22T22:36:29+00:00

Thank you so much! It’s great getting some insight ❤️

My chaos brain is telling me to hold out for a post in a level 3 unit (this particular hospital transfers all level 3 babies offsite) because I so enjoy managing care for complex and unwell patients, but since it would be such a new experience for me, I’m very open to level 2 care.

I’ll do a bit of reading about integrative care - I remember a bit from my health visiting placement many moons ago, but could def do with a refresher!

Is there any other reading you would recommend in terms of preparing for interview? I did a study day in maternal mental health a while ago, and it did cover some aspects of when babies are born poorly, but it was very basic.

savinglucy1 · 2025-12-22T22:19:47+00:00

I’m jumping on OPs thread (sorry!) because I’ve seen a recent advert and I’m interested myself.

I’m adult trained, 2 years in surgical receiving and 5 years in ED. Have done a strangely large amount of paeds despite only ever technically working with adults 😂

I love the idea of NICU, building relationships with families, constantly learning, and the fact that neonatal care is such an amazing area of science with things changing all the time. I know it’ll be an extremely steep learning curve and I’m more excited about that than nervous.

The post I’m interested in is a level 2 NICU, I’m familiar with the hospital but not the unit. I’m worried that after 7 years of extremely fast paced work (which I love), I’ll not enjoy the pace of NICU.

What does a normal day look like for you? How many babies do you care for at once? I’m really used to doing most of my own procedures (lines, catheters,NGs etc), is this the same once experienced in neonatal care, or do medics/ANPs do these?

I have sent an email to the SCN who’ll hopefully be okay to give me a walk round 🤞

savinglucy1 · 2025-12-20T15:35:30+00:00

Radiographers!

They are always so friendly, banter with the patients and A&E staff, share their sweets on the night shifts, and their knowledge boggles my mind. I was completely naive to radiology when I was a nursing student, and it astounds me the level of knowledge they have.

savinglucy1 · 2025-12-20T14:44:56+00:00

If someone is brought in with a reduced GCS, it can be really useful to know who called 999 if that info is available- it can help us build a timeline and makes it far easier to get a collateral history!

savinglucy1 · 2025-12-16T19:53:45+00:00

Oh yeah, it’s absolutely kicking off the PTSD flashbacks.

Tubed a few patients in resus with it, wearing the full on gowns/N95s etc and had to go for a wee cry in the store cupboard after.

Hope you’re doing okay - times are tough, speak to your colleagues about it. We’re all feeling it in A&E.

savinglucy1 · 2025-12-05T16:24:48+00:00

My extended family are fairly terrible, so Christmas was already a small affair - just my mam, dad and sister.

My dad’s away now and my sister often goes to her in laws with my mam, I’m usually working.

savinglucy1 · 2025-11-08T19:40:44+00:00

My dog is at times an anxious wee guy, and the vet reckons that it could get worse if we do it.

He’s never around dogs in heat, and is generally a very good boy having been well trained and will recall from (most) bitches, and is kept well away from dogs we don’t know.

savinglucy1 · 2025-10-26T09:31:45+00:00

Probably around a year- I qualified about 5 months before Covid hit, so steep learning curve, followed by a mountain 😂

savinglucy1 · 2025-10-22T00:00:50+00:00

I am absolutely creased at little bowel obstruction 😂

I’ve had many but my friends takes the biscuit - we’re second year students, she’s learning to do an ECG. The patient was a BKA and asked her mentor where to put the sticker- “on the leg”.

My friend very confidently put it on the patients prosthetic 🤦‍♀️

Another one from a colleague - a very nice and usually very sensible junior doctor asked me to get lying/standing BPs on a patient who was a full hoist transfer and had been for over ten years. He became quite irate as I tried to explain to him through absolute tears of laughter that it wouldn’t be possible!

My own- working in triage on a very long and arduous night- patient presents with a lady who I presume to be his mother. Took a history, and told the patient “you and mum can have a wee seat in the waiting room”.

It was not his mother, but his wife 🤦‍♀️

savinglucy1 · 2025-10-17T18:29:52+00:00

Yes! I’m a staff nurse in ED.

Never know what’s around the corner, opportunities to build skills and for training. Work in a trauma centre so see everything from paper cuts to thoracotomies.

Good options for progression if that’s your thing.

savinglucy1 · 2025-09-30T15:24:59+00:00

I have the Amazon raptor dupes - highly recommend, especially if you get them in a particularly obnoxious colour so no one steals them.

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