Health Information

Trauma and Life Support Center at UW Hospital and Clinics HF#4310

Our Services

Welcome to the Trauma and Life Support Center (TLC) at the University of Wisconsin Hospital and Clinics. TLC is an intensive care unit (ICU) that provides care for patients who are critically ill.

TLC supports a patient and family centered approach to care. The core concepts of patient and family centered are dignity and respect, information sharing, participation, and collaboration.

o We invite patients to be as involved in their own health care as they want to be.
o We actively involve patients and families to partner with the health care team.
o We see the patient and family as important members of the health care team.

We value your input. Please feel free to ask questions and share your thoughts with the nurse or any health care team member.

- TLC staff

A Note to You and Your Family

Being a patient or a family member of a patient in the ICU can be an intense experience. It is our goal to clearly share information with you while also being careful to maintain patient privacy and confidentiality. Below are a few guidelines that we use.

Visiting

The primary support persons and family of a patient will most often be able to visit any time during the patient’s stay in the hospital. Visiting hours for all other guests are from 8:00 am to 9:00 pm. In order to provide a safe setting, people who have been granted permission to stay after 9:00 pm will need to obtain an ID badge from the nurse.

To ensure privacy and safety for all patients, we do ask that all visitors call the unit each time before you enter the patient’s room. Phones are available in the family lounge for your convenience.
TLC South (bed #1-12) – 608-263-8134
TLC North (bed #13-24) – 608-263-8954

Patient Updates

One or two people may be named as primary contacts to receive regular updates on the patient’s condition. This contact is often a family member or a trusted friend. Privacy laws limit the amount of information that hospital staff can provide to other people.

The primary contacts may wish to call the unit to get updates about the patient’s condition and plan of care. While attempts are made to respond to every call, there may be times when the staff is unable to come to the phone. In these instances we will arrange for the staff to get back to you as soon as possible.

Communication with the Interdisciplinary Team

While in the hospital you may hear the phrase “interdisciplinary team” being used. The interdisciplinary team includes a number of people who will be directly involved in treatment and plan of care. We see the patient and family as important members of this team. We welcome your questions and value your input.

Interdisciplinary Team

Each patient has a team of doctors who will develop the plan of care (primary team). The team will consist of one attending doctor and may include other doctors in-training, referred to as fellows and residents. At times, the primary team may consult specialists. This means that the consulting team will provide the primary team with suggestions related to their area of specialty. For example, a cardiologist specializes in the heart and may be consulted for heart related concerns.

Each patient will have a primary nurse. Even when this nurse is off duty, consistent nursing care will be given by other nurses.

Some additional examples of interdisciplinary team members include: respiratory, occupational, physical, and/or speech therapists, pharmacists, clinical nutritionists, nursing assistants, case managers, social workers and eICU nurses and physicians.

Because the interdisciplinary team can consist of many people, it may be helpful to write down the names of the team members for your reference. Paper for this can be found at the end of this packet.

Daily Interdisciplinary Rounds

The plan of care is discussed during rounds each day. It is made up of many items, which may include decisions related to medicines, diet, activity, procedures, tests, and moving to the next level of care.

The patient and/or primary supports are encouraged to take part in rounds. It is important to note that the timing of these rounds may vary between services and from day to day. We suggest you talk with the nurse to plan the best way for you to attend.

Patients and families often find it helpful to write down questions and concerns that they have ahead of time. Paper for note taking can be found at the end of this packet.

Family Meetings

A family meeting is another way to communicate with the interdisciplinary team. If you wish to have broader discussion with the care team and/or with other family members, please talk with any of the Interdisciplinary Team members to arrange this. During these meetings family members can talk with the healthcare team about the patient’s treatment plan and goals of care.

Communicating Patient Preferences

We make every effort to understand the wishes of the patient. Advance directives are legal forms that allow patients to state health care wishes in the event they are unable to do so themselves. They also allow patients to name the person(s) they want to act as agent/spokesperson for their wishes.

Advance Directives

Wisconsin and most states have two forms of advance directives – Power of Attorney for Health Care and the Declaration to Physicians (also known as a “Living Will”). Federal law requires that we have a copy of any formal advance medical directives in the patient’s medical record. Please make sure that we have a copy of any completed advance directives.

Some patients choose not to have advance directives or have not yet completed one. When there is no advance directive, doctors often turn to adult family members to make decisions. Some questions to consider when making these decisions might be:

Did you ever talk about what the patient would want if things did not go the way the patient had hoped?
What do you think the patient would want, and what is best for him or her?

If you want to learn more about advance medical directives, we can arrange for the social worker to meet with you.

Equipment in the ICU

There are monitors, machines, and tubes that patients may have during a stay in the hospital. Please ask your nurse if you have any questions about the equipment in the ICU.

Monitor

The monitor is used to measure how the heart and lungs are doing. It tracks heartbeat, oxygen level, blood pressure, and other body functions. The numbers and pictures are seen in the room and at the nursing station 24 hours a day.

Nurses constantly monitor patients and respond to the alarms. The monitors have alarms for all the patients, so you may hear the monitor beep when the alarm is for another patient. The purpose of this is to quickly convey important patient information to all nurses when they are in patient rooms.

Pulse Oximeter

A device that clips to the finger. It has a red light at the (pulse Ox) end of it. It measures the oxygen level in the body.

Ventilator (Vent)

A machine used to help patients breathe and give higher amounts of oxygen. Severe illness or injury can cause too low levels of oxygen or too high levels of carbon dioxide.

This machine is connected to the patient through a tube in the mouth (ETT) or neck (tracheostomy or trach). A breathing tube may be uncomfortable. It can make some people anxious. Patients can get medicines to help them be comfortable. The ventilator will be removed as soon as the patient is able to breathe well on their own.

Arterial Line (A line)

A tube in an artery, usually in the wrist, used to measure blood pressure. It is also used to draw blood for lab tests without having to use a needle.

Central Line

A tube in a large vein in the neck, leg, or arm (PICC). It is used to give certain medicines.

Bladder Catheter

A tube used to collect urine into a bag. Checking the (Foley) amount of
urine helps us to know how well the kidneys are working. Sometimes patients feel the urge to urinate even though the catheter is in place, and this is normal.

Feeding Tube

A small tube placed in the nose or mouth. It is used to
(Dobhoff) give fluids, food, and medicine to patients who cannot take them by mouth.

Sequential Stockings (SCDS)

Special wraps that are placed on the legs. The wraps are attached to a
machine that inflates and deflates in a routine pattern. This helps blood flow and decreases blood clots.

e-Care Camera

This camera allows e-Care staff to remotely monitor patients. E-Care includes critical care doctors and nurses that provide additional patient care support. To ensure privacy, cameras are turned off except when needed to check patient status or deliver care. When a camera is off, it faces the wall. All audio and video communication is not recorded.

Procedures in the ICU

ICU rooms are equipped to handle many procedures in the room. Some procedures or tests may need to be done outside of the unit. Patients in the ICU are always accompanied by the nurse and/or doctor when they leave the ICU room.

Common Medicines in the ICU

Pain Medicines

There are many ways to manage pain. Examples of pain medicines include morphine, hydromorphone (Dilaudid®) and fentanyl. There are many causes of pain and nurses often assess pain level. Please talk to the nurse if you are concerned about managing pain or you think that the patient looks uncomfortable.

Sedation Medicines

These act in the brain to cause sedation (sleepiness, drowsiness), decrease anxiety, and provide amnesia (help the patient not remember much of their time in the ICU). Examples of sedation medicines include lorazepam (Ativan®), midazolam (Versed®), and propofol.

Vasopressors "Pressors"

These medicines are used when a patient’s blood pressure is too low.
They work in the heart and blood vessels to increase blood pressure. Examples of vasopressors include norepinephrine (norepi), vasopressin, and dopamine. Nurses may make frequent changes to the medicines to keep a patient’s blood pressure within a specific range.

Antihypertensives

These medicines are used when a patient’s blood pressure is too high. They work in the heart and blood vessels to decrease blood pressure. Examples of antihypertensives include nitroglycerin, labetalol, and esmolol.

Insulin

This medicine is used when a patient’s blood sugar is too high. The stress of critical illness and/or medicines can cause a patient’s blood sugar to increase. Just because a patient needs insulin in the ICU does not mean he will need it forever. A small blood sample from the finger is used to check the blood sugar level often.

Supporting the Caregiver

Having a family member in the ICU can be a very stressful time. Stress can affect the body and mind. It is important to take care of yourself. Remember basic needs, stay well-hydrated, eat regular meals, and try to get adequate rest.

Family Support

There are resources available for support. Please ask the nurse if you would like to speak with a social worker, case manager, or chaplain.

Worship services are held in the chapel on the main floor of the American Family Children’s Hospital. The schedule for worship services may change. For the most recent schedule call (608) 263-8574 or go to www.uwhealth.org and click on “Patients and Visitors” link to find the UW Hospital Visitor Guide.

Resources in the Hospital

Please use the “Finding Your Way” brochure in this
folder for hospital maps and information on services such as the cafeteria, pharmacy and gift shop. If you need assistance, please don’t hesitate to ask for help from any hospital employee.

Internet Access & Web Resources

Complementary Wi-Fi wireless internet access
is available from your own wireless device throughout the hospital.

Public computers are located in the TLC Family Lounge and the Surgical Waiting Area in the B module on the 2nd floor.

A hospital visitor guide is also available on www.uwhealth.org. Click on “Patients and Visitors” link to find the UW Hospital Visitor Guide.

Supporting the Caregiver

Ideas For When You’re in the Patient Room

Let the patient know that you are there. A well-known voice and a gentle touch can provide comfort. Consider reading aloud or talking about daily events. You should speak in a calm voice.

Keep in mind that the patient might not be able to respond to you, either because there is a breathing tube in place that does not allow the patient to speak, or because of medicines or altered awareness.

Be yourself. There may be moments when you may feel like laughing or crying with the patient.

Talk with the nurse about helping with personal cares, if you’re interested. Examples may include: applying lip balm, giving a hand and/or foot massage, helping in passive range of motion exercises.

Journaling

Putting your thoughts and feelings on paper may help reduce stress. Writing may also help you keep track of daily events. Paper is provided in this packet for you.

Reviewing notes from the ICU stay can also help patient recovery. A better understanding of the time in the ICU may reduce subsequent stress and anxiety, especially for patients who are unable to recall portions of the ICU stay.

Leaving the ICU

Patients are ready to move from the ICU when their care needs change. The unit that the patient is transferred to depends upon the patient’s needs. Transfer plans will be discussed with the patient and family as soon as possible.

Transfers

When a patient is ready to move from the ICU to another unit in the hospital or to another facility, they may be moved to an “IMC” – intermediate care or “to the floor” – general care unit, based on their care needs. Most often, moving from the ICU also means that patients are getting closer to being discharged from the hospital. Hospital staff makes every effort to predict when the transfer will happen and to tell the family about the move as soon as possible.

The new unit will most likely include new nurses and doctors, different medical equipment and different structure (visiting hours, time for rounds). Staff on the new unit will be happy to answer questions and explain what to expect during your stay with them.

Discharge Planning

Discharge planning begins at admission. It includes input from the care team and most importantly from patients and their families. Case management staff (nurses and social workers) will begin discussing and exploring possible needs for when a patient is ready to leave the hospital. Not all patients require more support or medical care after the hospital. However, there are different types of care available for those who do – such as home health services, long term acute care hospitals, skilled nursing facilities and inpatient rehabilitation units.

Palliative Care

Sometimes, in spite of our treatments and hopes, a patient cannot recover or returned to a desired quality of life. There are some cases where the patient does not want further treatment.

Palliative care is focused on giving patients relief from the symptoms, pain, and stresses of a serious illness, whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided in a number of settings, including the ICU. The hospital also has a palliative care unit and a specialty team available if needed.

Questions

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Notes

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Names of Team Members

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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 07/25/2012

Copyright © 07/25/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4310

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