Process map the management of blood pressure during a patient’s journey from acceptance of referral to discharge from ICU:
- What ICU capacity is available and what happens when demand exceeds capacity?
- Which health care workers are involved with admissions?
- Who sets the MAP target and when?
- Who inserts the appropriate monitoring and are there delays in this process?
- What medication is used to achieve a certain blood pressure and how is this provided, made up and prescribed?
- What measures are in place to ensure that recordings are accurate and reproducible?
- Is further training required in the use of ultrasound, management of central and arterial line?
- Is availability of equipment, such as ultrasound, optimal?
- Is a peripheral vasoconstrictor appropriate if MAP target unlikely to be achieved within two hours?
Run charts may be helpful to visualise progress with compliance over time:
- Are critical care nurses able to adjust inotropes?
- What is the locally agreed policy for confirmation of central line insertion?
- Is a chest x-ray required prior to starting inotropes? Are there delays in achieving this?
