FICM Guidelines & Resources
In 2021 the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS) recommended that United Kingdom (UK) consensus guidance on ancillary investigations to support the clinical diagnosis of death using neurological criteria (DNC) should be developed. In collaboration with the British Society of Neuroradiologists, a consensus group has established a standardised protocol for CT angiography (CTA) when used as an ancillary investigation to support the clinical diagnosis of DNC.
Developed along with the Intensive Care Society, this resource was guided by the results of a national survey of members to identify current practices and challenges in managing patients in the prone position and to determine whether there was a need for national guidance.
Accurate prognostication in life threatening brain injury is difficult, particularly at an early stage. The eventual outcome for such patients is often death or survival with severe disability. Controlled studies to provide evidence to guide decision making are few and the risk of a ‘self-fulfilling prophecy’, with early prognostication leading to early WLST and death, continues to exist.
Following discussion at the Board of the Faculty of Intensive Care Medicine, we convened a consensus group with representation from stakeholder professional organisations to produce this guidance. It recognised that the weak evidence base makes GRADE guidelines difficult to justify. We have made twelve practical, pragmatic recommendations we hope will help clinicians deliver safe, effective, equitable and justifiable care within a resource constrained NHS.
In the situation where patient centred outcomes are recognised to be unacceptable, regardless of the extent of neurological improvement, then early transition to palliative care without admission to ICU would be appropriate. This consensus statement is intended to apply where the primary pathology is DBI, rather than to the situation where DBI has compounded a progressive and irreversible deterioration in other life threatening co-morbidities.
For the purpose of this statement DBI is defined as 'any neurological condition that is assessed at the time of hospital admission as an immediate threat to life or incompatible with good functional recovery AND where early limitation or withdrawal of therapy is being considered'.
A decade ago, critical care units prepared medicines for infusion in a fashion determined by each individual unit and without reference to a central recommended list. As a consequence, there were a huge variety of compositions of medications and fragmentation in practice, with implications for training, use of language/terminology, efficient use of resources and lack of purchasing power to influence development of medicines manufactured in a ready-to-use format.
Subsequently, the Intensive Care Society consulted on and adopted a core set of standard medication concentrations which have now been in place since 2010. The addition of new medicines to the market place, combined with findings from more recent work that explores the extent of adoption of the standards, have revealed the need to update the list.
Version 2 now includes dexmedetomidine, adrenaline and a different phosphate presentation. An additional column now denotes route (central vs peripheral). We urge practitioners to review practice on their unit, and consider adoption of the standard concentrations wherever possible.
The forms below are consistent with and should be used in conjunction with, the AoMRC (2008) 'A Code of Practice for the Diagnosis and Confirmation of Death' and have been endorsed by the FICM. The forms were last updated in 2021.
You can download the long version or the short version updated to reflect the 2021 review and recommendations accepted by the FICM and ICS. You can also download the supplementary guidance is for the Diagnosis of Death using Neurological Criteria when the patient is supported with extracorporeal membrane oxygenation (ECMO) HERE.
The NHS Blood and Transplant website also has educational videos available on this topic.
Choosing wisely is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
By having discussions that are informed by the doctor, but taking into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
The FICM has contributed to a list of forty treatments and procedures that are of little or no benefit to patients, which have been drawn up by the UK’s medical royal colleges.
See here for full details.
The Choosing Wisely website has a section for patients as well as clinicians.
The purpose is to provide an evidence-based framework for the management of adult patients with ARDS which will inform both key decisions in the care of individual patients and broader policy. The development process was based on the previous NICE approval process and has used GRADE methodology to review an extensive evidence base. We would like to thank all of those involved in bringing this guideline to fruition!
The full guideline and accompanying appendices can be found below:
This supplementary guidance is endorsed by the Faculty of Intensive Care Medicine, the Intensive Care Society Standards Committee and the NHS England Severe Respiratory Failure Network for adults and children older than 16 years. It should be used in conjunction with the Academy of Medical Royal Colleges (AoMRC 2008) A Code of Practice for the Diagnosis and Confirmation of Death and the forms for the Diagnosis of Death using Neurological Criteria endorsed by the Faculty of Intensive Care Medicine, Intensive Care Society and the National Organ Donation Committee.
Following calls from doctors, responsible officers and appraisers, for clearer information on what is meant by 'reflection' as part of practice; the Academy, the Conference of Postgraduate Medical Deans (COPMeD), the General Medical Council (GMC) and the Medical Schools Council (MSC) have produce a three part publication providing guidance on reflective practice. This guidance supersedes the interim guidance produced by the Academy and COPMED in March 2018
The guidance outlines the importance of reflection for personal development and learning; it highlights how reflection can help doctors and medical students to maintain and improve their professional practice, and drive improvements in patient safety.
The Faculty was delighted to co-fund and provide administrative support for this important development framework, which was completed as a joint project with the ICS. This framework is intended to facilitate the structured development and career progression of post registration Allied Health Professionals (AHP) working in a critical care environment. The scope covers four AHP therapies working with critically ill patients and their carers. These are: :
Speech and Language Therapy
The FICM and ICS have produced this guidance to offer an important framework for the multidisciplinary teams across the country who are integral to the safe transfer of the UK's most critically ill patients.
A framework for improved collaborative working between Emergency Medicine and Intensive Care Medicine.
The patient population in NHS hospitals that are managed with a tracheostomy has evolved significantly over the last 20 years. The majority are performed percutaneously by intensivists, in the Intensive Care Unit, on critically ill patients or those recovering from critical illness.
Most tracheostomies are temporary. The vast majority of patients with ‘surgical’ and ‘non-surgical’ tracheostomies experience critical care at some stage of their journey. The multidisciplinary nature of tracheostomy care is a familiar working environment for our specialty, with tracheostomy care being perhaps one of the best examples truly multidisciplinary care.
There is increasing evidence from national and international quality improvement programmes that a multidisciplinary tracheostomy team that reviews and coordinates the management of tracheostomy patients can bring benefits for the quality and safety of care, including organisational efficiencies and significant cost savings.
This guidance was produced by the Short-life Standards and Guidelines Working Party of the UK National Tracheostomy Safety Project on behalf of the Intensive Care Society and has been endorsed by the FICM.
Want to know more?
Read the GPICS standards.