Neurosciences Critical Care Unit (NCCU) information for relatives

This leaflet aims to give you simple and practical information related to your relative/friend’s admission to NCCU. We appreciate that this is a very stressful time and hope that this leaflet will answer some of the questions you may have. NCCU is a 27-bed neuro intensive care unit. We specialise in neurological and trauma care, but also have specialist skills required to care for anybody requiring care in an intensive care unit (ICU) or high dependency unit (HDU).

Admission to NCCU

Your relative has been admitted to NCCU because they require constant monitoring and treatment. Your relative’s condition may change quickly and be life-threatening, and because of this, the information you receive may differ from day to day. All patients on arrival to NCCU will have a thorough assessment by the doctors and nurses. During this time, you will be asked to wait in the relatives’ room. The waiting time can be an hour or more depending on how much intervention/investigation is needed by your relative. A nurse will be with you as soon as your relative’s condition has been stabilised.

Your relative may be surrounded by a lot of equipment and monitoring, which can appear quite daunting at first. This amount of equipment and monitoring is quite normal in an ICU.

The bedside nurse can answer any questions you may have. You will have regular opportunities to speak to the doctors regarding your relative's condition and treatment plan. Where possible, we will discuss in advance any proposed treatment for your relative. However, in some urgent situations this will not be possible.

Useful telephone numbers

• Hospital switchboard: 01223 245151 or 01223 805000
• NCCU (J3) main reception: 01223 216297
• NCCU (J3) nurses station: 01223 257097 or 01223 216358
• Trauma High Dependency Unit (A3) – B bay: 01223 596147
• Trauma High Dependency Unit (A3) – C bay: 01223 349868
• Trauma High Dependency Unit (A3) – D bay: 01223 349869

Who’s who

Consultant

A consultant leads the NCCU team and is supported by doctors and advanced critical care practitioners (ACCPs) training to work in critical care.

Admitting consultant

The admitting consultant is the specialist consultant, for example surgeon, neurologist etc. They will work in conjunction with the NCCU team to make decisions about your relative’s care/treatment.

Nurse in charge

There is always a senior nurse in charge of NCCU and HDU, if you have any questions or concerns, please ask to speak with one of the nurses in charge and we will arrange this for you.

Critical care nurse

There will always be a nurse providing continuous care for your relative. Care is often provided on a one nurse to one patient or one nurse to two patient basis subject to how critically ill and unwell your relative is.

Health care assistant (HCA)

Health care assistants are a vital part of the nursing team on ICU. They work alongside nurses in critical care to provide care for your relative. Allocation of nurses is reviewed on a shift-by-shift basis to ensure that all patients are cared for in a safe, kind, and excellent manner.

Clinical nurse specialist (CNS)

Clinical nurse specialists are available to support patients and families on their critical care journey, preparing the patients for discharge to the wards, assessing their rehabilitation/recovery needs on transfer from critical care to the wards and reviewing longer stay patients on the wards post critical care. They are also able to offer advice once home and run a follow up clinic.

You can contact the CNS team by email or by telephone on 01223 596430 or 07874 637348.

Physiotherapist

Physiotherapists are an integral part of the multidisciplinary team in critical care and are uniquely qualified with skills and expertise to assess and manage respiratory complications, physical deconditioning, neuromuscular and musculoskeletal conditions.

Physiotherapy interventions help reduce the incidence of ventilator-associated pneumonia, facilitate weaning from ventilation and promote safe and early discharge from intensive care.

Pharmacist

The pharmacist monitors the effect of medicines on patients and ensures the unit has a sufficient supply of medicines.

Dietitian

Most patients in NCCU are unable to eat or drink and require nutritional support. The dietitian assesses each patient’s dietary requirements, and prescribes the appropriate nutrition care.

Ward assistant

The team of ward assistants are responsible for cleaning the ward and ordering and serving meals to our patients.

Rehabilitation multidisciplinary team (MDT)

Once a week the rehabilitation MDT (physiotherapist, occupational therapist, Dietitian, psychologist, speech and language therapist, critical care CNS, Major Trauma coordinators and unit doctor and nurse in charge) discuss patients who are starting to improve in their condition. During this meeting, patient rehabilitation/recovery needs and goals are discussed and plans are started for any potential future rehabilitation requirements. Loved ones are welcome to ask the team about these discussions.

Ward clerk

During the daytime, the ward clerks are based at reception desk and can assist/support relatives with non-medical enquiries. They also provide administrative duties for the unit.

ICU psychologist

ICU psychologists offer assessment and intervention for emotional distress to support critical care patients during their stay. Single session follow-up can also be provided on the general wards and signposting to other support services as appropriate. In conjunction with the CNS team support can also be offered for relatives.

Speech and language therapist (SLT)

Speech and language therapists provide early rehabilitation to support tracheostomy weaning, eating, drinking and swallowing, and to promote communication.

Occupational therapist (OT)

Occupational therapists support patients to return to doing the day to day activities that they would normally do, such as grooming, washing, dressing, shopping and hobbies. OTs will find out what life was like before your relative came into hospital, to work out what they need and what is important to them. OTs will work with patients and relatives to relearn skills and return to independence, whether that is brushing their teeth or reading a book. OTs provide early support to assist with, for example:

• physical recovery (dealing with weakness and pain)
• cognitive (thinking ability) recovery (dealing with feelings of confusion or disorientation)
• other difficulties preventing your relative from doing what they want to do, such as anxiety or fatigue (tiredness)

Visiting

Visiting on NCCU and HDU is between 8am and 8pm. We do, however, kindly encourage visiting after midday as the unit can be busy with assessments and procedures in the morning. Visiting hours are subject to change, but you will be informed of any changes.

We only allow two visitors at the bedside at any one time. We strongly advocate this for the safe and timely delivery of care to your relative and an attempt to keep noise levels down (exceptions to this can be made following discussion with the nurse in charge). You may wish to limit the number of visitors to your relative to allow for frequent rest periods. In our experience, too many visitors over too long a period can be very tiring for the patient, so please bear this in mind when thinking about visiting. While waiting to visit, please use the concourse or relatives' room, and please avoid waiting in the corridors as these need to be kept clear for safety reasons.

Children visiting NCCU

We do not currently allow children under 12 to visit. In exceptional circumstances, children are allowed to visit but this must be discussed with the NCCU consultant and the nurse in charge prior to a visit and planned accordingly. What you can tell the child will depend on their age and why their parent or relative is in NCCU. You can help a child deal with the situation by:

• trying to keep to their routine as much as possible (including school trips, seeing friends and going to after-school clubs if the child wants to)
• making sure the child is looked after by someone they know, so they can feel safe at a difficult time
• telling the school, and any other relevant groups, that the child’s parent or relative is in intensive care
• explaining the situation and being honest if you don’t know what is going to happen – if you are not sure, try to say something they can understand that will help the child feel secure and reassured, for example, "Daddy is very ill, but the doctors are doing everything they can to help him."

We do have books for children that contain age-appropriate activities than can help them prepare on their level of understanding. Please ask your nurse if you would like one.

Telephone enquiries

We welcome telephone enquiries, but would ask that you nominate one family member to make these calls and then feed back to the rest of the family and friends. This gives the nurse more time to care for your relative. It is also helpful if you can avoid calling between 07:00 (7am) and 08:00 (8am), and 19:00 (7pm) and 20:00 (8pm), as these are the shift change periods when nurses have handover and do their patient assessment.

The nurse caring for your relative will arrange a password for you to use when telephoning the unit.

Please note: It is hospital policy not to give out specific patient information over the phone. Therefore the information you will be given will be minimal.

We would appreciate if all mobile phones are put on silent before entering the unit and that calls are not taken in the clinical area. You will see clinical staff using mobile devices as part of our clinical care.

Privacy and dignity

Addenbrooke’s Hospital is committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment.

While your relative requires intensive therapy and high dependency care with the use of specialised equipment they may not be cared for in a same-sex bay. However, staff will always do their best to respect your relative's privacy and dignity. This may be with the use of curtains or, where possible, nursing them next to a patient of the same sex.

If you have any concerns about your relative’s privacy or dignity, please speak to the nurse in charge. Once your relative is well enough to be transferred to the ward, they will be cared for in same-sex bays in wards with separate sanitary facilities. During any nursing/medical handovers, procedures or personal care, we ask all visitors to wait in the relative’s room for confidentiality reasons.

Infection control

Before entering NCCU you will be asked to leave your coat and belongings in the relatives’ room (please don’t leave any valuables in there).

To protect both you and your relative from the risk of infection, we ask all visitors to wash their hands and also use the alcohol hand rub on entering and leaving the unit.

In some instances, you may also be asked to wear an apron/gown and gloves. The bedside nurse will discuss this with you.

You will also be asked to vacate the relatives’ room twice a day to allow for cleaning.

If you have any symptoms of respiratory viruses or diarrhoea and vomiting please do not visit the unit.

Ward routine (these are approximate times only)

07:00 (7am) to 07:30 (7:30am)
Nursing handover. You will be asked to leave the bedside during this time.

08:00 (8am) to 09:00 (9am)
The doctors caring for your relative meet to discuss their condition and treatment plan.

09.00 (9am) to 11.00 (11am)
Morning ward round – The doctor caring for your relative will perform an assessment and order any tests and investigations that may be required. The physiotherapist may treat your relative and review them for further physiotherapy needs for the day.

11:00 (11am) onwards
Consultant ward round begins.

17:00 (5pm) onwards
Evening ward round begins.

19:00 (7pm) to 19:30 (7:30pm)
Nursing handover. You will be asked to leave the bedside during this time.

Any time during the day or night your relative could be taken for a scan or other diagnostic procedure, we will try our best to keep you up to date with these plans but occasionally they are undertaken urgently.

If your relative is able to eat or drink:

• breakfast is served from 08:00 (8am) onwards
• lunch is served from 12:00 (noon) onwards
• supper is served from 17:00 (5pm) onwards

If you wish to bring in food or drink for your relative, please feel free to bring in fruit, squash, biscuits and other dry snacks. Unfortunately, we do not have the facilities to refrigerate large quantities of food.

Your involvement in care

Your relative may be sedated. You should, however, always assume that they can hear your voice. Feel free to hold their hand. It may be possible for you to assist in certain aspects of your relative’s care, such as washing hands and face, brushing hair etc. Please discuss this with the nurse looking after your relative. We provide soap, wipes and towels, but it would be helpful if you could bring in a razor, shaving foam, toothbrush, toothpaste, lip balm and deodorant etc. You are also welcome to bring in small items such as a photograph or teddy bear.

Facilities and refreshments

Tea and coffee are available in the relatives’ room. There is also a microwave, toaster and fridge available for you to use. There is a water fountain on NCCU.

In the main concourse of the hospital (turn left out of NCCU), you will find various food outlets, newsagents, mobile phone charging dock and clothes shops. However, please note that fresh flowers are not allowed on NCCU due to infection risk.

There are ATM machines and public telephones in the concourse shopping area. The outpatient area (turn right out of NCCU) sells light refreshments and newspapers.

There are toilets available for visitors to use outside the front doors to NCCU (turn left out of NCCU, just past the lifts on the right). You will also find toilets available in main reception, concourse and a restaurant area towards the outpatients department.

Accommodation

It may be possible for the hospital to provide emergency accommodation for two nights, for a limited number of relatives when their family member is first admitted to NCCU. Rooms are allocated on a daily basis. Please ask the bedside nurse or the nurse in charge if you require a room.

Please note:

• You are not guaranteed a room, this is dependent on availability.
• If a room is available, you cannot leave your belongings in the room.
• If you have additional mobility needs (such as you use a wheelchair), please let us know so we can find suitable accessible accommodation.
• If there is a room available for your use you will be informed by the nurse in charge.
• Keys must be returned to main reception by 11.00 (11am) the following morning.
• For health and safety reasons, we cannot allow you to sleep in the relative’s room overnight. A list of local accommodation is available from the ward clerk.

Car parking

Car parking can be expensive at Addenbrooke’s and spaces are limited.

Where possible, please use the park and ride or other public transport. We are able to offer one weekly concessionary ticket per patient, usually to the next of kin; these can be obtained by asking the nurse in charge or the ward clerk at reception. If your relative is likely to be in hospital for some time, other family members may be able to purchase additional concessionary parking tickets which can also be obtained from the customer service desk at both car park 1 and car park 2.

Patient valuables

When your relative is admitted, the nurses will write an inventory of your relative’s property. Any valuables or money will be deposited for safekeeping. You may be asked to take home other items such as clothing. Please do not bring any valuables or large sums of money in, as the Trust cannot be held responsible for it. We advise that you do not leave items of sentimental value at the bedside; you are able to bring them in with you when you visit, but we would ask you take them with you when you leave.

Sick notes/insurance forms

You may need a certificate for your relative’s employer or an insurance form to be filled out. Please speak to the nurse looking after your relative or the nurse in charge. The ward clerks are able to provide letters of proof of admission as needed.

Spiritual and psychological wellbeing support

Chaplains from various denominations are always available and can be contacted by the nursing team. Your own clergy or religious leaders are also welcome. There is a chapel in the main concourse that is accessible 24 hours a day.

Psychological Wellbeing Service team members are available to offer psychological support and advice to patients and relatives following admission to NCCU – please speak to one of the nurses if you would like to speak to this team.

Interpreters

If you require help with translation, please speak to the nurse looking after your relative.

Discharge to the ward

Your relative will be transferred to an appropriate ward when they are well enough, usually when they are no longer requiring specific intensive care therapies. Prior to transfer to a ward it is possible that your relative may be moved to our HDU on Ward A3; this area is for patients who no longer require support from a ventilator but are not yet quite well enough to go to a ward. Nurses and doctors who work on NCCU also staff HDU.

Discharge from NCCU or HDU to the ward is an important step forward in your relative’s recovery. You may feel anxious about your relative moving to an area where there will be less medical and nursing intervention. You may find it helpful to speak to the nurse about your fears. The clinical nurse specialists are also here to help with this transition and any concerns. They will review patients with identified needs on the ward normally within a few days of leaving ICU.

Wards

The ward that your relative is transferred to will be dependent upon their medical needs. For instance, if they have neurosurgical or neurology needs, they will be transferred to one of the A wards, or to Ward C8 or Ward J2. These wards specialise in that particular area and have different visiting hours. You must only visit during these times, to allow your relative to receive the rehabilitation and rest periods that they require. If you have difficulty visiting within these times, please speak to the nurse in charge of the ward.

Research

NCCU actively supports medical and nursing research projects to improve patient care. We may speak to you about the possibility of your relative taking part in a research study. The decision you make will in no way affect the care you or your relative receive.

Rapid response team (RRT)

When your relative is discharged from NCCU, they will be referred to the RRT. This means that a team of doctors and nurses who have a lot of intensive care experience will follow up your relative on the ward in order to check that they are coping well without the higher level of intensive care. This follow up will usually start the day after your relative has been discharged, and continue for as long as required.

Follow-up clinic

Following your relative’s stay on NCCU they may be invited to attend our follow-up clinic. The aim of this clinic is to talk to you and your relative about their recovery, and to discuss any ongoing concerns you may have.

The clinic is run by an NCCU consultant and critical care nurse specialist. Your relative may also see a specialist therapist depending on the issues identified. The nurse specialist team will phone patients who have had longer ICU admissions to review their progress. This appointment is in addition to any other appointments they may receive following their hospital discharge.

You can email the critical care nurse specialists

Or phone them Monday to Friday on 01223 596430.

Concerns and questions

Although the circumstances surrounding your relative’s admission to NCCU are often traumatic and extremely stressful, we aim to provide both you and your relative with an excellent service within a safe, caring, environment. If, however, you feel you need to raise a concern about, or question any aspect of, your relative’s admission with us, then please speak to the nurse in charge in the first instance. Any problems can usually be resolved very quickly.

Patient Advice and Liaison Service (PALS) and complaints

The PALS and complaints service (opens in a new tab) is located close to the main reception. They are available to provide information, advice and support to patients, families and carers. You can Email PALS or call on 01223 216756.

The Friends and Family Test (FFT)

Patients and their relatives can tell us what you think about the care you received in our hospitals by completing one of the Friends and Family patient experience surveys, please choose NCCU from the drop down menu: Secure Membra (opens in a new tab)

For a digital copy of this leaflet, please access the QR code below:

Charity/support contact information

• ICUsteps (opens in a new tab) – Email ICUsteps – Telephone: 07423 586672
• Headway (opens in a new tab) – Telephone: 01223 576550
• Spinal Injuries Association (opens in a new tab) – Telephone: 0800 9800501
• Brain Injury is BIG (opens in a new tab) – Telephone: 01483 770999
• Carers Trust (opens in a new tab) – Telephone: 0345 241 0954
• CHUMS – offers support to children and young people (opens in a new tab)
• Critical care recovery website – information for patients and relatives (opens in a new tab)
• Healthtalk.org – videos of people sharing their experiences of ICU (opens in a new tab)
• Healthunlocked - online support forum for ICU patients and their loved ones (opens in a new tab)
• Intensive Care Society – resources for patients and relatives (opens in a new tab)
• IAPT – Improving Access to Psychological Therapies (opens in a new tab)
• NHS choices – information about intensive care (opens in a new tab)