03_02_01 The ICU record

The ICU record
Session Overview
Description
This session provides an introduction to intensive care documentation including, clinical record, physiological and other data recording, information management and their uses.

Learning Objectives
By the end of this session you will be able to:

• List the different types of information recorded in intensive care
• Rate the importance of identifying short-term trends in physiological data, blood tests and clinical information
• List the advantages and disadvantages of electronic data recording
• State the potential uses of an intensive care database

Maintaining accurate records of patient status and management is an important part of any type of healthcare.

In addition to standard documentation on progress, treatments, test results and management decisions, the recording and appropriate presentation of physiological data are particularly important in critically-ill patients in order to review short-term trends and identify abnormalities.

Over the last 20 years there has been increasing interest in the advantages of electronic data recording and processing, enabling an extension of the uses of intensive care data.

In your role as an anaesthetist, it is important to maintain accurate records.