Intensive care is exactly how it sounds, its intensive and A&E worked at fast pace. In intensive care the medical staff included as Anaesthetist (Consultant, SpR, SHO), Pharmacist and the Nursing Officer. Medical alliances that were on the unit included ECG technicians, physio therapist and nursing assistance. Every month there were a turn over of Consultants and Pharmacists, every morning they would each do a around and consider the plan, observe changes and what needs to be done. If a drug was not ideal for a patient then and there, there pharmacists could change the particular drug. The nursing officer would also contribute and identify any problems that had been handed over or documented.
Every nurse was allocated one patient and had to care for them throughout the shift unlike A&E whereby staff were allocated to an area whether it be majors, minors, triage, resus or paediatrics. They received verbal handover in the staff room, then by the bed side, which was given by the previous nurse who also would identify any outstanding things that needed to be done for the patient i.e. X-ray, scan etc. The staff now on duty would read through the patients notes, then wash the patient, take vitals signs and administer medications. Patients were usually on intravenous medication and fluids. Common drugs included Propofol (sedation), Tacurium (muscle relaxant) and Inotropic therapy such as Dobutamine and Adrenalin and Nor-Adrenaline (vasoconstrictors). Every intervention was documents systematically using the nursing process and assessments. The nursing staff there had a close team which I think is not only in the best interest of the staff but also in the best interest of the patients. These patients usually suffered from trauma, shock, multi organ failure or severe respiratory failure. They were visited by their families who prayed for them and some just stood in silence. This placement I must say was touching as there was so many ethical issues to deal with, it made me view life in a different way and I can say was a major learning curve for me.
The accident and emergency it was very much unlike ITU, it was at a fast pace, it had a number of people in every coner and unlike ITU wereby all the patients were sedated or in a coma patients spoke to you. I felt more included when providing care for patients and the day-day routine was far different than ITU. In A&E there was a handover every morning which students including myself never attended to or was invited to. Usually it was the nurses coming on which attending the hand over, there was no structure in the handover it seemed because those that were allocated in resus for an example still listened in the handover but seen as this was mostly in Maltese I could be wrong. In the day, we usually stocked up the trolley, the person allocated to triage would go straight there and the one allocated in resus would stock the resus rooms up. The A&E department also had a control room where calls came in for ambulances, in the mornings there was someone also allocated to the control room. The department received all sorts of injures, all sorts of people and all types of calls. Common injuries and illnesses that came through the department included, muscle skeletal injuries from falls, trauma from motor vehicle accidents and road traffic accidents (MVA's and RTA's) and medical emergencies such as Shock, CVA, cardiac arrests etc. The best part of this A&E was that I was able to do things I would not have ever been given the chance to do in the UK, such as ride on an ambulance to a scene, take arterial blood gasses, cannulation and give IV drugs (under supervision).
Patients that came into A&E via ambulance were either put on on high priority or in the resuscitation room, those that came through triage unless was an emergency were made seated until it was their turn to be seen, unlike the UK were we used the Manchester triage system there was nothing like that in place it was more of a 'first come first served' system which could have put ill patients in immediate harm. Some patients waited so long in the department that they would leave and I believe the system needs to be changes for the grater good. Staff in the department included A&E Dr's, nurses, nursing assistants and cleaners. Although, specialist were some times called, during the time I was there a nutritionist, a psychologist, a surgeon and an anaesthetist were called out for their speciality. I recall on a number of transfer's to X-ray's or CT scan's an anaesthetist accompanied the patient and nursing staff. At the time of this placement was when people from Libya were cast of the country due to civil war, in turn, we had patients who came of the boat from Libya and were cared for in the A&E department. These people felt traumatised and were so please and thankful for every intervention taken out for them. During this placement at times I noticed the Maltese patients pointing and making remarks which felt quite odd. A&E was an interesting place as everything came through the door, although some people abused the services it was an amazing experience for me.
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