COVID-19 NICE Guidance - Critical Care in Adults
The purpose of this guideline is to maximise the safety of patients who need critical care during the COVID-19 pandemic while protecting staff from infection. NICE has developed a critical care referral algorithm to support decision making.
Admission to hospital
- Use the Clinical Frailty Scale as part of a holistic assessment where appropriate and record in the patient’s medical record
- The CFS should not be used in younger people, people with stable long-term disabilities, LD or autism
- Consider comorbidities and underlying health conditions in all cases
- When patients with possible COVID-19 has been identified follow appropriate UK government guidance on infection prevention and control measures.
- If COVID-19 is diagnosed in someone not isolated from admission or presentation, follow UK government guidance on actions required when a case was not diagnosed on admission
Admission to critical care
- Discuss risks, benefits and possible likely outcomes of the different treatment options with patient, families and carers using decision support tools so they can make informed decisions about their treatment wherever possible
- Involve critical care teams in discussions about admission to critical care.
- Support non-critical care healthcare professionals to discuss treatment plans with patients who would not benefit from critical care treatment or who do not wish to be admitted to critical care
- Sensitively discuss a possible ‘DNACPR’ with all adults with capacity and assessment suggested if increased frailty
- Ensure healthcare professionals have access to resources to support discussions about treatment plans
Starting, reviewing and stopping critical care treatment
- Start critical care treatment with a clear plan of how the treatment will address the diagnosis and lead to agreed treatment goals
- Review critical care treatment regularly and when the patient’s clinical condition changes
- Stop critical care treatment when it is no longer considered able to achieve the desired overall goals. Record the decision and the discussion with family and carers, the patient (if possible) or an independent mental capacity advocate