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Slide 10 On arrival to the ICU the patient was awake, in some discomfort and obviously frightened. It is of paramount importance that the patient be reassured and informed of what is happening. The doctor gives explanations and the nurse gives added reassurance, aiming to calm the patient and gain the patients trust. During the initial stages of admission there is a lot of activity and noise and the patient requires maximum support. It is during this time that caring for the patient requires two nurses, one of whom dedicates time to supporting patient and family. Other patient care needs, need to be met. General discomfort and thirst require particular attention. Analgesics are given and gentle handling of the patient is necessary. Mouthcare aims to relieve thirst as the patient must be kept nil by mouth [in case intubation is required]. As the patients condition worsens and the need for further interventions take priority, less time is available to spend directly with the patient. It is of paramount importance that the nurse gives explanations whilst carrying out tasks. This continues once the patient is sedated. A rapidly deteriorating condition means that the nurse must prioritise management of physiological status above basic patient care needs with the aim to address these once stabilisation is achieved.

Slide 11 Once the patient is admitted to ICU priority is given to allowing the family to see the patient and receive information from the senior doctor. Once it becomes apparent that the patients condition is rapidly deteriorating it is vital that the family are made aware of the life threatening sequalae taking place. Time is set aside for the doctor to talk honestly with the family and answer any questions. The nurse is present to provide support for family and doctor. Whilst the patient is conscious the family are encouraged to spend time at the bedside. This is a time for the nurse to provide clarification. Once escalation of treatment is required the family stay in a designated relatives room where they can rest and make refreshments. Remaining at the bedside is impractical and family are aware that some time may elapse before they can return. Access to a phone means that they can contact other family members and nursing staff relay brief information to family who phone the unit.

Slide 12 The rapid onset of meningococcal septicaemia with development of life threatening multiple organ failure means that the multidisciplinary team must act promptly and cohesively. Supporting each other helps to reduce the stress that is a feature for all team members. Sharing common skills and tasks maximises collaboration and improves efficiency whilst constantly sharing information and keeping each other up to date with patient progress works to positively influence patient outcome.

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