Seeing a “tree of life” can be an intimidating sight. When you see this number of pumps for one patient, you instantly know things are pretty serious. This sight is almost a daily occurrence in our ICU.
Now, your first reaction may be to turn around and walk quickly in the other direction. However, rather than feel overwhelmed at the whole sight, think of the saying: “How do you eat an elephant? Piece by piece.”
Take things one step at a time.
Step 1: stop and reset
Take a deep breath and reset. This is important, as these patients are complicated. If you’re not mentally ready for handover then you will miss important details critical for understanding the patient as a whole.
Step 2: understand the patient
It is important to know what is going on with the patient as this will provide context to the “tree of life”.
If you are handing over, make sure it is comprehensive. If you are on the receiving end of a handover make sure you are paying attention, and ask questions or seek clarification.
Step 3: group the meds
Grouping the meds helps chunk them. Group them into categories such as pain relief, antibiotics, antiarrhythmics, pressor agents and supplements (such as glucose and potassium). It also puts their use into perspective.
Step 4: know what the fluid therapy plan is
This step is often forgotten. Always ask what the fluid status of the patient is. Also, at what phase of the fluid plan they are in – correction of perfusion, rehydration or maintenance. Also, consider if there are any on going losses being accounted for.
The next time you walk into an ICU and are about to take handover of a patient who has a “tree of life”, it won’t be such a daunting task if you follow this process. I truly acknowledge anyone out there who has learned to see this sight as an exciting challenge, and the chance to learn and make a difference.
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