TABLE 2.
Interprofessional Team Member Roles in the ICU
| Intensivists |
| Provide leadership and oversight of ICU care |
| Lead multidisciplinary rounds |
| Oversee the many decisions involved in a critically ill patient’s care |
| Coordinate other services the patient may need—including those from specialists |
| Diagnose, manage, and deliver the care of critically ill patients |
| Have the medical training and skills to manage multiple health problems, including but not limited to: |
| Cardiovascular: shock, myocardial infarction, cardiac failure, and arrhythmias |
| Respiratory: prevention and treatment of pneumonia, respiratory failure, acute respiratory distress syndrome, chest trauma, smoke inhalation, and burns |
| Neurologic: stroke, traumatic brain injury, intracranial hypertension, seizures, and brain death evaluation |
| Renal: insufficiency or failure, electrolyte and acid base disorders, and rhabdomyolysis |
| Endocrine disorders: adrenal insufficiency, diabetic emergencies, and thyroid storm |
| Gastrointestinal: pancreatitis, gastrointestinal bleeding, and hepatic failure |
| Pharmacologic emergencies: overdose, drug reactions, and poison |
| Hematologic: anemia, coagulation disorders, and thrombotic disorders |
| Infectious disease: treatment of multiple infections and recognition of and treatment of sepsis |
| Nutritional: prevention, recognition, and treatment of malnutrition |
| Able to manage or perform certain unit-specific procedures, including but not limited to: |
| Endotracheal intubation and mechanical ventilation |
| Placement of intravascular catheters, including central venous catheters, pulmonary artery catheters, dialysis catheters, and arterial catheters |
| Cardiac pacing device insertion and management |
| Tube thoracostomy |
| Pharmacists |
| Assist healthcare team members in making informed decisions of pharmacotherapy options |
| Provide clinical pharmacotherapeutic consults to the care team |
| Review the medication history to determine which maintenance medication should be used |
| Prospectively evaluates all drug orders for appropriate indication, dose, interactions, allergies, and monitors for adverse drug events |
| Provide pertinent, comprehensive drug information |
| Collaborate with the healthcare team to prevent potentially inappropriate drug therapy |
| Provide pharmacokinetic monitoring and therapeutic adjustments with targeted drugs |
| Regularly attends rounds as member of a multidisciplinary critical care team |
| Assist with medication reconciliation at the time of ICU admission and discharge |
| Educate patients and caregivers on medications used in critical care |
| Perform independent patient assessments |
| Provide antimicrobial stewardship and monitoring services for anti-infective agents |
| Participate in resuscitation of emergencies with advanced life support skills |
| Provide drug therapy–related education |
| Review, consult, and advise on nutrition therapy |
| Respiratory therapists |
| Use protocols or guidelines based on evidence-based medicine and standards of practice targeted at improving patient outcomes |
| Implement respiratory therapy and diagnostic procedures as well as technology in the treatment and prevention of disease |
| Patient observation and monitoring of clinical signs, symptoms, and physiologic changes related to respiratory care and diagnostic interventions |
| Provide patient and family education to advance their knowledge of the disease process and understanding of prescribed therapy as well as resources available to assist them |
| Develop and facilitate disease management, patient care plans, and pulmonary rehabilitation |
| Participate in research to better understand current practice, improve patient outcomes, and advance the field of respiratory care |
| Promote cardiopulmonary wellness and prevention through public education |
| Facilitate training of the future healthcare professionals |
| Nurses |
| Provide direct care or influence care for acutely/critically ill patients who are at high risk for actual or potential life-threatening health problems |
| Monitor the critically ill patient including vital signs and physical assessment findings |
| Assess, plan, implement, and evaluate healthcare services for critically ill patients |
| Practice in settings where patients require complex assessment and therapies, high-intensity interventions, and high-level, continuous nursing vigilance |
| Lead and participate in collaborative interprofessional teams |
| Provide critical care treatments including oversight of mechanical ventilation, invasive monitoring, and other life support equipment |
| Respond to the unique needs of patients and families coping with unanticipated illness or injury and treatment, and advocate for their choices in quality-of-life and end-of-life decisions |
| Ensure the delivery of safe and high-quality patient care to critically ill patients |
| Collaborate with interprofessional team and provide oversight of patient care |
| Communicate and provide for family-centered care in the ICU |
| Clinical nurse specialists |
| Provide expert specialty consultation to nurses and other members of the ICU team related to complex patient care needs |
| Collaborate and consult with the interdisciplinary team, patient, and family |
| Coordinate patient/family education related to illness/disease, treatment plan, and medications (family-centered care) |
| Assess the nursing practice environment and processes for improvement opportunities |
| Incorporate national guidelines into ICU protocols and practice (e.g., Pain Agitation Delirium, Immobility, and Sleep Disruption and Nutritional Support Guidelines, Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of analgesia and sedation, Delirium: Assess, Prevent, and Manage, Early mobility and Exercise, and Family engagement and empowerment Bundle, Surviving Sepsis Campaign, Healthy Work Environment Standards) |
| Mentor nurses and nursing staff in using evidence-based practice principles |
| Lead and participate in systematic quality improvement and safety initiatives based on precise problem/etiology identification, gap analysis, and process evaluation at the unit and system level |
| Interface with clinicians and leaders across the continuum, leading system-wide initiatives and using research and clinical expertise to guide implementation and adoption of best practices at the bedside |
| Competency development and education of nurses and other frontline staff |
| Consultation and research support of quality improvement and institutional review board activities |
| Nurse practitioner and physician assistants |
| Assist in the care management of critically ill patients |
| Prescribe and perform diagnostic, pharmacologic, and therapeutic interventions consistent with education, practice, and state regulations |
| Collaborate and consult with the interdisciplinary team, patient, and family |
| Patient and family education regarding anticipated plan of care |
| Lead, monitor, and reinforce practice guidelines for ICU patients (e.g., central line insertion procedures, infection prevention measures, and stress ulcer prophylaxis) |
| Promote and enhance communication with other ICU professionals: registered nurses, clinical nurse specialists, registered respiratory therapists, nutritional support team, and consulting services |
| Perform procedures (as credentialed and privileged, such as arterial line insertion, suturing, and chest tube insertion) |
| Transfer and referral consultations |
| Serve on rapid response and post-ICU discharge follow-up teams to coordinate care |
| Lead quality-assurance initiatives such as ventilator-associated pneumonia bundle, sepsis bundle, and rapid response team |
References: SCCM (14), American Association of Critical Care Nurses (22), Kleinpell et al (30), Lat et al (60), and American Association of Respiratory Care (62).