Jump to content

Topics About 'Icu Patients'.

These are topics that staff believe are closely related. If you want to search all posts for a phrase or term please use the Search feature.

Found 2 results

  1. In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts. ABCDEF Bundle - Recommendations of best practices: A - Assess, prevent, and manage pain B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed: Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? Institutions are using many different methods to implement the ABCDEF Bundle. One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process. We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient. Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example? A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy. Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal? Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients. Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse? We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient? Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. Resources Utilized by Joanna Stollings: Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration AACN news release: Practical Advice for Implementing the ABCDEF Bundle Society of Critical Care Medicine
  2. The ABCDEF Bundle of Care A recommendation of best practices from the Society of Critical Care Medicine. It consists of: A - Assess, Prevent and Manage Pain Compare valid and reliable pain assessment tools. Identify special challenges to effective pain assessment, prevention, and management. Integrate effective strategies to prevent and manage pain into everyday clinical practice. B - Both SBT and SAT. Spontaneous breathing trials (SBT) and spontaneous awakening trials Studies have shown that using SAT and SBT synergistically helps decrease mechanical ventilation days, hospital lengths of stay and delirium. Focuses on setting a time(s) each day to stop sedative medications, orient the patient to time and day, and conduct an SBT in an effort to liberate the patient from the ventilator. C - Choice of Analgesia and Sedation Focuses on constructing a safe and effective medication regimen for the management of pain and agitation in critically ill adults, consistent with ICU pain, agitation and delirium (PAD). Guidelines recommendations: Treat pain first before considering sedative therapy. Not all mechanically ventilated ICU patients need to be started on IV opioid and/or sedation infusions following intubation. Use IV bolus doses liberally before starting or increasing opioid or sedative IV infusion D - Delirium; Assess, Prevent and Manage Delirium is experienced by 50%–80% of mechanically ventilated patients and 20%–50% of patients with illness of lower severity Results in prolonged hospitalization increased mortality and increased cost Long-term effects on the patient include an increased risk of mortality and long-term cognitive impairment. E - Early Mobility and Exercise The key question to ask during rounds is: Did the patient achieve maximum mobility or exercise today? Was the patient walking before admission? Is the patient hemodynamically stable? Is the patient awake? F -Family Engagement and Empowerment Keeping patients and families informed Actively involving patients and families in decision-making Actively involving patients and families in self-management Providing both physical comfort and emotional support to patients and families Maintaining a clear understanding of patients’ concepts of illness and cultural beliefs Mary Watts, BSN, RN, allnurses.com’s Content and Community Director recently met with Michele Balas, PhD, RN, CCRN, FAAN to discuss the ABCDEF bundle of care practices in the ICU. They discussed delirium as a syndrome that ICU caregivers used to think as “the patients are old, they get confused and it will get better by the time they go home.” This confusion is really a consequential experience. Having an episode of delirium in the ICU can cause cognitive changes even after patients are discharged home. “We now know that some common practices can cause more problems.” For instance, it is not always necessary to include benzodiazepines as part of a sedative cocktail. The use of some drugs can cause a lot of functional decline and they are also associated with problems with memory later on. Dr. Balas went on to state, “ICU care is focused on how to keep patients alive but we must also recognize how pts interact once they leave the hospital.” She emphasized that the ABCDEF bundle developed in stages: In the 1990’s - studies showed low tidal volumes helped to facilitate extubation, so they started daily weaning trials Pioneers in this field developed SBT (spontaneous breathing trials) and patients were off the ventilator sooner. These pts had better outcomes. The next stage was turning off the ventilator as well as sedation - these patients had even more improved outcomes Nurses were at the forefront of implementing the ABCDEF bundle and as continued studies are conducted, patient care will also continue to improve. Here is the entire interview.