Keeping Patients Vertical in the Intensive Care Unit

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients. Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem’s current practice on mobility is focused on ambulation for the most “able” patients; the more critical and unstable patients are not supported to avoid prolonged immobilization. The current performance data was reviewed and compared to the desired performance outcomes. The review revealed a performance gap in patient mobility and that key improvement efforts are needed to achieve the desired outcomes. Interventions: The mobility project “Keeping Patients Vertical in the Intensive Care Unit (ICU)” was initiated to mitigate the microsystem’s identified problem. Multiple interventions implemented include the following: mobility champions were established, education on equipment use and mobility documentation were completed, patient’s mobility information has been incorporated in the Nurse Knowledge Exchange (NKE) and daily multidisciplinary rounds (MDR). A process board was created to include mobility scores in huddles. The mobility equipment has been made available and more accessible for staff to use. Mobility exclusion criteria was established and the goal was set to include mobilizing two intubated patients daily that meet the established criteria. The Sara Combilizer (SC) was trialed for 90 days and was adopted for use to help maximize patient mobility. Measures: The performance outcome measures were identified as follows: the outcome measures are the Average Maximum Mobility (AMM) scores and the Percent Mobilized (PM). The AMM is the highest achieved scores the day prior, up to two highest mobility bouts. The PM is the percentage of patients with documented active mobility performed adhering to the existing time on the unit rules. The process measures are the percent lift utilization, which is the documentation of vertical lift and lift device usage on all ICU patients with Level I and II current level of function, and mobilizing two intubated patients that meet the established criteria. The balancing measures are the identified patient falls and staff injury related to mobilizing patients. Results: The implemented interventions positively impacted the outcomes. The ICU care team met the Outcome Metrics – AMM and PM reached target for three consecutive months (November 2019 – January 2020) after the project implementation. The Process Metrics were also met. Lift Device Utilization scores on 6 out 8 months were maintained at or above target of 75% from October 2019 through May 2020. Every day for a period of eight weeks, the ICU care team mobilized two intubated patients daily that meet the criteria. There were no staff or patient injuries related to mobilizing patients. Conclusions: The mobility project was a success and it resulted in notable changes and improvements in practices in mobilizing patients. By continuing the initiatives, the ICU care team is able to improve patient care experience, expedite patient recovery times, and help patients back to physical independence (Olavides, 2020). The overall extraordinary interdisciplinary engagement and commitment of the care team to mobilizing patients have added utmost value to the ICU in preventing patient harm and improving clinical outcomes

Using Mixed Methods to Identify Delirium Bundle Care in the Intensive Care Unit

Delirium is a serious complication experienced by patients in the intensive care unit (ICU). Over the past 15 years, researchers have identified risk factors, assessment techniques, pharmacological, and nonpharmacological interventions. Despite the current literature, there is a gap regarding delirium bundle care provided by an interprofessional team. This dissertation, a compendium of three manuscripts, delineates delirium bundle care by the interprofessional team in the ICU. The first manuscript details Rodgers’ Evolutionary Concept Analysis to identify attributes, antecedents, consequences, surrogate concepts, and related terms of bundled delirium care in the ICU. The second manuscript utilized the Social Ecological Model to identify factors that prevent or facilitate delirium bundle care in the ICU based on behavioral determinants and environmental factors. The third manuscript details a convergent parallel mixed-­‐method study guided by Consolidated Framework for Implementation Research to explore clinical perceptions, roles, and practices of the surgical ICU interprofessional team regarding delirium bundle implementation. Findings from the first study used Rodgers’ Evolutionary View of Concept Analysis to identify attributes, antecedents, and consequences of delirium bundle care. Results from the second manuscript identify the facilitators and barriers based on the Social Ecological Model for implementing the ABCDEF bundle and PAD guidelines for managing delirium in the ICU. The findings from the convergent parallel mixed-­‐method study identified factors associated with domains from the Consolidated Framework for Implementation Research. Results from this study showed that structural and cultural elements of an ICU need to be considered when exploring how the interprofessional team of nurses, physicians, pharmacists, respiratory therapists, and physical therapists implements the ABCDEF bundle. The findings of the three manuscripts are integrated in the conclusion of this dissertation

The occupational therapy intensive care unit guide: a practical guide for implementing occupational therapy services with people who are critically ill

Patients who are critically ill in the intensive care unit (ICU) or critical care unit are at risk for cognitive, psychosocial, and physical impairments as a result of their admitting diagnosis or secondary diagnoses acquired during their hospital stay. Occupational therapy is a profession that facilitates patients’ recovery through holistic evaluation and treatment. Occupational therapy in the ICU improves patients’ strength, cognition, functional independence in activities of daily living and walking, decreases the duration and incidence of delirium, decreases time spent on mechanical ventilation, decreases the length of time patients spend in the hospital, and saves the hospital money (Alvarez et al., 2017; Lord et al., 2013; Schweickert et al., 2009; Weinreich, Herman, Dickason & Mayo, 2017). However, the problem is that a small number of patients are receiving occupational therapy when they are in the ICU. Due to the complexity of the medical environment, severity of patients’ illness, limited education on ICU care in entry- level occupational therapy and occupational therapy assistant programs, and limited research on the efficacy of occupational therapy evaluations and treatments, many occupational therapy practitioners do not have the knowledge and confidence to work in the critical care setting (Accreditation Council for Occupational Therapy Education (ACOTE) 2018; Foreman, 2005). In addition, many critical care team members are not aware of the benefits of early intervention occupational therapy in the ICU, impacting the number of referrals placed for patients while they are in the ICU setting (Zanni et al., 2010). The Occupational Therapy Intensive Care Unit Guide (OT ICU Guide) was created to improve the knowledge, confidence, and competency of occupational therapy practitioners working in the ICU in order to increase the presence of occupational therapy practitioners in the ICU. Increasing the presence of occupational therapy practitioners in the ICU will lead to an increase in the number of patients receiving occupational therapy during their stay in the ICU. The OT ICU Guide is a “one-stop shop” to guide occupational therapy practitioners on providing safe and evidence-based evaluations and treatments to patients in the ICU. The OT ICU Guide includes handouts, resources, guides, and brochures highlighting the role and benefits of occupational therapy in the ICU, safety and medical information for working with medically complex patients, and examples of occupational therapy assessments and treatment interventions for patients in the ICU. The OT ICU Guide is a steppingstone for increasing the presence and frequency of occupational therapy services in the ICU

A Mobile App For Delirium Screening

Objective: The objective of this study is to describe the algorithm and technical implementation of a mobile app that uses adaptive testing to assess an efficient mobile app for the diagnosis of delirium. Materials and Methods: The app was used as part of a NIH-funded project to assess the feasibility, effectiveness, administration time, and costs of the 2-step delirium identification protocol when performed by physicians and nurses, and certified nursing assistants (CNA). The cohort included 535 hospitalized patients aged 79.7 (SD¼6.6) years enrolled at 2 different sites. Each patient was assessed on 2 consecutive days by the research associate who performed the reference delirium assessment. Thereafter, physicians, nurses, and CNAs performed adaptive delirium assessments using the app. Qualitative data to assess the experience of administering the 2-step protocol, and the app usability were also collected and analyzed from 50 physicians, 189 nurses, and 83 CNAs. We used extensible hypertext markup language (XHTML) and JavaScript to develop the app for the iOS–based iPad. The App was linked to Research Electronic Data Capture (REDCap), a relational database system, via a REDCap application programming interface (API) that sent and received data from/to the app. The data from REDCap were sent to the Statistical Analysis System for statistical analysis. Results: The app graphical interface was successfully implemented by XHTML and JavaScript. The API facilitated the instant updating and retrieval of delirium status data between REDCap and the app. Clinicians performed 881 delirium assessments using the app for 535 patients. The transmission of data between the app and the REDCap system showed no errors. Qualitative data indicated that the users were enthusiastic about using the app with no negative comments, 82% positive comments, and 18% suggestions of improvement. Delirium administration time for the 2-step protocol showed similar total time between nurses and physicians (103.9 vs 106.5 seconds). Weekly enrollment reports of the app data were generated for study tracking purposes, and the data are being used for statistical analyses for publications. Discussion: The app developed using iOS could be easily converted to other operating systems such as Android and could be linked to other relational databases beside REDCap, such as electronic health records to facilitate better data retrieval and updating of patient’s delirium status

Identifying ICU patient safety priorities within a Northern Ontario setting : a delphi study

The purpose of this study was to explore patient safety priorities as perceived by clinical experts working in a northern Ontario adult ICU. A modified Delphi was used to elicit consensus regarding patient safety priorities from the perspective of an expert panel of registered nurses and intensivists. At the onset of the study, the consensus level was set at 70%. Data was collected through serials rounds with researcher-developed questionnaires. Descriptive statistical analysis was completed. No consensus was reached at Round 1. Three points of consensus regarding patient safety priorities were reached at Round 2: improving pain and agitation management; incorporating a checklist into the bullet round reporting tool; and implementing use of visual cues for high-risk lines. These strategies support the need for anticipation, recognition, and management of at risk situations. The results have the potential to guide the advancement of the patient safety mandate within an ICU setting.Master of Science (MSc) in Nursin

Download entire issue- Jefferson Interprofessional Education and Care Newsletter, Fall, 2014, Volume 5, Issue 2

Download entire issue- Jefferson Interprofessional Education and Care Newsletter, Fall, 2014, Volume 5, Issue

Nursing Annual Report: 2013

Intensive Care Unit Receives Gold-Level Beacon Award Clinical Ladder Program is Restructured Clara\u27s House Expands Dialysis Achieves 5-Diamond Status Minnesota Hospital Association Caregiver of the Year Award Bernice Schoenbor

2022 - The Third Annual Fall Symposium of Student Scholars

The full program book from the Fall 2022 Symposium of Student Scholars, held on November 17, 2022. Includes abstracts from the presentations and posters.https://digitalcommons.kennesaw.edu/sssprograms/1026/thumbnail.jp