Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program.

The safety and efficacy of mobility programs for the ventilated patient and the ability to improve outcomes related to immobility of the critically ill are well documented in the literature. Early mobility programs have been proven safe and effective in study. However, a lack of literature describing application of the therapy and integration at the bedside exists. This article describes the multidisciplinary change process and partnerships necessary to provide the innovation of early mobility to ventilated intensive care unit patients. Early mobility targets ventilated patients upon admission to ensure that interventions are performed that promote physical therapy at first possible moment. In order to accomplish this innovation, evidence-based practice was used to guide culture change in an intensive care unit and build partnerships among disciplines that worked to achieve the same goals independently.

Nurse-led change: a statewide multidisciplinary collaboration targeting intensive care unit delirium.

For more than a decade, research has demonstrated both the widespread prevalence and negative outcomes associated with intensive care unit delirium. Hospitals are, therefore, being called to institute evidence-based protocols to prevent and manage its occurrence. Integrating evidence-based practice into bedside care can be a challenge. Having information ready and accessible is essential to implementing successful change. The state of Michigan, through the Michigan Health and Hospital Association Keystone Center, has historically gathered evidence and formulated processes to facilitate evidence implementation in statewide intensive care units. Toolkits have been developed to facilitate the spread of information and are used as a starting point for sites. This approach has been proven successful in reduction of ventilator-associated pneumonias and catheter-related blood stream infections, while in partnership with Johns Hopkins University. The purpose of this article is to describe the creation of evidence-based toolkits used to facilitate successful statewide changes in practice using an interprofessional team including nurses, physicians, and pharmacists. The content reflects a step-wise approach to not only engage and educate staff, but also strategies to execute and evaluate the effectiveness.

Cardiologist perceptions of family-centred rounds in cardiovascular clinical care.

Objective: Few data exist regarding physician attitudes and implementation of family-centred rounds (FCR) in cardiovascular care. This study aimed to assess knowledge and attitudes among cardiologists and cardiology fellows regarding barriers and benefits of FCRs. Methods: An electronic, web-based questionnaire was nationally distributed to cardiology fellows and attending cardiologists. Results: In total, 118 subjects were surveyed, comprising cardiologists (n=64, 54%) and cardiology fellows (n=54, 46%). Overall, 61% of providers reported participating in FCRs and 64% felt family participation on rounds benefits the patient. Both fellows and cardiologists agreed that family rounds eased family anxiety (fellows, 63%; cardiologists, 56%; p=0.53), improved communication between the medical team and the patient and family (fellows, 78%; cardiologists, 61%; p=0.18) and improved patient safety (fellows, 59%; cardiologists, 47%; p=0.43). Attitudes regarding enhancement of trainee education were similar (fellows, 69%; cardiologists, 55%; p=0.19). Fellows and cardiologists felt that family increased the duration of rounds (fellows, 78%; cardiologists, 80%; p=0.18) and led to less efficient rounds (fellows, 54%; cardiologists, 58%; p=0.27). Conclusion: The majority of cardiologists and fellows believed that FCRs benefited families, communication and patient safety, but led to reduced efficiency and longer duration of rounds.

After critical care: Challenges in the transition to inpatient rehabilitation.

PURPOSE/OBJECTIVE: The aftermath of treatment for critical illness and/or critical injury in the intensive care unit (ICU) often includes persisting cognitive and emotional morbidities as well as severe physical deconditioning (a constellation termed post-intensive care syndrome, or PICS), but most patients do not receive psychological services before they enter the inpatient rehabilitation facility (IRF). Although a burgeoning literature guides the efforts of critical care providers to reduce risk factors for PICS - for example, reducing the use of sedatives and enacting early mobilization, there is need for a corresponding awareness among IRF psychologists and other providers that the post-ICU patient often arrives in a state of significantly reduced capacity, with persisting cognitive impairments and acute psychological distress. Many are at risk for long-term complications of posttraumatic stress disorder, general anxiety and/or clinical depression, and assuredly all have experienced a profound life disruption. This paper offers a multilevel perspective on the adaptation of post-ICU patients during inpatient rehabilitation, with discussion of the psychologist's role in education and intervention. RESEARCH METHOD/DESIGN: Clinical review paper. RESULTS: NA. CONCLUSIONS: To optimize response to rehabilitation, it is important to understand the behavior of post-ICU patients within a full biopsychosocial context including debility, cognitive and emotional impairment, disruption of role identities, and environmental factors. The psychologist can provide education about predictable barriers to participation for the post-ICU patient, and guide individual, family and team interventions to ameliorate those barriers. (PsycINFO Database Record

Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.

BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included. CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.