Ateamapproachtocaringforthelongtermcriticallyillpatient

inICU

NicoleSmith,ClinicalNurseUnitManager.NepeanHospitalSydney,Australia

*  SnapshotofNepeanICU*  DefiningthefactorsthatcontributetowardslongtermpatientinICU*  Thechallenges*  EarlyincorporationofMultidisciplinaryTeam*  Rewards

Whattoexpect

*  Comprisesof2wings,ICU1andICU2*  Fundedfor21ICUpatients,16ventilatedand5HDU*  Unbiasedpatientallocationintheunit*  Approx110nursingstaffworkingarotatingroster*  Medicalteamallocationisdividedwithintheunit,althoughallpatientsarereviewed&discusseddaily.AfterhoursanICUconsultantsupportsthemedicalteamfortheentireunit

NepeanICU

Whatfactorsdefinelongterm?

Chroniccriticalillness

Sepsis/acuteco-morbities

Acutecriticalillness

Medical;surgicalneurological

cardiac

Chronicco-morbities

Ageasafactorforlongtermpatientssurvival

AUSAstudyenrolled1,419patientswithacriticalillnessin23hospitals,whowereventilatordependent.Themedianagewas71.8yrs.Thestudyhighlighted10frequentcomplications,mostcommonwereinfections,heartfailureanddiabetes.Concludingthat54.1%ofthegroupwereweanedtakingupto30days.1/3oftheinitialgroupremainedaliveafter12months

*  Ventilationweaning

*  Nutritionalsupport

*  Preventinfection&othercomplications

*  Optimisefunction&cognition

*  Integraterehabilitationservices

Treatmentchallengesthatdoublealsoasgoals

Wheretobeginwithforthepatient?

Patientand

family

ICUMedicalteamandother

specialists

ICUliaisonteam

Physio

Socialworker

Speech&occupationaltherapist

Primarynursingcare

Dietician

Gatheringtheteam

*  Collectivehealthcareapproach*  Improvedsurvivaloutcomes

*  Effectiverelationships&trustareestablishedwithhealthprofessionals

*  Streamlinedhealthcare

*  Improvedcomfortandbetterrestcyclesachieved

Benefitsforthepatientandtheirfamilies

*  Jobsatisfaction

*  Continuityofpatientcareandexpertknowledgeonthepatientshealthcareandneeds

*  Beingpartofateamapproachandbuildingworkingrelationships

Someofthebenefitsforthehealthcareteam

A55yroldworkingmalewhowasdiagnosedwithsevereGuillain-Barresyndrome.HispresentedtoEDwithanunsteadygait,within48hrsthisprogressedtofullbodyparalysisexceptforthemovementofhisRt)greattoe.Heendured241daysinICUè236ofthosedaysonmechanicalventilation.14daystayinward116daysataninpatientrehab4.5yearsrehabasanoutpatient

NepeanICUlongtermcriticalillnessrecordholder

*  IndependentwithhisADLs*  GBScommitteemember*  Walkedhisdaughterdowntheaisleforherwedding*  Sawhissonmarry*  Welcomedagranddaughter*  ReturnedtohisfootballclubasPresident‘til2013–henowmanagershisson’steam*  VolunteersatSydneyUni,wherehegivesapatientsperspectivetomedicalstudents*  Walkedunaided‘tilarecentfall,wherehe#femurin4places,butisbackwalkingwithaframe

Survival,thankstotheteam!

ICUkeptmealiveRehabgavemelife

Neverunderestimateateamsapproach

Inhiswords:

Lowry,F.2010.TeamapproachestoHospitalCareMayimproveoutcomes.MedscapeMultispecialtyRetrievedfrom:www.medscape.com./viewarticle/717448Scheinhorn,D.J.,Hassenpflug,M.S.,Votto,J.J.,Chao,D.C.,Epstein,S.K.,Doig,G.S.Knight,E.B.,Petrak,R.A.2007.PostICUmechanicalventilationat23long-termcarehospitals:amulticentreoutcomesstudy.Chest.Jan:131(1):85-93.Retrievedfrom:www.ncbi.nlm.nih.gov/pubmed/17218560/Thanksto:NepeanICUteamMrBrookandfamilyAnwar,SeniorPhysiotherapistNepeanICU

References: