A team approach to caring for the long term critically ill ... · the long term critically ill...
Transcript of A team approach to caring for the long term critically ill ... · the long term critically ill...
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
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