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Lost days—Diaries for ICU patients
PAPERS AND POSTER ABSTRACTS / Australian Critical Care 26 (2013) 81–98
surgical/general ICU. The body systems approach to handover was used as a framework to guide data analysis. Then three focus groups, using a modified nominal group technique, were used to formulate the minimum dataset. Ethics approval was obtained and all nurses consented to participate. Results: The majority of nurses giving handover had moderate (32.6%) to extensive (23.9%) nursing experience. All nursing levels were represented in focus groups. Observed handovers included reason for admission (85%), diagnosis (80%), clinical issues (89%), blood pressure (87%), circulation (87%), ventilation settings (85%), urine output (87%), microbiology results (91%) and medication charts (80%). However, there was minimal information regarding pain plans (20%), limb movement (20%), renal results (20%), antibiotic therapy (11%), wound management (20%) and social issues (20%). Despite these findings, focus group participants considered all concepts as important and necessary for inclusion in handover (mean importance rating ≥7/10). Conclusion: Although nurses identified important concepts to include in handovers, taped handovers indicated this was not reflected in practice, highlighting the need for a minimum dataset to standardise handover. http://dx.doi.org/10.1016/j.aucc.2013.02.013 Lost days—Diaries for ICU patients E. Bell WCHN, Australia Introduction: Jones et al. (2001) found that, patients who had memories of ICU, even unpleasant ones, suffered less anxiety, panic attacks and other PTSD-related symptoms compared to those who had no memories of their stay in ICU, Bergbom et al. (1999), undertook a small study involving 10 patients in a general ICU, who were given retrospective diaries. Her findings suggest that the use of diaries helped to reduce stress and anxiety following and ICU stay. Objectives: To explore the use of diaries at the bedside for critical care patients. Methods: Action research: nurses, family and visitors were able to contribute to the development of the patient diary, including photographs and reflections, guidelines for the use of the diary were developed, taking into account the relevant regulations and storage of patient information, also what was appropriate and not appropriate. Results: A number of patient experiences of their critical care stay highlighted how patients may have a distorted perception of the care that they receive, particularly those with a degree of memory or cognitive impairment. A very positive response, from both patients and their families was received. One patient was sedated and ventilated during a visit by Prince Charles and was very pleased to see a photo had been taken and the Prince had written a message in his diary. Conclusions: Patient diaries have been successfully implemented in many critical care units around the world, albeit with slight differences. The evidence for retrospective versus prospective diaries is not totally clear cut, although it is felt that prospective diaries offer a more meaningful experience. http://dx.doi.org/10.1016/j.aucc.2013.02.014
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Critical care nurses’ contribution to implementation of selective digestive decontamination (SDD) in clinical practice and research A. Marshall 1,2,∗ , L. Weisbrodt 3 , L. Rose 4 , B. Cuthbertson 5 , J. Francis 6 , I. Seppelt 3,7 , Investigators F 1,2,3,4,5,6,7 1
Griffith University, Southport, QLD, Australia The Gold Coast Hospital, Southport, QLD, Australia 3 Nepean Hospital, Penrith, NSW, Australia 4 University of Toronto, Toronto, Canada 5 Sunnybrook Health Sciences Centre, Toronto, Canada 6 University of Aberdeen, Scotland, UK 7 The George Institute for Global Health, Sydney, NSW, Australia 2
Introduction: Health care associated (HAI) infections are a major cause of morbidity and mortality for critically ill patients. Selective digestive decontamination (SDD) uses prophylactic antibiotics to reduce HAIs including ventilator associated pneumonia yet has not been widely adopted despite evidence of a mortality benefit. Objectives: A large international study investigating SDD from several perspectives was conducted in the UK, Canada, Australia and New Zealand during 2011. Through a secondary analysis of data obtained from the second stage of this study (Delphi Study) we explored factors nurses identify as important when introducing SDD in a clinical or research context. Methods: Twenty critical care nurses participated in the study and the semi-structured interviews obtained from round 1 of the Delphi study were analysed using an inductive approach to data analysis. Results: Few nurses were aware of the evidence base, rationale or specific components of SDD and a comprehensive education program was considered essential before introducing SDD. Most participants viewed nurses as a critical member of the multidisciplinary team who should assist in developing an implementation plan, including the development of SDD protocols. A strong patient focus was evident with concern about patient comfort, the development of diarrhoea, the impact of SDD on enteral nutrition, the potential for SDD to detract from the provision of mouthcare, and possible effects of SDD on tooth enamel. Conclusions: Critical care nurses are well positioned to contribute to implementation strategies should SDD be introduced as a component of clinical practice or research and should be included in SDD implementation and research teams. http://dx.doi.org/10.1016/j.aucc.2013.02.015 Fluid therapy using bicarbonate-containing crystalloid solutions and acid–base stability after cardiac surgery R. Smith ∗ , D. Reid, J. Santamaria St Vincent’s Hospital, Melbourne, Australia Introduction: Accusol (Baxter) and Hemosol (Gambro) contain, with other electrolytes, 35 mEquiv./L and 32 mEquiv./L of bicarbonate respectively. Objectives: To evaluate the effect of protocols for Accusol 1.5 mL/kg/h and Hemosol 3.0 mL/kg/h on acid–base stability after cardiac surgery. Methods: The records of patients admitted to a single intensive care unit in daytime hours after elective on pump coronary grafting from May–October 2008 (Pre-Bicarb group, n = 40), May–October 2009 (Accusol group, n = 51) and May–October 2011 (Hemosol group, n = 43) were examined. The groups were compared with
surgical/general ICU. The body systems approach to handover was used as a framework to guide data analysis. Then three focus groups, using a modified nominal group technique, were used to formulate the minimum dataset. Ethics approval was obtained and all nurses consented to participate. Results: The majority of nurses giving handover had moderate (32.6%) to extensive (23.9%) nursing experience. All nursing levels were represented in focus groups. Observed handovers included reason for admission (85%), diagnosis (80%), clinical issues (89%), blood pressure (87%), circulation (87%), ventilation settings (85%), urine output (87%), microbiology results (91%) and medication charts (80%). However, there was minimal information regarding pain plans (20%), limb movement (20%), renal results (20%), antibiotic therapy (11%), wound management (20%) and social issues (20%). Despite these findings, focus group participants considered all concepts as important and necessary for inclusion in handover (mean importance rating ≥7/10). Conclusion: Although nurses identified important concepts to include in handovers, taped handovers indicated this was not reflected in practice, highlighting the need for a minimum dataset to standardise handover. http://dx.doi.org/10.1016/j.aucc.2013.02.013 Lost days—Diaries for ICU patients E. Bell WCHN, Australia Introduction: Jones et al. (2001) found that, patients who had memories of ICU, even unpleasant ones, suffered less anxiety, panic attacks and other PTSD-related symptoms compared to those who had no memories of their stay in ICU, Bergbom et al. (1999), undertook a small study involving 10 patients in a general ICU, who were given retrospective diaries. Her findings suggest that the use of diaries helped to reduce stress and anxiety following and ICU stay. Objectives: To explore the use of diaries at the bedside for critical care patients. Methods: Action research: nurses, family and visitors were able to contribute to the development of the patient diary, including photographs and reflections, guidelines for the use of the diary were developed, taking into account the relevant regulations and storage of patient information, also what was appropriate and not appropriate. Results: A number of patient experiences of their critical care stay highlighted how patients may have a distorted perception of the care that they receive, particularly those with a degree of memory or cognitive impairment. A very positive response, from both patients and their families was received. One patient was sedated and ventilated during a visit by Prince Charles and was very pleased to see a photo had been taken and the Prince had written a message in his diary. Conclusions: Patient diaries have been successfully implemented in many critical care units around the world, albeit with slight differences. The evidence for retrospective versus prospective diaries is not totally clear cut, although it is felt that prospective diaries offer a more meaningful experience. http://dx.doi.org/10.1016/j.aucc.2013.02.014
85
Critical care nurses’ contribution to implementation of selective digestive decontamination (SDD) in clinical practice and research A. Marshall 1,2,∗ , L. Weisbrodt 3 , L. Rose 4 , B. Cuthbertson 5 , J. Francis 6 , I. Seppelt 3,7 , Investigators F 1,2,3,4,5,6,7 1
Griffith University, Southport, QLD, Australia The Gold Coast Hospital, Southport, QLD, Australia 3 Nepean Hospital, Penrith, NSW, Australia 4 University of Toronto, Toronto, Canada 5 Sunnybrook Health Sciences Centre, Toronto, Canada 6 University of Aberdeen, Scotland, UK 7 The George Institute for Global Health, Sydney, NSW, Australia 2
Introduction: Health care associated (HAI) infections are a major cause of morbidity and mortality for critically ill patients. Selective digestive decontamination (SDD) uses prophylactic antibiotics to reduce HAIs including ventilator associated pneumonia yet has not been widely adopted despite evidence of a mortality benefit. Objectives: A large international study investigating SDD from several perspectives was conducted in the UK, Canada, Australia and New Zealand during 2011. Through a secondary analysis of data obtained from the second stage of this study (Delphi Study) we explored factors nurses identify as important when introducing SDD in a clinical or research context. Methods: Twenty critical care nurses participated in the study and the semi-structured interviews obtained from round 1 of the Delphi study were analysed using an inductive approach to data analysis. Results: Few nurses were aware of the evidence base, rationale or specific components of SDD and a comprehensive education program was considered essential before introducing SDD. Most participants viewed nurses as a critical member of the multidisciplinary team who should assist in developing an implementation plan, including the development of SDD protocols. A strong patient focus was evident with concern about patient comfort, the development of diarrhoea, the impact of SDD on enteral nutrition, the potential for SDD to detract from the provision of mouthcare, and possible effects of SDD on tooth enamel. Conclusions: Critical care nurses are well positioned to contribute to implementation strategies should SDD be introduced as a component of clinical practice or research and should be included in SDD implementation and research teams. http://dx.doi.org/10.1016/j.aucc.2013.02.015 Fluid therapy using bicarbonate-containing crystalloid solutions and acid–base stability after cardiac surgery R. Smith ∗ , D. Reid, J. Santamaria St Vincent’s Hospital, Melbourne, Australia Introduction: Accusol (Baxter) and Hemosol (Gambro) contain, with other electrolytes, 35 mEquiv./L and 32 mEquiv./L of bicarbonate respectively. Objectives: To evaluate the effect of protocols for Accusol 1.5 mL/kg/h and Hemosol 3.0 mL/kg/h on acid–base stability after cardiac surgery. Methods: The records of patients admitted to a single intensive care unit in daytime hours after elective on pump coronary grafting from May–October 2008 (Pre-Bicarb group, n = 40), May–October 2009 (Accusol group, n = 51) and May–October 2011 (Hemosol group, n = 43) were examined. The groups were compared with