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The first 12 months of the critical care liaison nurse service
Papers and poster abstracts The first 12 months of the critical care liaison nurse service J. Molloy , N. Pratt, S. Reaper, E. Dunn, J. Botha, T. Tobias Frankston Hospital - Peninsula Health, Australia Introduction: In May 2009 a permanent Critical Care Liaison Nurse (CCLN) service was introduced to act as a link between the ICU and wards. The CCLN team consists of experienced critical care nurses who provide coverage 7 days a week, for 8 h a day. Objectives: To quantify the number of patients seen during the first 12 months of the CCLN service from the three key referral sources: (1) ICU patients discharged to the wards. (2) Attending MET or Respond Blue calls and ongoing review for all patients who remain on wards following a rapid response call. (3) Direct referral of patients from medical/nursing staff who require advanced clinical management. Methods: Patients are reviewed by the CCLN within 48 h of discharge from ICU, both during and following MET or Respond Blue calls or after direct referral from medical or nursing staff. Data is collected regarding these patients. Results: In the first year the service has reviewed and assisted in the management of more than 1000 patients. The service has seen an increase in patients seen per month since the commencement of the CCLN service due to an increase in all three referral sources. This has resulted in a 60% increase in the numbers of patients reviewed between the months of May 2009 and March 2010. Conclusion: Data collected from the commencement of the role indicates a consistent increase in patient referrals and reviews by the service. The CCLN service has provided an enhanced and alternative communication method for members of the multidisciplinary team. doi:10.1016/j.aucc.2010.12.051 Critical care nurses’ attidudes to delirium assessment before and after introduction of the CAM-ICU M. Reade , G. Eastwood, L. Peck, I. Baldwin, R. Bellomo Austin Hospital, Australia Nurses are usually the first to diagnose delirium in ICU patients, but little is known about how they do this. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is increasingly reported as an effective measure. We aimed
73 to assess the attitudes of Australian ICU nurses to the CAM-ICU. We surveyed all nurses in our ICU using two electronic questionnaires: the first after a one-month period of delirium assessment using any chosen method, and the second following an intensive CAM-ICU education programme and month of CAM-ICU assessments. The first survey response rate was 37% (65/174 nurses). Most (73%) thought active delirium assessment was ‘very important’ or ‘essential’, and 93% thought their assessments had been worth the time required. Most (75%) were ‘quite’ or ‘very’ confident their assessments were accurate. These assessments were largely unstructured, as only 20% knew a formal delirium test, and only 6% used such a test ‘sometimes’ or ‘often’. Experience did not predict responses. The second survey response rate was only 11%. Most (83%) still thought delirium assessment was ‘very important’ or ‘essential’, but only 67% thought the CAM-ICU worth the time required (p = 0.003 compared to the earlier period) and 33% were not confident their assessments were accurate (p = 0.001). Many (35%) found the CAM-ICU ‘quite’ or ‘very’ hard to perform. Critical care nurses think delirium assessment is important, though they prefer to use unstructured assessments as they find these easier to perform and perceive them as more reliable than the CAM-ICU. doi:10.1016/j.aucc.2010.12.052 Implementation of a bowel care protocol within ICU M. Ring Mater Adult Hospital, Australia This 11 bedded level 3 ICU did not have a formal bowel care protocol in place. Bowel care was addressed by giving a variety of aperients and a general observation over a period of several months was that constipation was a problem. A small audit was carried out in June to July 2008 on 7 patients. All patients were intubated and ventilated, receiving enteral feeding and had not had bowel surgery. The objectives were to determine how long after admission were aperients given, what aperients were given and how long after admission were bowels opened. Patients were commenced on aperients on day 4 of admission on average. All patients received prune juice BD and then varients of Movicol, Lactulose, Microlax and senna. Bowels were opened on day 9 of admission on average. A need for a bowel care protocol was identified. A protocol was developed between June 2008 and February 2009. Inservice sessions for staff were carried out
73 to assess the attitudes of Australian ICU nurses to the CAM-ICU. We surveyed all nurses in our ICU using two electronic questionnaires: the first after a one-month period of delirium assessment using any chosen method, and the second following an intensive CAM-ICU education programme and month of CAM-ICU assessments. The first survey response rate was 37% (65/174 nurses). Most (73%) thought active delirium assessment was ‘very important’ or ‘essential’, and 93% thought their assessments had been worth the time required. Most (75%) were ‘quite’ or ‘very’ confident their assessments were accurate. These assessments were largely unstructured, as only 20% knew a formal delirium test, and only 6% used such a test ‘sometimes’ or ‘often’. Experience did not predict responses. The second survey response rate was only 11%. Most (83%) still thought delirium assessment was ‘very important’ or ‘essential’, but only 67% thought the CAM-ICU worth the time required (p = 0.003 compared to the earlier period) and 33% were not confident their assessments were accurate (p = 0.001). Many (35%) found the CAM-ICU ‘quite’ or ‘very’ hard to perform. Critical care nurses think delirium assessment is important, though they prefer to use unstructured assessments as they find these easier to perform and perceive them as more reliable than the CAM-ICU. doi:10.1016/j.aucc.2010.12.052 Implementation of a bowel care protocol within ICU M. Ring Mater Adult Hospital, Australia This 11 bedded level 3 ICU did not have a formal bowel care protocol in place. Bowel care was addressed by giving a variety of aperients and a general observation over a period of several months was that constipation was a problem. A small audit was carried out in June to July 2008 on 7 patients. All patients were intubated and ventilated, receiving enteral feeding and had not had bowel surgery. The objectives were to determine how long after admission were aperients given, what aperients were given and how long after admission were bowels opened. Patients were commenced on aperients on day 4 of admission on average. All patients received prune juice BD and then varients of Movicol, Lactulose, Microlax and senna. Bowels were opened on day 9 of admission on average. A need for a bowel care protocol was identified. A protocol was developed between June 2008 and February 2009. Inservice sessions for staff were carried out