Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility
Autor: | Rick Bassett, Angi Kiewel, Mark Van-Leuven, E. Wesley Ely, Valerie Danesh, Sam Venus, Angie Haugen, Cora Small, Patricia M. Groat, Kelly McCutcheon Adams |
---|---|
Rok vydání: | 2015 |
Předmět: |
Critical Care
Leadership and Management Sedation media_common.quotation_subject Walking Article Culture change Nursing Health care medicine Humans Hypnotics and Sedatives Pain Management Care bundle Quality of Health Care media_common Teamwork business.industry Delirium Reproducibility of Results Length of Stay medicine.disease Respiration Artificial United States Intensive Care Units Harm Scale (social sciences) Medical emergency medicine.symptom business Patient Care Bundles |
Zdroj: | The Joint Commission Journal on Quality and Patient Safety. 41:62-74 |
ISSN: | 1553-7250 |
Popis: | Article-at-a-Glance Background Sedation management, delirium monitoring, and mobility programs have been addressed in evidence-based critical care guidelines and care bundles, yet implementation in the ICU remains variable. As critically ill patients occupy higher percentages of hospital beds in the United States and beyond, it is increasingly important to determine mechanisms to deliver better care. The Institute for Healthcare Improvement's Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. Case studies of a convenience sample of five participating hospitals/health systems chosen in advance of the determination of their clinical outcomes are presented in terms of how they got started and process improvements in sedation management, delirium management, and mobility. Methods The IHI-RCC program involved one live case study and five iterations of an in-person seminar in a 33-month period (March 2011–November 2013) that emphasized interdisciplinary teamwork and culture change. Results Qualitative descriptions of the changes tested at each of the five case study sites demonstrate improvements in teamwork, processes, and reliability of daily work. Improvement in ICU length of stay and length of stay on the ventilator between the pre- and postimplementation periods varied from slight to substantial. Conclusion Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The key lessons of the IHI-RCC program are as follows: the importance of testing changes on a small scale, feeding back data regularly and providing sufficient education, and building will through seeing the work in action. |
Databáze: | OpenAIRE |
Externí odkaz: |