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Bringing patients and their families into the ICU team

Bringing patients and their families into the ICU team. Three power tools for building a person-centered ICU Shaun Maher ICU, Stirling Royal Infirmary. Background – policy. The Six Dimensions of Quality Care Safe Effective Patient Centred Efficient Timely Equitable

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Bringing patients and their families into the ICU team

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  1. Bringing patients and their families into the ICU team Three power tools for building a person-centered ICU Shaun Maher ICU, Stirling Royal Infirmary

  2. Background – policy The Six Dimensions of Quality Care Safe Effective Patient Centred Efficient Timely Equitable (IOM 1999 – Crossing the Quality Chasm)

  3. Background – policy NHS Scotland Healthcare Quality Strategy (May 2010) • Caring & compassionate staff • Good communication (inc. listening) • Collaboration (between provider & recipient) • Clean hospitals • Continuity of care • Clinical excellence

  4. Background - literature Critical Care Family Needs Inventory (CCFNI) (Molter & Leske 1983) • Proximity & Access • Information • Assurance • Comfort & support Review of 57 Belgian ICU’s – ALL reported using restrictive visiting policies. Vandijck et al; Heart & Lung; March 2010 Families of pts in ICU suffer from significant levels of anxiety, depression, PTSD Jones et al; Int. Care Med 2004 Pochard et al; Crit Care Med 2001

  5. Background – our experience • Sept 2006: Families experience of ICU • 23 families • Found it difficult to retain information • Found environment bewildering • Written communication would be helpful • Information about functioning of an ICU would be helpful • Would like visiting to be more flexible

  6. Proposed Improvements…. • Invite families to participate in setting daily goals • Abolish restrictive visiting in favour of flexible visiting

  7. Three power tools to build a person centred ICU • Structured communication tool to promote collaboration • Complete removal of visiting restrictions • “Person-centred” focus groups for staff

  8. Implementation….. • Structured communication tool • Lots of small tests over a 4 wk period Mar/Apr 2010 • 1pt 1 nurse, then 2, then 3, and all • Opportunity to iron out flaws & make tool fit for purpose • Raised awareness amongst staff, gave opportunity to get used to tool, ask questions, etc.

  9. Implementation • Remove visiting restrictions • Evoked strong emotions! • Not amenable to small tests of change!

  10. Implementation…… • Person centered Focus Groups • Informal & formal over a three month period • 1:1 interviews with key medical & nursing staff • 2 questions that helped staff to step outside of a staff-centric mind set • Formation of guidance document & circulated for comment • August 2010 - implementation • Teething problems

  11. Implementation…… • Focus Group Questions • What impact do you think a liberalised visiting policy would have on your job? • What type of access would you like if a member of your family was critically ill in ICU?

  12. Take home message…… • The power of patient centeredness informing & driving change • The importance of formalising & structuring communication • Families of ICU patients are not “visitors”, we are the visitors. • Patients & family are allies for quality & safety. They are important members of the healthcare team • Use the power tools!

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