Bringing patients and their families into the ICU team

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
NHS Scotland Healthcare Quality Strategy (May
2010)
Background policy

1. Caring compassionate staff
2. Good communication (inc. listening)
3. Collaboration (between provider recipient)
4. Clean hospitals
5. Continuity of care
6. Clinical excellence

4
Background - literature

• Critical Care Family Needs Inventory (CCFNI)
  (Molter Leske 1983)
• Proximity Access
• Information
• Assurance
• Comfort support

Review of 57 Belgian ICUs 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
(No Transcript)
7
Proposed Improvements.

• Invite families to participate in setting daily
  goals
• Abolish restrictive visiting in favour of
  flexible visiting

8
Three power tools to build a person centred ICU

1. Structured communication tool to promote
   collaboration
2. Complete removal of visiting restrictions
3. Person-centred focus groups for staff

9
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.

10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13

14

15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Implementation

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

22
Implementation

• Person centered Focus Groups
• Informal formal over a three month period
• 11 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

23
(No Transcript)
24
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?

25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
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!