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Wilmington Hospital ICU Christiana Care Health System Wilmington, Delaware

The Road Less Traveled Integrating Patients & Families into the Adult Critical Care Team. Wilmington Hospital ICU Christiana Care Health System Wilmington, Delaware. Patient Family Centered Care Council. Known Patient Benefits of PFCC. Decreased anxiety . Decreased delirium.

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Wilmington Hospital ICU Christiana Care Health System Wilmington, Delaware

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  1. The Road Less Traveled Integrating Patients & Families into the Adult Critical Care Team Wilmington Hospital ICU Christiana Care Health System Wilmington, Delaware

  2. Patient Family Centered Care Council

  3. Known Patient Benefits of PFCC Decreased anxiety Decreased delirium Decreased length of stay Improved safety Improved coping Improved patient satisfaction Decreased cost

  4. Known Family Benefits • Decreased anxiety, helplessness • Improved sleep • Emotionally better prepared • Health care providers communicate & share complete & unbiased information with patients & families in ways that are affirming & useful • Individuals & families build on their strengths by participating in experiences that enhance control & independence • Includes people important to the patient, eliminating artificial barriers

  5. Data • Medical College of Georgia • Compared 2 adult ICUs, one with PFCC, one without • Controlled for case mix, severity of illness, age, race, sex, payer • Cost & LOS compared to DRG expected • Complication rate – aspiration pneumonia, post procedure hemorrhage, post op MI, CVA, perforation, DVT/PE • AHRQ Safety indicators – Post-op PE/DVT, failure to rescue, post-op respiratory failure, skin breakdown, infection r/t medical care

  6. Adult ICUs with PFCC Excel in Every Category

  7. Best Practice for Adult ICU • Eliminate Visiting Hours • AIDET • Acknowledge • Introduce • Duration • Explanation • Thank You • Bedside Interdisciplinary Rounds • Bedside nurse shift report • Purposeful Hourly Rounds • White Boards • Nurse Manager Rounds

  8. Visiting Hours Typical ICU Limitations Limited to immediate family / blood relatives

  9. No Visiting Hours • Eliminate restrictions on times • Encourage family participation • Eliminate restriction on relationship • Guidelines provided to enhance family involvement & quality patient care The PFCC Difference

  10. Bedside Interdisciplinary Rounds • Old State – Team rounds outside rooms Monday – Friday 0900 – 1000 • Intensivist, nursing, PA, respiratory therapy, clinical pharmacist, social work, residents • Discuss medical history, current condition, diagnostics, goals of care & plan for the day. • Families restricted from visiting during rounds to protect confidentiality & prevent interruption. Patients’ door closed.

  11. Physician Buy-In • Rounds don’t take more time • More professional demeanor on rounds • Questions get answered & best decisions made first time • Less family anxiety, families appreciate inclusion • Builds trust amongst team • Gives more time during day not having to review repeatedly with families.

  12. Nursing Buy-In • Education – why & how involve families • What about challenging families • HIPPA

  13. Incorporation of Palliative Care • Regardless of patients’ prognosis • With or Without a palliative care consultant

  14. Elements of Daily Goals Checklist • Infection Prevention • Ventilator Associated Pneumonia • Central Line Blood Stream Infections • Catheter Associated Urinary Tract Infections • Goals of Care • Pain & Symptom Management • Antibiotic Stewardship • Need for additional consultations

  15. Palliative Care in ICU Care & Communication Bundle • Day # 1 Identify decision maker, determine goals of care, provide clear information with empathy & compassion. Assess & manage pain & symptoms. Involve family in determining plan of care. • Day # 3 Assure social and spiritual support – consult social work and chaplain for spiritual assessment • Day #5 Mandatory family meeting to discuss progress, prognosis and re-evaluate goals of care.

  16. Bedside Shift Report

  17. AIDET

  18. Purposeful Hourly rounds • Link to 5 P’s sign

  19. White Boards

  20. Nurse Manager Rounding • Day of Stay Specific - HCAPS • Identify any opportunities • Offer contact information • Thank You Daily rounds with patient / family

  21. Barriers • Uncomfortable with family presence • Appear to be inadequate • Not know something • Time • HIPAA • Need to adequately prep for on-coming shift – IV’s not empty, room neat, etc. • Litigious Society • Lack of insight from families

  22. Future • Family Support Facilitator Role • Customized orientation for families • Spread throughout CCHS

  23. How will your organization move toward Patient Family Centered Care?

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