BACCN 2011 Handbook by Benchmark Communications

CONTENTS 2011 Welcome

Conference Highlights

Acknowledgements

CONFERENCE

CORPORATE PARTNER BACCN would like to thank our Corporate Partner for their invaluable help and continued support, both at the Conference and throughout the year. We look forward to more collaborative ventures during 2012. BACCN are delighted to confirm our Corporate Partner is:

Conference Sponsors

Instructions to Presenters

Keynotes

Programme

Poster Walk Timetable

EXHIBITION

Exhibitor List & Floorplan

Exhibitor Abstracts

REFERENCE

General Information

The City of Newcastle

ABSTRACTS

Workshops

Concurrent

ViPER

Poster

www.facebook.com/BACCN

wifi log in details: zencom Password: freewifi

Welcome

WELCOME

TO NEWCASTLE UPON TYNE O

n behalf of the British Association of Critical Care Nurses we are delighted to welcome you to our 26th National Conference here in Newcastle upon Tyne. This year’s conference is entitled ‘First Class Critical Care: Using Evidence to Create the Future’ and has been constructed to help us share and disseminate best practice, and to encourage you to not only use the evidence but also to produce the evidence. To encourage you to think about publishing you will see this year we have Professor Julie Scholes, one of our Editors of Nursing in Critical Care, here co-facilitating a publication workshop along with members from the editorial board. Julie will also be taking your questions and offering individual advice at our BACCN stand in the breaks. The BACCN has a long tradition of staging professional, topical and enjoyable conferences, and we are sure that this year’s conference will be no exception. With a line up of well known experts, and a programme packed with a wide variety of presentations, workshops and poster displays, there is something for everyone. This year's closing session is a question time debate on patient visiting as we launch our mission statement on the subject. We hope you are able to participate in this and all that this year's conference has to offer. We are very grateful to our loyal exhibitors and sponsors and we hope this proves to be an enjoyable and worthwhile event for them. Please take time to visit the exhibition and talk to your colleagues from industry, as their contribution to your learning opportunities is an integral part of this conference experience. It does not have to be all work as, in addition to the exhibition, we are again providing a Chill Out Zone; we hope it provides you with a welcome space to take some well deserved “time out” during your no doubt busy two days. Due to popular demand there is also the WiFi lounge for your use. As well as enjoying the conference programme, we hope that you take some time over the next two days to find out more about the BACCN as an association. We are very proud of our association and the national board and regional committee members work hard throughout the year to deliver an effective service to our members. Conference time provides us with the opportunity to celebrate the work and achievements of our members and regional committees. BACCN’s social programme commences on Sunday evening where we have a welcome reception for delegates & exhibitors at the Discovery Museum, one of the city's most interesting Museums. Whilst enjoying a glass of wine you can explore the museum and take up our early registration opportunity. This year's gala dinner is a black tie dinner and dance in the glamorous Hilton in Newcastle upon Tyne. Once again, on behalf of the National Board and BACCN, I wish you a very warm welcome to Newcastle upon Tyne. We hope you enjoy a fun, informative and unforgettable Conference.

Juliet Anderson Chair BACCN

Colette Laws-Chapman BACCN Conference Director

Conference Highlights Acknowledgements

WHY BECOME A CORPORATE PARTNER WITH BACCN? With 15 regions spanning the UK and over 3000 members, the BACCN is one of the largest and most influential professional organisations within critical care. Annual national and regular international conferences, regional study days and events, an interactive website as well as its own journal ‘Nursing in Critical Care’ has set BACCN apart as one of the most progressive critical care organisations of its time. A member of the European Federation of Critical Care Nursing Association, and the World Federation of Nurses, the BACCN is also working to build links with other critical care colleagues across Europe and the rest of world. To continue to lead the way in critical care nursing, the BACCN wishes to encourage the partnership between medical supply and service companies with the aim of working towards the objectives of BACCN; to advance the art and science of critical care nursing through mutual support, education, research and multi-disciplinary collaboration. With additional resources and funding, renewed emphasis has been placed on the BACCN corporate partnership scheme. The premise that a range of companies in the marketplace with different levels of motivation and funds would need to be catered for, has led to the new tailor-made packages. It is hoped that the increased range of options and benefits means that there will be a scheme for everyone wishing to participate.

BACCN ENDORSEMENT Our emphasis on education and best practice is focal and remains at the forefront of our aims and objectives. Because of our high profile, we are keen to engage with companies seeking endorsement for educational or promotional products that meet a high quality standard. BACCN Endorsement will provide your company with creditable support from the largest critical care nursing organisation in the UK. Should you wish to discuss this opportunity further or perhaps you have another idea that is mutually beneficial please find either David Waters or Jay Hennessey on the BACCN stand, alternatively email: baccn@baccn.org

CONFERENCE HIGHLIGHTS CHILL OUT ZONE - SPONSORED BY LINET UK This extremely popular area is back for another year offering delegates the chance to relax during the busy Conference period. The Chill Out Zone will be situated outside the Gosforth Park Suite on level one of the venue. You can expect to find the following in this area:

SATINS AND SILKS Satins and Silks will be here with their beautiful and colourful silk and satin handbags and silk accessories, including their handcrafted Fair Trade silk collection. Satins and Silks bridge the gap between high fashion and handcrafted design for the ethically conscious woman of today, giving you the reason to treat yourself, or as a gift for someone special.

THE SOAP BAR The Soap Bar is based in the north east and brings together a range of handmade luxury bath products, including soap, bath bombs, post bathing creams and lotions. Our products make ideal gifts, and all are made from natural product, animal fat free and not tested on animals.

STALL 3 Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip

ACKNOWLEDGEMENTS

The BACCN would like to say a big thank you to: • The staff at Newcastle Racecourse and Conference Centre • The BACCN National Board Members for their help, support and input from start to finish of the important annual event • To all sponsors and exhibitors for their participation in the Exhibition and efforts to help make the Conference a success

WIFI LOUNGE To use the free WiFi facilities located on the first floor in the Cocktail Lounge follow the signs to level one. Enjoy free internet access to catch up while away from the office. In addition there will be spaces available to set up your own laptop and connect to the internet. Be sure to check out www.facebook.com/BACCN

REGIMENTAL AID POST We are pleased to host a Regimental Aid Post from the Army. Visit their hospital just outside the Exhibition to explore and interact. The primary role of a Medical Section is provision of emergency medical support, treatment and the evacuation of front-line battlefield casualties. Most of our soldiers are trained to become Combat Medical Technicians, and work with doctors and nurses to provide expert medical treatment for battlefield and humanitarian casualties combined with leadership skills to coordinate large-scale medical situations on the battlefield and on humanitarian operations.

We will be exhibiting at the Annual BACCN conference in September! Come and Visit us on stand 29!!

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CONFERENCE

Our Conference Sponsors & Instructions to Presenters

OUR CONFERENCE SPONSORS Linet UK

Hollister

LINET is a world class manufacturer of hospital and nursing care beds. We focus on development, innovation and the practical application of advanced technologies. We work closely with medical professionals to design solutions based on their needs. Therefore we are able to offer comfort to both sides –maximum safety for patients and caregivers alike.

Hollister is dedicated to working with and helping healthcare professionals deliver better products and services to make life more rewarding and dignified for those who use our products.

Phillips Healthcare

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Simple. Convenient. Effective.

We do this by simplifying the delivery of healthcare, improving clinical outcomes and reducing healthcare system costs. This includes helping to improve the diagnosis, treatment and management of many of today’s deadly and debilitating diseases, such as cancer and heart disease.

Introducing Anchor Fast Oral Endotracheal Tube Fastener. The secure and easy to use alternative to tape for fastening oral ET tubes. Its latex-free design secures and eases movement of ET tubes, designed to help minimise pressure on the upper lip and surrounding tissue, and will not occlude the tube.

To achieve this we design solutions around peoples’ needs, applying advanced thinking and technology to deliver more innovative, meaningful and effective solutions.

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Tube Fasteners

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INSTRUCTIONS TO ALL SPEAKER AND POSTER PRESENTERS Plenary and Oral Speakers Please make sure you come to the registration desk on the ground floor of Newcastle Racecourse and Conference Centre to let us know you have arrived well before the time of your presentation. This way we can check to see if we have received your PowerPoint presentation prior to the Conference or ask you for your presentation to load onto the laptop in your presentation room. We can then direct you to the room you are presenting in and introduce you to the technician who will be responsible for that room and the smooth running of your presentation.

Poster Displays Please make sure you come to the registration desk on the ground floor of Newcastle Racecourse and Conference Centre to let us know you have arrived. We will issue you with Velcro and direct you to your poster board in the Colonel Porter Hall, connected to the Exhibition area by a short walkway on the lower level. All posters are required to be in place by 10.30 on Monday 12th September. Remember to take your poster home with you. All posters must be removed by 17.30 on Tuesday 13th September.

ViPER Displays Please make sure you come to the registration desk on the ground floor of Newcastle Racecourse and Conference Centre to let us know you have arrived. We will issue you with Velcro and direct you to the poster and ViPER display room – the Colonel Porter Hall. Once there, you will be able to put up your poster and check that your presentation is uploaded, as well as run through any technical issues before your ViPER presentation. All posters are required to be in place by 10.30 on Monday 12th September. Remember to take your poster home with you. All posters must be removed by 17.30 on Tuesday 13th September.

Keynotes

CONFERENCE

Keynotes

S01

S02

Rules, Roles and Rituals: Changing Culture in Critical Care

Modernising Nursing Careers: Changes and Challenges

Mandy Odell, Nurse Consultant, Critical Care, Royal Berkshire NHS Foundation Trust

David Foster, Deputy Chief Nursing Officer, Department of Health

BIOGRAPHY

Mandy qualified as a general nurse in 1979 and has worked in critical care for thirty years. After completing a twenty year apprenticeship in intensive care, she became Nurse Consultant in Critical Care in 2001. Her main focus of practice is in improving the care of critically ill patients on the general wards through expert role modelling, education, and support; as well as the facilitation and development of Critical Care Outreach and the Reading-Modified early warning score.

David Foster was appointed Deputy Chief Nursing Officer at the Department of Health for England in December 2008. His portfolio includes responsibility for acute nursing, nursing and midwifery workforce and education issues, modernising nursing careers, measuring the quality of nursing and midwifery care, implementing clinical academic research training programmes and advice on midwifery issues.

A keen supporter of the British Association of Critical Care Nurses (BACCN), Mandy was the National Chair for three years and National Secretary between 2002 and 2007. Through the BACCN Mandy has been involved in the development of national critical care policy, such as Comprehensive Critical Care and the NCEPOD report. Mandy was the first non-medical member elected to the Council of the Intensive Care Society, setting up the division and representing the nurses and allied health professional members. Mandy has been widely published and regularly speaks at conferences both in the UK and abroad. She is currently completing a PhD in the detection and management of the deteriorating ward patient.

ABSTRACT Healthcare is a social structure that imposes a social order upon the people that are involved in it. Using nurses and doctors as a typical example, we will explore how we occupy specific roles and conform to certain expected behaviours and practices that we may recognise as stereotypical behaviours. These stereotypes are a result of complex influences on us that include: gender, profession, role, education and economics. We may be unaware of these influences on our day to day behaviour and practice, and yet they can be sustained and legitimised by our ongoing acceptance and adoption of the professional ideology in healthcare. This presentation will explore this ideology and the potential influences on practice and patient outcome, in particular in the field of patient safety. Critical care nurses will be able to see how their behaviour and practice may be a result of subliminal influences, and by adopting a human factors approach to practice, critical care culture can be influenced and the patientsâ&#x20AC;&#x2122; experience and outcome may be improved.

The Department of Health recruited David from Imperial College Healthcare NHS Trust where he was Director of Non-medical Postgraduate Development. Prior to which he was Director of Nursing at Hammersmith Hospitals NHS Trust for a number of years during which time he also chaired the national Association of UK University Hospitals Directors of Nursing Group for a twoyear term. David trained in nursing at the Middlesex Hospital, London and in midwifery at Falkirk and Stirling Royal Infirmaries, in Scotland. His postgraduate career focused on intensive care nursing before moving into management and professional leadership roles. He obtained an MSc in management and was awarded a PhD for his research into developing nurses as managers. He also has a diploma in personnel management and is a Fellow of the Chartered Institute of Personnel and Development. In August 2009 David was appointed visiting professor at Buckinghamshire New University and in July 2010 he was awarded an honorary doctorate conferred on him by Middlesex University.

ABSTRACT The challenges affecting nursing are, as ever, profound. The NHS reforms are bringing significant changes to structure of the health service with a particular emphasis on the importance of clinical leadership. This is, therefore, a time at which nurses can be ambitious for themselves, the profession and most importantly for their patients, their families and carers. Although there are specific challenges about funding the NHS, nurses are at the forefront of initiatives to improve the quality and productivity of the service; but there is also more to achieve by being innovative and developing strategies for preventative care. Nurses are great catalysts for change and are driven by values which ensure care is given intelligently, with compassion and to an exemplary standard. This presentation will focus on national and local changes and challenges and help nurses in leadership positions, in any part of the system, to recognise the contribution they can make to take action and improve services.

Keynotes

S03 The Assistant Practitioner and Healthcare Assistant Role in Critical Care Annette Richardson, Nurse Consultant, Critical Care, Newcastle upon Tyne Hospitals NHS Foundation Trust

BIOGRAPHY Annette has nearly twenty years critical care nursing experience gained in a variety of critical care clinical specialities including Neuro-trauma, Cardio-thoracic, Paediatric and Liver Transplantation in the UK and USA.

A vision for the future will be outlined with the need for a multiprofessional team approach to staffing of critical care in which key health care staff complements each other through communication and collaboration of expertise.

References BACCN (2010) Standards for Nurse Staffing in Critical Care. http://www.baccn.org.uk/downloads/BACCN_Staffing_ Standards.pdf Department of Health (2008). The National Educational and Competency Framework for Assistant Critical Care Practitioners. London, Department of Health. McGuire, A. Richardson, A. Coghill, E. Platt, A. Wimpenny, S. Eglon, P. (2007) Implementation and Evaluation of the critical care assistant role. Nursing in Critical Care. 12 (5) 242-249.

Joined the NPSA in April 2008 and has contributed to a number of patient safety strategies and solutions, most recently providing advice, direction and contribution to the delivery and implementation of Matching Michigan in England. In 2008 provided consultancy to World Health Organisation on their first Global Challenge ‘Safe Care is Clean Care’. Has advised the Department of Health on a number of national critical care developments such as; Principles for Nurse Staffing for a Flu Surge and the Advanced Critical Care Practitioners and Assistant Critical Care Practitioner education and competency frameworks. Annette was elected to the British Association of Critical Care Nurses (BACCN) National Board in 2002 and since then has served as the Membership Secretary/Publicity and Web Coordinator. Is on the editorial board for the Journal ‘Nursing in Critical Care’ and has authored numerous papers aimed at developing a wide range of nursing and critical care strategies. Nursing practice and research interests include: patient safety, development of new nursing roles, staff working patterns, continuous renal replacement therapy (CRRT), sleep assessment and sleep promotion strategies. In 2006 was delighted to be awarded winner of a ‘Nursing Times’ award in the category ‘Back to Basics’ for the clinical work leading the promotion of sleep for critical care patients.

ABSTRACT The assistant practitioner and HCA role will be reviewed to provide a platform to launch the BACCN’s inaugural assistant practitioner / HCA programme. HCAs and assistant practitioners in critical care provide an important role and can add value to the care of the critically ill (BACCN, 2010). The development of the critical care assistant practitioner role has now been implemented widely for at least a decade and reasons include: the need to modernise the NHS, increasing demand for critical care services, the shortage of critical care nurses and the pressure to develop a more flexible approach to workforce planning. A challenge has been to develop these new roles in critical care, while ensuring a continuing commitment towards achieving quality and safe patient care (MaGuire et al, 2007). The National Assistant Critical Care Practitioner Framework (DOH, 2008) will be reviewed and how these roles have been implemented and evaluated will be examined. 9

Keynotes

S04 Engaged Scholarship and the Development of Practice: Knowledge Co-production in Action Professor Brendan McCormack D.Phil (Oxon.), BSc (Hons.), PGCEA, RNT, RMN, RGN. Director, Institute of Nursing Research and Head of the Person-centred Practice Research Centre, University of Ulster, Northern Ireland

BIOGRAPHY Brendan is Director of the Institute of Nursing Research and Head of the Person-centred Practice Research Centre at the University of Ulster. He leads a number of practice development and research projects in Ireland, the UK, Europe and Australia that focus on the development of person-centered practice. His writing and research work focuses on gerontological nursing, person-centered nursing and practice development and he serves on a number of editorial boards, policy committees, and development groups in these areas. He has a particular focus on the use of arts and creativity in healthcare research and development. Brendan has more than 110 peer-reviewed publications as well as 5 books published. He is the Editor of the “International Journal of Older People Nursing”. He has coauthored Practice Development in Nursing which has now been translated into two languages and Practice Development in Nursing: International Perspectives (published 2008). His most recent book, co-authored with Professor Tanya McCance ‘Personcantered Nursing’ was published in July 2010. Brendan has been appointed as a standing member of Sigma Theta Tau’s Global Health Advisory Council, President of the All-Ireland Gerontological Nurses Association [AIGNA] and Chairman of the charity ‘Age NI’.

ABSTRACT The landscape of research and development is changing. In a healthcare arena where continuous development of patient care is the expected (and sometimes accepted!) norm, then finding ways of engaging in practice development that are effective and efficient is a challenge. Similarly, universities are increasingly expected to demonstrate impact of teaching/learning, research and development activities. More often than not, these agendas are seen as being different from each other, whilst in reality they have a synergistic relationship and enable the effectiveness of each other. Engaged scholarship (Van de Ven 2007) is a methodology that promotes integrated approaches to practice development, knowledge generation and outcome evaluation. Engaged scholarship has an explicit intention, the ‘coproduction’ of knowledge (Gibbons 2008). Traditional forms of knowledge production make a distinction between knowledge producers and knowledge consumers and the challenge for any practice-based profession is to find ways of generating, disseminating and using knowledge that inform and are informed by practice itself. One way of doing this is to adopt

principles of participatory research with the co-creation of research agendas that focus on the everyday experiences of clinicians and service users and that utilise systematic processes of inquiry. These participatory and facilitated processes lead to the co-production of knowledge and to a reduction in the reliance on externally derived knowledge and forces to shape and re-shape experiences. Co-producing knowledge is not an automatic process and requires a sustained and committed cooperative relationship, it requires insightful and reflexive facilitation that pays attention to the processes and ensures that shared principles of participation are worked with. Critical to the process is the idea of ‘transactional spaces’. Such spaces provide opportunities for creative problem solving and the determining of practical, context specific solutions. In this presentation, these issues will be explored and examples of engaged scholarship through the creation of transactional spaces identified.

References Gibbons M (2008) Why is knowledge translation important? Grounding the Conversation. Keynote address, Knowledge Translation Forum, Banff http://www.kusp.ualberta.ca/KT08documents.cfm [accessed 21/7/2009] Van de Ven A (2007) Engaged Scholarship: A Guide for Organizational and Social Research. Oxford University Press, Oxford.

S05 Extra Corporeal Life Support Nick Barrett, Consultant in Critical Care, Guys’ & St Thomas’ NHS Foundation Trust

BIOGRAPHY Dr Nicholas Barrett trained at Royal North Shore Hospital in Sydney where he completed fellowships in anaesthesia and in intensive care medicine. He joined Guy’s and St Thomas’ NHS Foundation Trust in 2007 as a consultant in critical care. He leads on extracorporeal life support at GSTT and has a special interest in severe respiratory failure.

ABSTRACT This presentation will cover the current state of the art in extracorporeal life support, the issues around setting up a new ECMO service and the expansion of the nursing role to facilitate ECMO.

Keynotes

S06 Question Time: To Visit or Not to Visit, That is the Question for our panel of experts following the launch of the BACCN position statement on patient visiting Panel: Professor Julie Scholes, Editor of Nursing & Critical Care; Mandy Odell, Nurse Consultant, Critical Care, Royal Berkshire NHS Foundation Trust; Dr Nick Barrett, Consultant in Critical Care, Guys’ & St Thomas’ NHS Foundation Trust; Peter Gibb and Barry Williams, Members of the Patient and Relatives Expert Forum.

‘In it to Win it’ Delegates attending this session will be entered into a free prize draw for a place at the BACCN Conference 2012.

Restrictions on visitors to critical care units remain a contentious issue. Visiting of patients on critical care units can be restricted in terms of duration of visiting times, who can visit, how many can visit and timing of visiting hours. This is often justified by nurses (and other health care professionals) arguing that visitors tire patients, increase noise levels, take up space, reduce access to the patient, delay care being given and increase infection rates. The BACCN has received many enquiries regarding visiting policy and practices and therefore in 2010 commissioned the Professional Advisers and members to form an expert panel and develop a Position Statement on Visiting in Critical Care Units in the UK. This plenary session will consist of a presentation of the BACCN standards for visiting on critical care units in the UK followed by a debate on visiting. High profile professionals, former patients and delegates will participate in a debate about visiting policies and practices. What do you think? Is it time to call time on open visiting? Which side of the fence do you sit on?

HEALTHCARE ASSISTANT AND ASSISTANT PRACTITIONER AFTERNOON The BACCN Conference 2011 has expanded to include an afternoon dedicated to Healthcare Assistants and Assistant Practitioners. On the afternoon of Monday 12th September, HCAs and APs will have the opportunity to attend a half-day session dedicated to your role. Beginning with the keynote session lead by David Foster, Modernising Nursing Careers: Changes and Challenges, and continuing with a talk on The Assistant Practitioner and Healthcare Assistant Role in Critical Care by Annette Richardson, the afternoon will culminate with delegates undertaking the BEACH session. BEACH is a course for Health Care Assistants using a structured and prioritised system of patient assessment to ensure early recognition of deterioration and provides clear strategies for communicating any signs of deterioration to colleagues. HCAs have gained an increasingly important role in patient care and will often have close patient contact.

BEACH improves the skill of recognising the deteriorating patient and teaches the importance of proactive communication with colleagues. Content includes: • • • • •

Airway Problems Breathing Problems Circulation Problems Good Handover of Critical Information Prioritisation of workload

Delegates will receive a BEACH manual and a nationally recognised certificate of attendance. The plenaries are taking place in the Gosforth Park Suite at 13:30 - 14:30, before the BEACH course gets underway in the Annual Members Room from 14:35. Please note this session is scheduled to end at 18:00.

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Conference Programme

CONFERENCE

Programme

Conference Programme

MONDAY 12TH SEPTEMBER 2011 TIME

GOSFORTH PARK SUITE

08:00 - 09:00

PARK VIEW SUITE Registration, Tea & Coffee

09:00 - 09:15

Welcome to BACCN 2011 Colette Laws-Chapman, BACCN Conference Director

09:15 - 09:45

Chair’s Opening Remarks Juliet Anderson, Chair of BACCN

09:45 - 10:30

S01 KEYNOTE ADDRESS Rules, Roles and Rituals: Changing Culture in Critical Care; Mandy Odell, Nurse Consultant, Critical Care, Royal Berkshire NHS Foundation Trust Chair - Colette Laws-Chapman

10:30 - 11:15

11:15

Chair - Colette Laws-Chapman C01: Knife Crime; Challenges of a South London Trauma Centre; Joanne Hunter, King’s College Hospital Foundation Trust

11:35

C02: Potential for Optimising Transfusion Practice in Critical Care; Simon Noel, Oxford Radcliffe Hospitals NHS Trust

11:55

C03: Moving Images: To Promote Rest and Relaxation in Critical Care; Alison Kelly, The Christie Hospital

12:15 - 13:30

Morning Tea & Coffee - Exhibition Area Poster Walk 1 – 10.35-11.00 Chair - Marion Warner Workshop: W01 Key Advances in Weaning from Mechanical Ventilation Phil Osborne, Patient Monitoring Clinical Information Applications Specialist, Philips Healthcare

PHILIPS LOGO

Lunch - Exhibition Area Poster Walk 2 – 12.45-13.15

Conference Programme

CHARLES BRANDLING ROOM

CLARKE’S BAR

ANNUAL MEMBERS

Registration, Tea & Coffee

Morning Tea & Coffee - Exhibition Area Poster Walk 1 – 10.35-11.00 Chair - Vanessa Gibson C04: Aeromedical Considerations for Transportation of Patients Across International Borders; Fiona Pilkington, International SOS C05: Network Audit of Therapeutic Hypothermia; Catherine Plowright, Medway NHS Foundation Trust

C06: The Same Old Problem? Older Patients and Critical Care; Phillip Woodrow, East Kent Hospitals University NHS Foundation Trust

Chair - Melanie Gaiger & Helen Stirton for the ViPER C07: Paediatric Long Term Ventilation: is it the Right or Wrong Move?; Hannah Baird, University of Manchester C08: Addressing Sepsis Awareness Amongst Undergraduate Nursing Students – an Educational Initiative; Aidin McKinney, Karen Page, Queen’s University Belfast V01: ViPER: Implementation of a successful Sepsis Recognition Tool and Care Pathway; Kelly Carter, The Christie Hospital

Lunch -Exhibition Area Poster Walk 2 – 12.45-13.15 Chair - Karen Hill, Julie Schole

Conference Programme

MONDAY 12TH SEPTEMBER 2011 TIME

GOSFORTH PARK SUITE

PARK VIEW SUITE

13:30 - 14:00

S02 KEYNOTE ADDRESS Modernising Nursing Careers: Changes and Challenges; David Foster, Deputy Chief Nursing Officer, Department of Health

14:00 - 14:30

S03 KEYNOTE ADDRESS The Assistant Practitioner and Health Care Assistant Role in Critical Care; Annette Richardson, Nurse Consultant Critical Care, Newcastle upon Tyne Hospitals NHS Foundation Trust Chair – Juliet Anderson

14:30 - 14:35 14:35

Room Change Break Chair - Juliet Anderson C09: Nursing Practice Standards in Detecting and Managing the Deteriorating Ward Patient; Mandy Odell, Royal Berkshire NHS Foundation Trust

14:55

C10: Introducing HEWS – HDU Escalation Warning System; Laura Harvey, Ayrshire and Arran Acute Hospitals

15:15

C11: Healthcare Professionals’ Perceptions of the Impact of Outreach Services within a District General Hospital; Claire Martin, Medway NHS Foundation Trust

15:35 - 16:10

CHARLES BRANDLING ROOM

Chair - Trish Delaney Workshop: W02

Chair - David Waters Workshop: W03

An Introduction to Chest X Ray Interpretation from Novice to Expert Becky Gosling, Southampton General Hospital

Endotracheal Tube Management- Advanced Technology for Improved Patient Outcomes Michael Hewitt RRT-NPS, FARRC, FCCM, Hollister

Afternoon Tea & Coffee - Exhibition Area

Conference Programme

CLARKE’S BAR

ANNUAL MEMBERS

CLERK OF THE COURSE

Room Change Break Chair - Marion Warner C12: Development of an Online Learning Resource in Advanced Life Support; Margaret Wheeler, Queensland University of Technology C13: Multidisciplinary Learning to Improve Patient Safety in Critical Care; Alex Avens, Guys & St Thomas’ NHS Foundation Trust

Assistant Practitioners and Healthcare Assistants – Bespoke Workshop Incorporating the BEACH Course Catherine Plowright, Consultant Nurse Critical Care, Medway NHS Trust, Karen Hill, Acuity Practice Development Matron, Southampton University Hospital NHS Trust

C14: Midwifery Students’ Recognition of, and Response to, Rapid Maternal Deterioration in the Simulation Environment; Professor Julie Scholes, Centre for Nursing and Midwifery Research, University of Brighton

Chair - Colin Steen C15: Delays in Organ Donation from the Intensive Care Unit: A Root Cause Analysis; Bethan Moss, Phil Walton, NHSBT C16: Development and Introduction of a Competency Based Acutely Ill Patient Programme (AIP); Catherine Rowe, Derby Hospitals NHS Foundation Trust C17: Assessment of Orientation Learning Needs: Everyone Doesn’t Need to do the Same Thing; Julia Garrison, The Christ Hospital, Mason, Ohio

Afternoon Tea & Coffee - Exhibition Area

Conference Programme

MONDAY 12TH SEPTEMBER 2011 TIME

GOSFORTH PARK SUITE

16:10

Chair - Joanna McCormick C18: Breaking the Mould with Graduate Internship Programmes; Julia Garrison, The Christ Hospital, Mason, Ohio

16:30

C19: Delirium in the Critical Care Areas: Experience on Implementing a Delirium Assessment and Treatment Programme in the Department; Nuno Pinto, Zoe Andrews, Jocelyn Pearson, Medway NHS Foundation Trust

16:50

C20: Questioning Culture in Nursing Education: Critical Care Nurses’ Perspectives; Mansour Mansour, Faculty of Health and Social Care, Anglia Ruskin University

PARK VIEW SUITE Chair - Mary Parfitt Workshop: W04 Arterial Blood Gas Workshop Mary Coggan, Clinical Educator for Critical Care

17:10 - 19:15

Close of day one – Delegates prepare for Conference Dinner

19:30 - 00:00

Conference Dinner arrival 19.30, Dining at 20.00 The Hilton, Newcastle Gateshead

Conference Programme

CHARLES BRANDLING ROOM Chair - Annette Richardson C21: The Development of Paediatric Intensive Care Retrieval Services in the UK; Lynda Pitilla, Retrieval Coordinator, PICU, Great North Children's Hospital C22: International Perspectives in Critical Care: An Exchange Scholarship Offering an Opportunity to Explore Critical Perspectives in Patient Care; Chrissie Guyer, Southampton University NHS Trust

CLARKE’S BAR

ANNUAL MEMBERS

Chair - Helen Stirton Workshop: W05 Chronic Obstructive Pulmonary Disease and the use of Non Invasive Ventilation Vanessa Gibson, Margaret Douglas, Northumbria University

C23: Declining Consent to Organ Donation: A Reflection on the Collaborative Approach; Heather McMurray, NHSBT, Belfast Trust

Close of day one – Delegates prepare for Conference Dinner Conference Dinner arrival 19.30, Dining at 20.00 The Hilton, Newcastle Gateshead

Conference Programme

TUESDAY 13TH SEPTEMBER 2011 TIME

GOSFORTH PARK SUITE

08:30 - 09:15

Registration, Tea & Coffee

09:15 - 09:30

Housekeeping Colette Laws-Chapman, BACCN Conference Director

09:30 - 10:15

S04 KEYNOTE ADDRESS Engaged Scholarship and the Development of Practice: Knowledge Co-production in Action; Brendan McCormack, Professor/Director, Institute of Nursing Research Chair - David Waters

10:15 - 10:45

Morning Tea & Coffee – Exhibition Area Poster Walk 3 – 10.20-10.40 Chair - Annette Richardson, Mike Kelleher

10:45

Chair - Colin Steen C24: Ultrafiltration Therapy for Treating Heart Failure Patients with Fluid Overload; Naim Abdulmohdi, Anglia Ruskin University

11:05

C25: Improving the Inter-Hospital Transfer of Critically Ill Patients: a Service Improvement; Brian McFetridge, Western Health and Social Care Trust

11:25

C26: It’s a HIT: Covering the Bases Regarding Heparin-Induced Thrombocytopenia; Julia Garrison, The Christ Hospital, Mason, Ohio

11:45

C27: The New 2010 Ventilation Care Bundle: Is it Manageable?; Alison Ruffell, Colchester General Hospital

12:05 - 13:15

PARK VIEW SUITE

Chair - Catherine Plowright Workshop: W06 Interactive Session Examining New National Guidelines and Using Research-Based Protocols to Prevent Incidence of Ventilator-Association Pneumonia Emily Hodges, Julie Allen, Peter Young, Queen Elizabeth Hospital

Lunch - Exhibition Area Poster Walk 4 – 12.30-13.00 Chair - Colin Steen, Trish Delaney

Conference Programme

CHARLES BRANDLING ROOM

CLARKE’S BAR

ANNUAL MEMBERS

Registration, Tea & Coffee

Morning Tea & Coffee – Exhibition Area Poster Walk 3 – 10.20-10.40 Chair - Annette Richardson, Mike Kelleher Chair - Vanessa Gibson C28: Developing End of Life Care; Giving Bereaved Families the Option of Corneal Donation; Heather Savage, National Health Service Blood & Transplant

Chair - Colette Laws-Chapman & David Waters V02: Guidelines for Use of Speaking Valves in Long Term Ventilated Patients in Critical Care; Anne Malpeli, Senior Sister, Critical Care, Royal United Hospital, Bath

C29: A Bereavement Follow Up Service – Facing the Challenges Ahead; Sally Spencer, Derby Hospitals NHS Foundation Trust

V02: Delirious in Critical Care; Janet Thomas, Sheila Goodman, West Suffolk Hospital NHS Trust

C30: Enhancing Communication Skills in Complex Situations Using Actors as Simulated Patients and Relatives; Judy Dyos, Tania Topp, Fiona Hall, Southampton University Hospital Trust

V03: Rehabilitation after Critical Care: Using Audit to Guide Changes in Practice, a Multidisciplinary (MDT) Approach; Debora Green, Emily Blake, Nicola Glasby, King’s College Hospital NHS Trust

Chair - Joanna McCormick Workshop: W07 Writing Successfully for Publication Professor Julie Scholes, Editor of Nursing & Critical Care, Annette Richardson, BACCN and Editorial Board of Nursing in Critical Care

Lunch - Exhibition Area Poster Walk 4 – 12.30-13.00 Chair - Colin Steen, Trish Delaney

Conference Programme

TUESDAY 13TH SEPTEMBER 2011 TIME

GOSFORTH PARK SUITE

PARK VIEW SUITE

13:15 - 14:00

S06 KEYNOTE ADDRESS Extra Corporeal Life Support; Nick Barrett, Consultant in Critical Care, Guys’ & St Thomas’ NHS Foundation Trust

14:00 - 14:25

BACCN AGM Chair - Mary Parfitt

14:25 - 14:30

Room Change Break

14:30

Chair - Mary Parfitt C31: Sharing Perspectives: the Collaborative Care for the Cancer Patient; Joanne Atkinson, Vanessa Gibson, Northumbria University

14:50

C32: Specialist Rehabilitation Nurses in Critical Care Units – Reflecting on the Portuguese Experience – Can it be Transposed to the UK?; Nuno Pinto, Catherine Plowright, Medway NHS Foundation Trust, Antonio Simoes, St Maria Hospital Lisbon Portugal

15:10

C33: Compliance with NICE Rehabilitation after Critical Illness Guidelines (2009) – The Role of a Nurse-Led Follow Up Clinic in a District General Hospital; Nicola Morton, Northern Lincolnshire & Goole NHS Foundation Trust

15:30 - 15:50 15:50 - 16:50

Afternoon Tea & Coffee - Exhibition Area S07 PLENARY Question Time: To Visit or Not to Visit, That is the Question for our panel of experts following the launch of the BACCN position statement on patient visiting. Join our final session to enter into our IN IT TO WIN it free prize draw. *Delegates attending this session will be entered into a free prize draw for a place at the BACCN conference 2012* Panel includes: Nick Barrett, Consultant in Critical Care, Guys’ & St Thomas’ NHS Foundation Trust; Mandy Odell, Nurse Consultant Critical Care, Royal Berkshire NHS Foundation Trust, Barry Williams & Peter Gibb, Members of the Patient and Relatives Expert Forum Chair - Julie Scholes

16:50 - 17:15

Chair - Mike Kelleher Workshop: W08 Advancing Critical Care Practice Using Evidence-Based Chest Pain Treatment Guidelines Monica Simpson, Braver & Braver, Janis Smith-Love, Broward Health, Broward General Medical Center

Closing Address & Awards Colette Laws-Chapman, BACCN Conference Director

Conference Programme

CHARLES BRANDLING ROOM

CLARKE’S BAR

ANNUAL MEMBERS

Room Change Break Chair - Melanie Geiger C34: Developing the Assistant Practitioner Role in a Cardiac Intensive Care Unit; Graham Brant, Sarah Dodds, University Hospitals Bristol NHS Foundation Trust

Chair - Juliet Anderson & David Waters V05: Oral Hygiene in the Intubated Patient: An Educational Reminder; Nicola Elizabeth White, Royal Derby Hospital ICU

C35: Boomers, Xers and Nexters: How to Retain, Manage and Educate Them; Julia Garrison, The Christ Hospital, Mason, Ohio

V06: Minimising the Psychological Distress of ICU: the Role of the Clinical Psychologist; Lisa Browning, Jacqueline Weaver, Jayne Sheppard, Maria Ford, Salisbury NHS Foundation Trust

Chair - Trish Delaney Workshop: W09 The Nurse Navigator: Where Will Your Nursing Career Take You? Matthew Jenning, Murray Chick, Britain’s Nurses, www.britainsnurses.co.uk

C36: Advancing Practice: Critical Care Outreach and Prescribing; Mark Wilson, Karin Gerber, Royal Berkshire Hospital NHS Foundation Trust

Afternoon Tea & Coffee - Exhibition Area

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Poster Walk

POSTER WALK TIMETABLE MONDAY 12TH SEPTEMBER 2011 10:35 - 11:00

POSTER WALK 1

P01

The Effect of Influenza on a Critical Care Outreach Service

P02

Improving Drug Dosage Calculation Competency in Intensive Care Nurses

P03

Team Work in ICU Education

P04

Preparing For the Future: Critical Care Band 5 Development Programme

12:45 - 13:15

POSTER WALK 2

P05

Reducing Drug Omission in Critical Care: Following NPSA Guidelines

P06

An Exploration of Psychological Assessment in the Critical Care Unit

P07

Setting Up the Intensive Care Emergency Admission Bay

P08

Productive Ward Within ICU

P09

Explicit Memory of ICU Patients - An Evaluation of Dreams, Nightmares, Hallucinations and Correlation to UK-PTSS-14 (Post Traumatic Stress Syndrome Scale)

P10

Development & Introduction of a Competency Based Acutely Ill Patient Programme (AIP)

TUESDAY 13TH SEPTEMBER 2011

10:20 - 10:40

POSTER WALK 3

P11

Stand Tall, Don't Fall: A Staff-Driven Fall Elimination Response Team

P12

What are the factors related to critical care nurses' decisions to refer to physicians when they want treatment modality changes for their patients?

P13

Patchwork Text Assessment: Changing the Assessment Strategy Enhances Learning

P14

Mentoring Matters: Enabling a Cultural Change

12:30 - 13:00

POSTER WALK 4

P15

Using 'smart infusion devices' to deliver medication in ICU and across the hospital - safe and effective or costly and dangerous?

P16

Whatâ&#x20AC;&#x2122;s the Recipe for a successful Regional Committee?

P17

Organ Donation after Cardiac Death

P18

Weaning the Mechanically Ventilated Patient

TECHNOLOGY THAT LEADS THE WAY Intavent Direct offers an innovative range of products for airway management, oxygen enrichment, topical application management and critical care monitoring. Intavent Direct is committed to the provision of clinical programmes and formalised training for the life of its products, ensuring optimum clinical benefit of the device, together with safe, effective and appropriate use. For more information visit www.intaventdirect.co.uk

INNOVATORS IN ANAESTHESIA AND CRITICAL CARE

EXHIBITION

Exhibitor List & Floor Plan

EXHIBITOR LIST

1 2 3 4 5 6 7, 8 9, 10 11 12 13 14 15 16 17 18 19, 20, 21 22 23 24 25, 26 27 28 29 30 31 32, 33 34 35 36 37 38 39 40 41 42 43 44

EXHIBITOR BACCN Stand Hollister Henleys Medical Supplies Ltd Fisher and Paykel Healthcare TO CONFERENCE Spacelabs Healthcare SESSIONS Navitas Workforce Solutions Baxter Draeger Medical Intersurgical 35 Hamilton Medical UK 36 Health Match BC Fukuda Denshi UK 37 Gambro Lundia AB 38 Smiths Medical International Fannin UK Ltd Bard Ltd Linet UK Kapitex Healthcare Sendal UK Ltd Merck Serono Carefusion Ltd 39 Philips Healthcare Orion Locums 40 Pulse Critical Care 41 Inspiration Healthcare Ltd Central Medical Supplies Ltd Stryker EXIT Intavent Direct Ltd ARJOHUNTLEIGH Army Medical Services - Territorial Army Nursing Times GBUK Healthcare Solus Medical Ltd Birmingham City University Nihon Kohden UK Ltd Ferno (UK) Ltd Covidien MedicsPro FIRE EXIT/LOADING BAY

STAND

ENTRANCE

1 2

30 44

CATERING

STORAGE 42

CAFE EXIT

Introducing a new infant nasal CP PAP system CPAP

'HVLJQHG WR FDUH For more information: www.intersurgical.co.uk

Quality, innovation and choice

Exhibitor Abstracts

EXHIBITOR ABSTRACTS ARJOHUNTLEIGH

Stand 35

Visit ArjoHuntleigh UK on stand 35 to discover more information on the Combilizer®. The Combilizer is a single solution that brings together functions from several traditional types of aids to enable optimum versatile support in the mobilisation and care of weak and disabled patients.

Birmingham City University

Stand 40

Virtual Case Creator is a web-based training platform designed for the health care sector. VCC provides interactive practice simulations that support vocational training and can integrate with existing provision or as a stand-alone solution. VCC offers all of the the cost benefits of e-learning with zero compromise on educational quality.

Army Medical Services - Territorial Army Stand 36 The Army Medical Services Territorial Army are looking for trained nursing professionals to provide and support a deployed hospital in order to maximise operational capability. If you seek a challenge and rewarding experience outside of normal working hours then please visit our stand for more information or call Free phone 0800 7311201.

BACCN Stand

Stand 1

The British Association of Critical Care Nurses - BACCN - is one of the leading Organisations in critical care nursing. BACCN was established in 1985 and has grown and developed through the hard work and dedication of its members, regional committees and National Board. The 14 BACCN regions span Great Britain and Northern Ireland providing one of the largest and influential professional Organisations within critical care. This year at the conference the first 15 new joining members will received a free BACCN fob and critical care related books. We will also be holding a price draw to win a Thornton’s hamper.

Bard Limited

Stand 18

This year Bard Limited is exhibiting the BARD® DIGNICARE™ stool management system, specifically designed for patients with faecal incontinence. The advanced features of DIGNICARE™ help reduce the risk of skin breakdown and keep potentially infected material contained reducing the risk of cross infection. IV therapy is an essential component of patient treatment. To help safeguard continuous vascular access, StatLock® Stabilisation Devices are designed to deliver proven clinical performance that results in improved patient outcomes, quality of care, and economic efficiencies. Bard, Dignicare and Statlock are trademarks/registered trademarks of C.R. Bard Inc., or an affiliate.

Baxter

Stand 25 & 26

CareFusion is committed to delivering complete systems to fit into your environment. This means offering a range of solutions for Critical Care. To find our more please contact CareFusion on 0800 917 8776 for Infusion Products or 0800 151 3580 for Ventilation Products.

Central Medical Supplies Ltd

Stand 31

CMS has a 20 year heritage in specialist patient care. When it’s time to cool, Cincinnati Sub-Zero offers the most effective solution with Blanketroll III and the Kool-Kit. This temperature management system provides an effective alternative to traditional patient cooling techniques. The revolutionary system combines the SMART technology of the Blanketroll III with the body surface area coverage of the Kool-Kit for a non-invasive whole-body temperature management solution.

Covidien

Stand 43

We are Covidien. One of the world’s largest providers of advanced medical devices, supplies, imaging products and pharmaceuticals. For everything from saving lives to bringing new lives into the world. Formerly Tyco Healthcare, we’re now a dynamic, independent healthcare company committed to providing positive innovations and partnerships to the medical community.

Draeger Medical

Stand 9 & 10

Dräger is an international leader in the fields of anesthesia, respiratory care, warming therapy and patient monitoring and IT. Our success is a result of our core strengths: collaboration with our customers, the expertise of our employees, continuous innovation and outstanding quality. “Technology for Life” is our guiding principle. Wherever they are deployed – Dräger products protect, support and save lives. With its headquarters in Hemel Hempstead, Draeger Medical employs over 150 people, of which two thirds are in the field supporting our customers every day.

Stand 7 & 8

Baxter supplies thousands of medical products and services to almost every hospital in the UK, as well as working on supporting more and more patients in the community. Over 1,350 people are employed in the UK to combine a virtually unparalleled ability to meet the demand of today and tomorrow’s healthcare needs.

CareFusion Ltd

Nursing Times

Stand 37

Share our Independent view of the Nursing world, explore the latest Practice methods and ground breaking discoveries. Every new issue brings you the latest developments and news stories affecting you as a Nurse. Combined with the nursingtimes.net CPD units, Nursing Times will help you be the best nurse you can be.

Exhibitor Abstracts

Fannin UK Ltd

Stand 17

At Fannin we are very proud of our long heritage. The company was established in 1829. MicroCLAVE is the world market leading Needle Free device. We provide Gama Alcoholic/ Chlorhexidine wipes, Pall filters, Implantable Ports/Power Ports, PICCs and Power PICCs plus customised Cannulation Packs

Ferno (UK) Ltd

Stand 42

Ferno (UK) Limited is a world leading innovator, manufacturer and supplier of medical equipment to Emergency Medical Services, Fire & Rescue Services, Hospitals and other major industries throughout the UK. We specialise in patient transfer equipment and are at the forefront of Critical Care Trolley design and development. Visit www.ferno.co.uk for more details.

Fisher & Paykel Healthcare

Stand 4

Fisher and Paykel Healthcare is a leading designer and manufacturer of innovative healthcare devices which incorporate unique features to improve patient care. Our latest contribution to real innovation is the introduction of Optiflow™ Nasal High Flow™, the most significant advance in respiratory medicine in recent years.

Fukuda Denshi UK

For more information come and see the latest DynaScope range of patient monitors and the Metavision Clinical Information System on our stand, visit www.fukuda.co.uk or speak to one of the many satisfied FDUK customers.

Stand 15

Gambro is a global medical technology company and a leader in developing, manufacturing and supplying products and therapies for Kidney and Liver dialysis. Gambro’s Prismaflex system has been specifically designed to meet the demands placed on blood purification therapies in intensive care units. The Prismaflex delivers a full choice of therapies adapted to individual patient needs.

GBUK Healthcare

Stand 12

Hamilton Medical UK, based in Birmingham, developed a passion to improve the lives of ventilated patients to create a new generation of intelligent microprocessor-controlled intensive care ventilators featuring revolutionary new modes and diagnostic tools. With support from our Head Office in Switzerland, we combine quality Swiss manufacturing systems with global resources and reliability of a focused organisation.

Orion Locums

Stand 28

Orion Locums provides general and specialist nursing services to clients across the UK. With extensive experience of supply to NHS and independent sector, and community settings, we offer a service based on quality. Orion holds the National and London framework agreements ensuring our nurses have access to work at all times. 0845 8888312 email - nursing@orion-locums.com www.healthcarelocums.com/orion-nurses

Health Match BC

Stand 13

Health Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada. Our consultants assist qualified registered nurses in finding opportunities that suit their career and lifestyle interests. If you are a registered nurse seeking employment in BC, contact Health Match BC today.

Stand 14

Fukuda Denshi UK, at the forefront of Patient Monitoring and Clinical Information Systems. We provide cutting edge patient monitoring design, unique and flexible installation solutions, flexible clinical information systems, low cost of ownership and market leading customer support to the NHS.

Gambro Lundia AB

Hamilton Medical UK

Stand 38

GBUK HEALTHCARE is a leading UK manufacturer and distributor of suction disposables, and we work constantly to advance our portfolio, and offer significant savings to hospital Trusts. Experts in Suction our products include “CareTip” open catheters, “TenderTip” closed catheters, and wound drains inc. fluted drains. Tel: 01757 288587 web: www.gbukhealthcare.com

Henleys Medical Supplies LTD

Stand 3

Long recognised as a leading name in medical supplies nationwide, Henleys Medical has almost 60 years experience with a product range encompassing the needs of almost all hospital departments. Please visit us on Stand 3.

Hollister

Stand 2

Hollister Bowel Care offers a family of products and services to help healthcare providers optimise patient care, control utilization and manage overall costs. The product portfolio consists of ActiFlo Indwelling Bowel Catheter System, InstaFlo Bowel Catheter System and Hollister Faecal Collectors. Visit www.hollister.com/uk for more details.

Inspiration Healthcare Ltd

Stand 30

A welcome change in healthcare suppliers... Inspiration Healthcare offers a fantastic range of innovative products and solutions for Intensive Care and Emergency Medicine. Our aim is to provide absolute excellence in customer service by following a simple philosophy of putting the patient first. We are always looking to improve our customer service and are open to new ideas and change.Our cutting edge product range is supported by a range of technical service programmes and a 24/7 emergency hire service. Visit www.inspiration-healthcare.co.uk for more details. 33

Exhibitor Abstracts

EXHIBITOR ABSTRACTS Intavent Direct Ltd

Stand 34

Intavent Direct Ltd offer an innovative range of Airway Management devices including Critical Care Monitoring. We are delighted to introduce the Venner™ PneuX P.Y.™ - VAP Prevention System designed to prevent pulmonary aspiration, the leading cause of Ventilator Associated- Pneumonia, whilst minimising damage to the airway.

Intersurgical

Stand 11

For over twenty five years Intersurgical has been supplying a wide range of quality respiratory products to hospitals all over the world. We have always believed that the best way to maintain the highest standards in design, manufacture, quality and customer care is to have complete control of these aspects of our business. This integrated in-house philosophy means we can continue to provide products that consistently meet the demands of changing clinical practice, and user requirements. We are committed to providing the most comprehensive range of respiratory products offering quality, innovation and choice. www.intersurgical.co.uk

Navitas Workforce Solutions Creating opportunities for your success

We are an Australian recruitment company specialising in the placement of skilled and experienced healthcare professionals into top positions. At Navitas Workforce Solutions we offer a personalised, comprehensive and caring service to our candidates; we aim to find the ideal role and are there to help throughout your career. www.navitasrecruitment.com

Nihon Kohden UK Ltd

Stand 22

Kapitex, the Specialists in Tracheostomy Care and Airway Management offer a comprehensive product range: Tracoe Experc Percutaneous Kit with Atraumatic inserter – available with Tracoetwist and the Vario Adjustable Tracheostomy tubes – Passy Muir Speaking Valve for use in line with the ventilator – extensive range of Tracheostomy accessories.

Linet UK

Stand 19 - 21

MedicsPro

Stand 44

MedicsPro offer locum and permanent staffing solutions across most medical professions, which includes nursing and operating theatre staff of all grades. We also work with doctors, AHP and HSS staffing. A national supplier of medical staffing to the UK’s NHS National Frameworks through BUYING SOLUTIONS, MedicsPro also supply the MOD, private hospitals, clinics and care homes. We have established a solid reputation for providing high quality candidates and excellent customer service delivered by a highly motivated team of recruitment consultants.

Merck Serono

Stand 24

Merck Serono Gastroenterology offers an extensive range of high quality, NPSA compliant enteral feeding devices, including the Corflo and Cortrak range. We recognise the importance of added value and as part of our commitment to our customers, we offer a wide range of services from training packages to patient advice materials.

Stand 41

Nihon Kohden is Japan’s leading manufacturer for Patient Monitoring, Neurology and Cardiology instruments. We develop our products in line with our core philosophy of using innovative technologies to improve patient outcomes. “Fighting Disease with Electronics”- our corporate philosophy-reflects the high standards that we set ourselves in developing our medical systems.

Philips Kapitex Healthcare

Stand 6

Stand 27

At BACCN, Philips will introduce Clinical Decision Support, presenting traditional monitoring and ventilation data in a way that enables clinicians to make fast, informed choices for treatment of critically ill patients. Increasing pressures on resources require a new approach to patient care. Visit Philips to see how our range of intuitive monitoring and ventilation solutions could improve your patient outcomes. Valerie Lovell; email: supplies.orders@philips.com; 0870 6077677

Pulse Critical Care

Stand 29

PULSE is recognised across the UK as one of the largest Multi-National Framework and Private Healthcare providers of temporary staffing. PULSE have a variety of work available at competitive rates and for further information on working with PULSE and what we offer, please contact us: nursing.turnford@pulsejobs.com www.pulsejobs.com

Sendal

Stand 23

Sendal has had over 20 years experience in the manufacture and design of sterile disposable products. Sendal UK Ltd supplies direct from the manufacturer allowing for reduced overheads so that we can offer high quality, lower costs and more choice. We can supply a huge range of products, many created with the valuable input of our customers such as our unique 3-in-1 administration systems e.g. our VH-33 and VH-94-UK. Our product range includes admin sets, blood sets, stopcocks, mainfolds, filters, 3 way taps, extension lines and needlefree devices. Many of our lines are available through the NHS Supply chain.

Exhibitor Abstracts

Smiths Medical International

Stand 16

Smiths Medical is a leading global provider of medical devices, used during critical and intensive care, surgery, post-operative care during recovery, and high-end home infusion therapies. We offer some of the most respected and easily recognisable brands within our portfolio, including: Portex™, Medex™, Deltec™, Level1™, Graseby™, CADD™, Jelco™ and Medfusion™.

Solus Medical Ltd

Stand 39

Solus Medical sells, distributes and services medical products and equipment to hospitals throughout the UK. Our product ranges are primarily used in respiratory and critical care, we are specialists in CPAP and High Flow Therapy. Solus Medical offers clinical and product expertise, backed-up by an efficient administration and after-sales service.

Spacelabs Healthcare

Stand 5

Spacelabs has long been a pioneer in patient monitoring focussing on connectivity and patient data availability. We now introduce Xprezzon, the new face of patient monitoring offering state of the art styling and design. The ICS Xprezz application can display patient data on the iPad or android device anywhere, anytime.

Stryker

Stand 32 & 33

At Stryker, we make products that not only care for patients but also use the right technology and processes to help reduce the risk of adverse events in the ICU. Stryker’s InTouch bed delivers intuitive and advanced technology that helps you to provide simplified care and exceptional outcomes.

PHILIPS Advert

REFERENCE

General Information

GENERAL INFORMATION Registration and Conference Information Desk The Conference registration desk will be on the ground floor of Newcastle Racecourse and Conference Centre and will be staffed at all times. The registration desk will be open throughout the Conference, however the main registration times are 08.00-09.30 on Monday and 08.30-09.15 on Tuesday. Please ensure you register in plenty of time before the Conference sessions begin. Please direct all enquiries to the Conference registration desk or Conference staff.

Messages Messages for fellow delegates can be left at the registration desk. If you need to be contacted, messages can be taken via the Conference Office:

Conference Sessions The main Conference room is on the first floor of the Racecourse, and is called the Gosforth Park Suite. All breakout rooms are signposted and accessed via lifts and stairs. Please leave plenty of time to reach your session to avoid disappointment, as some sessions may be extremely popular. Please check the Conference programme on page 13 for room allocations and times of sessions.

EfCCNA The British Association of Critical Care Nurses (BACCN) is one of the founding member associations of EfCCNa, and has played an instrumental role in its progress and development.

We will endeavour to get the message to you as soon as possible.

The European Federation of Critical Care Nursing Associations is officially established, with a working constitution and elected administrative board - the Council of the Federation meets twice annually, and is made up of one representative from each member association. Since its inception, the motives of the Federation have been to promote equity and collaboration, which is captured in its guiding slogan: Working Together - Achieving More.

Security

Lunch & Refreshments

Please wear your name badge at all times; it is your pass to gain access to all Conference sessions. These will be given to you at the time of your registration at the Conference.

Tea and coffee will be served during all Conference breaks. A buffet lunch will be served throughout the Exhibition area. Please ensure you have informed the Conference staff if you have any special dietary requirements and make yourself known to the venue staff at lunchtimes.

tel: +44 (0)191 241 4523, fax: +44 (0)191 245 3802 or email: info@baccnconference.org.uk which will be directed to the Conference registration desk.

Toilet & Cloakroom Facilities There are accessible toilets located on the ground floor of the reception foyer. There is also a cloakroom to leave luggage and coats, however, if possible, we recommend you leave your luggage at your hotel as we cannot be held responsible for loss or damage to your luggage. Please ensure items are clearly marked with your name.

Taxis If you require a taxi, the following companies offer 24-hour taxi services: LA Taxis – 0191 287 7777 Noda Taxis – 0191 222 1888

Parking

Blueline Taxis – 0191 262 6666

There is a free car park at the venue.

Buses Exhibition, Posters, Chill Out & WiFi Lounge The Exhibition features over 40 companies and will be held in the Grandstand Hall of Newcastle Racecourse and Conference Centre. The Poster Displays will be set out in the Colonel Porter Hall, along a short walkway from the Exhibition area on the lower level. The WiFi Lounge and Chill Out are located in the Cocktail Lounge on the first floor outside of the plenary room. All catering will be served within the Exhibition.

We are operating coach travel for delegates whose hotel is located in the centre of Newcastle. The coach tickets cost £4 for a return from Newcastle Central Station to the Racecourse and back. No single tickets will be available for these journeys. Delegates can also book single tickets from the Newcastle Marriott to the Hilton for the Conference Dinner for £2. This is a single ticket, and no returns are available. If you would like to buy bus tickets, please visit the registration desk.

General Information The City of Newcastle Gateshead

Social Programme A key element of the BACCN Conference is the social programme, and all delegates are encouraged to take part. If you are registered for the full conference you can attend all social events free of charge. If you are a day delegate and wish to purchase tickets, please visit the registration desk.

Welcome Reception Sunday 11th September 17:30 – 20:00 The Discovery Museum, Newcastle Join us at the Discovery Museum the evening before the Conference begins to register for the Conference and enjoy a welcome drink. The Discovery Museum is the ideal place to find out all about life on Tyneside, from the region’s shipbuilding heritage to inventions that changed the world. Packed full of interactive displays it is the perfect place to meet your fellow conference delegates. Guests are then free to discover the many restaurants Newcastle upon Tyne has to offer.

Gala Dinner Monday 12th September, 19.30 – 00:00 The Hilton Newcastle Gateshead With a drinks reception, three course meal, lively after dinner entertainment and plenty of dancing; this is an event not to be missed! The Hilton is a fantastic venue, overlooking the Tyne Bridge on the popular Quayside area of the city. Close to lots of bars for those who wish to continue the party into the early hours!

The timings for the evening are as follows: 19.30

Welcome drinks

20.00

Dinner is served

21.15

Speeches and Regional Awards

21.30

Live music provided by Grooveline

00.00

Bar Closes

Remember to bring your tickets directions are on the reverse.

THE CITY OF NEWCASTLE GATESHEAD Welcome to NewcastleGateshead:

a destination like no other. United by seven bridges across a spectacular riverscape, Newcastle (a city on the north bank of the River Tyne) and Gateshead (a town on the south bank) form a single, diverse and extremely vibrant visitor destination. World-class culture, vibrant nightlife, award-winning dining, inspiring heritage, fantastic shopping and acclaimed architecture are linked here, as nowhere else, by the famous Geordie spirit which is symbolised by Antony Gormley’s iconic Angel of the North as it welcomes travellers to the area. Surrounded by stunning countryside and the award-winning golden beaches of North Tyneside, South Tyneside and Sunderland, NewcastleGateshead has something to offer every visitor. It’s rare to find anywhere so diverse, amazing visitors at every turn with its dialogue between ultra-modern and ancient, urban and rural, tradition and innovation and its unique blend of the worldclass and well-known with all that is local, individual, unspoiled and full of character. Our brilliant nightlife is a point we needn’t labour, and you won’t be short of surprising places to eat, drink and be merry during the daytime too – whether it’s dining out, calling into a cosy bar or being spotted in a cutting-edge club, NewcastleGateshead and its surroundings provide a feast of choice. For something a little different why not try Blackfriars restaurant which, housed in a historic friary in Newcastle City Centre, is the country’s oldest diningroom, or the award-winning Colmans of South Shields for the best fish and chips money can buy!

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ABSTRACTS Workshop Concurrent ViPER Poster Displays

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Workshop Abstracts

ABSTRACTS

Workshop

Workshop Abstracts

W01: Key Advances In Weaning From Mechanical Ventilation

Glyn Stephens, Deborah Mather and Amanda Walker, Clinical Applications Specialists, Angela Mowat, Sales Development Specialist, Phil Osborne, Patient Monitoring Clinical Information Applications Specialist at Philips Healthcare Philips monitoring and ventilation technologies have been combined to aid in the reduction of weaning times of ventilated patients.

Digital Autotrak Is an auto-adaptive algorhythm which automatically compensates for changes in leak and patient breathing patterns. This allows for unsurpassed patient/ventilator synchronicity.

AVAPS (Average Volume Assured Pressure Support) By introducing this new mode of ventilation into the critical care environment, Philips proposes the use of an auto titrating bi-level support mode of ventilation for weaning critically ill patients from mechanical ventilation. AVAPS automatically adjusts the inspired pressure support to deliver a pre set tidal volume. This mode combines the comfort of the pressure mode of ventilation with the safety and efficiency of the volume mode. The features and benefits of this mode will be discussed in detail during the workshop.

Clinical Decision Support Tools Philips Clinical Decision Support Tools, Horizon View and ST Map present key clinical data to the clinician, in a format that allows instant assessment of the patient condition. This essential data can then be used to enhance the weaning process. These support tools will be discussed and demonstrated during the workshop.

W02: An Introduction into

It is important for nurses caring for the critically unwell patient to understand the basics of chest x ray interpretation, especially in an age where we are faced with diluted medical staffing and skill mix within our critical care areas.

W03: Endotracheal Tube

Management – Advanced Technology for Improved Patient Outcomes

Michael Hewitt, Hollister One of the core purposes of Hollister over the last 90 years has been to “Help healthcare professionals like you deliver better products and services”. Hollister is committed to helping healthcare providers make better value decisions by balancing clinical needs and economic imperatives. This is accomplished by an open exchange of knowledge. It has been our endeavour to facilitate professionals to share their experiences with their peers across countries. Securing Endotracheal (ET) Tubes, while helping to reduce the incidence of oral pressure sores and facilitate ease of access for oral care is a priority in the critical care setting. In view of this we would like to invite you to attend the interactive speaker session on Monday, Sept 12 in the Charles Brandling suite at 2.35 pm by Michael J. Hewitt, RRT-NPS, FAARC, FCCM. Michael is the Director of the Respiratory Care Services Departments of St. Joseph’s Hospital and St. Josephs’ Children’s Hospital in Tampa, Florida, made up of 900 total beds. Michael was named a Fellow of the American Association for Respiratory Care (FAARC) in 2006. In addition, he was named the Texas Society for Respiratory Care Practitioner of the Year in 2003, 2004 & 2006. He currently serves as the Chair of the Adult Acute Care Section of the AARC.

Becky Gosling, Sarah Bashford, BACCN Wessex Regional Board

Michael completed a clinical study investigating use of devices in securing Endotracheal Tubes and the impact they have on lip and skin integrity, ease of access for oral care, ease of application and removal, ease of shuttle repositioning, acceptability of wear time, facial skin condition, and overall acceptability for device. He would share the findings with the group. We look forward to seeing you there........

Learning objectives:

References

Chest X ray Interpretation from Novice to Expert

• To introduce a methodical approach to chest x ray interpretation.

Advance for Managers of Respiratory Care 2009: 18 :( 3):26

• To develop an awareness of the normal and abnormal parameters within chest x rays.

W04: Arterial Blood Gases:

• To develop an awareness of the common abnormalities of chest X rays of patients within critical care.

Methodology Seminar based lecture session, to include smaller group working through examples from clinical practice. It will be an interactive session where delegates will be encouraged to participate and work through some of the common presentations in critical care.

The session content The aim of this session is to introduce BACCN delegates to a methodical approach to analysing chest x-rays, this will form a

basis for the understanding of some of the common presentations found within critical care areas. The session will not focus on diagnosis but recognition of the abnormal, by teaching the delegates about what is normal.

As Easy as ABG!

Mandy Coggon, Clinical Nurse Educator for Critical Care. Sherwood Forest Hospitals NHS Foundations Trust. Mandy.Coggon@sfh-tr.nhs.uk In 2007, I presented ‘Arterial Blood Gases, as Easy as ABG’ at the BACCN Conference in Brighton and to my surprise I won the award for the best presentation! Since then I have presented this workshop to many different groups and have had requests from as far afield as Malta for my ‘blood gas’ pocket aid-memoir. I am delighted to be able to present this again and promise that in 1 hour, you will acquire the skills of arterial blood gas analysis.

Workshop Abstracts Critical care is complicated enough, without having to struggle with difficult concepts of biochemistry, especially if you’re a busy hands-on person with little time for private study. I want you to be able to learn this essential skill without having to refer to text books for reference ranges and formulae, and most importantly to be able to remember it and use it on a daily basis. So what have you got to lose? Come and give it a go - you owe it to your patients.

concurrent slide presentation, we aim to demonstrate the use of humidification versus heat and moisture exchange filters, open and closed suction, oral care, tracheal tube cuff pressure control, subglottic secretion drainage techniques all supported by recent published work. All subglottic secretion drainage tubes and antibiotic impregated tubes will be discussed.

W05: Chronic Obstructive Pulmonary

Extubation practices in the UK (Nurs Crit Care2010 NovDec;15(6):281-4) and new techniques designed to prevent aspiration during extubation (Nurse Crit Care 2010 SepOct;15(5):257-61).

Vanessa Gibson, Margaret Douglas, Northumbria University

Delegates will have the opportunity to actively practice subglottic drainage and oral care, witness the scientific reasons for intermittent and/or continuous controlling cuff pressure of tracheal tubes, a demonstration of current and new extubation techniques.

Disease and the use of Non Invasive Ventilation

Chronic obstructive pulmonary disease (COPD) is a debilitating and common disease with an estimated 3 million sufferers in the UK. COPD accounts for approximately 30,000 deaths each year in the UK. Exacerbations are distressing and can be life threatening but most can be managed at home with antibiotics and steroids (NICE 2010). However, for some patients an exacerbation will involve an admission to hospital and possibly to a critical care unit. COPD is the second largest cause of emergency admissions in the UK (BLF 2007) and mortality rates remain high. If conventional therapies have failed to contain the exacerbation patients will require non-invasive ventilation (NIV). In the presenters’ experience COPD is a poorly understood disease. Therefore the aims of this workshop are; • To provide an overview of the disease processes which may be involved in COPD. • To discuss why the use of NIV is the treatment option of choice in acute presentations of COPD • To review the National Guidelines produced by the Royal College of Physicians (2008) and their relevance to practice • To identify the challenges and nursing priorities when caring for a patient receiving NIV Methods employed by the presenters during the workshop will be presentation, group work and discussion.

W06: Interactive Session Examining New National Guidelines and using Research Based Protocols to Prevent Incidence of Ventilator Associated Pneumonia

Guidelines and protocols will be available to share. Our expert speakers include a senior critical care sister/experienced practice development, a critical care sister/regional training coordinator and a consultant with extensive national and international speaking experience. The workshop will be aimed at all levels of competency as is considered best practice for critical care..

W07: How to Successfully Write for Publication Julie Scholes, Editor of Nursing & Critical Care, Annette Richardson, BACCN and Editorial Board of Nursing in Critical Care Writing for publication is an important way of communicating nursing knowledge, skills and experiences to improve patient outcomes (Rickard, 2009; Happell, 2008). However, nurses often lack confidence and experience with the process of writing (Richardson & Carrick-Sen, 2011). This workshop will offer a practical guide through the stages of writing a paper. This will include considering the topic for publication, focussing the content of the paper and honing the argument of a paper. It will attempt to enable nurses to be more familiar with the stages that may lead to successful publication in a peer review journal. The session will discuss and explore top tips to getting a paper published and will also identify the mistakes that cause papers to be rejected. The workshop is to be facilitated by experienced authors, reviewers and editors of books and nursing journals.

Emily Hodges, Julie Allen, Peter Young, Queen Elizabeth Hospital

References

We plan to examine and reinforce the national ventilator care bundle and best practice within our workshop.

Happel B (2008). Writing for Publication: a practical guide. Nursing Standard. 22 (28): 35-40.

We propose to conduct an interactive workshop based on National Guidance and changes in practice discovered through research including from our Critical Care Unit (J Crit Care. 2011 Mar 23) to improve humidification, oral hygiene, reducing aspiration (including semi-recumbency and subglottic secretion drainage) in order to prevent ventilator associated pneumonia (VAP).

Richardson, A & Carrick-Sen, D (2011). Writing for Publication made easy for nurses: an evaluation. British Journal of Nursing. 20 (12): 756-759.

Using equipment (which we will provide; including ventilator, humidifiers, tracheal tube and patient simulator/model lung) simulating a working circuit from ventilator to patient and a

Rickard CM, McGrail MR, Jones R, O'Meara P, Robinson A, Burley M, Ray-Barruel G. (2009) Supporting academic publication: evaluation of a writing course combined with writers' support group. Nurse Education Today. July; 29 (5): 516-21.

Workshop Abstracts

W08: Advancing Critical Care

Practice Using Evidence-Based Chest Pain Treatment Guidelines

Monica Simpson, Braver & Braver, Janis Smith-Love, Broward Health, Broward General Medical Center, mcs06@att.net Chest pain treatment guidelines developed by the European Society of Cardiology (2008) and the American College of Cardiology/American Heart Association (2007) define evidencebased approaches to diagnose and treat acute coronary syndromes. In order to improve mortality and morbidity, the expert critical care practitioner must demonstrate working knowledge of these guidelines and be proficient in their implementation. Rapid interpretation of patient symptoms and risk factors combined with cardiac biomarker and 12 lead ECG findings are necessary to improve survival. This workshop’s purpose is to enhance the critical care practitioner’s confidence and skills in the recognition of acute coronary syndromes and implementation of treatment guidelines. Participants will gain a working knowledge of targeted assessment strategies, biomarker interpretation, and 12-lead ECG pattern recognition of ischemia, injury, and infarction. Through the use of case-based exemplars, learning opportunities will be maximized as participants are actively engaged in acquiring knowledge and skill necessary to delivery the right care at the right time.

W09: The Nurse Navigator: Where

Will Your Nursing Career Take You? Matthew Jennings, Murray Chick, Britain’s Nurses, www.britainsnurses.co.uk, matthew@britainsnurses.co.uk

Britain’s Nurses hosts a workshop to introduce the Nurse Navigator - a profiling tool to show that there is no such thing as ‘just a nurse’. The Nurse Navigator uses a mixture of interactive questions to separate nurses into seven distinct personality cohorts - rather like the Seven Wonders of the World. The Navigator then links those cohorts to the various different aspects of nursing today. Which kind of wonder are you? What other kinds of nurses think like you? A stimulating and fun way to explore which career path might be right for you. The workshop will take about twenty minutes to complete, with written answers to a variety of conundrums ranging from what would you take with you on a life raft, through to trying to see in which direction a dancer is spinning.

ABSTRACTS

Concurrent

Concurrent Abstracts

C01: Knife Crime; Challenges of a

South London Trauma Centre

Joanne Hunter, King’s College Hospital Foundation Trust Kings College Hospital NHS Foundation Trust became one of four major trauma centres in London in April 2010, covering South East London. In its first year, the ICU admitted 207 trauma cases, and from that 23 (11%) were injuries sustained from knife injuries. South East London has pockets of socio-economically deprived areas, and meeting healthcare needs for the local population can be challenging, as the local community and surrounding boroughs generate some trauma through gun and knife crimes. Knife crime has increased in London by 9% over the last year, which is an increase of 1110 cases, and many sadly become fatal (MPA 2011). King’s is in the centre of around 15 gang regions and many high profile cases have hit the news and media. This presentation will explore the issues surrounding South East London and knife culture, discussing what motivates these crimes, which can be devastating amongst such a young population. Knife crime is becoming more prevalent amongst 13-24 year olds, through organised crime networks, gangs or through fear and fashion: carrying knives for protection or because it is associated with image. Other factors include social exclusion, lack of role modelling, poverty and lack of facilities or opportunities for youths (Kinsella 2011).

202 transfusion episodes were recorded involving 76 patients; 25 medical and 51 surgical cases. The results of the audit found that there was a marked reduction in adherence to the transfusion guidelines. Up to 55% of red cell transfusions, 65% of FFP and 36% of platelet transfusions were inappropriate. These results suggest that additional measures are needed to ensure continuing compliance and may represent a potential cost saving of up to £59,773/year. This paper hopes to highlight the implications of daily transfusion decision making in critical care and the role of the nurse in supporting and challenging medical staff in the transfusion process and examine the potential treatment dilemmas seen and the potential for changing practice in this challenging clinical environment.

C03: Moving images to Promote Rest and Relaxation in the Critical Care Patient Alison Kelly, The Christie Hospital, alison.kelly@christie.nhs.uk

BACKGROUND

Critical care sees an average of two stabbings a month; these injuries are often complex and life threatening, and now form a significant proportion of our case mix. This presentation will also examine the recovery and rehabilitation phase of a young man following multiple stabbings, including to his right ventricle. The case study looks at his critical care admission and the physical, psychological, social and emotional elements that this type of injury can affect, plus the challenges that critical care nurses, doctors and multidisciplinary team members have to face whilst dealing with these types of injuries.

Promoting the quiet and relaxation necessary for sleep in a busy, noisy critical care environment is a problem critical care nurses face daily. Research has shown that patients experience a positive outcome in an environment that incorporates natural light, elements of nature, soothing colours, meaningful and varying stimuli, peaceful sounds, pleasant views and a sense of beauty (Rubin et al, 1997). Despite our CCU being modern and built for purpose in 2006 it still lacks these important elements. Our patient feedback questionnaire also identified a need for a more welcoming and soothing environment; patients requested to see artwork, distraction therapy and a less alien environment.

CO2: Potential for Optimising

AIMS/OBJECTIVES

Transfusion Practice in Critical Care

Simon Noel, John Radcliffe Hospital, Oxford simon.noel@orh.nhs.uk Transfusion practice for critical care patients is one of potential conflict between the decision making of the clinicians treating these patients and the evidence base which indicates that restrictive transfusion strategy may improve clinical outcomes (Hebert et al 2001). This session will look at an audit of a 16-bedded general ICU based in a tertiary referral centre, where in 2004 restrictive blood component transfusion protocols were introduced. The change in practice saw a greater than 30% fall in the use of red cells, FFP and platelets. In 2010 a re-audit of the same unit was performed. This audit was undertaken by reviewing all transfusion activity for the ICU between for three months using the electronic transfusion system for the tracking and monitoring of all transfusions activity within the trust. Transfusions within ICU were cross-referenced

with the ICU patient management systems to ascertain patient diagnosis and the laboratory testing associated with each episode. Further confirmation of the decision making for each transfusion was sought from the clinical staff and patient notes.

• Overview of problems patients face in Critical Care. • Background to the development of the moving images project. • Implementation of the moving images project. • Presentation of findings pre and post project implementation. • Implications for the future.

INTERVENTION Moving images are an innovative development within Our Critical Care; they consist of short nature films showing trees, sky, flowers and open space together with relaxing meditative music and/or nature sounds. They aim to aid rest and relaxation, and to assist the patient’s natural sleep wake cycle. The moving image nature artist embraced the problems faced by CCU patients and tailored the videos to their needs, aiming to bring nature in and to create the illusion of looking out of a window.

Concurrent Abstracts RESULTS We were able to compare findings from patients studied pre and post implementation, which has shown a decrease in the incidence of anxiety and sleep disturbance within the Critical Care Unit. Patient questionnaires and staff feedback has detailed the benefit of this project within the CCU environment. The project was relatively low cost to implement and could be implemented in to any critical Care environment with ease.

C04: Aeromedical Considerations for Transportation of Patients Across International Borders

Fiona Pilkington, International SOS, fiona.pilkington@internationalsos.com In the field of medical assistance arranging the transportation of patients requiring medical intervention during a journey is one of our daily experiences. Organising such transportation is a complicated process involving considerable medical and operational expertise and time. Medicalised transportation can be arranged for an emergency or as a planned journey and the decisions whether a commercial aircraft or air ambulance is required requires a considerable amount of work and information gathering. The outcome for the patient, however, can be lifesaving and is a very rewarding part of our role. In preparation for medical transportation, it is vital that the planning is carried out meticulously to avoid preventable difficulties during the journey. As part of this process it is essential to consider the patient requirements, effects of altitude on physiology, management of the effects of altitude, medical escorts, capabilities of the mode of air transportation chosen, time scale that the journey is required, routing of the journey, airline regulations, immigration or cross border requirements and cost.

References David Smith, William Toff, Michael Joy, et al. (2010) Fitness to fly for passengers with cardiovascular disease, Heart 96: ii1-ii16 Gendreau M.A. and DeJohn D.O. (2002) Responding to medical events during commercial airline flights. N Engl J Med, April 4, Vol. 346, No. 14

C05: Network Audit of Therapeutic Hypothermia

Dr Paul Hayden, Catherine Plowright, Medway NHS Foundation Trust The aim of this presentation is to present the results of an audit undertaken in the Kent & Medway Critical Care Network between April 2009 and March 2010. We looked at the patients who received therapeutic hypothermia (TH) following an out of hospital (OOH) VF arrest on the critical care units in the Network and then post-discharge assessed these patients at 6 months using the Glasgow Outcome Score (GOS). The audit data was collected prospectively by the staff in the local critical care units and we assessed this against best practice guidelines. The criteria we measured against were: 1) Did the ICU’s use TH for survivors of OOH VF cardiac arrests?

2) Did appropriate patients receive TH following OOH VF cardiac arrest? 3) Was TH administered within 8 hours of cardiac arrest? 4) Was TH maintained for 12 to 24 hours? 5) Were there any complications of TH? 6) What was the mortality rate? 7) What was the 6 month neurological outcome for these patients? Results revealed that not all ITU’s in the Network used TH following OOH VF cardiac arrest. Not all of the ITU’s who routinely used TH submitted data, but of those that did we found that 84% of potential eligible patients were treated with TH following cardiac arrest and that it commenced within the time frame and was maintained for up to 24 hours. There were very few, self-limiting complications and the 6 month neurological outcome was at least as good as previously published data with approximately 60% of patients admitted to the ICU following VF cardiac arrest leaving the hospital alive with good neurological function at 6 months post-discharge.

C06: The Same Old Problem? Older Patients and Critical Care Phillip Woodrow, East Kent Hospitals University NHS Trust, Philip.Woodrow@nhs.net The majority of most patients in acute hospitals [Young & Sturdy, 2007], and within critical care [Pisani, 2009], are aged over 65. Healthcare should be provided according to clinical need, regardless of age [DOH, 2001; International Council of Nurses, 2006], yet deficiencies in care of older people were highlighted in both the NCEPOD 2010 report ‘An Age Old Problem’ and the 2011 Parliamentary and Health Service Ombudsman report ‘Care and Compassion?’ The latter report caused widespread public concern when it was used for the basis of a BBC Dispatches programme. The NCEPOD report highlighted concerns with surgical care by contrasting it with anaesthesia and critical care. However, the 10 cases investigated in the Ombudsman’s report include Mr C, whose artificial ventilation was discontinued after open heart surgery. This concurrent session revisits issues about ageism raised in my 2006 conference presentation, and uses the case of Mr C to explore how care can be improved for this often silent majority of our patients. The presentation is based on one developed for the BACCN Southern Region conference.

References DOH. 2001. National Service Framework for Older People. London. Department of Health. International Council of Nurses. 2006. The ICN Code of Ethics for Nurses. Geneva. International Council of Nurses. NCEPOD. 2010. An Age Old Problem. London. National Confidential Enquiry into Patient Outcome and Death. Parliamentary and Health Service Ombudsman. 2011. Care and compassion? London. The Stationery Office Pisani MA. 2009. Considerations in caring for the critically ill older patients. Intensive Care Medicine. 24 (2), 83-95. Young J, Sturdy D. 2007. Improving care for older people in general hospitals. Geriatric Medicine. 37 (4): 39-41.

Concurrent Abstracts

C07: Paediatric Long Term

Ventilation; is it the Right or Wrong Move? A critical analysis based on a case study in PICU, exploring the controversial issues surrounding the initiation of long term ventilation in children with chronic disease Hannah Baird, University Of Manchester hannah.baird@student.manchester.ac.uk

BACKGROUND The number of children in the UK that are supported by LTV has increased over the last decade, creating questions about its viability. Questions have arisen regarding this practice and its ethical, social and resource implications alongside the sustainability of LTV.

SUMMARY OF FINDINGS Evaluations of the workshop highlighted that students considered that they had not fully appreciated all of the early signs of sepsis and the importance of seeking early intervention. Students indicated that they felt the workshop broadened their awareness of sepsis and re-emphasised the importance of essential nursing duties such as carrying out and interpreting patient observations and prompt reporting of symptoms.

METHOD AND CONCLUSIONS

References

The case presented here is of KA, a 15 month girl with a complex cardiac condition. She has remained on PICU since birth on LTV, awaiting a high-risk cardiac operation. The high cost, poor prognosis and limited resources can make it difficult to justify the ongoing support required for LTV. However, this alone cannot supersede the basic human right to life. Controversy arises when it’s perceived that this practice is merely prolonging death rather than supporting life. The child’s best interests are paramount, although it’s important to try to comprehend the child’s quality of life; this is inevitably subjective, especially when a child is unable to communicate. Ultimately the situation must be evaluated in terms of its level of futility. The Royal College of Paediatrics and Child Health outline situations that can be regarded as futile, namely the “unbearable situation”. The difficulty that arises with LTV is determining if and when this situation is reached.

Gerber, K. (2010) Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to implementing evidencebased guidelines. Nursing in Critical Care. 15, 3, 141-151

C08: Addressing Sepsis Awareness

Robson, W., Beavis, S., Spittle, N. (2007) An audit of ward nurses’ knowledge of sepsis. Nursing in Critical Care. 12, 86-92 Tromp, M., Hulscher, M., Bleeker-Rovers, C., Peters, L., Van der Berg, D., Borm, G.F., Kullberg, B-J., Van Achterberg, T., Pickkers, P. (2010) The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: A prospective before and after intervention study. International Journal of Nursing Studies. 47, 1464-1473

C09: Nursing Practice Standards in Detecting and Managing the Deteriorating Ward Patient

Amongst Undergraduate Nursing Students - an Educational Initiative

Mandy Odell, Royal Berkshire NHS Foundation Trust mandy.odell@royalberkshire.nhs.uk

Aidin McKinney, Karen Page, Queen’s University Belfast

INTRODUCTION

LEARNING OBJECTIVE To discuss an educational initiative that was introduced to improve undergraduate nursing students’ awareness of the signs of sepsis and the importance of early intervention.

DESCRIPTION OF DESIGN/METHODOLOGY Early diagnosis and management of sepsis are crucial for successful treatment. Unfortunately it would appear that sepsis is still not being recognised soon enough, and mortality associated with the development of severe sepsis and septic shock remains unacceptably high (Gerber, 2010). Various initiatives such as the Surviving Sepsis Campaign have been developed to improve the treatment of sepsis and reduce sepsis mortality, however, as Tromp et al (2010) highlight, no specific role for nurses is described in the guidelines. Yet, given that nurses are the main healthcare professionals to carry out observations, it is essential to realise the important role that nurses have in recognizing

patients’ signs and symptoms. However, the literature has indicated that nurses’ knowledge of sepsis and recognition of the signs and symptoms has not always been adequate (Robson et al 2007). Therefore, an educational initiative was developed that specifically focused on nurses and their role in the recognition and treatment of patients with sepsis. In a final year module, a sepsis workshop was developed, and provided students with an opportunity to work through a real life case scenario that focused on early recognition of sepsis: the Surviving Sepsis Campaign recommendations of care and the importance of monitoring and detecting further deterioration.

Nurses are struggling to detect and adequately manage deteriorating ward patients, with studies reporting that patients’ vital signs can be inadequately monitored, and poor adherence to early warning scoring (EWS) protocols (NPSA 2007, Odell et al 2009). However, evidence to describe and enumerate the scale of the problem is lacking. As part of a larger study of nursing practice, evidence was sought to illustrate the scale of the phenomenon of ‘deterioration not recognised or acted upon’ (NPSA 2007b, p 16).

AIMS The presentation will share the findings from a study of nursing practice that quantifies and describes the phenomenon of the deteriorating ward patient in a district general hospital.

METHOD Data were extracted from the available records of all general ward patients who suffered a cardiac arrest in a district general

Concurrent Abstracts hospital during one year. The quality of nursing practice in recording observations, and referring according to a EWS protocol during the 12 hours preceding the cardiac arrest were evaluated according to eleven pre-determined standards of practice.

C11: Health Care Professionals’

RESULTS

Claire Martin, Jennifer Assimakopoulos, Melissa Balcorta, Shibu Chacko, Catherine Plowright, Medway NHS Foundation Trust

Of 211 cardiac arrests that occurred on the general wards, data were available for 123 cases. The maximum standard for observation practice was achieved in less than a third of cardiac arrest cases, while two thirds met the minimum standard of practice. Appropriate referral decisions were made in half the cases.

DISCUSSION Detecting and appropriately managing deteriorating ward patients is highly complex. In presenting a set of standards, nursing practice can be evaluated. The initial findings show that practice can be improved in the study hospital, and research is ongoing to determine the factors that may hinder or enhance quality practice.

References NPSA (2007a) Recognising and responding to early signs of deterioration in hospitalised patients. NPSA. London. NPSA (2007b) Safer care for the acutely ill patient: learning from serious incidents. NPSA. London. Odell M, Victor C, Oliver D (2009) Nurses’ role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing: 65(10); 1992-2006.

C10: Introducing HEWS - HDU Escalation Warning System

Laura Harvey, Joanne Howieson, Ayrshire and Arran Acute Hospitals, Laura.Harvey@aaaht.scot.nhs.uk Within Medical HDU, it was felt we needed a more objective system for Level 1 and Level 2 patients so we could measure their response to treatment and need for escalation in terms of medical management and/or referral to Following an extensive review of the literature, it became evident that there was little evidence of any such systems being used in the HDU setting. The authors therefore undertook an extensive case note review to determine triggers for treatment escalation and medical response. Based on treatment options and physiological data, a system was developed and called “HEWS” HDU Escalation Warning System. The system was then tested using recognised improvement methodology - PDSA cycles and changes were made based on findings. Following PDSA testing, the system was rolled out to all HDU patients and continually audited for 4 months. The results of ongoing audit demonstrated speedier medical involvement for escalation of care, earlier ITU referral with an increase in transfers to ITU, and earlier end of life decision making. We are satisfied we have developed a useful escalation scoring system that facilitates effective HDU management and early referral to Level 3 care, amongst acutely ill medical patients.

Perceptions of the Impact of Outreach Services Within a District General Hospital

The aim of this presentation is to present the results of an audit undertaken in 2011 at a District General Hospital. The aim of this audit was to evaluate staff perception of Outreach within this hospital. There has been a Critical Care Outreach Team (CCOT) at Medway Hospital since 2001. The service has been evaluated on a number of occasions by management and was evaluated in 2005 as part of a Critical Care Network wide evaluation of CCOT to investigate the views of staff of all disciplines of the Outreach services offered and the impact staff perceived Outreach to have on progressing patient care. The CCOT at Medway decided that after 6 years it was time to evaluate the service again that they provided. A questionnaire survey design was used, which sought to ascertain whether the CCOT service was valued; was perceived to have an effect on patient care; sped up ward patients admissions to critical care unit; facilitated discharges from critical care units; offered adequate and appropriate educational support. One hundred questionnaires were distributed on a given week to Registered Nurses, Health Care Assistants, Doctors of all grades and Allied Health Professionals. We aim to share our experiences with you and some of our results. It is envisaged that the results will enable the teams to develop teaching programmes, focus further research, and establish whether staff are aware of outreach and its role.

References Department of Health, 2003, Critical Care Outreach Progress in Developing Services, DoH, London Groom P, Neary H, Wellbeloved S, 2001, Critical care without walls : the Outreach experience of one Trust, Part 2 Implementation and evaluation, Nursing in Critical Care 6:279-284 Richardson A, Burnard V, Colley H, Coulter C, 2004, Ward Nurses Evaluation of critical care outreach Nursing in Critical Care 9:28-33

C12: Development of an Online

Learning Resource in Advanced Life Support

Margaret Wheeler, Karen Theobald, Queensland University of Technology, Brisbane, Australia mk.wheeler@qut.edu.au The scheduling constraints of clinical practice on timetabling of lectures and tutorials in a large final year undergraduate nursing program necessitated alternative teaching approaches to traditional face-to-face lectures and tutorials. This saw the development of a learning resource for teaching the theoretical component of Advanced Life Support in a high dependency

Concurrent Abstracts nursing unit that sought to ensure flexibility of access while delivering a coherent and robust education program. Thus an interactive online lecture and tutorial program was developed to support students’ differing learning styles and to meet the need for a more flexible approach to learning.

followed by a 30-40 minute debriefing session. The discussion is directed mainly towards non-technical skills with suggestions for application in practice. Key clinical issues are also addressed. Candidates complete a feedback questionnaire that is used to provide ongoing development of the course structure.

Development of the online teaching program necessitated expert input on online teaching strategies and their operationalisation. External expertise was employed in the form of an online learning designer to guide the process. Complex technical issues arose during development, requiring further input to ensure a quality online learning product resulted. Hence a considerable investment of time was required to both acquire the requisite expertise and overcome technological barriers.

RESULTS

An evaluation of the program was undertaken. A Likert item questionnaire was used to collect quantitative data and a free response section provided the opportunity for qualitative feedback. Of the 506 students enrolled in the high dependency nursing unit, 171 students completed the questionnaire, a response rate of 34%. Development of the online learning resource provided a fixed resource which was transferable across University semesters requiring only minor updating to remain current. Yet significant human and material resources were required for its development, and evaluation data were somewhat ambiguous. Students indicated overall satisfaction with the learning strategies but communicated a strong preference for face-toface teaching. The innovation differed significantly from previously used teaching methods. Development of this program, while providing a fixed resource, was not without resource implications.

C13: Multidisciplinary learning to improve Patient Safety in Critical Care

DISCUSSION Multidisciplinary simulation training provides a unique educational opportunity for nurses to practice clinical skills but more importantly to understand the essential role non-technical skills play in ensuring patient safety.

References Fletcher G et al. Anaesthetists’ Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. BJA 2003; 90(5): 580-8

C14: Midwifery Students’

Recognition of, and Response to, Rapid Maternal Deterioration in the Simulation Environment Julie Scholes, RN DipN DANS MSC (Nursing) D.Phil, Centre for Nursing and Midwifery Research, University of Brighton

BACKGROUND

Alex Avens, Danielle Coleman, Kath Daley, Chris Langrish, Peter Isherwood, Guys & St Thomas’ NHS Foundation Trust, alex.avens@gstt.nhs.uk

This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Severe haemorrhage is the cause of 25% maternal deaths internationally. This figure is much higher in developing countries but risk to maternal wellbeing and child health means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration.

AIM

METHODS

To develop a multi-disciplinary model of simulation training, incorporating clinical and non-technical skills, to build on nurses knowledge to improve patient safety in Critical Care.

A patient actress, wearing a birthing suit that simulated blood loss and a flaccid uterus created a dynamic high fidelity PPH scenario. The scenario provided low levels of uncertainty and high levels of relevant information. Midwifery students (n= 35) who undertook their training in Australia, were videoed responding to the simulated emergency in a clinical laboratory. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis.

METHOD We have developed a high fidelity simulation course for critical care nurses, doctors and physiotherapists. As a multidisciplinary faculty we have considered the learning needs of all multidisciplinary team members by combining the ICU nursing and medical curriculum and incorporating human factors training. Each day comprises 5-6 nurses, 5-6 doctors plus 1-2 physiotherapists. The day includes a session familiarising the participants with Sim Man and a patient safety lecture introducing the concept of non-technical skills. We simulate 6 clinical scenarios - all candidates have the opportunity to participate in at least one scenario. A video-link enables those candidates not directly involved to participate in the debriefing session that follows, where both technical and non-technical skills are discussed as a group. Each scenario runs for 15 minutes

Our feedback to date shows that candidates undertaking our simulation training course feel an increased awareness of the importance of non-technical skills in the workplace.

RESULTS Students struggled when they had to prioritise a response to a clinical cue that required a number of simultaneous actions. They did not necessarily use mnemonics as heuristic devices to guide their actions. The students were reluctant to formulate a diagnosis based on inductive and deductive reasoning cycles to help problem solve and to avoid fixation error.

Concurrent Abstracts CONCLUSIONS The students’ response demonstrated that a number of basic clinical skills require updating on a regular basis, that they needed more learning through simulation to help them communicate, delegate emergency response tasks to others and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students or help them plan care prospectively. The implications of this study raise important lessons for educators and trainers of acute care staff and how we maintain the currency of emergency response skills. Professor Julie Scholes will present this paper (lead qualitative analysis) on behalf of member of the International Team, who undertook this research.

C15: Delays in Organ Donation from the Intensive Care Unit: A Root Cause Analysis

Bethan Moss, Phil Walton, NHSBT, phil.walton@nhsbt.nhs.uk In 2007, the Organ Donation Taskforce submitted 14 recommendations to improve Organ Donation rates throughout the U.K. Following their national acceptance, there have been significant changes to the infrastructure within the Organ Donation service in order to meet the potential for increased donors. Despite this, there remains much conjecture surrounding the length of time it takes to facilitate an organ donor (either donation after brain death (DBD) or donation after circulatory death (DCD)). It is not uncommon for the donation process to extend past 16 or even 20 hours. This places significant pressure upon on the host ICU in terms of bed capacity, staffing and resources. During this time, the donor families are present on the unit and faced with increasing delays to what has already been a tragic and emotional experience for them. In an attempt to improve the understanding of the process we have explored the donation timeline for clinicians, nurses and allied health professions. The timeline is an in-depth look at the donation process and can be adapted for individual cases. The authors recognise the importance of analysing performance and improving service delivery. Through a system of process mapping, fishbone analysis and root cause analysis, the timelines of 66 donors in the South Wales region were studied in order to gain a greater understanding of the total time it takes from referral to retrieval, to highlight delays in the process and see how they may be reduced. This project has revealed common themes in the delays experienced across the region. These delays include the time of referral of a DBD to completing the BSDT, through to the correlation between the total length of time the process takes and the number of organs successfully retrieved. This project hopes to highlight the areas of greatest delay and through analysis, reduce those delays for the benefit of the ICU, the donor family and eventually the transplant recipient.

C16: Development & Introduction of

a Competency Based Acutely Ill Patient Programme (AIP)

Catherine Rowe, Derby Hospitals NHS Foundation Trust ‘Patients who are admitted to hospital believe that they are entering a place of safety...’ and ‘...feel confident that should their condition deteriorate, they are in the best place for prompt and effective treatment’ (NICE 2007). Existing evidence from the 1990’s, NPSA reports (2007) and the Patient Safety First Campaign (2009) suggest the disturbing reality that patients are dying because staff fail to recognise their deterioration or that recognition is not always associated with appropriate escalation and review. In response to the NICE guidelines 50 (2007) an organisational gap analysis revealed the lack of a competency based educational programme to support staff in the early recognition, monitoring, measurement, interpretation and management of acutely ill patients. The sequel document NICE (2008) was used as a template for the development of clinical competencies supported by a five day taught programme for both registered and unregistered staff and which negotiates a systematic journey of patient assessment and their proactive management using an ABCD approach. Senior staff from all practice areas were identified and prepared as competency assessors, and the course commenced in January 2010. Initially it was only offered to registered nurses, but more recently senior unregistered staff are invited to attend. We await their evaluations with interest. 164 registered staff have completed the taught programme and are being supported in achieving their clinical competencies. Ongoing evaluation of the programme remains very positive and comments including; ‘Every nurse should attend’, ‘Found the whole course useful to support everyday practice’ and ‘The course has had a positive effect on how I care for acutely ill patients,’ support our belief that the programme is influencing direct patient care in a positive and proactive way and making a positive contribution to the patient safety agenda to reduce avoidable harm.

C17: Assessment of Orientation

Learning Needs: Everyone Doesn’t Need to Do the Same Thing

Julia Garrison, The Christ Hospital, Mason, Ohio Assessing educational needs during orientation and determination of needed education is a necessary requirement of organizations. Necessary not only for it to be performed, but also for it to be performed consistently throughout the organization. How do organizations currently evaluate the educational needs of newly hired nurses? Is the process consistent regardless of experience level? Is it consistent between units? How do you determine individual learning needs to function in your department? As leadership, do you struggle with this issue with the experienced nursing population more than compared to new graduates? Participants will be able to identify ways of evaluating knowledge on hire regardless of experience level, state ways of how to incorporate consistent

Concurrent Abstracts assessment throughout the organization and its culture, and identify tools to use for post evaluation. This session is appropriate for managers, educators and staff nurses interested in determining educational needs of new hire employees. The only prerequisite is the desire to develop more standardized evaluation methods for their institution. Participants will take away ideas of how to ensure their organization is evaluating all new hires appropriately and consistently to ensure the provision of quality care to patients and families.

C18: Breaking the Mould with

It is our intention with this presentation to present the process of implementing the delirium assessment tool through a mixture of informal sessions and posters and to present the results of the audit and how it has changed the practice in the unit. Since the delirium screening is currently in place for all our patients, we will also be able to present our results for the last year, providing more significant number of patients results.

Graduate Nurse Internship Programs

RESULTS

Julia Garrison, The Christ Hospital, Mason, Ohio

The audit was done for a period of two months. 82 eligible patients were accessed for delirium twice a day for the period of their stay. These patients had an average stay of 5.3 days and an average age of 67.3 years of age, with the oldest being 85 and the youngest 26 years old. From the sample, we had a total of 4 described episodes of delirium (1.6%) corresponding to a total of 2 patients (4.5%).

Critical Care Internships may be commonplace, but some are more successful than others. Successful programs achieve higher retention, job satisfaction, and attract nurses nationally. Parts of a successful programme are the core content, provided clinicals, organizational specific information, and competency skill checkoffs. This session will discuss how to implement a programme with the necessary parts, examining the purpose and goals of the organization. Common pitfalls that frequently occur will be examined, as well as evaluation tools that can be used to perform quality monitoring and improvement. E-learning will be discussed in how to blend the content with classroom, case studies, and clinicals. Participants will be able to identify how to create or revise an internship programme, discuss how to implement the program to obtain high levels of success, and be able to evaluate current teaching tools to match the participant’s needs. Participants will also examine current programmes to evaluate what potentially is missing, as well as organizational structures that allow the opportunity for growth and accomplishment. This session is designed for those interested in orientation of new graduate nurses into critical care and the desire to create a optimal program meeting the intern and organization’s needs. Participants will walk away from this session with an understanding of how to examine their programs to ensure success.

C19: Delirium in the Critical Care

Areas: Experience on Implementing a Delirium Assessment and Treatment Programme in the Department

Nuno Pinto, Zoe Andrews, Jocelyn Pearson, Medway NHS Foundation Trust, nuno.pinto1@nhs.net Delirium is an increasing concern among health professionals in the UK. Many times overlooked or misunderstood in the past, this clinical syndrome has been proven to affect hospitalized patients daily lives by increasing their length of stay (McCusker 2003); mobility (Moller 1998) and mortality (McCusker 2002) while in the hospital but also their long term quality of life (Inouye 1998). Nurses have a preponderant role in preventing and diagnosing delirium early. Since this process was already in place on our

intensive care unit, we decide to implement the CAM tool to assess delirium in the high dependency areas. With this audit we would be able to determine if delirium is a focus of concern within our team, and then set up a working group to promote delirium screening and prevention methods in our unit.

C20: Questioning Culture in Nursing Education: Critical Care Nurses’ Perspectives Mansour Mansour, Acute Care Department, Faculty of Health and Social Care, Anglia Ruskin University, Veronica James, Alison Edgley, School of Nursing, Midwifery and Physiotherapy, University of Nottingham This paper draws one findings of a recently completed study on the critical care nurses’ perspective on the organisational contributions toward the safety of medication administration. The data suggests that the content of pre and post-registration nursing education can be influential in shaping the nurses’ willingness to question any aspects of patient safety across disciplines. Such questioning attitude, where staff are encouraged to question any safety issues, but also be receptive to being questioned, do not seem to have been adequately addressed in pre or post registration nursing education. In critical care context, this appears to have rendered many nursing staff either selective or less engaged in discussing issues related to safe medication administration, particularly when there is a perceived power imbalance among nurses themselves, and where the working culture is ill-prepared to facilitate such questioning attitude among health care professionals. To safeguard the patient, it is imperative that any educational plan should encourage nurses to engage in speaking up their concerns in any aspects of medication administration, and where anyone involved not only in medication administration, but also in any aspects of patient care, is expected to be challenged, as long as the aim is to improve patient safety.

Concurrent Abstracts

Intensive Care Services in the UK

Britto J, Nadel S, Maconochie I et al, Morbidity and severity of illness during interhospital transport: impact of a specialised paediatric retrieval team. BMJ 1995; 311: 836-9.

Lynda Pittilla, Retrieval co-ordinator, PICU, Great North Children’s Hospital, Newcastle upon Tyne

National Report of the Paediatric Intensive care Audit Network, January 2006-December 2008. University of Leeds: Paediatric Intensive care Network (PICANet), 2009.

C21: The Development of Paediatric

Background: Paediatric Intensive Care (PIC) services have been centralised in Britain. This development has included PIC retrieval teams to ensure safe and rapid transport of sick children from District General Hospitals to regional PIC units.Two main principles have shaped the development of PIC retrieval services in Britain. The centralisation of PIC Services results in improved outcomes for patients and (1-3). Plus the use of specialist retrieval teams to transport critically ill children as associated with reduced morbidity (4-5). The Present: Nearly all critically ill children are now cared for in dedicated PICU’s, and of the 5000 children admitted from other hospitals to PICU’s each year, over 80% are transported by PIC retrieval teams (6). The traditional retrieval model is for teams to be made up of staff already working on the ICU. One of the main changes to PIC retrieval has been a gradual shift from small teams based on individual PICU’s to large regional retrieval teams that are staffed separately and independently commissioned. Retrievals in Britain have been undertaken by PICU trained physicians-nurse teams, usually including a PIC Intensivist or experienced PIC trainee with a background in paediatrics or anaesthesia. Other staffing models use advanced nurse practitioners (ANP), and/or respiratory therapists. ANP’s have been increasingly used in Britain over the past few years in neonatal as well as PIC retrieval. The development of advanced nursing roles has significantly accelerated by recent changes to postgraduate medical training, junior doctors working hours and shortage of trainees in high intensity specialities. Paediatric Intensive Care Networks: All regions in England have an established paediatric critical care network involving the PIC retrieval service and referring hospitals. The Department of Health suggested a team approach to the management of the acutely ill or injured child, and recommended the use of common guidelines for the management of emergencies and for drug preparation, standardisation of equipment and sharing of expertise across the network (7).

CONCLUSIONS The challenges for the future lies with the development of a successful staffing model, to sustain the service that will give the best possible outcomes to the children who require intensive care.

References Pearson G, Shann F, Barry P et al. Should paediatric intensive care be centralised? Trent versus Victoria. Lancet 1997; 349 1213-17. British Paediatric Association. Report of a Multidisciplinary Working Party on Paediatric Intensive Care. London. British Paediatric Association, 1993. Department of Health, Paediatric Intensive Care, a Framework for the Future. Report from the National Coordinating Group on paediatric Intensive care to the Chief Executive of the NHS executive, London: DH 1997.

Department of health. The Acutely or Critically Sick or Injured Child in the District General Hospital: A Team response. London: Department of Health, 2006.

C22: International Perspectives in

Critical Care: An exchange Scholarship Offering an Opportunity to Explore Critical Perspectives in Patient Care

Chrissie Guyer, Helena Francis, Southampton University NHS Trust, Chris.guyer@suht.swest.nhs.uk

BACKGROUND For more than a decade, health care within the United Kingdom has been shaped, influenced and directed by a national political agenda [DOH,1998]. Given the global health care economy, the need to ensure that critical care services are delivered, with the patient at its centre and in the most effective and efficient way, to optimise patient outcomes is paramount [DOH, 2010].

AIM This presentation will explore an international perspective in relation to Critical Care nursing within Southampton University Hospital NHS Trust in the U.K. and Wellington Hospital New Zealand. An application process awarded two critical care nurses from the U.K the opportunity to explore and contrast the care of critically ill patients within N.Z. The catalyst for the exchange started with a visit to the U.K. by a critical care nurse from N.Z., resulting in an exchange from the U.K. to Wellington Hospital N.Z. This journey created an exciting opportunity for us to experience and embrace the care of critically ill patients in an alternative healthcare setting. The objectives of the scholarship were to form alliances, partnerships and collaboration, to inform an international perspective in sharing critical care practices and cultures.

OUTCOME Participating in the exchange has enhanced our critical care skills both from a personal and professional perspective, which in turn, has enhanced and improved the care of our critically ill patients and their families. It has forged international alliances between Southampton and Wellington critical care units, providing opportunities to ‘create the future’ through the development of nursing research and evidence based practice in all aspects of critically ill patient care.

References A First Class Service :Quality in the new NHS, 1998, DOH, London. Equity and excellence: Liberating the NHS, 2010, DOH, London.

Barry PW, RalstonC. Adverse events occurring during interhospital transport of the critically ill. Arch Dis Child 1994: 71: 8-11.

Concurrent Abstracts

C23: Declining Consent to Organ

C24: Ultrafiltration Therapy for

Heather McMurray, NHSBT, Belfast Trust, Northern Ireland, heather.mcmurray@nhsbt.nhs.uk

Naim Abdulmohdi, Anglia Ruskin University, naim.abdulmohdi@anglia.ac.uk

BACKGROUND

Heart failure is a complex clinical syndrome. It is a leading cause of mortality, morbidity, and may lead to prolonged and frequent hospitalisation. Sodium and water retention are the hallmarks of heart failure. Acute decompensated heart failure (ADHF) with fluid overload is the most common cause for hospitalization.

Donation: A Reflection on the Collaborative Approach.

Family refusal to provide consent for donation is the most common reason for organs of medically suitable potential donors not being donated (Erhle et al 1999). Consent, and subsequently refusal rates, in organ donation depend on a variety of factors, with the manner in which families are approached for organ donation cited as being one of the most important factors (Siminoff et al, 2001). The main findings of a systematic review were that consent rates were higher when the request for organ donation was made by a specialist nurse organ donation (SNOD) in conjunction with hospital staff members, which is commonly referred to as “collaborative requesting”(Simpkin et al, 2009).

AIM Using a reflective account of a case study in which a family initially declined consent for organ donation, it is hoped to demonstrate the benefits of having a SNOD embedded in an intensive care unit (ICU) to provide specialist care to families where organ donation is requested.

FINDINGS A 20 year old man was diagnosed brain stem dead and his family were approached for organ donation by the lead clinician. The family initially refused consent to organ donation at this formal request. The SNOD, who was present on the ICU, but not involved in this initial conversation, subsequently spoke to the family at length about end of life care and their choices. The family had been formally approached for consent to organ donation in an unplanned and untimely manner. It was clear that after this formal request that they needed information, time and support. After further discussions, which included information on brain stem death, the option of organ donation and the benefits, and also a discussion of the wishes of their son, the family changed their mind and decided to give consent for organ donation.

CONCLUSION Approaching families for consent for organ donation should be carried out in a collaborative way by hospital staff and SNODs to ensure that families are approached in a timely manner, given the correct information and given support with their decision.

References Erhle, R., Shafer, T.J. & Nelson, K.R. (1999) Referral, request abd consent for organ donation: Best practice - a blueprint for success. Critical Care Nurse 19 pp21-30, 30-33. Siminoff, L.A., Gordon, N., Hewlett, J., & Arnold, R.M. (2001) Factors Influencing Families’ consent for donation of solid organs for transplantation. JAMA 286 (1), pp71-77. Simpkin, A.L., Robertson, L.C., Barber, V.S. &Young, J.D. (2009) Modifiable factors influencing relatives’ decision to offer organ donation: systematic review. BMJ, 338 ppb991.

Treating Heart Failure Patients with Fluid Overload

The current practice for treating patients hospitalized with ADHF with evidence of systemic congestion is by the administration of intravenous loop diuretics to enhance salt and water excretion. This reduces the intra-vascular volume, which relieves the symptoms of fluid congestion. However, routine and aggressive diuretic therapy in heart failure patients is usually associated with an undesirable reduction in renal function, and subsequently causes diuretics resistance. Mechanical removal of fluid by continuous veno-venous haemofiltration (CVVH) is the second most common treatment used. Although, CVVH is effective in fluid removal it is primarily a renal replacement therapy. Ultrafiltration (UF) is a process of removing the fluid by which plasma water is separated from the whole blood across a semipermeable membrane as a response to a transmembrane pressure gradient. This presentation will discuss the use of ultrafiltration as an alternative therapy for treating ADHF patients with fluid overload. An integrated literature review was conducted and concluded that ultrafiltration effectively eliminates more sodium than diuretics. Therefore, it takes more time for sodium and water to accumulate again. Subsequently, UF has substantial effects of rapidly relieving fluid and sodium retention, speeding up patients’ recovery and reducing hospital readmission. UF can remove fluid from the blood at the same rate that fluid can be naturally recruited from the tissue by compensatory mechanisms, plasma refill. This minimizes the sudden reduction in intravascular volume which causes haemodynamic instability. As a result of this review a change in practice was introduced into a local critical care unit.

C25: Improving the Inter-Hospital Transfer of Critically Ill Patients: A Service Improvement

Brian McFetridge, Caroline Harley, Agnes Diamond, Jackie McGrellis, Mark Gillespie, Neal McAllister, Patrick Stewart, Western Health and Social Care Trust, John McClintock, Northern Ireland Ambulance Service HSC Trust, brian.mcfetridge@westerntrust.hscni.net

AIM This presentation aims to share the learning from service improvements to the inter-hospital transfer of time-critical patients, and reflects the benefits to patients, critical care staff and the ambulance service.

Concurrent Abstracts BACKGROUND Transfer of critically ill patients to intensive care or high dependency units in other hospitals for clinical or non-clinical reasons is common practice. However, it is well recognised that such transfers pose risks to both patients and staff. Careful planning, preparation of staff, stabilisation of the patient and appropriate use of equipment are necessary to reduce the risks associated with such transfers.

SERVICE IMPROVEMENT STRATEGY Nursing, technical, anaesthetic and ambulance staff collaborated to address the local needs of critical care staff transferring “time critical” patients to a regional specialist centre and to improve the process of these transfers. This service improvement aimed to enhance the processes surrounding the stabilisation and preparation of patients, develop an individualised Critical Care Transfer Trolley, ensure efficient utilisation of ambulance resources and develop a one day Time Critical Transfer Training Programme. In recognition that critically ill patients may be transferred from intensive care units, emergency departments or theatres, training focused upon staff from all of these clinical areas. Inclusive in the training are staff from paediatric settings.

OUTCOME OF SERVICE IMPROVEMENT This service improvement activity has resulted in enhanced safety for patients and staff. Significantly, reductions have been seen in the time taken in transferring patients based upon improved use of transfer equipment, improved processes and more appropriate use of ambulance resource. Based upon this improvement strategy, the time critical transfer process, training and equipment have now been implemented within a second acute hospital site within the Trust.

C26: It Is a HIT: Covering the Bases Regarding Heparin Induced Thrombocytopenia

Julia Garrison, The Christ Hospital, Mason, Ohio 2 million patients receive either unfractionated heparin or lowmolecular weight heparin in the United States each year. Of the patients exposed to heparin, up to 50% develop heparindependent antibodies and approximately 3% develop Heparin Induced Thrombocytopenia. What is the concern? Thromboembolic complications occur in approximately 50%, which is 15,000 patients. The thrombotic complications of HIT can be catastrophic, including losing limbs and death. This potential life threatening condition will be discussed including pathophysiology, signs and symptoms and diagnostic criteria. Potential complications of HIT will be examined and the clinical implications affecting the practitioner will be presented and discussed. Participants will be able to identify areas in their own practice to potentially improve care for this specific patient population. This session is appropriate for staff nurses interested in developing a deeper understanding of HIT. This session will enhance the synergy nurse competencies of clinical judgement and clinical inquiry, which will result in improved quality of care. The only prerequisite is the goal to learn more about HIT and the clinical implications affecting patients and their families.

C27: The New 2010 Ventilation Care Bundle: Is it Manageable?

Alison Ruffell, Colchester General Hospital, Alison.Ruffell@colchesterhospital.nhs.uk The aim of the presentation is to discuss the feasibility of implementation of the new ventilation care bundle proposed by the Department of Health at the end of 2010. Colchester Critical Care has been auditing the original care bundle and identifying and investigating incidents of VAP since January 2009 and the audit results produced unexpected findings that have not been identified in any papers and which has led to a change in practice in our Unit. The Unit had already implemented the new DoH guidelines whilst they were still in draft form in anticipation that the guidelines would be confirmed. Recent work has identified that the new care bundle may not be manageable due to issues with ETT cuff pressures, size of ETTS and the availability of appropriate ETTS in other areas of the hospital. The new components of the care bundle have only been audited for 3 months so sufficient meaningful results will not be available for another 3 months but will be well in time for the Conference. We believe that we are the first (and possibly only) District General Critical Care Unit that has currently implemented the new care bundle and as such, are unable to benchmark.

C28: Developing End of Life Care;

Giving Bereaved Families the Option of Corneal Donation Heather Savage, National Health Service Blood & Transplant, heather.savage@nhsbt.nhs.uk

BACKGROUND The unit at The Ulster Hospital historically has a very high referral rate for Donation following Brain Stem Death but no tissue only referrals. Across the region only 5 corneal only donations occurred in the year 09/10. It was widely felt within the unit families would not consider corneal only donation due to our culture of open coffins and the wake. The document ‘Organs for Transplant: A Report of the Organ Donation Taskforce 2008’ reviewed the process of organ donation and transplantation within the UK and made 14 recommendations; one of which is to make organ and tissue donation a usual, not unusual event in end-of-life care in all trusts. The introduction of a Specialist nurse in organ donation into the Intensive Care unit followed the recommendations, in February 2010.

AIM To ensure all families are given the opportunity to donate corneas if that is their, or the wishes of the deceased. Whilst it is recognised only a small percentage of the population can donate solid organs, there are few contraindications to corneal donation.

PROCESS An education programme was developed and implemented to give the nursing staff the skills and knowledge to approach families of all patients who died in ICU to consider corneal donation. In addition, corneal donation leaflets and posters were placed in relative areas with positive feedback from both families and nurses. 59

Concurrent Abstracts RESULT Nursing staff have taken responsibility for the approach to all families and feel corneal donation is a positive outcome within their unit. 2010/2011 family approach rate has increased from 16% to 69% overall, with some months the approach rate being 100%. Family consent rate currently overall is 33%.

C29: A Bereavement Follow Up

Service - Facing The Challenges Ahead

Sally Spencer, Derby Hospitals NHS Foundation Trust, sally.spencer@derbyhospitals.nhs.uk Death is part of life on an Intensive care unit (ICU), with an average mortality of 18-30%. We all learn to deal and cope with death in different ways, but for many relatives and friends of ICU patients who die it’s sudden and unexpected; they are left feeling bereft and in many cases with unanswered questions and the “what ifs”. It is a well known fact that by explaining and answering questions of those relatives who wish it, that the grief caused by the death of a loved one in ICU can be minimised (Voisey et al 2007). Our ICU has had a bereavement follow up service (BFUS) since 1998 when the Intensive Care Society (ICS) produced their recommendations in their ‘Guidelines for Bereavement Care in Intensive Care Units’ (ICS 1998). The original aim was to provide support to bereaved relatives. They could choose to come back to ICU to meet with nurses who were involved in providing care for their relative, where core issues such dealing with sudden loss and coping mechanisms were discussed. They could then be directed to access further support or counselling via their GPs or other specialist organisations such as Cruse. Over recent months it has become clear that the focus of our BFUS is changing. Our whole approach has evolved from the totally nurse led service and now has a much more multidisciplinary team focus as we aim to deal with the challenges of relatives’ changing expectations of the service. We now have a consultant intensivist on our team who is actively involved and this enables us to provide a robust yet sensitive service to our bereaved families.

C30: Enhancing Communication Skills in Complex Situations Using Actors as Simulated Patients and Relatives Judy Dyos, Tania Topp, Fiona Hall, Southampton University Hospital Trust Feedback from junior nursing staff within critical care provided the catalyst for this work. Asked what they found most challenging about working in the department, their answers held a similar theme, time and time again. ‘Talking to the patients and relatives, breaking bad news and knowing what to say’. It was recognised that our staff were ill prepared for the challenge of communicating with patients and relatives who were often experiencing one of the most stressful experiences of their lives. Compelled to find a better way to manage this vitally

important aspect of education, the team set up a developmental group. We enlisted the expertise of the hospital Trust Simulated Patient Lead to create a workshop that would facilitate simulated complex communication interactions. The interactions were based on real experiences of the clinical team and utilised actors to play the role of patients and relatives. Our workshop provides the opportunity for each staff nurse to undertake at least one simulation and observe a further five. The participants are fully in control of the experience and can choose to call ‘time out’ if they feel unable to manage the situation or need time to reflect. All group members get the opportunity to feedback, the most important feedback being that from the simulated patient or relative who remains in character and relates how they felt throughout the interaction. Evaluation undertaken by Bokken et al (2010) into the use of simulated patients (SP) workshops showed that most students preferred having several SP encounters before the real patient encounters. This is reflective of the evaluations we have received from our staff participants and although this does not provide proof of the benefits it seems clear that staff that are better prepared will manage future communications more effectively.

C31: Sharing Perspectives:

The Collaborative Care for the Cancer Patient Joanne Atkinson, Vanessa Gibson, Northumbria University Sepsis remains a major reason for admission to critical care units. The causes of sepsis are many and varied but this workshop will focus on why patients undergoing treatment for cancer are admitted to critical care units. The aim of the workshop is to provide critical care nurses with an insight into contemporary cancer treatment to try to dispel some of the myths regarding the futility of aggressive treatment in the critical care setting. As in many areas of clinical practice in the cancer setting we are undergoing major challenges in the way we deliver care. The treatment landscape is changing, becoming more targeted and more intense for many cancers. The aggressive nature of some chemotherapeutic regimens has severe side effects. As a result of the intensification of treatment patients develop suppression of the bone marrow and become severely immune-compromised. This can quickly escalate into life threatening sepsis (Atkinson and Richardson 2006). Transformation of hospital services in Newcastle has led to the centralisation of the Northern Centre for Cancer Care on a new site. This has impacted on the number of patients being admitted to the critical care unit with neutropenic sepsis. This workshop is pitched at an intermediate level and will consider a revision of the pathophysiology of sepsis, identification of the types of cancer requiring intensive treatment, explanation of chemotherapy and the impact on the patient. The workshop is a precursor to a more robust collaborative education programme between critical care and cancer care services in Newcastle.

Concurrent Abstracts References Atkinson J and Richardson C in Grundy M (2006) Ed. Nursing in Haematological Oncology. Second Edition. Balliere Tindall.

C32: Specialist Rehabilitation Nurses

in Critical Care Units - Reflecting on the Portuguese Experience - Can it be Transposed to the UK?

Nuno Pinto, Catherine Plowright, Medway NHS Foundation Trust, Antonio Simoes, St Maria Hospital Lisbon Portugal Thousands of patients are discharged from critical care units across the UK every year. And, if most of these patients recover quite smoothly and are able to return to their normal lives when going home, a few ones will be faced with a long and uncertain journey to full recovery, with added weight to the individual and their families. It is therefore essential to start the rehabilitation process as soon as possible, with early initial assessment, in order to identify patients at risk, and establish a rehabilitation care pathway through the work of a multidisciplinary team. NICE guidelines recommend that this rehabilitation process should be “coordinated by healthcare professionals with the appropriate competencies” (NICE, 2009). These professionals should be intensive care professionals, with a special interest and knowledge on physical and psychological rehabilitation. In Portugal, Critical Care units have a specialist rehabilitation nurse as part of the healthcare teams, and these are responsible for coordinating the rehabilitation process of their patients. These professionals are able to provide specific rehabilitation care, prevent complication and optimize the functional capacity of the patient, minimizing any possible sequelae, which may leave the patient with large reduction in their functional ability. Their work is direct to patient / family / community facilitating and streamlining the social reintegration of the patient within their community and assisting in returning to previous life. With this presentation we aim to present the Portuguese reality, reflecting on possible gains for the patients and if it could be adapted to the UK reality in line with NICE guidelines. Resourcing to some illustration and videos we aim to demonstrate these rehab nurses roles and responsibilities and to illustrate how these could or not be adapted to UK reality.

C33: Compliance with NICE

Rehabilitation After Critical Illness Guidelines (2009) - The Role of a Nurse-Led Follow Up Clinic in a District General Hospital

Nicola Morton, Northern Lincolnshire & Goole NHS Foundation Trust Rehabilitation strategies help to improve patient outcomes, minimise hospital readmission rates and reduce the use of primary care resources. Furthermore, these strategies could help patients return to their previous level of activities sooner. Physical morbidity problems after critical illness include weakness, fatigue, pain, respiratory problems, communication problems

and mobility problems. Psychological morbidity problems include psychological impairments and cognitive dysfunction such as anxiety, depression, nightmares, hallucinations and loss of memory. Rehabilitation strategies aid physical recovery and help people cope with the psychological problems associated with critical illness. The nurse-led follow up clinic, run by the Critical Care Outreach Team, reviews patients 3 months after their discharge from critical care. An informal functional assessment of their health and social care needs is carried out. Based on the functional reassessment the clinic will: 1) Refer the patient to the appropriate rehabilitation or specialist services if: - the patient appears to be recovering at a slower rate than anticipated or - the patient has developed unanticipated physical and/or non physical morbidity that was not previously identified. 2) Give support if the patient is not recovering as quickly as they anticipated. Accompanied visits to the ICU are also offered at the clinic appointment. This helps to re-orientate the patient to events that may be hazy to them. Booklets about life after critical illness and coping with traumatic experiences are offered at the clinic to all patients. Repeat appointments are offered to all patients if they feel it would be helpful.

Common clinic themes include: Physical - poor balance, lack of strength, poor appetite, shortness of breath. Psychological - Depression, flashbacks, memory loss. Patient feedback – “What a bonus. To be able to talk to someone who listens and is interested in you”. NICE clinical guideline 83 - Rehabilitation after critical illness

C34: Developing the Assistant

Practitioner role in a Cardiac Intensive Care Unit

Graham Brant, Sarah Dodds, University Hospitals Bristol NHS Foundation Trust The presentation will focus upon our experiences of implementing the role of the Assistant Practitioner in a critical care area and will focus on: why we choose the assistant practitioner role; how we managed to integrate the role within the wider team and the process we undertook in agreeing and developing the competencies. Since implementing this workforce, we now have 4 assistant practitioners working in the critical care area caring for critically ill patients.

C35: Boomers, Xers, & Nexters: How to Retain, Manage, & Educate Them

Julia Garrison, The Christ Hospital, Mason, Ohio Communication between Boomers, Generation Xers and Nexters requires different skill sets to be effective. Many years ago, the educational process appeared to go seamlessly, with nurses

Concurrent Abstracts talking “the same language”. Today, what happens when the educator is a Baby Boomer and the new nurse is a Generation X or a Nexter? Or vice versa? Is the process as seamless? Do you manage them the same way? Generation Xers, Nexters, and Baby Boomers are all unique in their views of the world as well as their communication styles. Each generation’s characteristics, values, and behaviours will be discussed. These areas will then be applied to the educational arena and will discuss of how to optimally educate multi-generational staff. The only prerequisite requirement to attend this session is the desire to be able to communicate better with others. The participants will walk away from this session with a better understanding of each generation, including being able to state three unique characteristics of each generation. They will also be able to examine specific communication techniques and discuss available educational tools and specific management skills to create a more optimal learning environment to maximize their contribution and resources to improving the healthcare of patients and their families.

C36: Advancing Practice: Critical Care Outreach and Prescribing

Mark Wilson, Karin Gerber, Royal Berkshire Hospital NHS Foundation Trust

INTRODUCTION It is five years since nurse prescribers have been able to independently prescribe licensed medication (DH 2006), and two years since the BACCN position statement on nurse prescribing (Bray et al 2009). Despite the growing evidence base in primary care there is a dearth of literature on nurse prescribing in critical care. Concerns were expressed in the position statement about the feasibility of critical care outreach (CCO) nurses prescribing for patients not currently under the care of the critical care unit (Bray et al 2009).

AIMS This presentation will show that CCO nurse prescribing is manageable. It can improve the teams’ effectiveness by facilitating rapid intervention and allow completion of the treatment loop. Our development of a CCO formulary has shown that despite covering an extremely diverse patient group a key group of intervention medications are at the heart of our prescribing.

METHOD Data has been collected on the prescribing decisions of two CCO independent nurse prescribers in a large DGH since January 2011.

RESULTS Initial findings suggest that the number of prescribing decisions per shift is increasing every month. 60% of prescribing relates to IV fluid with nutrition and nebulisers the next most prevalent. A formulary of approximately 50 medications has been identified.

DISCUSSION The analysis of CCO prescribing decisions is a key starting point in pushing forward into this advanced role. It will inform a wider debate and drive development of this under explored role.

References Bray K et al (2009) British Association of Critical Care Nurses position statement on prescribing in critical care. Nursing in Critical Care. 14(5): 224-234 Department of Health (DH) (2006) Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/ @dh/@en/documents/digitalasset/dh_4133747.pdf (accessed on 12/04/2011)

ViPER Abstracts

ABSTRACTS

ViPER

ViPER Abstracts

V01: Implementation of a successful Sepsis Recognition Tool and Care Pathway

Kelly Carter, The Christie NHS Foundation Trust kelly.carter@christie.nhs.uk Expert - Helen Stirton, BACCN Board

BACKGROUND Sepsis is not a new challenge but remains difficult to identify and treat (Carter, 2007). A majority of patients admitted to Critical Care with sepsis develop this on general wards (Robson et al, 2007). To reduce mortality, it is essential that ward nurses are aware of sepsis and its management, though some evidence highlights that ward nurses have a poor knowledge of this. The implications suggest that vulnerable patients will be diagnosed late and may not benefit from life saving measures proven by the Surviving Sepsis Campaign. Practical education for all ward nurses, informed by current evidence should be available to all staff and should focus on early recognition of the signs and symptoms of sepsis.

Aims and objectives: • Overview of the problem • Background to the Surviving Sepsis Campaign • Implementation of sepsis recognition tool • Findings post implementation • Future development

INTERVENTION The Survive Sepsis initiative recommends a tool known as the Sepsis Six, devised to empower all healthcare professionals to deliver life saving aspects of care to patients with sepsis (Survive Sepsis, 2010). The Sepsis Six is a set of interventions that need to be carried out within the first hour and are the first steps towards completing the 6 hour resuscitation bundle. A tool consisting of set identification of specific criteria and a care pathway has been implemented on the general wards to assist nurses in the recognition of the septic patient and to provide guidance with essential interventions.

RESULTS An audit carried out after the initial pilot demonstrated that the tool is effective, and demonstrates successful early recognition of sepsis. Initial compliance in using the tool was poor, further education and awareness improved compliance. Feedback from staff on the use of the tool has been positive.

V02: Guidelines for Use of Speaking Valves in Long Term Ventilated Patients in Critical Care

Anne Malpeli, Royal United Hospital, Bath

BACKGROUND This group of patients are alert and awake but their ability to communicate is very limited. They become frustrated, depressed and withdrawn as they cannot express how they feel. The optimism that they need for their recovery soon ebbs away and they become disillusioned and give up all hope of getting back

to a normal existence. It is also a difficult time for their relatives. Johnson et al (2006) reviewed studies, which have explored patients’ experiences of critical illness and found it to be unpleasant and frightening. Anxiety, helplessness, feelings of panic and uncertainty about their condition was a common theme.

LITERATURE REVIEW It is well documented that communication aids psychological recovery in critical care. Happ et al (2004) recognised that this inability to speak is a terrifying and isolating experience. A literature review was conducted prior to implementing this change. No recommendations could be found on introducing a speaking valve; some papers did list the benefits but none with helpful guidelines on how to accomplish this procedure.

AIMS & OBJECTIVES Due to this lack of information, a flow chart guideline was developed for the use of speaking valves on our ventilated patients. The aim for this poster presentation is to share these guidelines in order to introduce and promote speaking valve use in other critical care units.

CLINICAL CHANGE IN PRACTICE The speaking valve was instrumental in maintaining a positive attitude as well as giving some control back to this group of patients. Introducing these guidelines has resulted in an improvement in the clinical and psychological management of our long term ventilated patients.

CONCLUSION Speaking valves have since become an integral part of our patient management in order to allow these patients a voice to be heard.

References Happ MB, Roesch TK, Garret K, Electronic voice-output communication aids for temporarily non speaking patients in a medical intensive care unit: a feasibility study. Heart & Lung 2004; 33(2) 92-101 Johnson P. St John W, Moyle W. Long-term mechanical ventilation in a critical care unit: existing in an uneveryday world. The Journal Of Advanced Nursing 2006; 53(5)551-8

V03: Delirious in Critical Care Janet Thomas, Sheila Goodman, West Suffolk Hospital NHS Trust The CAM-ICU is a validated delirium detection tool with high sensitivity and specificity and high interrater reliability (Ely et al 2001). Recent surveys involving large numbers of ICU healthcare professionals have demonstrated that despite the increasing knowledge of the pathophysiology, risk factors, and outcomes associated with delirium, it is still under-diagnosed (Salluh et al 2009). The challenge of teaching nurses and medical staff is to assist them to embrace the tool as part of their routine assessment, rather than as something to be added on to existing procedures (Nelson LS 2009) and to assist them in identifying delirium in the critically ill patient.

ViPER Abstracts Clear guidance for the management of delirium is the key to resolving it, particularly if delirium is identified in the early stages of the disease process. A holistic approach, which takes into account both the patient and the environment, complemented with distraction therapy was used to develop guidelines. Therefore, despite drug therapy forming a major part of the treatment it was not the sole treatment used. Support of nursing, medical and allied teams was vital in the successful implementation of the guidelines. Ongoing support from the delirium group ensured staff members were both competent and compliant in using the guidelines. However it was clear early into implementation of the treatment guidelines that ‘one size does not fit all’ and the guidelines were not suitable for all patients.

Weekly MDT rehabilitation ward rounds and goal setting meetings were also commenced. A repeat audit using the same tool is to commence in December 2010/January 2011 and June 2011/July 2011, in line with original audit samples.

We want to share some of the ‘highs and lows’ we have encountered implementing the CAM-ICU, highlight the changes we have made to practice and what we hope to achieve for the future. Audit of compliance demonstrated that continued education is essential to ensure reliability of delirium assessment. This presentation demonstrates that a well structured implementation plan for delirium monitoring with continued education and support, is feasible and improves detection and management of delirium.

CONCLUSION

References Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R: Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001, 286:2703-2710. Salluh JI, Dal-Pizzol F, Mello PV, Friedman G, Silva E, Teles JM, Lobo SM, Bozza FA, Soares M: Delirium recognition and sedation practices in critically ill patients: a survey on the attitudes of 1015 Brazilian critical care physicians. J Crit Care 2009, 24:556-562. Nelson LS, Teaching Staff Nurses the CAM-ICU for Delirium Screening (2009) Crit Care Nurs Q Vol. 32, No. 2, pp. 137-143

V04: Rehabilitation after Critical

Care: Using audit to Guide Changes in Practice, a Multidisciplinary (MDT) Approach

Debora Green, Emily Blake, Nicola Glasby, King’s College Hospital NHS Trust

INTRODUCTION To audit the holistic assessment and treatment planning of Critical Care in line with the NICE (National Institute of clinical excellence) guidelines (March 2009). The guidelines state that each patient should have a comprehensive assessment and reassessment of all physical and non-physical potential problems, goal setting and documented communication between patient, multi disciplinary team and family members.

METHOD An audit form was developed from NICE guidelines and piloted with 10 patients, following staff feedback the audit form was amended. A sample of patients was identified and 10 sets of notes were assessed for inter-rater reliability. The results were then compiled and new documentation developed to prompt consideration of potential physical and non-physical problems.

RESULTS Physical problems were comprehensively assessed in 100% of the sample population however there was little evidence of assessment of potential non-physical problems in most patients. There was poor documentation of information giving to patient relatives in all aspects of their care. Transition from Critical care to ward is an area to be improved, with poor information provision to ward and patient/carer.

Following the audit, several initiatives were put in place to resolve the highlighted issues. A rehabilitation ward round was commenced with weekly MDT goal setting, a psychosocial history form was introduced plus a Critical Care multidisciplinary assessment tool. By the time of the conference the second audit will be completed which will give some indication of the impact of our change in practice. We feel that the multidisciplinary nature of the project and the changes in practice as a result of audit would be valuable to share with our peers.

V05: Oral Hygiene in the Intubated Patient: An Educational Reminder

Nicola Elizabeth White, Royal Derby Hospital nicola.white3@nhs.net

BACKGROUND Mechanically ventilated patients are at risk of developing ventilator-acquired pneumonia (VAP) for many reasons, one being that patients are dependent on others to provide their oral hygiene. Oral hygiene is part of standard nursing care but it is often neglected, or is performed incorrectly by just swabbing the mouth.

AUDIT STANDARDS & AIMS The current departmental protocol states that each patient should have the following; a daily oral assessment score, teeth cleaned twice daily with toothpaste and toothbrush, prescribed chlorhexidine should be used four times a day, moisturising of the mouth with water every two hours, application of Vaseline to the lips to prevent cracking and daily changing of the endotracheal tapes. The aims of the audit were to assess current departmental practice whilst increasing the staffs’ knowledge and awareness of the relationship between oral hygiene and ventilator-acquired pneumonia.

METHOD A proforma was used to retrospectively examine the ICU charts of twenty randomly selected patients during a 24-hour period. Data was collected as per the above stated departmental standards.

RESULTS Oral hygiene of the intubated patient was carried out irregularly. Only 10% of patients received the recommended twice a day use of toothpaste and 5% had the prescribed chlorhexidine treatment. 65

ViPER Abstracts CONCLUSION The literature significantly supports the hypothesis that oral hygiene reduces the risk of VAP in intensive care. In addition to other preventative methods of VAP such as patient positioning, stress ulcer prophylaxis and subglotic clearance, effective oral care also needs to be an important element of increasingly written ventilator care bundles. It is paramount that staff are reeducated and made aware of the importance of giving their patients regular effective oral care as per the departmental protocol.

References Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., and Majumder, M. (2009) Reducing ventilator-associated pneumonia through advanced oral-dental care: A 48- month study. American Journal of Critical Care. [online]. 18(6) pp 523-532. Available at: www.ajcconline.org [Accessed 4th October 2010]. Munro, C,L., Grap,M,J., Jones,D,J., McClish,D,K., and Sessler, C,N. (2009) Chlorhexidine, Toothbrushing, and Preventing ventilator-assocaited pneumonia in critically ill adults. American Journal of Critical Care. [online]. 18. pp.428-437. Available at: http://ajcnjournals.org/cgi/content/full/18/5/428 [Accessed 21 October 2010]. Pobo, A., Lisboa, T., Rodriguez, A., Sole, R., Margret, M., Trefler, S., Gomez, F., and Rello,J. (2009) A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest. [online] 136(2). pp433-439. Available at:www.chestjournal.org [Accessed on 3rd November 2010].

V06: Minimising the Psychological

Distress of ICU: the Role of the Clinical Psychologist Lisa Browning, Jacqueline Weaver, Jayne Sheppard, Maria Ford, Salisbury NHS Foundation Trust, lisabrowning@nhs.co.uk Problems following critical illness have been well documented and include generalised physical disability related to the illness that precipitated admission to hospital and the interventions carried out on the ICU. Until recently, however, a stay in an Intensive Care Unit (ICU) was deemed to be a success if the patient left the ICU alive. This measure of success however does not take into account mortality on the wards, poor quality of life after discharge from hospital, or recurrent readmission to hospital for ongoing complications. Over recent years concern has been growing over the large proportion of intensive care patients who go on to experience long-term psychological disturbances including post-traumatic stress disorder. The follow up clinic in Salisbury has been running for over ten years and recently greater emphasis has been placed on actually eliminating the distress of amnesia, hallucinatory images and delusional episodes. This has been achieved in a number of ways including patient diaries and the introduction of a delirium risk assessment strategy. More recently the team has appointment a clinical psychologist who provides patients with effective resources to cope both during and after their stay on the unit. The following paper will explore how the introduction of the clinical psychologist to the multidisciplinary follow up clinic at Salisbury District Hospital has helped to provide individuals with

effective resources to cope with some of the distressing psychological problems associated with admission to ICU. Early identification of actual or potential problems together with appropriate referrals and treatment has improved the patientâ&#x20AC;&#x2122;s experience thus reducing psychological stress following discharge.

Poster Display Abstracts

ABSTRACTS

Poster Displays

Poster Display Abstracts

P01: The effect of Influenza on a

Critical Care Outreach Service

Linda Chu, Kim Williamson, Linda Kent, Anne Carter, Francis McGuigan, Kelvin Wright, Frimley Park Hospital criticalcareoutreach@fph-tr.nhs.uk Winter has a huge impact on demand and provision of critical care services. Last winter, proved exceptionally challenging with the addition of the H1N1 influenza. Frimley Park Hospital is a 720 bedded District General with a 12 hour outreach service along with night nurse practitioners. The outreach service is assessed monthly against key performance indicators, these are: 1. Follow up on all prolonged recovery and ICU patients within 24 hours of discharge 2. Review all ward patients with a MET score > 6 3. Attend all MET and crash calls The target for this is 100%. During the months of December 2010 and January 2011 these fell to 90-95% for follow up patients, 68-87.5% for reviewing all ward patients with a Met score > 6 and 86-91.6 % for attendance to MET and crash calls. We examined ICU patient dependency along with the number of staff on duty and any available beds that could be utilised. The critical care unit increased its capacity by nearly 33% to increase the number of beds from 12 to 16 which ultimately had an impact on the critical care outreach service. We then looked at the effect this had on the Trust as a whole, and in particular the readmissions to ICU due to early discharge, the increase in the number of referrals of patients with a high MET score, cardiac arrests and Medical Emergencies (MET calls) within the Trust.

P02: Improving Drug Dosage Calculation Competency in Intensive Care Nurses Barbara Day, Royal Derby Hospital The preparation & administration of infusion products is part of a complex area of practice in intensive care and it is essential for patient safety that ICU nurses must be able to calculate drug dosages safely and accurately. However, problems with numeracy among nurses are well documented with reports showing that that as many as one in six medication errors is due to dose miscalculation (DoH 2004, NPSA 2009). In addition to the financial cost to the NHS there is the potentially huge personal cost to the individuals involved. While drug calculation errors occur for a number of reasons, in local clinical incidents the lack of confidence in performing the more complex dosage calculations required was often cited as a contributing factor. It became increasingly evident that there was a need to introduce strategies to ensure staff competency in dosage calculation. A training need analysis was performed in the form of a written test followed by individual discussion. This enabled us to assess individual ability in performing dosage calculation and also identify nurses main strengths and weaknesses.

The results of the test showed that a significant number of nursing staff of all grades experienced difficulties. Tailored training was provided in the form of one-to-one sessions and a series of calculation workbooks was developed. The calculation assessment is now part of the annual IV update and we have not only seen significantly improved scores, but also increased selfawareness and confidence in performing complex drug calculations. The exercise has fostered a culture of openness, encouraging staff to share concerns and difficulties. Training has now been expanded to cover all new staff during the induction period. Department of Health (2004) Building a Safer NHS for Patients. Improving Medication Safety. London The Stationery Office Limited National Patient Safety Agency (2009) Review of Patient Safety for Children and Young People. London: NPSA.

P03: Team Work in ICU Education Salinda Garawal, ICU, Royal Derby Hospital ‘The nice thing about teamwork is that you always have others on your side’ Margaret Carty Intensive Care related knowledge and technologies are in a state of constant development and innovation. Organising mandatory training, maintaining staff competence and responding to an ongoing practice development agenda poses huge challenges that must be met by the Education Team (ET). Competent and capable workforce enables local and organisational objectives for safety and high quality care to be achieved in a timely and professional manner. To meet these challenges the decision to educate and professionally develop our ICU staff in teams was locally the best way forward. With support from the Senior Team the 130 ICU staff were organised into 7 teams defined by colour, led by two Band 7 sisters. Three ‘Team Time Out’ (TTO) training dates were scheduled into the ‘off-duty’ for each team throughout the year. Notwithstanding exceptional circumstances, all members of the team attend the TTO day. Team leaders in collaboration with the ET organise the programme for each TTO day. They monitor mandatory training compliance, address areas of competence, ensure individual training records are maintained accurately and collated onto the Trust Database. In addition staff personal development plans are reviewed to ensure that they are up-todate through the Performance and Development Review process. Band 6 team members are actively encouraged to support the Team Leader to organise TTO days and support junior members of staff as part of their personal development. TTO days have helped staff to work effectively together. They have improved communication, accomplished shared projects, ensured competence and knowledge in relation to new technologies, which in turn improved compliance to mandatory requirements and competency skills within ICU. The successful ICU TTO format has now been actively utilised by the matron in the Step-Down Unit within Derby Hospitals.

Poster Display Abstracts

P04: Preparing For the Future:

and delayed medication as the second largest cause of medication incidents in England and Wales in 2007 and issued a Rapid Response Report (RRR) in 2010, highlighting the potential harm of omitted or delayed medication doses.

Sophie Hadfield, Mick Dowling, Kings College Hospital Foundation Trust

The aim of this service improvement project was to implement an annual audit in ICU in order to improve medication safety and identify the extent of drug omission and drug error reporting.

Critical Care Band 5 Development Programme

BACKGROUND Historically, recruitment and retention of experienced intensive care nurses has posed a challenge in London ICUs due to competition from other inner city hospitals and the migratory working pattern of nurses in London. The senior nursing team at a South London ICU devised a band 5 development programme to assist in the professional development and ultimate retention of skilled staff within the unit.

AIMS The course aims to provide staff with an opportunity to gain the management experience, knowledge and skills in order to prepare them for future promotion and to support both junior and senior nursing teams. Candidates are exposed to leadership and management opportunities in a structured and supported way and the nurses who complete the course are given the opportunity to take a more participative role in shift management and develop their profile within the unit.

INTERVENTIONS Senior band 5 nurses who have completed the ICU course and mentorship courses are nominated to apply for this course with the support of their line manager after appraisal. The course runs twice a year and includes three in-house study days covering management issues and clinical development is structured using a practice assessment document based upon the EKSF band 6 competencies.

RESULTS The course is continually evaluated through candidate feedback, recently demonstrating that they feel more confident to take a lead on service improvement, staff supervision and clinical decision making. 15 participants have completed the course in the last twelve months and 4 have been promoted internally and 3 sought posts externally.

DISCUSSION This course has helped to develop, promote and retain staff on our unit. It has helped improve the confidence and motivation of our staff and gives them a focus for their career pathways, which in turn enhances the quality of care provided to our patients and service users.

P05: Reducing Drug Omission in

Critical Care: Following NPSA Guidelines Donna Pierre, Kings College Hospital

PURPOSE Critical care nurses are increasingly involved in reducing drug errors as they are uniquely positioned to identify, interrupt, correct and report these occurrences (Henneman, 2010). The National Patient Safety Agency (NPSA) identified drug omission

PROCESS A small working group of Critical Care Nurses and pharmacists in a London ICU, developed a compliance checklist for audit and a feedback mechanism to nursing staff. The total number of doses that should have been given on regular prescriptions were reviewed. These were described as the numbers of scheduled doses that were not signed for. The percentages of missing signatures were then calculated. A comparison was made with the number of drug omission errors reported on the Trust risk reporting system.

RESULTS AND RECOMMENDATIONS • Drug omission in ITU is one of the most underreported drug errors. • The use of the medicine â€˜not administeredâ€™ codes on inpatient prescription charts and a recorded reason for omitted doses constitutes to an omission. • The omissions were then separated into critical drugs where timeliness of administration is crucial and then reported as drug errors. • Patient safety is paramount and drug omission teaching was communicated to staff. • Education was given on the importance of timely critical drug administration and the appropriate actions to take when prescribed medication is omitted. • Regular audits need to be performed to ensure compliance with recommendations and monitor improvements in practice. Henneman, E., Gawlinski, A., Blank, F., Henneman, P., Jordan, D. and McKenzie, J. (2010) Strategies Used by Critical Care Nurses to Identify, Interrupt, and Correct Medical Errors. American Journal of Critical Care.19 (6); 500-509 National Patient Safety Agency. Reducing harm from omitted and delayed medicines in hospitals. NPSA/2010/RRR009 NPSA: London www.nrls.npsa.nhs.uk/alerts

P06: An Exploration of Psychological Assessment in the Critical Care Unit

Laura Taylor, The Royal Marsden NHS Foundation Trust The practice of psychological assessment in critical care patients has been recommended in order to provide effective, quality and patient centred care. The short and long term effects of the critical care experience have been documented and recommendations by the National Institute of Clinical Excellence have been published as best practice, including assessment of psychological function of critical care patients. Despite this, contemporary research suggests that there is no consensus on how to conduct a psychological assessment on such a patient cohort and little is known of the nursing experience of this.

Poster Display Abstracts This project was designed to gain an understanding of how often nurses document an informal psychological assessment in clinical practice, using the local psychological care plan as the standard. A critical appraisal of the literature was carried out from 2000-2010 and a clinical audit took place on a convenience sample (n=20) using a quantitative, retrospective method. Data was analysed using simple descriptive statistics. Of the 431 shift documentations audited, poor compliance (15%) was found to the local standard and less than half (46%) of the total shifts detail an informal psychological assessment was documented by nurses, hence a need to implement a change was exposed. Using change strategy and force field analysis an action plan has been implemented into clinical practice to develop the service in this area. National Patient Safety Agency. Reducing harm from omitted and delayed medicines in hospitals. NPSA/2010/RRR009 NPSA: London www.nrls.npsa.nhs.uk/alerts

P07: Setting Up the Intensive Care Emergency Admission Bay

Sally Spencer, Derby Hospitals Nhs Foundation Trust Emergency admissions can arrive on the Intensive care Unit (ICU) at any time of the day or night, Despite being prepared, nurses were often to be found running to and from the store rooms to collect vital pieces of equipment or consumables necessary for time critical procedures and interventions. The uncoordinated approach to ICU admissions was felt to be wasting nursing time and more importantly may be detrimental to the outcome for the patient. Therefore the whole process was reviewed so it could be improved. Out of the review came the idea for the emergency admission bay. The objective of setting up the admission bay is to have everything needed within the vicinity of the bedspace, to safely admit a critically ill patient and to enable time critical procedures/resuscitation to be carried out efficiently. It is a well known fact that early recognition and early goal directed therapy can reduce mortality quite significantly (Simmonds et al 2008), particularly in severely septic patients. This is in line with the premise that patients survival is at its greatest if they receive treatment within the golden hour (Wikipedia 2011). Our aim is to have the patient intubated, lines inserted and intravenous antibiotics administered within the first ‘golden’ hour of admission; and in most cases this is being achieved. The admission bay has made a big difference and having everything, both equipment and consumables to immediate hand in trolleys has saved nursing time, made the whole process more efficient and although not formally evaluated has probably improved the outcomes for our patients.

References Simmonds M, Hutchinson A, Chikhani M, Berwick J, Meyer J, Davies S, Morris C, (2008) Surviving sepsis beyond intensive care: a retrospective cohort study of compliance with the international guidelines. Journal of the Intensive Care Society Volume 9 Number 2 July 2008

P08: Productive Ward Within ICU Karen Greatorex, Royal Derby Hospital karen.greatorex@derbyhospitals.nhs.uk Productive ward was introduced by the Institute of Innovation and Improvement. The focus is on improving ward environment and processes by reducing waste and eliminating unnecessary steps, releasing nurses and therapists to spend more time delivering direct patient care thereby improving safety and efficiency (NHS Institute for Innovation and Improvement 2008). This is guided by 11 modules, which concentrate on different aspects of ward activity impacting directly and indirectly on a patient’s stay. Implementation in ICU has been facilitated by staff with an interest or responsibility in areas covered by the modules, forming teams to examine current practice and implement modifications that will benefit the patient and staff. The modules are rolled out consecutively. The core module ‘Know how we are doing’ was modified to analyse areas such as MRSA, C Diff, VAP rates alongside our prevalence of pressure sores, central line infections, unplanned staff absences and visitors and staff satisfaction. Using SMART goals, these results are collated monthly and displayed alongside the ward vision statement on the ICU main corridor for staff and relatives to view. The specific modules undertaken to date have improved the appropriateness of observations, reduced clutter in storage areas and improved communication for members of the Multi Disciplinary Team. Currently there are modules which have yet to be initiated, however those which have been undertaken are becoming embedded in practice and proving to be sustainable.

P09: Explicit Memory of ICU Patients - An Evaluation of Dreams, Nightmares, Hallucinations and Correlation to UK-PTSS-14 (Post Traumatic Stress Syndrome Scale)

Natalie Rich, Sarah Bowrey, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Elizabeth Trubshaw, Professor Michael Wang, Clinical Psychology Unit, University of Leicester, Jonathan Thompson, Dept of Anaesthesia, University of Leicester, natalie.rich@uhl-tr.nhs.uk

BACKGROUND Intensive Care Unit (ICU) patients are commonly sedated and many have little in the way of explicit memories after discharge. However, some studies suggest that as much as 25% experience psychological disturbance at follow-up (Jones et al 2007).

AIMS We aimed to explore the possible link between patients’ dreams, nightmares and hallucinations during their ICU stay and the incidence of psychological disturbance after discharge.

METHOD Wikipedia 2011 Golden hour (medicine) http://en.wikipedia.org/wiki/Golden_hour_(medicine)

After LREC approval, 36 patients were followed up for 5 weeks after ICU discharge between 09/2009 and 03/2011. At 1-2 weeks, patients completed the ICU Memory Tool (Jones et al

Poster Display Abstracts 2000) and a Memory Diary. This was repeated at 4-5 weeks and a UK-PTSS-14 scale (Twigg et al 2008).

RESULTS 23 males and 13 females were recruited (N=36; 23 emergency admissions, 13 elective). There was no significant correlation between UK-PTSS-14 score at 4 -5 weeks after ICU discharge and age, duration of sedation, ventilation, ICU stay, Apache II score or duration of ICU stay without sedation. Mean (SD) UK-PTSS-14 score in females was 21.8 (0-77) & 13.8 (0-40) in males. 3 out of 23 emergency admission patients (13%) scored >45 UK-PTSS-14 and were followed up by a psychologist, but they did not report a higher incidence of dreams, nightmares or hallucinations at 12 weeks. Analysis of patients (N=19) who recalled dreams, nightmares and hallucinations identified common themes of sensory distortion and disorientation (31%), fear of people/objects (26%), travelling (21%) and being trapped (26%).

DISCUSSION We found that explicit memory at 1-2 weeks after ICU of dreams; nightmares and hallucinations during admission as well as severity of illness and length of stay were not associated with higher UK-PTSS-14 scores.

CONCLUSION In this series, the incidence of marked psychological disturbance was low, with no link between the incidence or severity of patients’ dreams, nightmares and hallucinations and a high score on the UK-PTSS-14 scale.

References Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths R D (2007) Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Medicine; 33: 978-85. Jones C, Humphris G, Griffiths R D (2000) Preliminary validation of the ICUM tool: a tool for assessing memory of the intensive care experience. Clinical Intensive Care; 11 (5): 251 - 255 Twigg E, Humphris G, Jones C, Bramwell R, Griffiths R D (2008) Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Acta Anaesthesiologica Scandinavica; 5: 202-208

P10: Development & Introduction of

a Competency Based Acutely Ill Patient Programme (AIP) Catherine Rowe, Derby Hospitals NHS Foundation Trust ‘Patients who are admitted to hospital believe that they are entering a place of safety...’ and ‘...feel confident that should their condition deteriorate, they are in the best place for prompt and effective treatment’ (NICE 2007) Existing evidence from the 1990’s, NPSA reports (2007) and the Patient Safety First Campaign (2009) suggest the disturbing reality that patients are dying because staff fail to recognise their deterioration or that recognition is not always associated with appropriate escalation and review. In response to the NICE guidelines 50 (2007) an organisational

gap analysis revealed the lack of a competency based educational programme to support staff in the early recognition, monitoring, measurement, interpretation and management of acutely ill patients. The sequel document NICE (2008) was used as a template for the development of clinical competencies supported by a five day taught programme for both registered and unregistered staff and which negotiates a systematic journey of patient assessment and their proactive management using an ABCD approach. Senior staff from all practice areas were identified and prepared as competency assessors and the course commenced in January 2010. Initially it was only offered to registered nurses, but more recently senior unregistered staff are invited to attend. We await their evaluations with interest. 164 registered staff have completed the taught programme and are being supported in achieving their clinical competencies. Ongoing evaluation of the programme remains very positive and comments including; ‘Every nurse should attend’, ‘Found the whole course useful to support everyday practice’ and ‘The course has had a positive effect on how I care for acutely ill patients,’ support our belief that the programme is influencing direct patient care in a positive and proactive way and making a positive contribution to the patient safety agenda to reduce avoidable harm.

P11: Stand Tall, Don’t Fall: A Staff-

Driven Fall Elimination Response Team

Janis Smith-Love, Broward Health, Broward General Medical Center smithlovej@bellsouth.net

PURPOSE Falls are a growing public concern viewed as the healthcare provider's failure to maintain a safe environment. Falls have a significant impact on patient outcomes and healthcare costs and are considered "never events" that should never happen. A multimodal, staff-directed response team led the initiative on the Progressive Cardiac Care Unit with the purpose of eliminating falls and defining best practice.

DESCRIPTION The fall elimination response team reviewed retrospective and concurrent fall data (n= 74) from September, 2009 through June, 2011. Patient fall etiology, patient feedback leading to the event including contributing factors, staff knowledge of fall risk assessment, diagnoses and interventions based on current use of the Morse Fall Risk Assessment Scale (2009), and technology designed to assist with fall prevention were evaluated. Industry best practice recommendations from the United States Veterans Health Administration (2009) and the Agency for Healthcare Research and Quality (2010) were used as clinical practice guidelines.

OUTCOMES Data from the past 21 months revealed significant improvement in fall prevention clinical practice strategies from 50% to 95% compliance; falls per quarter dropped by 69%; and fall-related injury severity initially decline and was maintained at 0% (2nd and 3rd quarter fiscal year 2011). However, two falls with injury occurred during the 4th quarter of fiscal year 2011.

Poster Display Abstracts CONCLUSIONS

• Making nurses’ contribution to decisions about critically ill patients’ treatment modalities more explicit.

The Stand Tall, Don’t Fall response team increased the number of fall prevention and management experts, involved patients and families in the process, and utilized a multimodal approach to improve patient safety outcomes with fall elimination as the goal. Ten best practice interventions were adopted.

• Providing an in-depth exploration of the phenomenon of referral as an example of inter-professional collaboration.

Ongoing patient, family, and staff education is needed to address the impact of cardiac medications on fall risk and the patient’s over confidence with their physical abilities and attempts to maintain independence while hospitalized. Innovation, creativity, and best practice solution implementation are keys to a successful safety initiative. Improving patient safety and eliminating falls through an evidence-based approach is the first step to achieve world class healthcare.

P12: What are the factors related to critical care nurses’ decisions to refer to physicians when they want treatment modality changes for their patients?

Josef Trapani, Assistant Lecturer, University of Malta josef.tranpani@um.edu.mt

BACKGROUND AND AIM Previous research has suggested that nurses rarely take decisions on their own on any aspect of care, and constantly seek advice from their colleagues and other professionals. However, there is very limited research around the factors related to and the actual process of critical care nurses’ decisions to seek help from doctors when they want changes in their patients’ treatment modalities. This is precisely what this research study is seeking to explore in the context of an intensive therapy unit in a general state hospital in Malta.

METHODS Participants (ten Maltese and non-Maltese nurses working in a critical care unit in Malta) were purposively selected using emergent sampling. Data were collected between April and December, 2010 by means of participant observation, informal interviews and formal individual semi-structured interviews. The study is underpinned by a symbolic interactionist perspective and data analysis, guided by the principles of dimensional analysis, is currently underway.

RESULTS Preliminary data analysis suggests that critical care nurses’ decisions to seek help from doctors are complex and frequently mediated by factors which are unrelated to the actual clinical situations, such as experience, confidence, positive and negative re-enforcement from past experiences and also the nurse’s and the doctor’s nationality. There appears to be a balance between several, occasionally conflicting, motivators for nurses’ decisions to seek help from doctors, including acting in the patient’s best interest, protecting their own selves from anxiety and building professional identity.

DISCUSSION AND CONCLUSIONS The findings will be discussed in view of the following implications arising from the study:

• Highlighting nursing education implications in terms of the skills required by critical care nurses to contribute to decisions related to treatment modality changes.

P13: Patchwork Text Assessment: Changing the Assessment Strategy Enhances Learning

Sarla Gandhi, University of Central Lancashire sgandhi4@uclan.ac.uk Whilst not exactly new in higher education, patchwork text assessment strategy has been introduced into a number of critical care modules. This poster will highlight the benefits of such an assessment strategy as well as some hints and tips for colleagues who may wish to use this form of assessment. Traditional forms of theoretical academic assessment in critical care modules within higher education institutes (HEI) tend to focus around the essay or examination, and often students focus on passing the module and perhaps “play the system” (Winter, 2003) using surface learning rather than deep, meaningful learning (Biggs, 1999). Neurosciences is a diverse field of practice and when the student selected a neuroscience topic for their essay, the breadth of the student application of neurosurgical care and trauma management knowledge could not be demonstrated as students focussed their essay assignment on a narrow topic area. The assessment strategy was amended 24 months ago to patchwork text, in this way the module attempts to engage the students in demonstrating the application of the breadth of their theoretical knowledge to ensure clinical practice is examined critically. Patchwork text assessment enables students write small, complete “patches” of assessment, which in themselves are complete and focus of different aspects of the module. The “patches” are structured learning activities that are lecturer led, but the specific topics are student led to ensure the student centredness of the assessment strategy in order to enhance both patient care and personal learning/personal development planning (PDP). This allows individual students to personally engage in their learning (deep) by linking the specific module learning outcomes to the assessment process. The patches are then “stitched together” with a retrospective reflection of the student’s personal learning journey throughout the module. Student feedback has been more positive since the change in the assessment strategy.

P14: Mentoring Matters: Enabling a Cultural Change Caroline Ennis, Cardiac Surgical Intensive Care Unit, Royal Victoria Hospital, Belfast The Cardiac Surgical Intensive Care Unit and High Dependency Unit (CSICU) within the Belfast Health and Social Care Trust (BHSCT) is the largest cardiac surgery intensive care unit in the island of Ireland with a throughput of 1000 major cardiac cases yearly.

Poster Display Abstracts In 2005-2006 CSICU commenced a modernisation programme in order to increase bed capacity to maximise throughput of patients. In a planned expansion nursing levels were to increase by 20 WTE (whole time equivalent) by 2007-2008. At this time staff in CSICU were experiencing “mentor fatigue” and it was proving more challenging to encourage staff to be mentors for new staff in CSICU. We needed to invest time in supporting our mentors as well as mentees.

How was it implemented? We held facilitated workshops with mentors using ground rules and formatted questions for group work around their role as a mentor. As a result of feedback from the mentor workshops dual mentorship was introduced allowing the workload to be shared. We were very conscious that to sustain and develop this practice development work we needed a team approach to drive this forward. This led to the formation of a Core Lead Mentor group who support the mentors within CSICU. This group now have a shared vision and shared goals. They co-facilitate structured workshops for mentors and attend bi annual workshops which allow the core mentors to focus on the way forward for mentoring in CSICU. We have recently evaluated the changes which have been introduced using both a Qualitative and Quantitative approach.

What are the implications for practice? By investing time in supporting and listening to staff, CSICU now have a structured support programme in place for mentors. There is also an element of transferability as other clinical areas and health professionals have expressed an interest in this approach.

P15: Using ‘Smart Infusion Devices’

to Deliver Medication in ICU and Across the Hospital - Safe and Effective or Costly and Dangerous?

Kathy Dalley, St Georges Hospital, London, Nursing & Midwifery Council St Georges Hospital has undertaken the largest project in Europe in introducing infusion devices programmed with drug information across all clinical areas. This allows for restriction of unsafe practices such as fast infusions of potassium chloride or large boluses of insulin and prompting of users on issues such as medication concentrations. The project introduced a concept that every (non-emergency) intravenous drug should be given via a pump. No more timed boluses delivered by the nurse. The work in developing the necessary drug libraries (including every foreseeable I.V. medication) and safety mechanisms was enormous, but so was the potential prize of eliminating a large proportion of medication errors. This paper will explore the potential and experienced benefits of such an ambitious project and highlight some of the unanticipated problems that have arisen to date.

P16: What’s the Recipe for a Successful Regional Committee? Diane Eady, Caroline Wood, Elizabeth Ellis, Sue Snelson, Amanda Holmes, Tracy Moore, Maggie Smith, Yorkshire & Lincolnshire BACCN Regional Committee In 2006 the Yorkshire & Lincolnshire region of the BACCN was re-formed. We quickly acquired the ingredients for success and we set about offering our members a variety of study events to satisfy their varied palate. Our menus have ranged from Trauma to Ethics, Gut to Obstetrics, Delirium to Alcohol and far beyond the boundaries of critical care. We have peppered our audience with midwives, ODP’s, ambulance staff, A& E and general ward staff, AHPs. We have developed robust links with our suppliers so we are always sponsored by the companies we all deal with on a daily basis. This is a reciprocal arrangement whereby our sponsors financially support our events and in return they have access to a variety of staff from across our region and beyond, our last study day welcomed staff from Glasgow and London! We’ve built a reputation for wacky titles and eye catching posters, recognising that publicity is essential. Our forums include the lead nurse and network groups, the BACCN journal and website and of course Facebook (however did we all cope without it?). A central venue, with easy access and shopping afterwards is a winner and our innovative “buy three get one free” approach to realistic costing has proved effective. Like your favourite meal we adopt a thematic approach with a starter to set the scene, a main course that will deliver the tastes and a dessert to generate discussion and debate from all our guests. None of this is possible without effective teamwork, recognition and utilisation of each others strengths is key and our BACCN awards cabinet is testament to that success. Consequently as a region we regularly support some of our committee to attend conference.

P17: Organ Donation after Cardiac Death

Abigail Bryant, Derby Foundation Hospitals NHS Trust abigail.bryant@nhs.net The purpose of my poster was to introduce the idea of Organ Donation after cardiac Death. Although this is a new concept within the critical care environment, Non Heart Beating organ donation has been around since the 1950s, however was virtually abandoned with the introduction of brain stem death diagnosis (Edwards et al 1999). At present the difference between the number of organs available and the number of people requiring a transplant is becoming greater, potentially due to the static pool of organs available from Heart Beating Donation. In response to this the Organ Taskforce published ‘Organs for Transplant’ (DoH 2008) 14 government approved recommendations, which hope to increase donation by 50% over the next 5 years. Although Heart Beating Donation remains gold standard (Devey and Wigmore 2009) Non Heart Beating 73

Poster Display Abstracts Donation should be considered in as many cases as possible, with the hope of Non Hearting donation becoming ‘usual practice’. As this is a new element of care there is much debate over the process and the ethical implications associated with it. Equally with any aspect of patient care the patient’s wishes and needs should be fully considered. With this in mind it is essential that families are offered the opportunity and the choice for their loved one to become a donor.

P18: Weaning the Mechanically

Ventilated Patient

Karen Greatorex, Royal Derby Hospital NHS Foundation Trust karen.greatorex@derbyhospitals.nhs.uk Weaning covers the entire process of liberating a patient from mechanical ventilation and from an artificial airway. ‘Weaning accounts for 40% of the total time spent on mechanical ventilation’, Boles et al (2007). Delays in weaning may have significant adverse effects for patients such as ventilator acquired pneumonia resulting in increased length of stay in Intensive Care Unit. Examination of current local practice shows that although a nurse led weaning protocol exists it can be difficult for nurses to identify when the patient is ready to begin weaning. Additionally as identified by Crocker & Scholes (2009) patients ready to wean from the ventilator may be allocated inexperienced nurses as these patients are seen as being less sick/ dependent to care for, but inexperienced staff may not be confident to use protocols and also may not recognise when the patient is becoming fatigued. Also continuity of care can impact greatly on the weaning process, the concept of the nurse knowing the patient may have a significant impact on a successful outcome (Crocker & Scholes 2009). To improve weaning outcomes it is recommended that all staff receive training in using existing protocols. Current weaning protocols must be expanded to include information about when to start weaning and include information about how to predict the probability of success. Additionally junior nurses are to be facilitated to gain experience by working alongside their more experienced colleagues when carrying out the weaning process. Efforts must be made during staff allocation to ensure continuity of care to support the patients during this potentially difficult process.

Notes