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01623 445100 or e-mail: firstname.lastname@example.org
Fresenius Medical Care UK Ltd • Nunn Brook Road • Huthwaite • Sutton in Ashfield • Notts • NG17 2HU • England • Phone: +44 (0) 1623 445 100 • Fax: +44 (0) 1623 550 807 Head office: Else-Kröner-Straße 1 • 61352 Bad Homburg v.d.H. • Germany www.fmc-ag.com
WELCOME TO THE 4TH INTERNATIONAL BACCN CONFERENCE 2012 I'm delighted to welcome you all to the British Association of Critical Care Nurses 4th international conference in Brighton. Brighton's reputation as London by the sea, where tradition and contemporary fuse together, mirrors this year’s conference and social programme to form another exciting and innovative annual conference in BACCN's 27 year history. In such an exciting year for Great Britain where we have been celebrating, amongst other things, the Queen’s Diamond Jubilee, the 2012 Olympics and Paralympics, the World’s pooh stick championships and the upcoming World’s Porridge Making championship in the Scottish Highland village of Carrbridge, we are proud to host such an amazing programme for you in 2012.
Colette Laws-Chapman BACCN Conference Director
This year’s title Going Global: Around the world in 48 hours, Quality and Safety in Critical Care, inspired by our international drive to ensure high quality care, innovation and evidenced practice, has brought expert practitioners, educators and leaders in the critical care field together to celebrate and share their work from around the nation and the world. We have a varied, innovative and full conference for you this year with a plethora of international and British speakers with presentations in a range of formats from visual presentation with expert review (ViPER), poster walks, concurrent short papers, interactive workshops and simulation sessions and two dedicated symposia focusing on paediatrics on Monday afternoon, and research on Tuesday afternoon, all designed to develop your skills and knowledge in critical care. In this historic year for Great Britain, where it has been the wettest drought in British history, we have set our own record and that's to have a live simulation lab where delegates have the opportunity to sign up to participate in one of four simulation scenarios (see page 13 for more details). In a non-specific simulation facility, the teaching team and Laerdal Medical Ltd. have done us proud to establish this training facility- so do sign up for a session and visit the Old Courtroom, an historic venue on Church Street. Being a member of BACCN means you are also an associate member the European Federation of Critical Care Nurses (EfCCNa) and we are delighted to have hosted this year’s EfCCNa business meeting adjacent to conference and welcome members of the EfCCNa committee here today, some of whom are presenting for us as key note and invited speakers. We are very proud of our association and its sister association EfCCNa. If you are not a member, why not visit our stand to find out more about the Association and see what the benefits of joining are (you can speak to the BACCN team by visiting us at the stand in the foyer). We have an excellent trade exhibition for you this year, where our exhibitors and sponsors have produced an excellent display of the latest products and learning opportunities within critical care. Please take time to visit our colleagues from industry and complete your international passport competition as they are integral to the overall learning experience that conference provides. Our social programme commences on Sunday evening with a welcome fish and chip supper and drinks on Brighton Pier, and a Best of British street party on Monday evening in the Hilton Brighton Metropole, where we will have a drinks reception, a medley of British food, our annual awards ceremony and some amazing dancing opportunities with our band The Gifted. The dress code is party in Red, White and Blue..... On behalf of the National Board and the BACCN we welcome you to quintessential Brighton for what we hope will be the climax in our conference history so far, we also hope that you enjoy your experience and find lots to take back to your workplaces.
CONTENTS 2012 Welcome Contents Corporate Partner Acknowledgements Highlights
1 2 3 3 3
REFERENCE General Info Brighton
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 2013. BACCN are delighted to confirm our Corporate Partner as follows:
Conference Sponsors Instructions to Presenters Keynotes Pre-conference Masterclass Simulation Labs Healthcare Assistant and Assistant Practitioner Afternoon Programme Poster Walk Timetable
8 9 10 12 13 13 14 22
EXHIBITION Exhibitor List Floorplan Exhibitor Abstracts
26 24 28
ABSTRACTS Workshop Concurrent ViPER Poster
32 37 56 62
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.
CONFERENCE HIGHLIGHTS CHILL OUT ZONE 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 just outside the Founder’s Room on the mezzanine bar.
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: email@example.com
The BACCN would like to say thank you to: a
• Our international speakers for travelling such great distances to join us
• Evelina Children's Hospital simulation team and the adult simulation team from Guy's and St Thomas Trust
• The staff at Brighton Dome, Red Anywhere Catering and the Hilton Brighton Metropole
SIMULATION LABS Join us for adult and child simulation sessions throughout conference. For full details see page 13.
SYMPOSIA We are excited to bring you two symposia focused on Paediatrics (Monday) and Researh (Tuesday). For programme timings, see page 14.
• The BACCN National Board Members for their help, support and input from start to finish of this important annual event
• To all sponsors and exhibitors for their participation in the exhibiton and efforts to help make conference a success
WiFi LOUNGE There is free wifi available throughout the Brighton Dome. There are also dedicated laptops for you to catch up whilst 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 and www.twitter.com/BACCNUK
REFERENCE GENERAL INFORMATION Registration and Conference Information Desk
Exhibition, Posters, Chill Out & WiFi Lounge
The Conference registration desk will be in the entrance foyer of the Brighton Dome and will be staffed at all times. The registration desk will be open throughout the conference; however, the main registration times are 08.00-09.00 on Monday and 08.30-09.15 on Tuesday.
The Exhibition features over 40 companies and will be held in the Corn Exchange of the Brighton Dome. All catering will be served within the exhibition. The Poster Displays will be set out in the Foyer Bar, outside the Founderâ€™s Room breakout space. The WiFi Lounge and Chill Out are located in the Foyer Bar mezzanine, above the Foyer Bar.
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: tel: +44 (0)191 241 4523, fax: +44 (0)191 245 3802 or email: firstname.lastname@example.org which will be directed to the Conference registration desk. We will endeavour to get the message to you as soon as possible.
Security 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.
Conference Sessions The main conference room is on the ground floor of Brighton Dome, and is called the Concert Hall. 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 14 for room allocations and times of sessions. The Old Courtroom and Unitarian Church are 5 minutes from the main plenary room. Please follow signs or ask the onsite stewards for directions.
BACCN 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 regions span Great Britain and Northern Ireland, providing one of the largest and most influential professional organisations within critical care. If you are not already a member and would like to join BACCN, please visit the BACCN stand in the entrance foyer.
Toilet & Cloakroom Facilities There are male and female toilets just by the registration point, behind the bar in the main Dome Concert Hall Foyer. There is also a cloakroom to leave luggage and coats, however, if possible, we strongly recommend you leave your luggage at your hotel as space at the venue is strictly limited and we cannot guarantee we will be able to accommodate all luggage. We cannot be held responsible for loss or damage to anything you leave in the cloakroom. Please ensure items are clearly marked with your name.
Lunch & Refreshments 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.
Taxis Parking There is no car parking available at the venue. The nearest car park is the NCP on Church Street. Alternatively, there is a list of car parks available at registration and maps of Brighton for you to help yourself to.
If you require a taxi, the following companies offer 24-hour taxi services: Brighton Taxis: 01273 204060 Brighton and Hove Streamline: 01273 747 Brighton and Hove City Cabs: 01273 205 205
General Information The City of Brighton
BACCN 2012 Conference Office c/o Benchmark Communications 14 Blandford Square, Newcastle upon Tyne NE1 4HZ Tel: +44 (0)191 241 4523 Fax: +44 (0)191 245 3802 Email: email@example.com Website: www.baccnconference.org.uk
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 9th September 17:30 – 20:00 Brighton Pier, Brighton Join us on Brighton Pier at Horatio’s Bar to register for the conference, enjoy a discounted fish and chip supper courtesy of BACCN with your fellow delegates and National Board Members. Fish and chips will set you back just £4.95 and your voucher can be used at Palm Court Fish & Chips on the Pier until 7:00pm.
BACCN Best of British Street Party Monday 10th September, 19.30 – 00:00, The Hilton, Brighton We’re celebrating the Best of British at our conference dinner this year, with something a bit different! Join us at the Hilton Brighton Metropole, right on the seafront, for our street party – with PIMMS on arrival, a delicious British menu and a lively rock n roll band to dance the night away to, this a night not to be missed! The hotel is centrally located for those who wish to continue the party into the small hours. Dress code – red, white and blue!
The timings for the evening are as follows: 19.30 20.00 21.15 21.30 00.00
Welcome drinks Dinner is served Speeches and Regional Awards Live music provided by The Gifted Bar Closes
THE CITY OF BRIGHTON Brighton, one of Britain's liveliest cities, has a bohemian, artistic and eccentric atmosphere that can't be found anywhere else in the UK. Combining the modern with the traditional, Brighton has a heritage that is rooted in the Regency era and is brought up to date with a unique cultural offer. Visit the Royal Pavilion, seaside fantasy palace of King George IV, built by John Nash, which combines an Indian mogul exterior with an exotic Chinese interior. Or take a look at the lifestyle of Edwardian gentry at Preston Manor with its collections of furniture, paintings and porcelain upstairs, and the simpler surroundings of the servants' quarters below stairs. Stroll along the vibrant Beachfront with its Artists' and Fishing Quarters, trendy bars and clubs. Enjoy traditional seaside fun against the backdrop of Brighton's Regency architecture, the Brighton Pier and Sea Life Centre. Shop for antiques and designer goods in the 17th century Lanes, or browse for bargains in the bohemian North Laine. Check out the big-name stores in the brand new Churchill Square shopping complex or go discount shopping among the millionaire yachts at the Marina. Add to that great nightlife, a lively arts scene, plenty of places to stay, over 400 restaurants, a non-stop programme of special events, including England's largest international arts festival in May, and you have a unique holiday destination. Brighton is not only a stylish seaside city, but a great base for exploring the beautiful Sussex countryside. Historic houses, glorious gardens and picturesque little villages are all just a short drive away. Only 49 minutes by train from London and easily accessible from the M25 and M23 motorways, Brighton really is the perfect city break by the sea.
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Our Conference Sponsors & Instructions to Presenters
CONFERENCE SPONSOR SECTION OUR CONFERENCE SPONSORS CAE Healthcare - Masterclass Sponsor CAE Healthcare delivers leading-edge simulation training solutions to hospitals, physicians, nurses, students, emergency responders and the military worldwide. Visit the CAE Healthcare booth to learn about our advanced patient, imaging and surgical simulators, including iStan, CAE VIMEDIX and CAE CathLabVR. Ask about our evidence-based curriculum and LearningSpace center management solution.
Laerdal Medical - Simulation Lab Sponsor These are exciting times for healthcare education. As technology advances, so do the possibilities of realistic healthcare training through the use of patient simulation. Synonymous with simulation training since the launch of Resusci Anne in 1960, Laerdal Medical has been an integral part of its development in healthcare education. SimMan Essential – the company’s latest innovation is one of a more extensive portfolio of patient simulators that exemplifies the unique benefits of simulation in support of safer clinical practice.
Sidra Medical Research - Conference Handbook Sponsor Sidra is a groundbreaking medical, research and education institution in Doha, Qatar, focused on the health and wellbeing of women and children. Sidra’s clinical experts will work in partnership with leading international institutions, to deliver world-class patient care and cutting-edge research.
Pulse – Prize Sponsor (Region of the Year and Regional Committee Member of the Year) 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: North: 0845 601 7280 South: 01992 305 626 www.pulsejobs.com
Dräger Medical – Parallel Session Sponsor 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, Dräeger Medical employs over 150 people, of which two thirds are in the field supporting our customers every day.
Our Conference Sponsors & Instructions to Presenters
Fresenius Medical Care (UK) Ltd – Parallel Session Sponsor Fresenius Medical Care, Nunn Brook Road, Huthwaite, Sutton-in-Ashfield, Nottinghamshire, NG17 2HU. Tel: 01623 445100; Fax: 01623 550807; e-mail address: firstname.lastname@example.org; Web site address: www.fmc-ag.com Fresenius Medical Care is the world’s leading company in the field of dialysis, combining expertise in the development and production of technologically advanced products with comprehensive care for patients. We offer products and services to optimise the therapy outcome, inline with the specific needs of the individual patient and therapy approach. We are also market leaders in the provision of partnership dialysis unit programmes with nearly 60 clinics in the UK. Our programmes include: Haemodialysis/Haemodiafiltration; Continuous Renal Replacement therapy (CRRT); Pharmaceuticals (Nephropharm); Renal Clinics; Peritoneal dialysis; Home Haemodialysis; Water treatment; Dialysis software.
Thank you to: Wiley-Blackwell for donating prizes for the best presentation awards, and Linet UK for donating our international passport prize.
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 Brighton Dome 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.
Please make sure you come to the registration desk on the ground floor of Brighton Dome to let us know you have arrived. We will issue you with Velcro and direct you to the poster and ViPER display room – the Foyer Bar. 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 10th September. Remember to take your poster home with you. All posters must be removed by 17.30 on Tuesday 11th September.
Poster Displays Please make sure you come to the registration desk on the ground floor of Brighton Dome to let us know you have arrived. We will issue you with Velcro and direct you to your poster board in the Foyer Bar, just outside of the Founder’s Room. All posters are required to be in place by 10.30am on Monday 10th September. Remember to take your poster home with you. All posters must be removed by 17.30 on Tuesday 11th September.
We will ask all presenters for their consent to place a copy of their presentation or poster on the membership area of the BACCN website. Please notify the staff at the registration desk if you do not wish to give consent.
CONFERENCE Keynotes S01 Making Simulation Real: A Global Perspective! Professor Guillaume Alinier, University of Hertfordshire, Professor of Simulation in Healthcare Education
highlight simulation related developments throughout the world and encourage the audience to also try and make a difference for the benefit of patient safety and to achieve better patient outcomes. For example, in Qatar, at the Sidra Medical and Research Center simulation will be a core element of staff onboarding and orientation to the new hospital. It is also intending to become a regional hub of exemplary healthcare education practice and has started to collaborate with local hospitals and educational institutions to train simulation educators to a common level to ensure the delivery of standardised and sound simulation-based educational programme.
BIOGRAPHY Professor Guillaume Alinier started his career in clinical simulation as a Researcher in 2000 at the University of Hertfordshire, UK. He had a rapid academic career progression that saw him involved in a number of programmes across the University, ranging from Pharmacy to Electronic Engineering, in the areas of assessment, simulation education, and mentoring of fellow faculty. He was instrumental in designing and running a large multi-professional simulation centre at the University of Hertfordshire from where he recently received his Professorship in Simulation in Healthcare Education. He joined the Sidra Medical and Research Center (Doha, Qatar) in 2011 to help develop a state-of-the-art simulation training facility and educational program that will be used to on-board hospital staff. He has held national and international roles in the simulation community, notably with the Society in Europe for Simulation Applied to Medicine (Secretary and Conference Chair), the Association for Simulated Practice in Healthcare (Treasurer and Conference Chair), and the Society for Simulation in Healthcare (Conference co-chair). He has been involved in several research and consultancy projects, contributed to a number of journal publications and book chapters, and received two prestigious awards from the Higher Education Academy (UK) (National Teaching Fellowship in 2006 and Senior Fellowship in 2009).
ABSTRACT Simulation-based education is taking off at an unprecedented pace throughout the world as it is becoming recognised as a more credible and ethical way of providing advanced clinical education in the technical and non-technical areas of clinical practice. This trend is not only visible in developed countries, but also in the poorer regions of the world where education can literally mean life. It is becoming more and more apparent that the educational concepts around simulation surpass the technology we use, and that however basic or technologically advanced the tools we use are, the outcome is linked to the way the learning experience is presented to the learners. We are starting to realise that simulation is more about the technique than the medium. It is about recreating the elements which are critical to addressing the intended learning objectives so that learners can contextually put their knowledge and skills in practice and derive meaning from the experience during and after the experience through reflection. This presentation will
Children in the IUC: Is special attention needed for quality & safety? Jos Latour, Nurse Scientist, Erasmus MC – Sophia Children’s Hospital
BIOGRAPHY Jos Latour is a nurse scientist at the Erasmus University Medical Centre – Sophia Children’s Hospital in Rotterdam, Netherlands. He has been a PICU and NICU nurse since 1986. Jos received his PhD from the Medical Faculty of the Erasmus University Rotterdam. His PhD programme is called; EMPATHIC study (EMpowerment of PArents in THe Intensive Care). Currently this programme is implemented in several European countries. Other research lines focus on end-of-life care, family presence during resuscitation, and transition of adolescents from paediatrics to adult care. Jos Latour has over 50 publications in peer-reviewed journals. He is associate editor of the journal Pediatric Critical Care Medicine and editorial board member of several international journals. Jos is a teacher at the Care Academy of the Erasmus Medical Centre and at international nursing postgraduate courses. Internationally, Jos is the treasure the World Federation Pediatric Intensive Critical Care Societies and is actively involved in the European federation Critical Care Nursing associations (EfCCNa). Previously, he was the president of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Nursing. Jos has been honoured with several awards such as Fellowship of EfCCNa in 2008 and the Life Time Achievement Award of ESPNIC in 2009.
ABSTRACT Introduction: The cognitive and psychosocial development of a child is one of the considerations healthcare professionals need to be aware of when a child enters an Intensive Care Unit (ICU). Caring for children in an ICU needs special attention regardless the child is admitted or visiting a beloved family member.
Keynotes Aim: To review the literature on caring for a child admitted to, or visiting, an ICU and to provide recommendations for a child’s safe passage thought the ICU. Method: Literature search directed to children in the ICU. Results: A child is an individual developing at his own speed, mentally and physically, into adulthood. Each age has its own physiology, pathology, and psychology which determine how a child needs to be approached (Gobréau-Kuijpers and Latour, 2001). Critically ill children are able to report their memories. A study confirmed that 64 (63%) interviewed children reported factual memories and 33 (32%) reported delusional memories of their ICU admission. Extended duration of opiates was associated with delusional memory and post-traumatic stress was higher among children reporting delusional memories (Colville et al. 2008). Studies suggest that ICU nurses need education on competencies of listing and understanding children’s needs. A study interviewing nine family confirmed that children (<14 yrs) focus on the ICU environment while young people (14-25 yrs) experienced their visit on an abstract level, focusing on the function of the ICU (Kean, 2010). To address the children’s needs, a study day with personal learning objectives pertaining to paediatrics was developed and tested. Evaluation demonstrated an increase in knowledge and confidence amongst nurses to care for children in the adult ICU (Offord, 2010). Conclusion: Education is needed specifically directed to communicating with children in the ICU and the children’s response of an ICU admission or visit to reduce negative longterm effects. References: Colville G, et al: Children’s factual and delusional memories of intensive care. Am J Respir Crit Care Med 2008;177:976-982 Gobréau-Kuijpers C, Latour J: Unmet nursing needs of children in AICUs. CONNECT: World Crit Care Nurs 2001;1(3):99-101 Offord RJ: Caring for critically ill children within an adult environment – an educational strategy. Nurs Crit Care 2010;15(6):300-307 Kean S: Children and young people visiting an adult intensive care unit. J Adv Nurs 2010;66(4):868-877
Specialist for the Medical ICU’s at Henry Ford Hospital in Detroit Michigan. Currently her company, ADVANCING NURSING LLC, is focused on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. Ms. Vollman serves as Clinical Faculty for the CNS program at Michigan State University. In 2009, Kathleen was inducted into the American Academy of Nurses. In addition, she designed & developed the Vollman Prone Positioner. Ms. Vollman in 2012 was appointed to serve as an honorary ambassador to the World Federation of Critical Care Nurses.
ABSTRACT Evidence supports that errors and poor quality are often the result of faulty system or processes versus individual behavior and are impacted by the work culture. The multidisciplinary unit team is in an excellent position to lead, participate and design the necessary changes required in acute care setting to meet the patient safety, quality and economic agendas that are reshaping health care delivery. Nurses, as the largest group of professional within a unit environment, must accept responsibility for the work cultures we create. Organizational structure and unit culture will shape clinical practice and determines whether we will be successful at creating a culture of safety. How do we create a value change and develop an environment that fosters professional growth and enthusiasm towards change, reduction of error and quality improvement? This session will focus on front-line strategies developed and implemented to enhance nurses feeling of personal power, teamwork, communication and professional ownership in shaping a safe and quality focused culture. An extensive review of evidence-based tools and techniques used to successfully change and sustain improvements will be outlined. Measureable outcomes for reductions in health care acquired infections and other injuries will be directly linked with an improved culture.
SO4 Critical Care Research: Networks, Forum and Foundation – what’s it all about?
Changing Work Culture to Improve Quality and Patient Safety
Hannah Reay, Deputy Director of Research for Nurses and Allied Health Professionals, Intensive Care Foundation; Lead Research Nurse, BBC CLRN (Birmingham and the Black Country Comprehensive Local Research Network)
Kathleen Mary Vollman, Clinical Nurse Specialist, Advancing Nursing LLC, Miami
BIOGRAPHY Ms Vollman is a Critical Care Clinical Nurse Specialist, Educator and Consultant. She has published & lectured nationally and internationally on a variety of pulmonary, critical care, prevention of health care acquired injuries, work culture & professional nursing topics. She earned her nursing degree from Wayne State University in Detroit Michigan and her Master’s in Critical Care Nursing from California State University in Long Beach. From 1989 to 2003 she functioned in the role of Clinical Nurse
Hannah Reay is a Lead Research Nurse within the Birmingham and the Black Country Comprehensive Local Research Network (BBC CLRN) and the Intensive Care Foundation’s Deputy Director of Research for Nurses and Allied Health Professionals. She has more than fourteen years post registration experience caring for acutely ill patients within both critical care and other hospital settings. Over half of this period she has also been involved in clinical and academic research activities regionally, nationally and internationally. She coordinated the development of competencies for Critical Care Medicine across Europe (CoBaTrICE) and was involved in facilitating a national multicentre critical care trial (BALTI-2) before joining the BBC CLRN
Keynotes where she supports staff to deliver clinical research across multiple specialities. She has a passion for multidisciplinary critical care research collaborations and a commitment to the delivery of high quality research which is of relevance to patients, their families and those who care for them. Mrs H. Reay RN; MPhil; BNurs (Hons).
ABSTRACT The organisation and delivery of clinical research has undergone enormous change in the UK over the last five years. Clinical research is now regarded to be ‘core business’ of the NHS and critical care is no exception. This presents new opportunities for more nurses to be involved in critical care research which will be explored in this session. It will explain the important changes that have occurred, describe how these affect critical care research in the UK and what they mean for critical care nurses and their patients. It will review of some of the organisations involved in the development and delivery of studies and provide an overview of the NIHR critical care research portfolio. Opportunities for critical care nurses to contribute to studies along the patient pathway as well as develop novel research proposals will be identified. The session will also illustrate how, as critical care nurses, we have an exciting opportunity to take a lead in embedding clinical research in our everyday practice.
SO5 Nursing protocols: Straight Jacket or Safety Net? Panel: Professor Julie Scholes, Editor of Nursing & Critical Care; Annette Richardson, Nurse Consultant, Critical Care, Newcastle Hospitals; Dr Bronagh Blackwood, Lecturer in Nursing, Queen’s University, Belfast; Kathleen Vollman, Clinical Nurse Specialist, Advancing Nursing LLC, Miami
SYNOPSIS This plenary session is designed:
Delegates attending the final debate will be entered into a free prize draw for a place at the BACCN Conference 2013.
Pre-Conference Masterclass As part of our continued commitment to presenting delegates at the BACCN Conference with new and innovative learning experiences, we are excited to announce the inclusion of pre-conference masterclasses as part of the 4th International conference year. The masterclass, led by Professor Guillaume Alinier, Simulation Programme Manager for the Sidra Medical Research Center, Qatar and Clair Merriman, Principal Lecturer-Head of Professional Practice Skills, Oxford Brookes, and from the executive committee of the Association of Simulated Practice in Healthcare, is for individuals who would like to find out more about the latest evidence and recommended practices in simulation education and training. Our experts will provide delegates with an interactive opportunity to explore best practice in simulation education to help improve quality and safety in critical care. The masterclass will provide you with some amazing insights and tips for using and getting the most out of simulation, and as experts in their field, Professor Alinier and Mrs Merriman, will bring us the latest research from the world of simulation. This masterclass is supported by CAE Healthcare, and will take place on Sunday 9th September 2012 in the Pavilion Theatre, Brighton Dome between 1:30pm and 4:00pm.
To explore how protocols can impede or enhance our practice as care providers. The international panel will explore the key principles and approaches to using protocols in practice development. There will be opportunity for celebration of, and in-depth critical reflection on, the theoretical development and practical implications that working within protocols can present. There will also be a chance to put your questions to the panel or share your views with the audience. This session offers a formal yet fun way to actively explore the role of protocols and how they affect impact upon nursing and health care practice.
13:00 Arrive for registration, tea and coffee in the Pavilion Theatre
Who should attend?
13:30 Welcome from CAE Healthcare
This unique session is designed for all health professionals attending conference who are contributing to, leading and influencing and using protocols to guide their day to day practice. So do come along to this final session to hear about the current perspectives on working within protocol systems and remember you have to be in it to win it*
‘In it to Win it’
13:35 “Best Practice in Simulation Education”, Prof Guillaume Alinier and Clair Merriman 16:00 Session close
HEALTHCARE ASSISTANT AND ASSISTANT PRACTITIONER AFTERNOON Following the success of last year’s course, we are bringing back an afternoon dedicated to Healthcare Assistants and Assistant Practitioners. On the afternoon of Monday 10th September, HCAs and APs will have the opportunity to attend a half-day session dedicated to your role. 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 BEACH course gets underway in the Unitarian Church (across New Road from Brighton Dome) from 14:25.
Adult and Child Simulation Lab sessions, sponsored by Laerdal Medical Do you want an opportunity to participate in simulated practice to help improve you and your team’s patient safety and quality of care provision? Are you an adult practitioner who wants to know more about managing the critically ill child undergoing stabilisation and transfer, or do you want to gain hands on experience in managing severe deteriorating adult ICU patients? Then sign up to one or all four of our interactive simulated practice sessions! This is an ideal safe environment to explore these situations, build upon your existing knowledge and get hands on skills experience whilst under the supervision of our experts, who will debrief and discuss the scenarios with you at the end.
Child 1) Neurosurgical scenario: Designed for all delegates working in A&E or adult critical care who may be involved in the stabilisation and transfer of a child with a neurosurgical condition.
Child 2) Collapsed neonate scenario Suitable for all delegates working in A&E or adult critical care who may be involved in the assessment and stabilisation of a critically ill neonate awaiting the arrival of a dedicated paediatric transfer team.
Adult 1) Management of a newly admitted, acutely unwell patient scenario Designed for all delegates working in A&E or adult critical care who may be involved in the stabilisation of an acutely unwell ventilated adult with an unstable and deteriorating condition.
Please note this session is scheduled to end at 18:00.
Adult 2) Progressive physiological deterioration scenario Suitable for all delegates working in A&E or adult critical care who may be involved in the assessment and stabilisation of a critically ill adult. THINK THESE SESSIONS AREN'T FOR YOU because you’re not child trained or working in PICU? Or you have years of experience in your unit already? Remember - there are differences in the critically ill adult and child yet there are some commonalities. There are also contextual variances when working in a different situation or team, and so your skills will transfer to the situations our experts have devised and you may be at a transferring centre...
Please sign up for your preferred session at the registration desk. Please note places are strictly limited to 15 per session, and bookings are taken on a first come, first served basis.
MONDAY 10TH SEPTEMBER 2012 TIME
FOUNDER’S ROOM A Registration, Tea & Coffee
8:00 - 9:00 09:15 - 10:00
FOUNDER’S ROOM B
Welcome to BACCN 2012 Colette Laws-Chapman, BACCN Conference Director
Chair's Opening Remarks Juliet Anderson, Chair of BACCN
10:00 - 10:45
S01 KEYNOTE ADDRESS Professor Guillaume Alinier, University of Hertfordshire, Professor of Simulation in Healthcare Education, Making Simulation Real: A Global Perspective!
10:45 - 11:15
End of Life Care
C01: What factors influence nurses decisions to activate or not activate a RRS: An exploratory study; Debbie Massey, Griffith University, Australia
C04: Recognising Educational Quality (REQ) in the Critical Care Setting: practice educators and the university working in partnership; Helen Stanley, University of Brighton, UK
C07: Meeting the Challenges of Emergency Department Donation at the University Hospital of North Staffordshire; Katie Fox, NHS Blood And Transplant, UK
C02: Interventional Procedures: Best Practice to Avoid Complications; Marcia Bixby, Critical Care Clinical Nurse Specialist – Consultant, USA
C05: National Standards for Critical Care Nurse Education: The Next Competent Steps!; Andrea Baldwin, Lancs & S Cumbria Critical Care Network, UK
C08: Critical care outreach and end-of-life decisions; Natalie Pattison, Royal Marsden Hospital, UK
C03: Investigating Human Error and Patient Safety in Acute Care Nursing Using Platform Simulation; Sian Shaw, Anglia Ruskin University, UK
C06: Perceptions of nursing staff towards a Practice Development Research Partnership: 5 years on; Adam Keen, University of Chester, UK
C09: NICE 135 Organ donation for transplantation guideline: its implications for critical care nurses; Tim Collins, Maidstone & Tunbridge Wells NHS Trust, UK
12.15 - 3.30
Morning Tea & Coffee - Exhibition Area
Lunch – Exhibition Area 12.40-13:00 - Poster Walk 1 (P01 – P04) 13.00-13:20 - Poster Walk 2 (P05 – P08)
BAR AREA (Outside Founder’s Room)
Registration, Tea & Coffee
Morning Tea & Coffee - Exhibition Area Research & Innovation
C10: Dual Agency and Critical Care Nursing: Factors associated with Maltese critical care nurses' decisions to seek help from doctors; Josef Trapani, University Of Malta, Malta
Education - ViPERs
W01: Non Invasive Ventilation, Penny Andrews, Draeger Medical UK Ltd., USA
11:05 – 11:45 Paediatric Scenario 1
C11: A Dimensional Analysis of Decision-Making in Acute Care Nursing with Acutely Unwell Patients; Sally Smith, Maidstone & Tunbridge Wells NHS Trust, UK C12: Realistic Evaluation of EWS and ALERT: factors enabling and constraining implementation; Jennifer McGaughey, Queens University, Belfast, Northern Ireland
V01: Using Simulation to Assess Clinical Skills: Sharing Experiences of an Intensive Care Nursing OSCE; Heather Baid, University Of Brighton, UK
V02: Utilising Technology for Learning in Critical Care; Hayley Gilbrook, West Suffolk Hospital, UK
11:50 – 12:30 Paediatric Scenario 2
V03: Curriculum design and development of critical care module; Valerie Poole, Stockport Foundation NHS Trust, UK
Lunch – Exhibition Area 12.40-13:00 - Poster Walk 1 (P01 – P04) 13.00-13:20 - Poster Walk 2 (P05 – P08)
MONDAY 10TH SEPTEMBER 2012 TIME 13:30 – 14:15
FOUNDER’S ROOM A
FOUNDER’S ROOM B
S02 KEYNOTE ADDRESS Children in the ICU: Is special attention needed for quality & safety?; Jos Latour, Erasmus MC – Sophia Children’s Hospital, Netherlands Room Change Break
14:15 - 14:25
C13: Two years of Call 4 Concern (C4C): Patient and relative initiated Critical Care Outreach (CCO); Mandy Odell, Royal Berkshire Hospital, UK
C16: The Critically Ill Child in the Adult Setting; Getting it Right; Fiona Lynch, Evelina Children's Hospital, Guys & St Thomas' NHS Trust, UK
14.25 – 15.05
C14: Introducing SBAR to our Trust; Grace McMahan, East Kent Hospitals University Foundation Trust, UK
C17: Augmenting Learning: Utilising Simulation in Specialist PICU Modules; Matthew Norridge, King's College London, UK
W02: Mentoring in Nursing: How to Influence Quality Outcomes; Monica Simpson, Janis Smith-Love, Palm Beach Gardens Medical Center; Palm Beach Gardens, Florida, USA
15:05- 15.35 15:05
C15: Using The Model for Improvement in practice Scotland's experience!; Laura Harvey, Ayrshire and Arran Acute Hospitals, UK
W03: Intra-Abdominal Hypertension: What’s in YOR belly?; Marcia Bixby, Critical Care Clinical Nurse Specialist Consultant, USA
Afternoon Tea & Coffee - Exhibition Area 15:45 - 16:05 Poster Walk 3 (P09 - P12)
15:25 - 16:10 Education
Research and Innovation
C22: Introducing Delirium scoring; Liz Shaughnessy, Essex Cardiothoracic Centre, UK
W04: Using high fidelity simulation as a paediatric intensive care orientation tool; Kathryn Bland, Evelina Children's Hospital, Guys & St Thomas’ NHS Trust, UK
W05: Use of medical records as a data collection tool; Debbie Massey, Griffith University, Australia
C23: Proning: the Challenge for a District General Hospital; Gemma Millen, East Kent University Hospital NHS Trust, UK
C24: Incorporating Oral Care into a Ventilator Associated Bundle; Bridging the Gap; Phyllis Fearon, Southern Health & Social Care Trust Nothern Ireland
17:10-19:30 19:30 – 00:00
C18: An Approach to End of Life Care on one PICU, Kathleen Sert, Kingston University, London, UK
Close of day one – Delegates prepare for Conference Dinner at 19.00 Conference Dinner – 19:00 arrival; 19:30 start
BAR AREA (Outside Founder’s Room)
Room Change Break Research and Innovation C19: A desire to give back: the ICU patient's quest. Empowering ICU patient. Enabling innovation; Mark Wilson, Royal Berkshire Hospital, UK C20: Can Airway Pressure Release ventilation Prevent ARDS in Traumatic patients?; Penny Andrews, R Adams Cowley Shock Trauma Center, USA
Research and Innovation Simulation Lab 14:25 – 15:05 Adult Scenario 1
Assistant Practitioners and Healthcare Assistants – Bespoke Workshop Incorporating the BEACH Course
15:10 – 15:50 Adult Scenario 2
Catherine Plowright, Consultant Nurse Critical Care, Medway NHS Trust, Karen Hill, Acuity Practice Development Matron, Southampton University Hospital NHS Trust
C21: Withdrawn NB The BEACH course runs until 18:00
V04: Improving Oral Hygiene and Peristomal Care in ICU using Anchorfast; Shaun Maher, NHS Forth Valley, UK V05: Tales from a Trauma Centre: Traumatic Brain Injury (TBI); Joanna Hunter, King's College NHS Foundation Trust, UK V06: The use of Anchor Fast Endotracheal Tube Fastener in the safe and effective management of the proned patient; Linda Gregson, Royal Blackburn Hospital, UK
Afternoon Tea & Coffee - Exhibition Area 15:45 - 16:05 Poster Walk 3 (P09 - P12)
Assistant Practitioners and Healthcare Assistants – Bespoke Workshop
16:10 – 16:50 Adult Scenario 3
Incorporating the BEACH Course
Research and innovation C25: The Challenges of Moving to a new build hospital with an All Single Room ICU; Lindsey Reynolds, Maidstone And Tunbridge Wells NHS Trust, UK
Catherine Plowright, Consultant Nurse Critical Care, Medway NHS Trust, Karen Hill, Acuity Practice Development Matron, Southampton University Hospital NHS Trust
C26: Implementation of Citrate as Regional Anticoagulation in Continuous Renal Replacement Therapy (CRRT); Andrew Mizen, West Suffolk NHS Foundation Trust, UK C27: Early mobility in ICU patients: development and psychometric evaluation of an instrument to assess staff perception; Jayanthi Shamalee Patabendige, Dr Dimitri Beekman, Dr Maria Daruso, Kings College Hospital, UK
16:55 – 17:35 Adult Scenario
NB The BEACH course runs until 18:00
Patient Safety V07: Use of interventional lung assist (iLA) in the intensive care setting - are we following best practice guidelines?; Sophie James, Susannah Eyre-Book, Oxford Radcliffe Trust, UK V08: Organ and tissue donation: an evaluation of health care professionals’ knowledge and training and implications for education; Tim Collins, Maidstone Hospital, UK Research and Innovation V09: Nurse Perception on the Introduction of Citrate; Simone Hunter, West Suffolk Hospital, UK
Close of day one – Delegates prepare for Conference Dinner at 19.00 Conference Dinner – 19:00 arrival; 19:30 start
TUESDAY 11TH SEPTEMBER 2012 TIME
FOUNDER’S ROOM A
FOUNDER’S ROOM B
Registration, Tea & Coffee
8:30-9:15 9:15 - 9:30
Housekeeping Colette Laws-Chapman, BACCN Conference Director
9:30 - 10:15
S03 KEYNOTE ADDRESS Changing Work Culture to Improve Quality and Patient Safety; Kathy Vollman, Clinical Nurse Specialist, Educator, Consultant, Advancing Nursing LLC, Miami
Morning Tea & Coffee - Exhibition Area 10.25 - 10.45 Poster Walk 4 (P13 - P16) Research and Innovation
NB start time early
C28: Accelerated Experience Based Co Design: Using a National Archive of Patient Experience Narrative Interviews to Promote Rapid Patient Centred Service Improvement; Melanie Gager, Royal Berkshire Hospital, UK
C32: Factors Facilitating and Inhibiting Effective Clinical Decision Making in Nursing; Nicola Morton, University Of Hull, UK
10:30 – 11:10
C29: Watching myself in an unreal world: Patients' experiences of technology in adult intensive care; Louise Stayt, Oxford Brookes University, UK
C33: Leadership Development of Junior Sister Role to enhance patient safety; Anan Purushothaman, Anitha Nundlall, Kings College Hospital, UK
C30: Enhancing understanding during early critical illness recovery; the use of a ‘lay’ patient discharge summary; Suzanne Bench, Florence Nightingale School of Nursing And Midwifery, UK
C34: The "So What" Factors of an ICU Patient Support Network; Melanie Gager, Royal Berkshire Hospital, UK
C31: Recognising Patient Deterioration; Debbie Massey, Griffith University, Australia 11:45
12.05 - 13.15
W06: Can we teach recognition and response to acute deterioration in hospital patients using simulation?; George Hogg, Dundee University, UK
11:15 to 12.05 W07: A participatory reflexive workshop - learning from a patient's story; Lorraine Burgess, Liverpool John Moores University, UK
C35: Streamlining the workforce for a modern cardiac intensive care unit; Graham Brant, University Hospitals Bristol NHS Foundation Trust, UK
Lunch – Exhibition Area 12:30-12:50 - Poster Walk 6 (P24 – P27) 12:50-13:15 - Poster Walk 7 (P28 – P33)
BAR AREA (Outside Founder’s Room)
Registration, Tea & Coffee
Morning Tea & Coffee - Exhibition Area 10.25 - 10.45 Poster Walk 4 (P13 - P16) Education C36: Critical Care Education The Real Reality Show; Sean Morton, University Of Lincoln, UK
Simulation Lab 10:45 – 11:25 Paediatric Scenario 1
W08: Regional Citrate anticoagulation with Ci-Ca CVVHD: the new standard in CRRT; Dr T Slowinski Charite Hospital, Berlin (sponsored by Fresenius Medical Care)
Poster Walk 5 P17 – P23
C37: Care & Compassion in an Age of Financial Austerity; Pam Page, Anglia Ruskin University, UK
C38: Wikki's, Discussion Boards, Blogs and Vodcasts: Developing Learning Resources for an International. Distance Learning MSc in Critical Care Nursing; Sian Shaw, Anglia Ruskin University, UK
C39: Sharing Expertise across Europe; Adriano Friganovic, European Federation of Critical Care Nurses Associations, Croatia
11:30 – 12:10 Paediatric Scenario 2
Education C40: A collaborative development of a bespoke Band 4 Cardiac Assistant Practitioner Foundation Degree; Helen Cox, University of the West of England, UK
C41: Two Years On: The Assistant Practitioner Role Reviewed; Leisa Bingham, University Hospital Southampton Foundation Trust, UK 12.30 W09: Turning papers into publications workshop; Professor Julie Scholes & Dr John Albarran
TUESDAY 11TH SEPTEMBER 2012 TIME 13:15-13:45
FOUNDER’S ROOM A
FOUNDER’S ROOM B
S04 KEYNOTE ADDRESS Critical Care Research: Networks, Forum and Foundation – what’s it all about?; Hannah Reay, Deputy Director of Research for Nurses and Allied Health Professionals, Intensive Care Foundation
14:25 - 14:30
Room Change Break Education
Research and Innovation
C42: Using Story Dialogue Methodology to explore how nursing students construct knowledge and understanding about complexity of care through a critical care patient's story; Lorraine Burgess, Liverpool John Moores University, UK
Today's research, tomorrow's treatment: can nurses make a difference?; Dr Bronagh Blackwood, Queen’s University, Belfast, Northern Ireland, Dr John Albarran, University of the West of England, UK
C45: Back to basics: critical care in an extreme environment; Kay Mitchell, University College London, UK
C43: Critical care nursing skills utilised in global medical assistance; Fiona Pilkington, International SOS, UK
C44: Implantation Of The 'Nurse-Tutor' Figure For Training And Teaching Staff In An ICU, From A Spanish Hospital; Miryam Gonzalez Cebrian, Marques de Valdecilla University Hospital, Spain
C47: Therapeutic Hypothermia following cardiac arrest: A review of the evidence; Tim Collins, Maidstone & Tunbridge Wells NHS Trust, UK
Afternoon Tea & Coffee - Exhibition Area In it to win it Closing Debate: “Nursing Protocols: Straight Jacket or Safety Net?” Professor Julie Scholes, Editor of Nursing & Critical Care; Annette Richardson, Nurse Consultant, Newcastle Hospitals; Dr Bronagh Blackwood, Lecturer in Nursing, Queen’s University, Belfast; Kathleen Vollman, Clinical Nurse Specialist, Advancing Nursing LLC, Miami
C46: Delirium - a choice of two tools; Claire Pegg, Medway NHS Foundation Trust, UK
Closing Address & Awards Colette Laws-Chapman, BACCN Conference Director
BAR AREA (Outside Founder’s Room)
Room Change Break Patient Safety
W10: It’s All About You! How self-awareness and team dynamics positively impact performance; Jenny Sergeant, Jenny Sergeant & Associates, UK
V10: Leading and developing a Tool to Evidence the Effectiveness of a Critical Care Outreach Team; Joanna Wailing, Brighton and Sussex Hospitals, UK
Simulation Lab C48: Prevalence, management and clinical challenges associated with acute fecal incontinence (AFId) in the ICU and critical care settings: The FIRST (Fecal Incontinence Re-Evaluation Study) programme; Rachel Binks, Airedale NHS Foundation Trust, UK
14:30 – 15:10 Adult Scenario
Research and Innovation
C49: "An apple a day keeps the Doctor away"; Deborah Higgs, East Kent Hospitals University NHS Foundation Trust, UK
V11: Development and piloting of a Critical Care Follow-up Evaluation and scoring Tool (CCFU - TEST); Carolyn Barrett, Oxford University Hospitals, UK
C50: Developing a Critical Care SKIN Bundle - The North West Critical Care Networks Approach; Andrea Berry, Greater Manchester Critical Care Network, UK
Education V12: Non Invasive Ventilation; Laura Harvey, Ayrshire & Arran Acute Hospitals, UK
Afternoon Tea & Coffee - Exhibition Area
POSTER WALK TIMETABLE MONDAY 10TH SEPTEMBER 2012 Poster Walk 1; 12:40 – 13:00 (4 papers) P01
Retrospective study of 22 patients with de-compensated respiratory acidosis treated with non-invasive ventilation, Iain Wheatley, Phillippa Dibley, Taru Sairanen, Bagnos Cudiamat, Lani Santos, Bukola Olayanju, Emma Fryer, Stacey Starr, Frimley Park Hospital NHS Foundation Trust
Improving Global Health through Leadership Development - a UK Fellows Cambodian Experience, Ruth Butler, Royal Berkshire NHS Foundation Trust
Holistic Rehabilitation from Intensive Care: Lessons from America, Joanne McPeake, University of Glasgow
Development of a Business Case to Improve the Method of Securing Endo-Tracheal (ET) Tubes Within the Critical Care Unit at the Royal Blackburn Hospital, Linda Gregson, Royal Blackburn Hospital
Poster Walk 2; 13:00 – 13:20 (4 papers) P05
Introducing a collaborative approach to ward rounds on a busy critical care unit, Jessica Wadsworth, Critical Care, Kings College Hospital
Developing a Protocol for Nasal High Flow Therapy in Medical HDU, Laura Harvey, David McCrone, Ayrshire & Arran Acute Hospitals
Swallow Screening, Vanessa Harradon, Nichola Raval, Southampton University Foundation Trust
Research Secondment: A Trial or a Triumph, Abby Brown, The Royal Berkshire NHS Foundation Trust
Poster Walk 3; 15:45 – 16:05 (4 papers) P09
Early warning system calculation accuracy and action plan compliance, Pamela Munro, Barts Health NHS Trust, Angie Rock, Welch Allyn
Learning From Errors, Catherine Plowright, Vicky McLelland, Medway NHS Foundation Trust
To NEWS or not to Use, Linda Kent, Frances Clark, Linda Chu, Anne Carter, Kim Williamson, Dr Elaine Hipwell, Frimley Park Hospital NHS Foundation Trust
Benefits of a Bowel Management System in the Critical Care Unit - A case study, Ali Kelly, The Christie Hospital
TUESDAY 11th SEPTEMBER 2012 Poster Walk 4; 10:25 – 10:45 (4 papers)
Unplanned Transfers to HDU, Laura Harvey, Ayrshire & Arran Acute Hospitals
Experiential Learning...... Is it “Old Hat” or Good Practice?, Lorraine Bell, Debbie Wightman, BHSCT, Royal Group Hospital
Managing risk, responding with education, Daren Briscoe, Clare McGregor, BSUH NHS TRUST
Evolving ECMO therapy in Clinical Practice: a Response to Service Development in a Cardiothoracic ICU, Allan Seraj, Moya Piper, Bradley Pates, Nicola Mackay, Royal Brompton & Harefield NHS Foundation Trust
Poster Walk 5; 10:45 – 11:45 (7 papers) P17
The Effectiveness of a Multidisciplinary Recovery Pathway on the Physical Outcome for Critical Care Patients, Charlotte Burleigh, Brighton and Sussex Medical School, Sister Louise Skelt, Rebecca Rowlands, Worthing Hospital-Western Sussex Hospitals NHS trust
Improving Safety for Patients with Limited English Proficiency, Janis Smith-Love, Broward Health Medical Center; Fort Lauderdale, Florida
Acute Illness Management in Uganda; Our Experiences of Teaching and Learning in a Resource Depleted Environment, Samantha Cook, Greater Manchester Critical Care Network
New Registrants: Are they safe in Administration of Medicines In the Critical Care Setting?, Gillian Reid, Lorraine Bell, Laura Adair, BHSCT
Heads Up - Are Nurses Perceptions Decreasing Ventilator Care Bundle Head Elevation Compliance?, Suzy Hogg, Kings College Hospital NHS Foundation Trust Critical Care
Is a Progressive Care Unit the future in Thoracic surgery?, Gillian Reid, Lorraine Bell, Laura Adair, BHSCT
Development of Clinical Education for Junior Band Five Nurses, Lindsey Hockin, Guys and St Thomas' NHS Foundation Trust
Poster Walk 6; 12:30 – 12:50 (4 papers) P24
Leading the Way. A leadership Development Programme in Intensive Care, Nicola Wilson, Alison Stevens, Frimley Park Hospital; Major Cindy Lethbridge, Major Kerrie Pealin, Queen Alexander's Royal Army Nursing Corps
Supporting a Healthy Work Environment: Transforming frustrations into accomplishments, Janis Smith-Love, Yola Dorvil, Belinda Faustin, Broward Health Medical Center
Introducing a Tracheostomy Support Team; A trust wide initiative, Hannah Saunders, Sue Moorse, Tash Arnott, Aileen Parry, Portsmouth Hospitals NHS Trust
The Introduction of a Protocol to Manage Faecal Incontinence in Critical Care, Liz Ellis, Intensive Care Unit, Pinderfields Hospital, Mid Yorks NHS Trust
Poster Walk 7; 12:50 – 13:15 (6 papers) P28
Post Partum Haemorrhage in ICU- A Holistic Approach, Laura Watson, Jenny Davis, Intensive Care Unit, Royal Berkshire NHS Foundation Trust
Academic Health Science Centres and Critical Care: Opportunity or Threat?, Joanna Hunter, King's College Hospital NHS Foundation Trust; Alex Avens, Guys and St Thomas NHS Foundation Trust
Assessment and Management of Alcohol Related Admissions to Intensive Care: A National Survey, Joanne McPeake, University of Glasgow
Do the Patient No Harm!, Denise Smith, Rachel Midforth, West Suffolk Hospital
The role of subglottic suction in reducing ventilator associated pneumonia, Lucy Morgan, Hannah Little, Kings College Hospital
Exhibitor List & Floor Plan
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, 31 30. 32 33 34 36 37 38 39, 40 41 42 43 44
EXHIBITOR Central Medical Supplies Ltd Linet Fannin UK Ltd ETHICON BIOPATCH® Edwards Lifesciences Trudell Medical International Fukuda Denshi Co Ltd Fresenius Medical Care (UK) Ltd Kimberley-Clark Health Care Pulse Critical Care CAE Healthcare VACSAX Ltd Draeger Medical UK Ltd Fisher & Paykel Healthcare Health Match BC Laerdal Medical Ltd Secco FMS Anglia Ruskin University P3 Medical Ltd Thornbury Nursing Communicare (GB) Ltd Kapitex Healthcare Ltd Armstrong Medical Ltd Intersurgical Convatec Gambro Lundia AB Stryker UK Ltd B Braun Medical Ltd Hamilton Medical UK Henley Medical Supplies Solus Medical Ltd Charter Kontron Ltd CORPAK Medsystems Ferno Hollister Ltd Code Blue Nurses London Orion Pharma (UK) Ltd Distinctive Medical Intensive Care Society
1 2 3
11 Catering Table
Find your blank conference passport in your delegate pack, and visit each exhibitor and sponsor to collect an international flag from their representative.
All completed entries will be entered into a prize draw for a £50 Amazon voucher, sponsored by Linet UK!
Exhibitor List & Floor Plan
44 FIRE EXIT
Column 3x2m Display Stand
EXHIBITOR EDITORIALS Anglia Ruskin University
Anglia Ruskin University is the largest provider of health and social care courses across the East of England. We offer a range of nationally and internationally recognised courses and continuing professional development (CPD) modules, delivered in a variety of ways including face to face, blended learning and distance learning.
Armstrong Medical Ltd
Based in Northern Ireland, Armstrong Medical was established in 1984 to manufacture and sell respiratory disposable products for anaesthesia and critical care applications. Since then the company has grown considerably to become a worldwide leading manufacturer and supplier of high quality, innovative respiratory disposables for anaesthesia and critical care. Telephone: +44 (0)28 7035 6029; Fax: +44 (0)28 7035 6875; Email: email@example.com; Website: www.armstrongmedical.net. Contact Person: Julia Cathcart
BACCN Stand 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 most influential professional organisations within critical care. This year at the conference the first 15 new joining members will receive a free BACCN fob watch and critical care related books. We will also be holding a prize draw to win a Thornton’s hamper.
B Braun Medical Ltd
B. BRAUN Medical Ltd. offers a comprehensive portfolio of products and services that enable our customers to obtain all of their healthcare needs from one source. The Hospital Care Division provides intelligent solutions and innovative technologies within anesthesia, intensive care and emergency medicine to ensure the best patient treatment possible.
CAE Healthcare, 6300 Edgelake Drive, Sarasota, FL 34240. Tel: 0800 917 1851; Diane.firstname.lastname@example.org; www.caeheathcare.com CAE Healthcare delivers leading-edge simulation training solutions to hospitals, physicians, nurses, students, emergency responders and the military worldwide. Visit the CAE Healthcare booth to learn about our advanced patient, imaging and surgical simulators, including iStan, CAE VIMEDIX and CAE CathLabVR. Ask about our evidence-based curriculum and LearningSpace center management solution.
Central Medical Supplies Ltd
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.
Charter Kontron Ltd
Charter Kontron is a provider of a comprehensive range of innovative medical devices and solutions. These include Thermoregulation systems, Patient Monitoring, Clinical Information and Cardiology related products covering haemodynamic, electrophysiology and telemetry.
Code Blue Nurses London
Code Blue Nurses resources specialist nurses where their specialisation is recognised as an integral part of clinical practice. Our objective is to provide the Hospitals with the best staff available. Code Blue also ensure our nurses keep up their skills by offering free training through our close relationship with Code Blue Education.
Communicare (GB) Ltd
Communicare is a domiciliary care provider specialising in complex care for clients with neurological conditions, ventilator dependency, spinal cord injuries etc. We facilitate discharges from ITU to home with ventilatory support and provide quality services to enhance people’s lives and achieve the highest standards of care within a community setting. Contact Details: Jin Garcha, Associate Director. Tel No: 01536 268807; Mobile: 07734 926796; Email: email@example.com
At ConvaTec we are inspired not by what is, but by what can be. We believe that technological innovation is never static. It is driven by thinking that constantly shifts, adapts, and changes in the pursuit of newly defined needs. The refinement of our products and services is ongoing. We’re constantly reaching out, eliciting feedback from health care professionals and patients, to make what is good even better. It is all part of our passion to create breakthrough medical technologies that positively impact the work of health care professionals and the lives of their patients.
CORPAK MedSystems UK is a leading developer, manufacturer and marketer of innovative medical devices focused on the enteral feeding and bedside tube location technology. Under the Corflo and CORTRAK brand names these products have been distributed in the UK by Merck Serono. The Corflo product has established the leading market position in premium branded, nasogastric feeding tubes.
Distinctive Medical specialises in Medical Carts and Trolleys, supplying the UK’s best selling Resus and Paediatric Cart, backed up with a catalogue of over 6,000 products. For demonstrations and information on our vast product range visit stand 43 and see for yourself.
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.
Since the first successful heart valve replacement with the Starr-Edwards Silastic Ball Valve more than 50 years ago, Edwards Lifesciences has been dedicated to providing innovative solutions for people fighting advanced cardiovascular disease, the world’s leading cause of death and disability. Edwards is the global leader in the science of heart valves and hemodynamic monitoring. Driven by a passion to help patients, the company and its 7000 employees partner with clinicians to develop innovative technologies in the areas of structural heart disease and critical care monitoring that enable them to save and enhance lives.
ETHICON BIOPATCH®, a division of ETHICON Biosurgery, Johnson & Johnson Medical Ltd. is specifically dedicated to the prevention of Catheter Related Blood Stream Infections (CRBSI’s) associated with the use of all types of intra-venous catheter. It is designed to continually release Chlorhexidine Gluconate over a 7 day period to maintain skin antisepsis at the catheter insertion site.
Fannin was established in 1829 and today is part of the DCC group. We provide a cost-effective portfolio of highly innovative products for the Anaesthesia, IV Therapy and Critical Care markets. Please contact for more information on: tel: +44 (0) 800 212827; email: Enquiries@fannin.eu. And ask for: Giles Elliss - National Sales Manager – Anaesthesia; Anthony Roots - National Sales Manager - Crit Care IV
Ferno (UK) Limited has supplied to the health service for 40 years and 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 are committed to providing high performance, stateof-the-art products designed to ensure the best care and comfort for patients whilst ensuring your safety and well being. We specialise in patient transfer equipment and we are at the forefront of Critical Care Trolley design and development.
Fisher and Paykel Healthcare
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.
Fresenius Medical Care (UK) Ltd
Fresenius Medical Care, Nunn Brook Road, Huthwaite, Sutton-in-Ashfield, Nottinghamshire, NG17 2HU; Tel: 01623 445100; Fax: 01623 550807; e-mail address: firstname.lastname@example.org; web site address: www.fmc-ag.com Fresenius Medical Care is the world’s leading company in the field of dialysis, combining expertise in the development and production of technologically advanced products with comprehensive care for patients. We offer products and services to optimise the therapy outcome, inline with the specific needs of the individual patient and therapy approach. We are also market leaders in the provision of partnership dialysis unit programmes with nearly 60 clinics in the UK. Our programmes include: Haemodialysis/Haemodiafiltration; Continuous Renal Replacement therapy (CRRT); Pharmaceuticals (Nephropharm); Renal Clinics; Peritoneal dialysis; Home Haemodialysis; Water treatment; Dialysis software
EXHIBITOR ABSTRACTS Fukuda Denshi UK
Fukuda Denshi, at the forefront of Critical Care 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. For more information come and see the latest Fukuda Denshi range of patient monitors and the Metavision Clinical Information System on our stand, visit fukuda.co.uk or speak to one of the many satisfied customers.
Gambro Lundia AB
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.
Hamilton Medical UK
Hamilton Medical are global leaders in the supply of critical-care ventilators, with the largest, most sophisticated portfolio of any ICU provider. Manufactured in Switzerland and supported in the UK from our Birmingham HQ, Hamilton Medical has a proud history of providing systems of superior quality with a first class service”.
Health Match BC
Health Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada. Our nurse services team assists qualified critical care nurses in finding opportunities that suit their career and lifestyle interests. If you are a critical care nurse seeking employment in BC, visit us at stand 17!
Henleys Medical Supplies
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 33. Henleys Medical Supplies, Brownfields, Welwyn Garden City, AL7 1AN. Tel: 01707 333164; www.henleysmed.com; email@example.com
(Stand 39, 40)
Hollister Critical Care offers you a complete portfolio of products to manage most patients’ faecal management issues. ActiFlo and InstaFlo are both Indwelling Bowel Catheter systems. Faecal Collectors are designed to contain liquid stools. Anchor Fast Oral Endotracheal Tube Fastener is the secure and easy to use alternative to tape.
Intensive Care Society
The Intensive Care Society is the representative body in the UK for intensive care professionals and patients and is dedicated to the delivery of the highest quality of critical care to patients. We perform many functions for the intensive care community, such as the production of guidelines and standards, organising national meetings, training courses and focus groups. We represent Intensive Care in wide ranging organisations from the Royal Colleges to the Department of Health and other organisations and societies with an associated stake or interest. We are also represented on the Intercollegiate Board for Training in Intensive Care Medicine.
For over thirty 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. http://www.intersurgical.co.uk, contact: firstname.lastname@example.org
Kapitex Healthcare Ltd
Kapitex, specialists in Tracheostomy Care and Airway Management, offer a comprehensive product range: The Tracoe Experc Percutaneous Kit, with 3 alternative Tracheostomy tubes - the Tracoetwist, TracoeVario, and the new longer length Tracoetwist Plus; The Passy Muir Valve for ventilator use and an extensive range of Tracheostomy accessories. Tel: 01937 580211; Email: email@example.com
Kimberley-Clark Health Care
The Kimberly-Clark KimVent* range is designed to help prevent, diagnose and manage the key recognised risk areas linked to Ventilator Associated Pneumonia. Supporting our quality product range is the Kimberly-Clark Advantage*, a program of value-added services encompassing: in-service training, educational and best practice resources, knowledgeable customer support, clinical research and an expert sales force.
Laerdal Medical Ltd
These are exciting times for healthcare education. As technology advances, so do the possibilities of realistic healthcare training through the use of patient simulation. Synonymous with simulation training since the launch of Resusci Anne in 1960, Laerdal Medical has been an integral part of its development in healthcare education. SimMan Essential – the company’s latest innovation is one of a more extensive portfolio of patient simulators that exemplifies the unique benefits of simulation in support of safer clinical practice. Visit the Laerdal stand (No. 18) to find out more about their cutting edge simulation solutions.
(Stand 2 - 3)
LINET is Europe’s largest manufacturer and distributor of patient beds and pressure care equipment - Innovative brands such as Multicare, Latera and Eleganza beds. Pressure Ulcer treatment is provided by Virtuoso and Precioso including ‘Zero Pressure’. LINET UK provides: Sales & Rental, Service & Maintenance, Spare Parts, Cleaning & Decontamination
Orion Pharma (UK) Ltd
Orion is a Finnish born innovative European R&D based pharmaceuticals and diagnostics company with an emphasis on developing medicinal treatments and diagnostic tests for global markets. Orion develops, manufactures and markets human and veterinary pharmaceuticals and active pharmaceutical ingredients as well as diagnostic tests. Orion carries out extensive research with a goal of introducing additional new treatments into global markets. The core therapy areas in Orion’s product and research strategy are central nervous system, oncology, critical care and respiratory medicines.
P3 Medical Ltd
P³ Medical is a privately owned company specialising in high quality and cost effective medical devices for use by healthcare professionals in hospitals. We are proud to launch our new tracheostomy wound dressing that is a dedicated dressing to be used after the removal of a tracheostomy tube
PULSE Critical Care
(Stand 11, 12)
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: North: 0845 601 7280; South: 01992 305 626; www.pulsejobs.com
Secco FMS is a new bowel management system incorporating superabsorbent technology, which binds and immobilises infectious stool to help make a significant difference to the patient experience, clinical handling, odour control and infection control. It is also now available via the NHS Supply Chain catalogue - FWN091 - at over 30% less than the equivalent competitor products.
Solus Medical Ltd
Solus Medical sells, distributes and services medical products and equipment to hospitals throughout the UK. We offer a full range of high quality, innovative products across medical specialties including: Respiratory Care; Critical Care; Haematology; Neonatal. Solus Medical are committed to offering fantastic service from initial queries and product expertise to after sale support and training.
(Stand 29, 31)
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.
Established in 1983, Thornbury Nursing Services is one of the UK’s leading independent nursing agencies. We provide skilled healthcare workers across the UK to an ever expanding spectrum of clients requiring the best clinical staff on a temporary basis. We have a variety of work available with extremely competitive pay rates! For further information on how you can join our team contact us today: 0845 120 5252
Trudell Medical International
Trudell Medical International (TMI) manufactures the AeroChamber Plus range of Valved Holding Chambers (VHCs) for use with pressurised MDIs from all leading manufacturers, and the AeroEclipse II breath actuated nebuliser. AeroChamber Plus VHCs are available in infant mask (orange), child mask (yellow), large mask (blue) and mouthpiece variants.
VacSax are a British Manufacturer of disposable suction liners, which includes the Advance range and our latest product BactiClear™ which is the only Antibacterial suction liner system available in the market today. BactiClear™ provides round the clock protection against bacterial build up from harmful species such as MRSA, E.Coli and Legionella.
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1. Ibrahim EH, Tracy L, Hill C, et al. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest. 2001;120:555-561. 2. Craven DE, Steger KA . Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect. 1996;11:32-53. 3. Rello J, Ollendor f DA , et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122:2115-2121. 4. Warren D, Shukla S, Olson M, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Critical Care Medicine. 2003;31:1312-1317. 5. Fagon JY Y,, Chastre J, et al. Nosocomial Pneumonia in Ventilated Patients: A Cohor t Study Evaluating Attributable Mor tality and Hospital Stay. The American Journal of Medicine. 1993;94:281-288.
LINET House, 17 Murrills Estate, Por tchester, Hampshire, PO16 9RD www.linet.uk.com ttel: el: 023 9232 2130, ffax: ax: 023 9238 9540, e-mail: email@example.com, www .linet.uk.com
WORKSHOP Abstracts W01:
Non-Invasive Ventilation Sponsored by Dräger Penny Andrews, R Adams Cowley Shock Trauma, Baltimore, USA Non-invasive ventilation (NIV) is the application of positive pressure through an external interface such as a mask or nasal prongs. Because NIV does not use an invasive artificial airway, complications of intubation and invasive mechanical ventilation are decreased. The use of NIV may delay or avoid intubation, reduce the duration of intubation and allow for earlier extubation. In addition, NIV can be initiated, discontinued and re-initiated easily for the patient who requires intermittent support. The use of NIV as a strategy to avoid or reduce the time of intubation must be considered as the incidence of mechanical ventilation is predicted to increase, fueled by an aging population and increases in medical technology (1). This carries great implications as mechanical ventilation has been shown to worsen or even cause acute lung injury many times progressing to acute respiratory distress syndrome (ARDS). Further, ventilator associated pneumonia (VAP) is the leading cause of death among hospital acquired infections with mortality between 27% and 43%, increases ventilators days, length of ICU stay and overall length of hospital stay, thereby increasing costs (2). Arguably the most important component of NIV success is the patient – ventilator interface which must provide an appropriate seal to minimise leaks while being comfortable and causing minimal skin integrity issues. As the incidence of mechanical ventilation continues to increase, the use of NIV will play an important role in optimising resources and improving patient outcomes. Successful initiation and maintenance of NIV is in large part determined by clinician experience and communication between patient and medical team.
References: AACN Synergy Model for Patient Care (n.d.). American Association of Critical-Care Nurses. Retrieved from http://www.aacn.org/WD/Certifications/Docs/SynergyModelfor PatientCare.pdf Curley, MA (2007). Synergy: The Unique Relationship Between Nurses and Patients. Sigma Theta Tau International: Indianapolis, Indiana. Kerfoot, K. & Cox, M. (2005). The Synergy Model: The Ultimate Mentoring Model. Critical Care Nursing Clinics of North America, 17, 109-112.
W03: Intra-Abdominal Hypertension: What's in YOR Belly? Marcia Bixby, Critical Care Clinical Nurse Specialist, Nursing Education
Monica Simpson, Palm Beach Gardens Medical Center; Palm Beach Gardens, Florida, Janis Smith-Love, Broward Health Medical Center; Fort Lauderdale, Florida
Early identification and initiation of appropriate treatment strategies for patients with Intra Abdominal Hypertension ( IAH ) and Abdominal Compartment Syndrome ( ACS ) are crucial to preventing catastrophic complications and mortality. Abdominal compartment syndrome is a major complication of IAH. Initially thought to occur as a result of massive volume resuscitation in trauma patients, we now know it can occur in any critically ill patient, adult and paediatric. The World Society of Abdominal Compartment Syndrome (WSACS ) defines intra abdominal hypertension as an increased pressure in a closed anatomic space that threatens viability of surrounding tissue. The increased pressure in the abdomen occurs due to cellular ischemia that leads to capillary membrane permeability of the bowel. Bowel injury can occur directly due to a traumatic or surgical event, or indirectly due to hypotension from decreased cardiac output.
Starting a new job, particularly in a new specialty or an advanced role, is both challenging and exciting. In critical care units in the United States and abroad, new employees expect to receive a structured orientation guided by a preceptor. Often, assignment of the preceptor occurs because of their experience or educational level with limited
Unrecognized and unidentified IAH was found to be present in 32% of patients admitted to medical or surgical ICU's, and bladder pressure measurements of >12 mmHg was a predictor of mortality in a study done by Malbrain et al in 2005. Intra abdominal hypertension can have a mortality of 30-40% and abdominal compartment syndrome can have a
References: Schumaker G, Hill N. Utilization of critical care resources is increasing – are we ready? J intensive Care Med. 2006;21:191-193 Augustyn B. Ventilator associated pneumonia: risk factors and prevention. Critical Care Nurse 2007; 27(4):32 – 39
W02: Mentoring in Nursing: How to Influence Quality Outcomes
thought for the protégé’s needs. The concept of mentoring goes beyond the commonly understood responsibilities of a preceptor. A mentoring relationship is founded on trust and respect. Ideally, the mentoring relationship continues beyond the defined orientation period. Integral to a successful mentoring relationship is selecting the right personality fit through evaluation of personality types. Implementing a systematic approach to mentoring provides a defined model of learning and advancement in a reliable and structured way. Synergy created in the relationship avoids inadequate and unfulfilling outcomes. Mentors guide the development of the protégé with wisdom and trust, without the expectation of personal gain. Utilizing the Synergy Model for Patient Care framework, this session will highlight distinct characteristics of successful mentors. Responsibilities of the mentor and protégé will be presented, including how to maintain a successful mentoring relationship. Case studies of various mentoring situations will be discussed.
Workshop Abstracts mortality up to 100% depending on the number of organs that are compromised. Early identification and initiation of appropriate evidence based interventions can decrease length of stay, decrease ventilator days and decrease health care costs for these critically ill patients. This session will explore the concept of intra-abdominal hypertension and abdominal compartment syndrome incorporating evidence based practice from the 2007 Consensus definitions from the World Society of Abdominal Compartment Syndrome. Identifying patients at risk and initiating appropriate medical management strategies, outlined by the WSACS, will prevent complications and decrease mortality. Effective response to early interventions will also minimize the need for abdominal laparotomy and surgical decompression. The impact of IAH and ACS on the neuro, respiratory, cardiovascular and renal systems will be reviewed.
METHOD Simulation was incorporated into the final day of the six day course which focused on sepsis. Participants completed a pre and post course confidence scale self assessment of their perceived confidence and abilities, and a course evaluation which were scrutinised for themes.
RESULTS The course, and particularly the simulation day, was evaluated positively. Some increase was shown in participants’ perceived confidence and skill following high fidelity simulation. This was particularly the case regarding communication and awareness of the need to access help and assistance in demanding situations. However, the confidence scales and the post scenario debriefs highlighted weaknesses in clinical knowledge and the need for teaching on the pathophysiology of conditions and effect of interventions. Future recurrences of the course will incorporate high fidelity simulation as a method of clinical teaching as well as learning of human factors.
At the end of this session the learner will understand the patho-physiological mechanisms that lead to IAH and ACS. At the end of this session the learner will be familiar with the risk factors for patients to develop IAH. At the end of this session the learner will appreciate the impact of IAH and ACS on other organ function.
Data Collection Tool
Ms Debbie Massey, Professor Leanne Aitken, Professor Wendy Chaboyer, Griffith University
• • • •
The chart review as a data collection method: Why when and how.
Pathophysiology of cellular dysfunction Capillary membrane permeability Fluid shifting intravascular to interstitial tissue Impact on cellular function
References: DeWaele, J. (2011) Intra Abdominal Hypertension and Abdominal Compartment Syndrome. Am.J.Kidney Disease Wolfe T. (2011) AACN Intra-abdominal Hypertension: Detecting and Managing a Lethal Complication of Critical Illness World Society of Abdominal Compartment Syndrome (WSACS) 2010 AACN (2010 ) Policy and Practice Guidelines
W04: Using High Fidelity Simulation as a Paediatric Intensive Care Orientation Tool Kathryn Bland, Evelina Children’s Hospital, Guy’s and St. Thomas' NHS Foundation Trust. INTRODUCTION
W05: Use of Medical Records as a
The chart review is the most commonly used data collection method in assessment of the quality of medical care. This method of data collection is also frequently used when researchers are interested in examining the incidence, prevalence, clinical course, and prognosis of specific conditions. As a data collection tool chart reviews have significant advantages. The clinical data contained within a medical chart offers the researcher access to rich data. Charts can be relatively easily accessed and this often involves minimal cost. Despite the advantages offered by chart reviews there are a number of limitations associated with this data collection method. The quality of the data collected is dependent on the completeness and accuracy of the data documented in the chart and the reviewer's accuracy, impartiality and consistency in extracting the relevant data. Although frequently used as a method of data collection, there are minimal evidence based conceptual frameworks or guidelines available. This presentation will explore the rationale for conducting chart reviews, it will outline the processes researchers will need to consider and plan for prior to conducting a chart review. Finally it will offer some advice and strategies that may be useful in overcoming some of the limitations involved in chart reviews.
Staff new to the Paediatric Intensive Care Unit (PICU) are required to participate in an orientation programme designed to equip them with the skills and knowledge to competently care for a Level two patient without direct supervision. High fidelity simulation was introduced to the PICU’s orientation programme to facilitate assessment of clinical skills as well as learning opportunities for both human factors and clinical knowledge through submersion in a “safe” environment.
W06: Can We Teach Recognition and Response to Acute Deterioration in Hospital Patients Using Simulation? Mr George Hogg, Mr Paul Christie, Mrs Gillian Keith, University of Dundee Serious adverse events such as unexpected death, cardiac arrest and unplanned admission to Intensive Care are frequently preceded by changes in physiological observations (Buist et al, 2004; Hillman et al, 2001). One 1998 study (McQuillan et al) found that between 30% and 84% of patients who suffer a cardiac arrest show signs of deterioration in the 24 hours before the arrest. This suggests that many hospital deaths are potentially predictable and preventable (Smith and Wood, 1998). The Department of Health estimates that 1 in 10 patients admitted to the NHS will be unintentionally harmed and that around 50% of these patient safety incidents are avoidable, if lessons from previous incidents had been learned. Evidence of suboptimal care of emergency medical admissions (McQuillan et al, 1998; Seward et al, 2003). Evidence of marked physiological deterioration prior to unexpected cardiac arrests (Hodgetts et al, 2002; Nurmi et al, 2005).
RADAR© RADAR is a new initiative based on work for the Professional Doctorate in Education which aims to teach students’ to assess and manage the deteriorating adult patient. By including simulated patients in role rather than manikins the fidelity (realism) of situations is enhanced. Realism is further enhanced through the judicious use of moulage (make-up) to give patients the look of being unwell e.g. cyanosis, sweating, pallor etc. This workshop is designed to introduce participants to the use of moulage to enhance the fidelity of the learning experience for healthcare students. Participants will design and develop a teaching scenario incorporating social and psychological fidelity using a simulated patient script and basic moulage techniques.
LEARNING OUTCOMES At the end of the workshop participants will: 1 2 3 4
Define social, psychological and engineering fidelity Understand how the use of moulage combined with context enhances the fidelity of a teaching situation Demonstrate the application of basic moulage Develop a simple teaching scenario using patient scripts and basic moulage.
At the end of the workshop, groups will rehearse each other’s scenarios and get feedback and a prize for best interpretation of moulage. Participants will see how the combination of real patient and moulage enhance the students’ contextual learning of this vital aspect of patient care.
W07: A Participatory Reflexive Workshop - Learning From a Patient's Story Lorraine Burgess, Julie-Ann Hayes, Liverpool John Moores University In 2008 Cheshire and Mersey Critical Care Network commissioned the development of a DVD to record the unique story of an Intensive Care Unit (ICU) patient. The story was captured using a one-to-one interview between the patient and a psychotherapist together with a panel discussion with the professionals who played a part in the real life story. The story is told in four distinct chapters that cover the patient's memories of being: 1. critically ill during his three months in the ICU; 2. his transfer to the hospital ward; 3. his rehabilitation and, recovery; and eventually 4. his discharge home and coming to terms with the personal impact that being critically ill has had on him and his family. The delegates will watch a chapter of the story “30 minutes”; while watching the film they will be asked to note down any reflections that they have. Following the film the delegates will be facilitated through a reflective dialogue as they develop insights from the story. Insights generated may be as a result of the delegates questioning taken for granted truths about their personal and professional values as well as their practice. Delegates will be able to have first-hand experience of how practitioners (from all levels) are able to learn from the experiences of a patient, with the potential to change or question their values and practice.
W08: Regional Citrate Anticoagulation with Ci-Ca CVVHD: the New Standard in CRRT. Sponsored by Fresenius Medical Care Torsten Slowinski, Department of Nephrology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Humboldt University Berlin, Germany Acute kidney injury is a common complication among critically ill patients in the intensive care unit (ICU) and approximately 5% of such patients require renal replacement therapy. Although there is no agreement on the best therapy mode for RRT in critically ill patients, continuous renal replacement therapy frequently is preferred to intermittent dialysis because of better hemodynamic stability and metabolic control. A major drawback of CRRT is the need for continuous anticoagulation. Regional citrate anticoagulation during CRRT is a common alternative to systemic heparin anticoagulation. Citrate acts by chelating the ionized calcium in the extracorporeal circuit, thus blocking the coagulation cascade. A large amount of calciumcitrate complexes is removed in the extracorporeal circuit from the blood via the dialyzer. To compensate the removal of calcium from the blood, in most protocols an appropriate calcium substitution for the patient, e.g. via the venous line of the extracorporeal circuit is needed. Infused citrate is rapidly metabolized via the citric acid cycle liberating chelated calcium from calcium-citrate complexes. In combination with appropriate calcium substitution this protects patients from
Workshop Abstracts hypocalcemia. Moreover, the metabolism of citrate is necessary to avoid relevant systemic accumulation of citrate and calciumcitrate complexes. Liver dysfunction was shown to be no contraindication for regional citrate anticoagulation. Recent meta-analyses of prospective randomized clinical trials have documented the superiority of regional citrate anticoagulation over systemic anticoagulation in terms of bleeding incidence, filter life-time and a non-inferiority of regional citrate anticoagulation versus systemic anticoagulation in terms of metabolic control, regarding the incidence of metabolic alkalosis. However, in spite of the above advantages, citrate anticoagulation is not yet the standard anticoagulation mode for CRRT in most ICUs. Unwillingness to switch to regional citrate anticoagulation is often explained by concerns about the safety and possible metabolic complications of regional anticoagulation in different types of protocols for regional anticoagulation in CRRT. We presented a weight-adapted protocol for Ci-Ca regional anticoagulation in CVVHD that is easy-to-handle and with clear recommendations in the case of metabolic disarrangements providing excellent acid-base homeostasis.
W09: Turning Papers into Publications Workshop Professor Julie Scholes, Editor of Nursing & Critical Care, Dr John Albarran, Associate Head of Department for Research and Knowledge Exchange (Nursing & Midwifery), University of the West of England 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.
W10: It’s All About You! How SelfAwareness and Team Dynamics Positively Impact Performance
Jenny Sergeant, Lead Consultant, Jenny Sergeant & Associates This lively interactive taster session will leave you feeling refreshed, inspired and positive. The focus is you! What makes you tick, what causes you stress and how you can connect more effectively with others. The outcome - being stronger and more self-aware; having an appreciation of others in your team and of your collective impact on health and safety and patient care. How often do you spend time on yourself, really getting to understand what makes you tick? How much time do you spend getting to know and understand those who you work with? How often do the ‘little’ differences in the way we communicate and behave create real barriers to working effectively as a team? The sessions provides an interactive and fun way for you to develop an understanding of yourself, your personal style and your impact on others. You will: • • •
OUTCOMES By the end of the experience you will be able to: • • • • •
The workshop is to be facilitated by experienced authors, reviewers and editors of books and nursing journals.
Explore not only WHAT makes you tick but what makes others tick too. Get to grips with what stresses or frustrates you and others Understand HOW you can improve your communication not only to be heard but also to understand colleagues and break down the barriers in relationships, moving your team to the next level.
Describe your values, talents and strengths Understand the impact you have on others Identify your personal stress triggers and the impact they have on your behaviour Develop an appreciation of the needs and strengths of others and how to relate more effectively with them Gain insights into your team dynamics and the requirements of different individuals.
Happel B (2008). Writing for Publication: a practical guide. Nursing Standard. 22 (28): 35-40. Richardson, A & Carrick-Sen, D (2011). Writing for Publication made easy for nurses: an evaluation. British Journal of Nursing. 20 (12): 756-759. 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.
CONCURRENT Abstracts C01:
What factors influence nurses decisions to activate or not activate a RRS: An exploratory study Ms Debbie Massey, Professor Leanne Aitken,Professor Wendy Chaboyer, Griffith University Rapid Response Systems (RRS) provide a hospital wide system response for patients who suddenly deteriorate in the hospital ward. Recent research suggests that nurses are not activating RRS in an appropriate or timely manner but there is limited understanding about why this occurs. The aim of this study was to identify factors that influenced nurses utlisation of RRS. After consenting, 15 female Registered Nurses who cared for patients during the 12 hours prior to an unplanned admission to ICU were interviewed using a semi-structured interview guide. Interview questions focused on barriers to using the RRS and strategies that could be developed to improve RRS activation. Interviews were conducted within 48 hours of the patients' admission to ICU and were audiotaped, transcribed, and thematically analysed. The study was approved by the human ethics committee at the hospital and the university. Five themes emerged from the analysis; these themes are: sensing deterioration, resisting and hesitating, pushing the button and reflecting on the MET. Participants' identified reluctance to activate the RRS because they thought they would be reprimanded for wasting resources. Lack of confidence in recognising a deteriorating patient also hindered RRS activation. The results of this study should inform the development of strategies to assist nurses in the early recognition and appropriate response to the deteriorating ward patient. For example, participants identified that use of ward-based simulation activities helped to improve their confidence in recognising and managing a deteriorating patient.
C02: Interventional Procedures: Best Practice to Avoid Complications Marcia Bixby, Critical Care Clinical Nurse Specialist, Nursing Education Diagnostic and Interventional Procedures are done by many disciplines including cardiologists, interventional neurosurgeons, interventional vascular surgeons and interventional radiologists. It is difficult to get a true number of how many procedures are done yearly, but there are known complications that can occur during these procedures. The three major complications include Contrast Induced Nephropathy (CIN), Radiation Injury and Damage to arterial and venous access sites. Knowledge of strategies that are evidence based to assess patients prior to procedures and manage patients after procedures will minimize complications regardless of who performs the procedures.
Contrast Induced Nephropathy (CIN) occurs in 3% of patients undergoing procedures that require injections of contrast medium. CIN is the 3rd leading cause of Acute Kidney Injury in hospitalized patients and is responsible for 11% of hospital acquired renal failure. CIN can occur in 20%-30% of patients with pre existing renal disease, diabetes or cardiac dysfunction. Radiation Injury occurs as a result of exposure to radiation during procedures. All procedures require access via a venous or arterial puncture. Managing vascular access sites during and post procedures are crucial to identify patients who may develop bleeding or hematoma at the site, or disruption to the vascular system distal to the puncture site. Strategies to prevent or minimize all of these complications will be included in this presentation. Treatment strategies to prevent or minimize CIN from occurring include pre hydration, type and volume of contrast medium used, and administration of medications that are renal protective. Measures to minimize radiation exposure during procedures and assessing skin post procedure, as well as caring for patients with vascular access devices or vascular occlusive devices will be included.
OBJECTIVES • • •
At the completion of this program the learner will be able to identify patients at risk for CIN At the completion of this program the learner will understand the pathophysiology of CIN At the completion: Be aware of assessment techniques to utilize when caring for patients after vascular access or closure devices.
CONTENT OUTLINE • • • • • • • • • • • • • • • •
Risk factors for CIN Inflammation - ischemia Pre existing renal insufficiency Release of mediators Diabetes Vasoconstriction Cardiac Disease Renal ischemia Hypotension Acute tubular necrosis Renal toxic drugs Assessing perfusion distal to access sites Contrast medium affect on renal endothelium Vascular access technique Vasodilatatin Types of sheath
References: Brendan, J. (2006) Preventing nepropathy induced by contrast medium. NEJM January Katzberg, R. (2010) Contrast- induced nephropathy in 2010. Applied Radiology. 39 (09) Rudnick, M. (2006) Contrast-induced nephropathy: How it develops, how to prevent it. Cleveland Clinic Journal of Medicine 73(1)
C03: Investigating Human Error and Patient Safety in Acute Care Nursing Using Platform Simulation Sian Shaw, Anglia Ruskin University BACKGROUND & PURPOSE Error is endemic within the National Health Service. As well as the human suffering, the total cost to the NHS of litigation for adverse patient incidents was 787 million in 2010 -2011; there where 6,655 claims of clinical negligence and 4,346 claims of non-clinical negligence (NHS Litigation Authority 2012). Platform simulation has been used extensively within aviation to study error and more recently has been adopted in anaesthetic training. The aim of this study was to investigate how human factors contribute to patient safety in acute care nursing.
METHOD / DESIGN A scenario of a deteriorating patient was replicated using two identical platform simulations, these were video-recorded. Semi-structured interviews were conducted with individual participant nurses. These interviews were transcribed verbatim and the videos analysed. A descriptive qualitative approach was used for data analysis.
FINDINGS This presentation focuses on four selected active errors demonstrated. The nurses lacked confidence in challenging medical personal, had limited situational awareness, demonstrated behaviourist decision making and had difficulty in identifying key physiological cues signifying patient deterioration. Relevance to clinical practice: Acute care nurses need to develop skill in situation awareness, rapid identification of key deterioration cues, & confidence in vocalising concerns to other health care professionals. References: NHS Litigation Authority (2011). Home page: Key facts about our work.NHSLA, http://www.nhsla.com/home.htm Accessed 20 April 2012
C04: Recognising Educational Quality (REQ) in the Critical Care Setting- Sussex Critical Care Network: Practice Educators and the University of Brighton working in partnership Mrs Helen Stanley, School of Nursing and Midwifery, University of Brighton; Mrs Sylvia Hedges, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust; Mrs Louise Skelt, Worthing Hospital, Western Hospitals NHS Trust; Mr Roy Johnson, Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust; Mrs Cathy McGuinness, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust This presentation is to share the experience of awarding a REQ mark to acknowledge the quality of critical care educational programmes developed by Practice Educators in the Sussex Critical Care Network.
The School of Nursing Midwifery, University of Brighton, developed a REQ mark system which is awarded to an organisation that fulfils predetermined educational standards on the quality of a work-based clinical programme. In addition, staff can claim academic credit through Recognition of Work-related Learning (RAWL) modules. The Practice Educators from the Sussex Critical Care Network submitted three programmes for the REQ mark award: 1 2 3
Introduction to Critical Care Nursing, Health Care Assistants (HCA) Introductory Programme Leadership Development Nursing Programme specific to Critical Care
The Practice Educators led the initiative and further developed their curriculum design, pedagogical skills and experience. This process has enabled the programmes to gain greater educational credibility and offered income generating potential. The University recognised these learning initiatives as fitting the national agenda for work-based learning to gain academic credit (DoH 2012) and for robust work-based educational experiences for critical care staff (Critical Care Nation Nurse Leads Group 2012) that compliment rather than compete with the current level 6 Critical Care Pathway university provision. References: Department of Health. 2012 .Liberating the NHS Developing the Healthcare workforce - From Design to Delivery [http://www.dh.gov.uk/en/Publicationsandstatistics/Publication s/PublicationsPolicyAndGuidance/DH_132076 accessed 16.5.12] Critical Care Networks National Nurse Leads Group. 2012. National Standards for Critical Care Nurse Education - A framework to improve educational outcomes & quality of care. [http://www.baccn.org.uk/news/12.01.23.National%20Standar ds%20for%20Critical%20Care%20Nurse%20Education%2020 11.pdf?Archive=0 accessed 16.5.12]
C05: National Standards for Critical Care Nurse Education: The Next Competent Steps! Mrs Andrea Baldwin, Critical Care National Network Nurses (CC3N), Lancs & S Cumbria Critical Care Network, Mrs Andrea Berry, Critical Care National Network Nurses (CC3N), Greater Manchester Critical Care Network, Mrs Melanie Kynaston, Critical Care National Network Nurses (CC3N), Cheshire & Mersey Critical Care Network Critical Care National Network Nurses (CC3N) have worked collaboratively with related critical care organisations and academia and in 2011, published the document “National Standards for Critical Care Nurse Education”. The aim of these “Standards” is to encourage healthcare provider organisations to liaise with their academic providers in developing educational programmes that ensures effective use of educational resources, and ultimately develop an adult critical care nursing workforce that meets the requirements of the service and the patients it cares for in today’s ever challenging NHS setting. 37
Concurrent Abstracts Application of these “Standards” can work towards eliminating the problems associated with variability between critical care courses, inconsistent outcomes and growing difficulties in workforce transferability, identified across organisational boundaries.
been vital to the success of the ED donation programme at UHNS and has meant that many families have been offered the option of organ donation. However running an organ donation programme on goodwill alone is not a sustainable long-term solution.
The “Next Competent Steps” to make these Standards a reality is to create a national set of critical care competencies that can be used by all to support learning in practice. By using a nationally agreed set of critical care competencies, developed by “experts”, we can develop and assess staff consistently to a safe proficient level. There are undoubtedly challenges not only associated with their development, but more so with encouraging their adoption in practice; However the net benefit can be realised by all working in the critical care community.
AIMS AND METHOD
C06: Perceptions of Nursing Staff
Towards a Practice Development Research Partnership: 5 Years On
Having an experienced ICU nurse purely for organ donation has been crucial and has markedly reduced the impact of ED donation on Theatre Recovery and Critical Care. Without the Pathway donation would have been difficult if not impossible to carry out.
Mr Adam Keen, Dr Annette McIntosh, University of Chester; Mrs Heather Cooper, East Cheshire NHS Trust This project sought to answer the question: what are the perceptions of nurses working within a Critical Care Unit towards a Practice Development Research Partnership (PDRP) five years on? The interpretivist study utilised a survey design. Data were collected using a questionnaire and a mixture of focus groups and one to one interviews. The questionnaire utilised sets of Likert styled questions to provide nominal and scale based data. Findings indicated that the PDRP was perceived as having a positive impact on personal professional development, however its more general impact was underestimated. Furthermore, results indicated a contradictory perception of the role of the PDRP in influencing change. Overall the analysis indicated further exploration was necessary. Three heterogeneous focus groups and three semistructured one to one interviews were conducted to gain a more in-depth overview of perceptions. Recorded data were transcribed and analysed using content analysis. Results indicated that the PDRP had lost some momentum, but that the PDRP had influenced practice via both direct and indirect means. In conclusion, the study recommends PDRPs as a mechanism for building research capacity and capability, but that care must be taken to ensure currency in the projects undertaken and continued motivation for those involved.
C07: Meeting the Challenges of Emergency Department Donation at the University Hospital of North Staffordshire Miss Katie Fox, Mrs Julie Pascoe, Miss Tamsin Fletcher, NHS Blood and Transplant, University Hospital of North Staffordshire BACKGROUND ED organ donation at UHNS has seen steady growth since 2007. The impact typically being borne by Theatre Recovery staff; who out of goodwill have provided a place and nursing staff to care for donors and their families. This in itself has
The aim of our project was to reorganise organ donation from the ED to deal with increasing numbers of donors and subsequently reduce the impact of this on Theatre Recovery and Critical Care. In order to do this a Pathway for identifying an ICU bed was developed plus twenty-five nurses from ICU were recruited to staff a rota for organ donors outside of their substantive posts with extensive training provided on all aspects of organ donation, including ventilation and donor management.
Extending donation to the ED poses many challenges. At UHNS we have gone a long way to meeting those challenges and have been able to offer organ donation to many more families, in addition organ donors have been cared for by experienced ICU nurses with the skills to manage complex brain stem dead donors and their grieving loved ones. Without the Pathway those families would not have been given the option of donation as a result, donors would have been lost and healthy organs buried or cremated.
C08: Critical Care Outreach and End-of-life Decisions Dr Natalie Pattison, Mrs Geraldine O’Gara, Royal Marsden NHS Foundation Trust Learning objective: The role that critical care outreach has in end-of-life (EOL) decisions will be discussed and the evidence from this service evaluation study used to explain the characteristics of transitions to end of life in acute and critical illness.
BACKGROUND Medical emergency teams (MET) and critical care outreach teams have a prominent role in triaging sick or deteriorating patients and determining their course of treatment, namely: admission to critical care or decisions to forgo life-sustaining decisions. Outreach have been shown to initiate limitations of treatment (subsequently leading to EOL decision-making) in as many as 25% of all referrals made to outreach (Pattison et al 2010), and were involved in many more. This figure is reflected in MET studies of EOL decision-making (Jones et al 2007; Calzavacca et al 2008; Calzavacca et al 2010). However, the course of patients who are acutely unwell and then transferred to an EOL model is difficult to map. The aim of this service evaluation was to establish how much time is spent with patients who subsequently are subject to EOL decisions or decisions to limit medical treatment, the characteristics of that time, and how much influence a nurseled critical care outreach team have on those decisions.
Concurrent Abstracts METHODS A retrospective review was undertaken of all medical records from the electronic patient record, medical notes and Intellivue Clinical Information Portfolio for data from Dec 2010-2011. The findings were analysed using SPSS version 19 and free text analysis (Pietrzyk, 1995) was used to analyse written documentation about the level of involvement at EOL, transfers decisions to EOL and any decision-reversals in EOL decision-making. The descriptive results from this service evaluation will be presented alongside a discussion of the phenomena found in the study, and conclusions made about the role outreach can have in managing EOL transitions. References: Calzavacca P, Licari E, Tee A, Egi M, Downey A, Quach J, Haase-Fielitz A, Haase M, Bellomo R. (2010) The impact of Rapid Response System on delayed emergency team activation patient characteristics and outcomes--a follow-up study. Resuscitation 81(1):31-5. Calzavacca P, Schneider A, Jones D, Hart GK, Silvester W, Dettering K, Bellomo R (2008) The role of a medical emergency team in limitation of medical treatment and end of life care: a five years single center retrospective study. European Society of Intensive Care Medicine Annual Conference. Barcelona Jones DA, McIntyre T, Baldwin I, Mercer I, Kattula A Bellomo R (2007) The medical emergency team and end-of-life care: a pilot study. Critical Care Resuscitation; 9: 151 - 156 Pattison N, Ashley S, Farquhar-Smith P, Roskelly L, O'Gara G (2010) Thirty-day mortality in critical care outreach cancer patients: an investigative study of predictive and referral factors Resuscitation 81 (12) 1670 - 1675 Pietrzyk PM. (1995) Free text analysis. International Journal of Biomed Computing. 39(1):139-44.
C09: NICE 135 Organ donation for Transplantation Guideline: its Implications for Critical Care Nurses Mr Tim Collins, Maidstone & Tunbridge Wells NHS Trust In December 2011, NICE published its clinical guideline titled “Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation”. Currently there is a shortage of organs available for transplantation with 3 people dying per day whilst waiting for a lifesaving transplant (NICE 2011). The aim of this guideline was to look at producing best evidence recommendations for health care professionals in order to increase donation rates through looking at methods to maximise identification, referral and consent rates in the NHS. The guideline contains 28 recommendations, which aim to increase the numbers of transplants available and reduce the UK transplant waiting list. The DH (2008) & NICE (2011) state that organ donation should be considered as part of usual end of life care. As the majority of organ donors come from critical care areas, this clinical guideline is very relevant to critical care nurses as they play a pivotal role in the identification and management of potential donors. The NICE guideline advocates the use of clinical triggers and required referral to aid identification of potential organ donors. The use of clinical triggers may be a new concept for most
hospitals but it is now the standardised point of initiating discussions with a Specialist Nurse for Organ Donation (SNOD). The use of required referral is where all anticipated deaths prior to withdrawal of treatment are discussed with a SNOD in order not to miss a potential donor. These recommendations have been based upon observational studies that have found they have increased the potential number of organ donors (NICE 2011). Due to the time constraints of the concurrent presentation the focus of this NICE guideline presentation will be on these changes in practice. As the sole nurse representative on the Guideline Development Group and contributor to this guideline, I will aim to provide an overview of these recently published NICE recommendations. I will explain the process of how the recommendations were decided and what impact they will have on clinical practice. All the recommendations are based upon published literature and I will discuss the evidence base behind the recommendations as well as reflect upon the limitations of this evidence (Collins 2012). As nurses have an important role in the donation process, I will explore what the evidence states nurses can do to enhance care and management of a potential or actual donor patient in their care. Evidence shows that relatives found that nurses provide valuable emotional support during the donation process and NICE recognise this significant role of the bedside critical care nurse (Jacoby et al 2005 & NICE 2011). The presentation will explore the recommendations from NICE but will explore strategies for how the recommendations can be adopted by nurses into their clinical practice, so that nurses can effectively identify and manage an organ donor and ultimately play a pivotal role in trying to reduce the transplant waiting list. References: Collins T (2012) Guest Editorial - Strategies to increase organ donation: the role of critical care practitioners. Nursing in Critical Care. 17: 112-114. Department of Health (2008) Organ donation task force. DH. Jacoby L, Breitkopf C & Pease E (2005) A qualitative examination of the needs of families faced with the option of organ donation. Dimensions of Critical Care Nursing. 24:183-189. NICE (2011). Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. www.nice.org.uk.
Dual Agency and Critical Care Nursing: Factors Associated with Maltese Critical Care Nurses’ Decisions to Seek Help from Doctors Josef Trapani, Professor Julie Scholes, University of Brighton; Dr Maria Cassar, University of Malta AIM To explore and explain critical care nurses’ decisions to seek help from doctors when they want treatment modality changes for their patients.
DATA COLLECTION INVOLVED (1) Fifty hours of participant observation and informal interviews in an intensive therapy unit in a general state hospital in Malta; (2) fifteen hours of formal semi-structured interviews with ten theoretically sampled critical care nurses
Concurrent Abstracts working in this unit. Concurrent data generation and analysis was guided by the dimensional analysis approach to grounded theory (Schatzman, 1991; Kools, McCarthy, Durham, & Robrecht, 1996).
FINDINGS AND IMPLICATIONS Nurses’ decisions to seek help from doctors are complex and frequently mediated by individual factors which are unrelated to the actual clinical situation, such as experience, assertiveness and willingness to take risk. These involve balancing several occasionally conflicting motivators, including a desire to act autonomously, attempting to prevent personal and professional risk, and being constantly mindful of the asymmetrical decision making power of nurses and doctors. Central to these decisions is the notion of dual agency which involves nurses balancing their role in safeguarding their patient’s interest with their duty to respect consultants’ preferences. The findings underscore nurses’ contribution to decisions about critically ill patients’ treatment modalities and provide an in-depth exploration of the phenomenon of referral as an example of inter-professional collaboration in the Maltese critical care context. References: Kools, S., McCarthy, M., Durham, R., & Robrecht, L. (1996). Dimensional Analysis: Broadening the Conception of Grounded Theory. Qual.Health Res., 6, 312-330. Schatzman, L. (1991). Dimensional Analysis: Notes on an alternative approach to the grounding of theory in qualitative research. In D.R.Maines (Ed.), Social Organization and Social Process (pp. 303-314). New York: Aldine De Gruyter.
C11: A Dimensional Analysis of Decision-Making in Acute Care Nursing with Acutely Unwell Patients Mrs Sally Smith, Maidstone & Tunbridge Wells NHS Trust My research arose from concerns about the factors that affect the decisions nurses make about patients’ conditions they are worried about in the acute care general ward setting. The aims of the research were to answer the following research questions 1
What are the contextual factors that affect the recognition and response to deterioration of the unwell ward patient? What influences decision-making when caring for a patient whose condition is deteriorating? Which contextual factors in a ward environment promote good quality care for this group of patients (defined as timely intervention when a patient’s condition deteriorated)?
Using grounded theory and Schatzman’s dimensional analysis the substantial theory of “mind accounting in clinical reasoning” emerged. The study comprised 18 months data collection in a district general hospital. Observations were carried out with 10 participants. 15 semi-structured interviews took place and one focus group comprising 9 participants. Data were analysed using dimensional analysis. Initially 23 dimensions
were conjured up, that later through differentiation became nine. An explanatory matrix was developed that explained the processes occurring when nurses cared for patients whose conditions were declining. Findings show that there are 3 tiers of clinical reasoning that contribute to the decisionmaking process. Firstly decision-making happens in normal ward routine named customary reasoning. When concerned about a patient, nurses' reasoning operates within an uncertain clinical picture, called crescendo of care - abductive reasoning. If uncertainty continues the nurses find themselves feeling like they are managing a crisis situation using confirmatory reasoning. This is often unique to that patient whilst around them the rest of the ward routines continue at a different and often slower pace. Values and beliefs have a strong influence on how and what the nurses do and say. The central organising phenomenon that explains the substantial theory of “mind accounting in clinical reasoning” will be presented. In this a variety of decision-making and clinical reasoning principles are employed prior to the input of critical care experts including outreach teams. This presentation will present the study findings, the explanatory matrix and the substantive theory.
C12: Realistic Evaluation of EWS and ALERT: Factors Enabling and Constraining Implementation Mrs Jennifer McGaughrey, Dr Bronagh Blackwood, Dr Peter O’Halloran, Prof Sam Porter, Queen's University Belfast LEARNING OBJECTIVES The learner will be able: 1
To understand the rationale underpinning a Realistic Evaluation approach to determine the effectiveness of EWS and ALERT in practice To critically debate the factors enabling and constraining the implementation of EWS and ALERT in practice
METHODS The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland . It followed the principles of realist evaluation research which gathered empirical data to test and refine RRS programme theory. This approach used a variety of mixed methods including individual and focus group interviews, observation and documentary analysis in a two stage process. A purposive sample of 75 key informants participated in individual and focus group interviews. Observation and documentary analysis of EWS compliance data and ALERT training records provided further evidence to support or refute the interview findings. Data was analysed using NVIVO8 to categorise interview findings and SPSS for ALERT documentary data. These findings were further synthesised by undertaking a within and cross case comparison to explain the factors enabling and constraining EWS and ALERT.
Concurrent Abstracts RESULTS A cross case analysis showed that personal (confidence; clinical judgement; personality), social (ward leadership; communication), organisational (workload and staffing issues) educational (constraints on training; no clinical educator on ward) and cultural (routine task delegated) influences impact on utilisation of EWS and ALERT.
CONCLUSIONS The findings from the Realist Evaluation are capable of informing the planning of future service provision and provide direction for enabling their success and sustainability. References: 1. McGaughey J, Blackwood B, O’Halloran P, Trinder T. J. & Porter S. (2010) A realistic evaluation of Track and Trigger systems and acute care training for early recognition and management of deteriorating ward-based patients. Journal of Advanced Nursing 66 (4), 923-932.
Two years of Call 4 Concern (C4C): Patient and Relative Initiated Critical Care Outreach (CCO).
Dr Mandy Odell, Royal Berkshire NHS Foundation Trust At the 2010 BACCN conference we presented the pilot of our Call 4 Concern (C4C) service. C4C enables patients and relatives to directly access the CCO team if there are worries about the patient’s condition (Odell et al 2010). Our aims were to reassure patients and relatives that they could access critical care expertise whenever they felt they needed it; provide alternative and complimentary communication channels between the patient, their relatives and the healthcare team; provide timely critical care intervention to prevent patient deterioration, and reduce complaints. The C4C concept aligns very closely with the Department of Health’s drives to improve the patient experience (http://www.dh.gov.uk/health/2012/02/patient-experienceframework/). Our initial pilot proved that this unique UK initiative was operationally feasible. The aims were achieved and patients and relatives fed back on the value of this service. The success of the pilot and winning a national patient safety award in 2011, gave us the motivation to implement C4C across the Trust. We now have nearly two years of data from 147 C4C calls across a variety of clinical settings. All C4C referrals were analysed and our presentation will share our findings of the C4C calls in relation to our initial aims. The findings will provide evidence of what really concerns patients and relatives about their physiological deterioration and critical illness experience, and where clinicians can concentrate on improving the patient experience through better communication and vigilance. References: Odell M, Gerber K, Gager M (2010) Call for Concern: a patient and relative activated critical care outreach. British Journal of Nursing: 19(22); 1590-1395
C14: Introducing SBAR in our NHS Trust Mrs Grace McMahan, Mr Ian Setchfield, East Kent Hospitals University Foundation Trust The aim of this presentation is to share our work on implementing the 'SBAR' (situation-background-assessmentrecommendation) communication tool within our trust. Poor communication within the NHS is well documented to have a detrimental impact on patient care and safety (National Patient Safety Agency, 2007). In recent years several guidelines have been released on how staff can improve communication within the healthcare environment. As recommended by the 'Patient Safety First' initiative, East Kent Hospitals University Foundation Trust adopted the SBAR communication tool, and the process of embedding it into our everyday communication culture began in 2010. This was led by the Critical Care Team at the Queen Elizabeth Queen Mother Hospital. We have previously presented our findings on implementing the tool at the 2010 BACCN conference. Two years on we are slowly but surely achieving our goal of it becoming embedded within the trust as the standard means of communicating both accurate and timely information to each other. It is envisaged that other delegates will be able to take away beneficial information, which they can then use when implementing the SBAR tool within their organisation. Data collated on the uptake of the tool will be discussed, and the challenges and successes of embedding this tool and recommendations for the future will be discussed in this presentation.
C15: Using the Model for Improvement in Practice Scotland's Experience! Ms Laura Harvey, Ayrshire & Arran Acute Hospitals The Scottish Patient Safety Programme (SPSP) has had incredible success since its launch in 2007 by the Scottish Government. It is lead by HIS (Health Improvement Scotland) and Scotland is the first country in the word to take this strategic, national approach to improving patient safety. The aim of the SPSP is to systematically improve the safety and reliability of hospital care throughout Scotland by supporting frontline staff to use the Model for Improvement to change and improve practice. There are 5 workstreams, including Critical Care and are currently working on introducing an HDU workstream (with which the author is part of the project team). The author plans to introduce The Model for Improvement (as recommended by SPSP), using a new HDU scoring system to illustrate the model. The model consists of 2 parts which help establish what we aim to improve, how we are going to improve it and then how we can measure that improvement has been achieved. It supports small scale tests of change Plan, Do, Study, Act.
Concurrent Abstracts Throughout the presentation, the author will illustrate the model using her own experiences with implementing a new quality improvement idea to her clinical area, in keeping with the Quality Strategy (NHS Scotland, 2010). She will demonstrate the five principles the model recommends; 1. Knowing why you need to improve 2. Feedback mechanism 3. Developing an effective change 4. Testing the change 5. Knowing how and when to make the change permanent From her own work, she will present the results of her improvement, taken from the Scottish Intensive Care Society Audit Group's database,and from case note reviews, and demonstrate a reduction in HDU mortality of 2.5%, a quicker, more effective means of referring patients to intensivists and in doing so, reducing the need for ITU admission by almost 20%. References: Department of Health (2010) The NHS Scotland Quality Strategy, DOH Edinburgh Langley, R et al (2009) The Improvement Guide (2nd Edition), Wiley, California, USA McQuillan, P et al (1998) Confidential enquiry into quality of care before admission to intensive care; British Medical Journal 316; 1853-8.
C16: The Critically Ill Child in the Adult Setting; Getting it Right Fiona Lynch, PICU Nurse Consultant, Evelina Children's Hospital, Guys and St Thomas’ NHS Trust INTRODUCTION & BACKGROUND The critically ill child may present to a variety of health settings. With the centralisation of Paediatric Intensive Care (PICU) provision in the late 1990s (DH 1997) the need to move the critically ill child by specialist transport services to a designated PICU became the norm. However, whilst awaiting arrival of the specialist transport teams, it is essential that the critically child is appropriately stabilised and managed. This may involve the children being cared for in areas unfamiliar with caring for critically ill children such as Adult Intensive Care Units (AICU), theatres and peri-operative settings. Nurses not used to caring for the critically ill child report increased anxiety and concerns when managing this patient group (PICS 2010).
AIMS & OBJECTIVES This presentation will highlight the differences and commonalities in caring for the critically ill child versus the critically ill adult. The audience will contemplate the strategies to approach the critically ill, identify the resources available to manage this population and reflect upon the professional and personal challenges. In doing so, it is envisaged that a better understanding of how to care for these patients will be explored and consider.
CONCLUSION Care of the critically ill child in an adult setting may not be common but is not unusual. Therefore, the principles and approaches to care needs to be considered by those in a position to care for this patient group. References: DH 1997 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 Crown Copyright, London. PICS (2010) Standards for the care of critically ill children (4th Version) Paediatric Intensive Care Society, London.
C17: Augmenting Learning: Utilising Simulation in Specialist PICU Modules Matthew Norridge, Evelina Children’s Hospital, King's College London/Guys & St Thomas’ NHS Trust INTRODUCTION To gain promotion to Band 6 within a PICU environment, staff must undertake two PICU Modules offered within the local HEI. Promotion to Band 6 generates greater expectations and responsibilities around the holistic care of the patient. To meet these growing expectations, an innovation in the teaching methods of the PICU module within one HEI was trialled using high fidelity simulation.
METHOD High fidelity simulation was trialled on the final day of the 2nd PICU module for 20 nurses. As part of the course students completed a pre and post course evaluation exploring their perceived confidence in their communication, leadership and patient management skills. Responses were explored to determine the impact of the course upon pre and post responses.
RESULTS A theme that came out during the scenarios and subsequent debrief was the ability for students to recognise and prioritise interventions from their patient assessments, but fail to appropriately articulate it. The pre and post questionnaires showed a notable increase in confidence levels, particularly in the areas of communication. The results of this exploratory highlight the positive impact of high fidelity simulation which warrants further exploration to determine impact upon students perceived levels of competence in the PICU environment.
C18: An Approach to End Of Life Care On One PICU Usha Chandran, Paediatric Intensive Care Unit, St Georges Healthcare NHS Trust The purpose of this paper is to share good practice models in PICU end-of-life care in the hope that it may contribute to a more holistic pathway for dying children and their families. Although an anecdotal approach, this model aims to illustrate
Concurrent Abstracts a model by which one unit strove to provide holistic end-of-life care for a small group of patients. It aims to share the structures and procedures involved in facilitating a holistic pathway and the pros and cons involved in this process. Child deaths are probably one of the most traumatic and tragic events in life. A sense of disbelief and unreality may prevail. Acceptance may be impossible and the distraught nature of pain and loss is probably second to none. Yet there are a paucity of models to base holistic hospital-based end-oflife care. Individual units may provide the best approach possible during this time, but there is very little sharing and contributions to standardisation of processes and mechanisms to promote best care. The hospice model of care is probably the best approach, but replicating the hospice model may not be practical in a PICU setting. Nevertheless, one should strive to provide care as close to this model as possible. Working in partnership with local hospices and integrating links with such organisations may however be the way forward and provide models for best practice. This paper aims to illustrate how one such unit aimed to provide holistic end-of-life care for our young patients by involving local hospices at an early stage. The poster also shows the importance of individual staff will and skill to facilitate this process and demonstrates how the pros and cons of hospital machinery requires skilled negotiation in order to manage this and provide comfort to patients and families during this distressing time.
C19: A desire to give back: the ICU patient's quest. Empowering ICU patients. Enabling innovation Mark Wilson, Royal Berkshire Hospital STATEMENT OF PURPOSE Empowering patients and enabling them to quest (payback) provides valuable learning opportunities and therapeutic benefits for the patients, relatives and staff.
DESCRIPTION Patients use narratives to seek meaning and make sense of their critical illness (Holloway and Wheeler, 2009). Frank (1995) in his work on illness narratives describes three types of themes restitution, chaos and quest. The quest narrative is told by people who are on a mission, who accept the challenge to learn something from their experience and feel they are on a journey. Through our work with follow up we have seen a desire from patients to become involved in a quest to payback. Our patient's have found therapeutic benefit through a variety of opportunities, innovated by them, and enabled by us. ICU Staff have had the opportunity to learn from their experiences and improve patient and staff experience as a result.
CONCLUSIONS Our ICU offers a wide range of ways for patients to become involved, which provides a channel through which patient's quests can be enabled to have therapeutic benefit. Staff learn from the patients experience getting to know the person behind the patient.
References: Frank A. W (1995) The Wounded Storyteller: Body, Illness and Ethics. The University of Chicago Press: Chicago. Holloway I, Wheeler S (2009). Qualitative Research in Nursing and Healthcare. 3rd edition. John Wiley and Sons: London.
C20: Can Airway Pressure Release Ventilation (APRV) Prevent ARDS in Trauma Patients? Ms Penny Andrews, R Adams Cowley Shock Trauma Center, Baltimore, MD USA PURPOSE Patients with traumatic injuries are at a greater risk of developing several forms of acute lung injury and typically require mechanical ventilation. However, mechanical ventilation can result in ventilator associated lung injury (VALI) and generate or potentiate lung injury. Although the majority of the literature has been focused on the management of acute respiratory distress syndrome (ARDS), little has been described on prevention of ARDS posing the question: â€œCan a mode of mechanical ventilation when applied early prevent ARDSâ€??
METHODOLOGY ARDS mortality has not changed significantly since 1994 and international mortality (including the UK) is 60% resulting in a negative impact on patients and the healthcare system. We reviewed early application of a non-traditional method of mechanical ventilation in high risk trauma patients to determine if we could impact ARDS incidence and mortality. Our recently published data demonstrated ARDS incidence at our trauma center of 1.4% and ARDS mortality of 3.9%, compared to the US national average of 13.% and 14.2% respectively. In addition, we reproduced and validated our clinical findings experimentally in a large animal model and prevented ARDS completely using this method of mechanical ventilation.
CONCLUSIONS The ideal method to treat ARDS in trauma patient remains unanswered; therefore, a preemptive ventilator strategy could have enormous impact on morbidity and mortality. Recent data suggest the method of ventilation and the timing of application in the pathogenesis of the disease (i.e. early or late) may play a key role. From our recent findings, we believe our novel strategy of applying airway pressure release ventilation (APRV) early in the clinical course may prevent the development or progression of ARDS. This session is intended for any nurse working in the critical care setting interested in ARDS management and treatment, use of APRV and the latest methods for prevention of ARDS. References: Roy S, Sadowitz B, Andrews P, Kuhn M, Ghosh A, Gatto LA, Marx W, Dean D, Lin X, Wang G, Ge L, Vodovotz Y, Nieman G, Habashi N. Preventative ventilation prior to lung injury averts ARDS: A novel timing-based strategy of ventilator therapy. J Trauma. In Press. Phua J, Stewart T, Ferguson N. Acute Respiratory Distress Syndrome 40 Years Later: Time to Revisit Its Definition. Crit Care Med 2008; 36(10):2912-2921.
Concurrent Abstracts Habashi N, Andrews P. “Ventilator strategies for posttraumatic acute respiratory distress syndrome: airway pressure release ventilation and the role of spontaneous breathing in critically ill patients”. Curr Opin Crit Care 2004, 10:549-557. Andrews PL, Habashi NM. Airway pressure release ventilation: A boost for spontaneous breathing. American Nurse Today (2008);1(1):10-12. Schiller H, McCann U, Carney D, Gatto L, Steinberg J, and Nieman G. Altered Alveolar Mechanics in the Acutely Injured Lung. Crit Care Med 2001;29(5):1049-1055. Habashi, Nader M. Other Approaches to Open-Lung Ventilation: Airway Pressure Release Ventilation. Crit Care Med 2005;33(3)Suppl:S228-240. Shiber J, O’Toole R, Habashi N. APRV is Associated with a Low Rate of ARDS in High-risk Trauma Patients. Crit Care Med 2009(suppl);37(12):A185. Navarrete-Navarro P, Rodriguez A, Habashi N, et al. Acute Respiratory Distress Syndrome Among Trauma Patients: Trends in ICU Mortality, Risk Factors, Complications and Resource Utilization. Intensive Care Med 2001; 27(7):11331140. Roy S, Kuhn M, Sadowitz B, Habashi N, et al. Preventative Ventilation Prior to Lung Injury Averts ARDS: A Novel TimingBased Strategy of Ventilator Therapy. The 26th Eastern Association for the Surgery of Trauma (EAST) Annual Scientific Assembly 2012. Recipient of the Raymond H Alexander, MD Resident Paper Competition Award.
C21: Withdrawn C22: Introducing Delirium Scoring Mrs Liz Shaughnessy, Essex Cardiothoracic Centre AIM To share an experience of introducing Delirium scoring into a Cardiothoracic Critical Care Unit and the lessons learnt.
BACKGROUND Delirium has serious consequences leading to increased length of stay in hospital, the possible development of dementia with the associated need for long term care and even death. It is therefore vital that the Critical Care nurses are able to prevent, recognise and manage delirium.
DATA SOURCES AND METHODS 108 patients who were admitted over a 6 week period were audited and their delirium score, documentation and treatment plans were reviewed.
RESULTS 21% of patients experienced delirium during their stay on Cardiothoracic Critical Care and hypoactive delirium was the most prevalent subtype. Of the 3 patients who stayed more than 20 days on critical care all suffered with delirium at some point during their stay . Documentation of delirium by both Nursing and Medical staff occurred in less than 50% of patients.
CONCLUSIONS The introduction of delirium scoring and audit of its practice has highlighted the incidence of delirium in critically ill patients and has resulted in; • • •
Improved quality of care by development of a delirium care bundle Improved recognition of delirium Instigation of practices to prevent and treat delirium
C23: Proning: the Challenge for a District General Hospital Mrs Gemma Millen, East Kent University Hospital NHS Trust AIM Following the influx of flu patients during the winter of 20102011 when conventional ventilation strategies and ARDS management were not seeing patient improvement, we started to ask the question ‘what else could we offer as a DGH?’ The difficult management of patients with “severe” ARDS and working closely with the retrieval service gave our ITU the opportunity to change practice to the benefit of patients. Part of this change was to introduce proning into practice. Due to severe hypoxemia, the retrieval team often requested patients to be proned to improve gas exchange prior to transfer. Previous to this the use of proning within our intensive care unit had been controversial due to the conflicting evidence and was not current practice. This session will re-evaluate the evidence regarding proning, focusing on the patients which fall into the “severe” ARDS category. This is the group where improvement in mortality has been seen.
CONCLUSION There is a need for early referral to specialist centres for patients with H1N1 and proning has a place in the retrieval process. The challenge for many ITU’s, is the introduction of new proning criteria and guidelines into practice. Staff awareness of the guidelines and changing the stigma associated with proning need to be addressed and managed, if we are to improve patient outcomes.
C24: Incorporating Oral Care into a Ventilator Associated Bundle: "Bridging the Gap" Mrs Phyllis Fearon, Mrs Linda McCready, Southern Health & Social Care Trust NI BACKGROUND The importance of oral care is well documented as not only a vltal aspect of comfort and care, but also an element to be considered towards the minimisation of Ventilator Associated Pnuemonia (VAP). The literature also highlighted that whilst there is ample information on what we should do, guidance on how oral care should be delivered is limited. (McFettridge 2009).
Concurrent Abstracts AIM The intention of the Practice Development Group (PDG) within the author's Intensive Care Unit (ICU), was to do a review of the available literature, develop a tool that would meet the critera for VAP prevention but also could meet the needs of all patients in hospital receiving oral care. Results from a prospective audit within ICU showed that nurses has difficulty putting theory into practice, the opportunity for the delivery of substandard/ineffective care maybe increased.
OUR INITIAL AIM WAS TO DEVELOP: •
• • • • •
An assessment tool for ventilated/non-ventilated patients that was easy to use and had the nursing care for each intervention built in. An algorthim for the treatment of specific oral hygiene needs and the appropriate tools to use. A formulary of products in use. A Patient Group Directive (PGD). An education Pack. Subsequent cascading of education within the author's Trust.
Following the development of the tool we as a group encountered many difficulties along the way, we would like to share our journey of how we "Bridged the gap" with you. References: McFettridge B. Comentary: Munro CL et al. (2006). Oral Health Status and Development of Ventilator-Associated Pnuemonia: a descriptive study. Nursing in Critical Care: 14: 34-39
The Challenges of Moving to a New Build Hospital with an All Single Room ICU Mrs Lindsey Reynolds, Maidstone and Tunbridge Wells NHS Trust The purpose of this presentation is to reflect on the challenges and safety concerns which arose when transferring a 6 bedded general hospital Intensive Care Unit 3 miles to a new hospital with all single rooms.
C26: Implementation of Citrate as Regional Anticoagulation in Continuous Renal Replacement Therapy (CRRT) Mr Andrew Mizen, Miss Kerry Charlton, Mrs Hayley Gilbrook, West Suffolk Foundation Trust Our Renal Interest Group has been in place for a little over four years. This group is made up of a number of different grades of nursing staff, a critical care consultant and our critical care pharmacist. In recent years the group has overseen the acquisition of new equipment and has reviewed and updated current protocols. Around a year ago the group started to look into the possibility of using Citrate as regional anticoagulation with our Prismaflex (CRRT) machines. During this past year the group have spent time researching the benefits and drawbacks of citrate; reviewing existing protocols whilst adapting and developing a protocol for our unit and planning the education of large quantities of nursing and medical staff. The culmination of this project resulted in the “go live” with citrate in February of this year. The aim of this presentation is to show the processes that the group went through to achieve this successful implementation. We will endeavour to discuss the highs and lows of this process and we will present data that we have collected thus far. Above all, this presentation will show that much can be achieved by a small number of committed practitioners in significantly changing practice and enhancing patient care.
Early Mobility In ICU Patients: Development And Psychometric Evaluation Of An Instrument To Assess Staff Perception Jayanthi Shamalee Patabendige, Dr Dimitri Beekman, Dr Maria Daruso, Kings College Hospital
The pre move planning, preparation and risk assessment will be identified, these concerns included;
Purpose of the study: Development and psychometric validation of an instrument to assess staff perceptions towards early mobility of patients in ICU.
• • • •
Patient safety during the transfer and for the following 24hours. Staff education and preparation prior to the move. Service reconfiguration. Physical move planning including stores and equipment. Challenges of nursing all critically ill patients within single rooms.
Move day itself will be discussed to enable delegates to gain an insight into the successes and pitfalls of the day and subsequent 24hours, reflecting on the effectiveness of the pre move planning. 6 months on from the move a personal perspective of working within the all single room environment will be presented; identifying new ways of working, staff challenges and applicability to other areas.
A prospective psychometric validation study. Method: A thorough literature review was performed in order to develop a twenty-five item instrument. Content validity of the instrument was quantified using a Delphi technique ICU experts. Subsequently, a 16-item instrument was pilot tested. A convenience sample of 131 critical care staff from three adult ICUs participated in the study. In order to establish testretest reliability, instrument was redistributed two weeks after the first administration.
RESULTS Two panels of experts established the content validity of the instrument. The exploratory factor analysis indicated a fourfactor solution, accounting for 61.5% of variances in response 45
Concurrent Abstracts for the perception of the staff towards early mobility activity in ICU. These four factors were named as four subscales. 1: Collaboration and team effectiveness, 2: Professional accountability, 3: Empowerment and the 4: Priority. Response rate among ICU staff was 65%. The minimum amount of data for factor analysis was 8 cases per item. In the first administration test-retest reliability of the instrument (Cronbach's alpha) was 0.84 and in the second administration instrument achieved Cronbach's alpha of 0.60.
CONCLUSION The results of the study confirm that the instrument is conceptually meaningful and psychometrically valid for assessment of staff perception towards early mobility activity in ICU.
Accelerated Experience Based Co Design: Using a National Archive of Patient Experience Narrative Interviews to Promote Rapid Patient Centred Service Improvement Mrs Melanie Gager, Mrs Ruth Tollyfield, Royal Berkshire NHS Foundation Trust
C29: Watching Myself in an Unreal World: Patients' Experiences of Technology in Adult Intensive Care Louise Caroline Stayt, Oxford Brookes University BACKGROUND Technology is fundamental to support physical recovery from critical illness. As well as physical corollaries, psychological disturbances are commonly reported in intensive care patients at all stages of their illness and recovery. Nurses play a key role in the physical and psychological care of patients, however there is a suggestion in the literature that the presence of technology may dehumanise patient care. Little attention has been paid to patients' perceptions of care in a technological environment. The purpose of this research, therefore, was to explore patients' experiences of technology and care in ICU.
METHODS This Heideggerian phenomenological study took place in a university hospital in England. Nineteen ICU patients participated in semi-structured interviews which were transcribed verbatim and analysed utilising Van Manen's framework.
FINDINGS STATEMENT OF PURPOSE The project seeks to improve the experiences of ICU patients, their carers and the staff in two participating Trusts (Harefield, London and Royal Berkshire, Reading).
DESCRIPTION An adaptation of Experience Based Co Design (EBCD) ; which is a participatory action research approach (Bate & Robert 2007), was used to provide an opportunity for patients, carers and staff to work together in redesigning ICU services in order to improve patient and staff experiences. Trigger films from a national archive of patient experience research were used in conjunction with the existing EBCD approach to identify co design projects.
CONCLUSION The identified co design projects from both Trusts demonstrate the creativity, synergy and learning generated by this approach. Examples of these projects include enhancing basic care, reducing noise and sleep deprivation, improving communication, improving patient/Dr communications on ward round, transition to the ward, hallucinations, ventilation and individualised care. The co design process has provided a vehicle to challenge thinking and shift paradigms for patients, carers and staff alike. It has also provided knowledge about how best to ensure patient perspectives are at the heart of service improvement (DoH, 2009b) and delivered in a timely and cost effective way.
Participants described how they endured technology by being invisible, and complying to an unwritten set of standards. Participants endured technology as they recognised the expertise of their carers and felt it was a necessary evil. ICU patients described paradoxical experiences of technology suggesting it was comforting yet uncomfortable, frightening yet reassuring.
CONCLUSIONS Positive experiences are associated with a close nurse presence. Holistic, person-centred care may provide comfort and reassurance to the patient.
C30: Enhancing Understanding During Early Critical Illness Recovery; the use of a ‘lay’ Patient Discharge Summary Mrs Suzanne Bench, Dr Tina Day, Mr Peter Milligan, Florence Nightingale School of Nursing and Midwifery, King's College, London; Ms Karina Heelas, Dr Philip Hopkins, Critical Care Unit, King's College Hospital; Mrs Catherine White, ICU steps charity; Professor Peter Griffiths, Professor Lucy Yardley, Faculty of Health Sciences, University of Southampton BACKGROUND AND PURPOSE
References: Bate SP & Robert G (2007) Bringing user experience to health care improvement: the concepts, methods and practices of experience based design. Oxford; Radcliffe Publishing Department of Health (2009b) NHS 2010 - 2015: From good to great. Preventative, people centred, productive. London: Department of Health
Being a patient in critical care can be profoundly distressing, often compounded by confused memories, which can affect psychological well being and recovery. (1) Building on the success of patient diaries, (2) “lay” patient discharge summaries may help early by enhancing understanding, but producing information in a format that is useful is challenging. This paper explores their feasibility, impact and associated challenges.
Concurrent Abstracts METHOD As part of a single centre Randomized Controlled Trial investigating critical care discharge information strategies, a “lay summary” written by the bedside nurse, using guidelines and a format developed by service users, was provided to 51 patients prior to their transfer to the ward. Summaries were examined for their content and readability, and questionnaire data provided patients' and nurses' perceptions of value. Patients' in-hospital anxiety and depression scores were also recorded.
RESULTS, DISCUSSION AND CONCLUSION This paper will report formal readability assessments and the qualitative content analysis to explore the extent to which nurses are able to complete effective lay summaries. Findings will be discussed in light of their implications for optimizing critical illness recovery. References: 1. Bench S, Day T. Int J Nurs Stud. 2010; 47(4): 487-499. 2. Jones C et al. Crit Care 2010; 14: R168.
C31: Recognising Patient Deterioration Ms Debbie Massey, Griffith University INTRODUCTION Technological developments, an increasing aging population and economic rationalisation are all factors responsible for increasing patient acuity in hospital wards.
DISCUSSION Several studies have demonstrated, that patients who deteriorate on hospital wards exhibit premonitory signs of physical decline, many hours before this life threatening deterioration. Failure to escalate care for patients at risk of life threatening deterioration can, and does have devastating consequences; it may lead to death increased length of hospital stay, decreased quality of life and a significant increase in healthcare costs. Timely access to appropriate interventions is therefore crucial in improving the morbidity and mortality of acutely ill patients and promoting safe high quality care. This presentation offers practitioners an opportunity to develop and their knowledge and understanding of patient deterioration. It suggests a systematic model that may be used in clinical practice.
CONCLUSION Early identification of patient deterioration plays an important role in preventing adverse events, promoting positive patient outcomes and improving patient care. This presentation uses a systematic model that practitioners may find useful to adopt within their clinical practice.
C32: Factors Facilitating and Inhibiting Effective Clinical Decision Making in Nursing Miss Nicola Morton, University of Hull LEARNING OBJECTIVES: • •
Explore the role and context of effective decision making in relation to nursing practice. To explore the theory surrounding an incident from clinical practice
Effective decision making is one of the most important components of professional nursing practice. It consists of gathering, processing and prioritizing critical patient information in order to implement actions and evaluate results. The dynamic nature of healthcare requires nurses' to be competent decision makers in order to respond to patients needs. Nurses, professional bodies, schools of nursing, nurse educators and the Government all have a responsibility for developing and finding strategies to facilitate effective nurse led decision making. This presentation aims to explore the factors influencing clinical decision making in nursing. These include feeling competent, being self-confident, organisational structure, being supported and the role of nurse education. A reflective approach will be used to reinforce understanding. This reflective piece explores a situation surrounding the resuscitation of a patient and involves a Critical Care Outreach Sister. General themes will include boundary-work, beneficence, non-maleficence, interprofessional team working, collaborative practice, communication and leadership. In the context of High Quality Care for All (DoH; 2008) it has become increasingly necessary to ask questions as to what knowledge and whoâ€™s knowledge is valuable. It is important that nurses realise their potential and gain the skills and knowledge needed to be effective decision makers and promote high quality, evidence based, safe care. References: Gieryn TF (1983) Boundary work and the demarcation of science from non-science : Strains and interests in professional ideologies of scientists American Sociological Review 48 pg 781-795 Department of Health (2008) High Quality Care for all : NHS Next Stage Review Final Report Department of Health. London Hall P (2005) Interprofessional teamwork : Professional cultures as barriers Journal of Interprofessional Care Supplement 1 pg 188-196 Cole E, Crichton N (2006) The culture of a trauma team in relation to human factors Journal of Clinical Nursing 15 pg 1257-1266 Gilligan P, Bhatarcharjee C, Knight G, Smith M, Hegarty D, Shenton A, Todd F, Bradley P (2005) To lead or not to lead? Prospective controlled study of emergency nursesâ€™ provision of advanced life support team leadership Emergency Medical Journal 22 pg 628-632 Zwarenstein M, Reeves S (2002) Working together but apart : Barriers and routes to nurse-physician collaboration Journal on Quality Improvement 28 pg 242-247
C33: Leadership Development of Junior Sister Role to Enhance Patient Safety Anan Purushothaman, Anitha Nundlall, Kings College Hospital The specialist intensive care unit (ICU) has 15 critical care level 3 beds and a 4 bedded surgical step down unit (SSDU). The turnover of patients is very high with the monthly bed occupancy rate of 95%, making the demands of the workload greater and stressful.
The comprehensive understanding of role, responsibilities and accountability amongst senior band 5 and band 6 nurses have been shown to be lacking. To address this, a combination of educational and management strategies were planned and implemented. The development programme included a study day, under take supernumerary in charge shifts with a supportive competency document and to have a better understanding of the band 6 role. The study day forms part of a comprehensive educational and management concept.
References: Stang, I & Mittlemark, B (2009) Learning as an empowerment process in breast cancer self-help groups. Journal of Clinical Nursing: Vol 18 (14) p2049-2057 Frank A. W (1995) The Wounded Storyteller: Body, Illness and Ethics. The University of Chicago Press: Chicago.
The aim was to enhance workforce quality by developing strong leadership and management without incurring additional costs. It was agreed a development opportunity was seen to provide a more autonomous management role, where they would entirely co ordinate the shift in SSDU, with support from the main shift co-ordinator, as required.
“So What” - through sharing the experience of the benefits of an ICU Support Network it is anticipated that thinking will be both challenged and ignited to realise and embrace this resource (which is available to all).
C35: Streamlining the Workforce for a Modern Cardiac Intensive Care Unit Mr Graham Brant, University Hospitals Bristol NHS Foundation Trust
In conclusion, the authors hope to reveal, how service improvement is enhanced through change and innovative practice.
With improved patient pathways and patients require less time at level 3 there was a need to review the working pattern of the CICU. This was carried out over a three year period starting with the introduction of Assistant practitioners before reviewing and altering the skill mix of the senior staff and once settled reducing numbers and introducing a 12 hour shift system. Since introducing the plan the number of patients passing through the unit has increased from 1500 to 1700 per year and length of stay within CICU has reduced.
C34: The “So What” Factors of an
C36: Critical Care Education - The
In addition they were allocated as team leader for 4 beds in the main ITU, coordinating and feeding back to the shift leader.
ICU Patient Support Network
Real Reality Show
Mrs Melanie Gager, Royal Berkshire NHS Foundation Trust; Mr Matt Wiltshire, Patient Representative Royal Berkshire NHS Foundation Trust; Miss Sara Evans, Royal Berkshire NHS Foundation; Miss Jenny Davis, Royal Berkshire NHS Foundation Trust; Mr Gordon Sturmey, Patient Representative - Royal Berkshire NHS Foundation Trust
Mr Sean Morton, Mr Trevor Simpson, University of Lincoln; Mrs Paula Sloan, University of Nottingham; Mrs Fiona Morton, United Lincolnshire NHS Trust
Statement of Purpose: To explore the multi faceted dimensions of the experience of the ICU patients, relatives and staff involved in a patient support network.
DESCRIPTION The main driver for establishing a patient support network was generated from a legacy from a previous patient who found one of the most beneficial therapeutic interventions in recovering from critical illness was hearing another patient’s story. Whilst this remains a vital element it is not the only element emerging from the evaluation of this support network. There is a learning component for patients, relatives and staff which include consciousness - raising, acquisition of objective
knowledge, learning from others’ experiences and discovery of new perspectives in life and in oneself (Stang & Mittlemark 2009). It has proven to be a vehicle to enable “questing” or “pay back” which is another vital part of the recovery process (Frank, 1995). The patient support network provides an environment enabling therapeutic relationships between patients, relatives and staff, synergy, creativity and empowerment.
The purpose of this paper was to bring together some within nursing education, firstly simulated practice, secondly, inter agency collaboration and thirdly inter-professional learning. It was felt that the justification of such a way of learning stems from the NMC (2007) guidelines allowing 300 hours of simulated practice but also ensuring patient safety by utilising a simulated environment. Students identified their anxieties when starting their critical care placements and having utilised simulation it was felt this method of teaching would be beneficial in their transition to critical care. The areas themselves differ in many ways, but the fundamentals of an ABCDE approach are recognised in the NHS and endorsed by NICE (2008) are the same. As a result we developed a programme which reflected the differences but also highlighted the essential skills and similarities of them all.
ViPER Abstracts We utilised the knowledge and skills of experienced practitioners in ICU, A&E and theatres to facilitate a day which would be interactive and stimulating, The event followed a patient and their journey from prehospital, to critical care environments, the student was able to utilise assessment of the patient using the ABCDE algorithm. They were expected to participate in interventions with equipment they would encounter in practice
C38: Wikki's, Discussion Boards, Blogs and Vodcasts: Developing Learning Resources for an International. Distance Learning MSc in Critical Care Nursing Sian Shaw, Anglia Ruskin University
We incorporated incidences including cardiac arrest, vomiting on intubation; these were designed to show the student that adverse events do occur and to assist them in development of critical thinking skills. The students were also expected to take SBAR reports to ensure that they were handing over the patient to the next area of care (NHS 2008) While this day was a pilot study, it evaluated positively and the results were that the students were able to leave the day still feeling anxious but had developed new skills and were able to identify skills they already. References: Institute for Innovation and Improvement 2008 SBAR “Situation, Background Assessment, Recommendation [online] Available from: http://www.institute.nhs.uk/quality_and_service_improvement _tools/quality_and_service_improvement_tools/sbar__situation_-_background_-_assessment__recommendation.html [Accessed 8th May 2012] NICE 2012 Head injury: Triage, assessment, investigation and early management of head injury in infants, children and adults [online] Available from: http://publications.nice.org.uk/head-injurycg56/guidance#assessment-and-investigation-in-theemergency-department [Accessed 8th May 2012] NMC 2007 Supporting direct care through simulated practice learning in the pre-registration nursing programme. [online] available from: http://www.nmcuk.org/Documents/Circulars/2007circulars/NMCcircular36_200 7.pdf [Accessed 8th May 2012]
C37: Care & Compassion in an Age of Financial Austerity Mrs Pam Page, Anglia Ruskin University This presentation focuses on the psycho-social needs of people who experience critical care: this includes patients, families and practitioners. Through the use of a short Pod cast the psychological impact of critical illness will be explored. This will include the impact of delirium and the cost-effective, as well as humanitarian benefits, of preventing, assessing, recognising and treating delirium. The role of the family will also be articulated as evidence develops regarding the contribution they can make and the audience challenged as to who is visiting who. Finally, the need for staff to maintain their own emotional literacy using Scholes (2008) model of the “resilient practitioner” will be presented. References: Scholes, J.(2008) Why health care needs resilient practitioners Nursing in Critical Care, vol 13, 6, pg 281-285
Testing and embracing the best of innovative methods of teaching and learning have been part of the ethos of Anglia Ruskin University. The University has been imaginative and pioneering in using these technologies to promote more accessible learning platforms for students and to increase the effectiveness of taught and flexible distributed learning. The MSc/PG Dip/PG Cert Adult Critical Care Nursing pathway utilises a range of new technologies to enable student to access and store content on a variety of desktop and mobile devices. This presentation will demonstrate how Wikki's, Discussion Boards, Blogs and Vodcasts can be used creatively in distance learning. The pathway recognises widening participation for students internationally, along with the expectation that students will learn at different rates and in diverse ways. To address the needs of diverse learning styles, a variety of teaching and learning strategies are designed to help students gain the most from their studies.
C39: Sharing Expertise Across Europe Adriano Friganovic, Eva Barkestad, European Federation of Critical Care Nurses Associations - EfCCNa INTRODUCTION In order to increase awareness and develop a deeper understanding of critical care nursing in different European countries, EfCCNa has established an exchange programme. The programme has enabled critical care nurses to visit other units and departments in a number of European countries and enhance their understanding of how care is delivered. Since 2007 a total of forty two nurses from various countries in Europe have participated in the exchange program. Individuals have not participated in the immediate care of patients but learned and gained from the expertise and knowledge of nurses at the host country
AIM The aim of this programme was to stimulate professional development and collaboration of critical care nurses through an exchange programme involving visits to critical care units across European countries.
METHODS Audit their visit by using a evaluation form with question concerning organization of visit and stay in the host country, exchange of competences and collaboration , and achieving their own objectives.
RESULTS 42 ICU nurses from 7 different countries have participated in the exchange programme. The countries who participated were Italy, Norway, Cyprus, Serbia, United Kingdom, Croatia
and Spain. 60 % of the nurses responded to the audit and answered the evaluation form. In their evaluation forms the participants valued the exchange of professional skills and sharing competences with critical care nurses from the host country. They were also grateful for all the help with the arrangements made by the representative from the hosting country and mentioned positively the support from the local mentor who was in charge of the program at the visiting hospital.
CONCLUSION During past 5 years European Federation of Critical Care Nurses set standards for using this program and to share expertise across the Europe. This programme promotes international collaboration and stimulates professional collaboration of critical care nurses.
C40: A collaborative development of a Bespoke Band 4 Cardiac Assistant Practitioner Foundation Degree Mrs Helen Cox, Mrs Lesley Donovan, University of the West of England The aim of this presentation is to discuss the collaborative development between the University of the West of England and the British Heart Foundation (BHF) including student progression. The NHS workforce is changing and it is forecasted that the qualified nursing workforce would diminish and the role of the Health Care Assistant (HCA)/Assistant Practitioner (AP) would be crucial in ensuring and maintaining the quality of patient care (NHS Employers 2009). The educational development of HCA’s to date has predominately been through the National Vocational Qualification (NVQ) route. The career framework for the NHS advocated a more structured approach to training and role competence for the entire workforce (DH 2004, 2010). Whilst the role of the Assistant Practitioner has been advanced to compliment and work across professional groups (DoH 2003), the educational attainment has also reflected this advanced role development, the consensus amongst the literature being that education should be at Foundation Degree level (Wakefield 2010). In light of the changing workforce needs the BHF advertised sponsorship for BHF Cardiac Assistant Practitioners, funded for two years within NHS trusts with the University of the West England commissioned to develop a bespoke programme leading to an FdSc Integrated Professional Development. References: Department of Health (2004) Delivering the NSH improvement plan : The workforce contribution. Department of Health. London Department of Health (2010) Widening Participation in Preregistration Nursing Programmes, London: DH. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalasse ts/@dh/@en/@ps/documents/digitalasset/dh_116655.pdf (accessed 07/02/12) NHS Employers (2009)Discussion paper 3: the role of the nurse. Tinyurl.com/role-discuss-paper Wakefield, A. Solisbury, K. Atkin, K. (2010) What work do assistant practitioners do and where do they fit in the nursing workforce : 106 (12) 14-17
C41: Two Years On: The Assistant Practitioner Role Reviewed Mrs Leisa Bingham, Mrs Rachel Spreadborough, University Hospital Southampton University Foundation Trust The Assistant Practitioner (AP) role was designed as an affordable solution to address staff recruitment shortages brought about by ever growing healthcare budget pressures. The purpose of the role was to provide patient focused care to assist the Registered Practitioner, allowing the Registered Practitioner to focus on more complex patient needs. Two years have passed since its introduction and now is the right time to draw breath to evaluate its impact, its successes and failures and to consider the opportunities for its future development. This paper will examine the structured implementation of the role at Southampton CTITU, alongside senior Band 5 (UB5) nurses. It explores initial stages of resistance from the UB5 team and the strategies employed to smooth these obstacles. Education was used as a key tool, with study day sessions put in place to build understanding and provide a forum for staff to express their concerns and be involved in establishing inclusion and exclusion patient allocation criteria. The paper finds the AP role, if introduced correctly can provide a highly proficient support, leading to improvements in quality and patient experience. Looking forward the question now is whether to increase capacity and widen the search to attract the young college leavers keen for a career in nursing but without the necessary qualifications to embark on the degree pathway.
C42: Using Story Dialogue Methodology to Explore how Nursing Students Construct Knowledge and Understanding about Complexity of Care Through a Critical Care Patient's Story Lorraine Burgess, Dr Lorna Porcellato, Dr Trish Livsey, Prof Fiona Irvine, Liverpool John Moores University, Staffordshire University BACKGROUND Critical care patients have unique needs that require insight of all healthcare professionals who care for them throughout their journey from critical illness back the health.
AIM To analyse how nursing students construct knowledge and understanding about “complexity of patient care” through exploration of a unique patient story.
METHOD Story dialogue methodology (SDM) has its roots in qualitative methods and is derived from critical pedagogy and constructivist theory (Labonte, Feather, & Hills, 1999,) with a purposive sample of twelve 3rd year pre-registration nursing students.
DATA COLLECTION Four workshops were conducted between June and September 2010, In February 2011 the participants took part in a focus group discussion about their practice experience.
DATA ANALYSIS The reflective dialogues from the workshops and the focus group were transcribed verbatim and analysed using NViVO 9 software.
FINDINGS Insights generated by the participants: Environment, Touch, Fear of death, Trust, Delirium, Control & Relationships
DISCUSSION The participants made sense of their insights through reflection of their past experiences, and being able to see the world through the patient's eyes.
CONCLUSION Through a participatory research method we have demonstrated how participants are able to demonstrate critical consciousness: showing how their knowledge empowers their practice developing their understanding of the critical care patient experience. Implications for practice. This study shows that nursing students are able to gain critical insights into the complex world of the critically ill, this could be a potential teaching and learning intervention for an area of nursing where practice placements are limited. References: Labonte, R., Feather, J. and Hills, M. (1999) A story/dialogue method for health promotion knowledge development and evaluation. Health Education Research, 14(1), 39-50. Simpson, K. and Freeman, R. (2004) Critical health promotion and education--a new research challenge. Health Education Research, 19(3), 340-8.
C43: Critical Care Nursing Skills Utilised in Global Medical Assistance Mrs Phyllis Fearon, Mrs Linda McCready, Southern Health & Social Care Trust NI Medical assistance is an area of nursing that may not necessarily be associated with critical care nursing as it is often remote from the patient and not face to face except in the cases of medically escorted movements. The skills that critical care nurses have obtained during clinical practice are highly sought and valuable in this speciality. Sometimes creativity in obtaining an in depth patient assessment is required and may involve not only the patient and the nurse but other health care professionals, family, friends and colleagues. I will discuss how critical care skills are transferrable into the world of medical assistance and the challenges that are presented to critical care nurses when they are remote from the patient they are managing. A further focus will be the varying standards of international healthcare and the additional knowledge required to support patients where appropriate levels of medical care may not be readily available hence the need for medical evacuation.
C44: Implantation of the 'NurseTutor' Figure for Training and Teaching Staff in an ICU, From a Spanish Hospital Mrs Miryam Gonzalez Cebrian, Marques De Valdecilla University Hospital, University Of Cantabria, Spain; Mr Hector Gomez Garcia, Salamanca University Hospital, Spain AIM To explain the role of the ‘nurse-tutor’ figure in order to improve the quality of the patient’s care and the nurses’ safety. Materials and Methods: The criterion to select this figure is based on a profile created by the hospital’s Nursing Department, which must include: - A nurse with proven experience in ICU and up to date training. - Teaching and training skills. This figure should preferably be in the morning shift and should not be assigned care loads, except for service needs and those inherent in the supervision of newly hired staff. This figure performs the following functions: 1. 2. 3. 4. 5.
Tutoring and training of the newly hired personnel, within and outside the ICU, and their supervision during the shift. Review protocols and create working groups. Support the rest of the staff with the new techniques and clinical practice. Training/organization of intra/extra ICU courses. Support, on demand, in other hospitalization areas that work with patients who require the same cares that the critically ill patients. Evaluation of the newly hired staff.
CONCLUSIONS We think that the creation of this figure can lead to a care of higher quality and a higher safety for the patient, and it will help to improve the safety in the professionals’ nursing practice. We consider that it is necessary to make an assessment through a survey to evaluate this project in a more exhaustive way.
C45: Back to Basics: Critical Care in an Extreme Environment Miss Kay Mitchell, University College London Critical care units care for our sickest patients, using complex treatments, and technology, managed by an expert multidisciplinary team. These units sit at the heart of institutions that offer sophisticated investigations and treatments that help the critical care team save lives. Yet, when such an environment is not available it is still possible to provide high quality critical care.
A case study illustrates how skilled practitioners provided critical care at Everest Base Camp (EBC). The Caudwell Xtreme Everest research expedition in 2007 studied 220 healthy volunteers trekking to EBC to investigate hypoxaemia. One of the volunteers developed abdominal pain at EBC and was suspected to have a perforated abdominal viscus. Within hours she became very unwell and required high dependency care whilst awaiting helicopter evacuation. A team of doctors and a dietician, organised by a critical care nurse, cared for the volunteer in a make shift HDU until she could be evacuated. The team had access to basic monitoring equipment, but were reliant on traditional assessment skills to ensure the woman remained stable. The team used the diverse experience of its members to deliver quality care, whilst maintaining the dignity of the volunteer, and supporting the needs of her family.
C46: Delirium - a Choice of Two Tools Mrs Claire Pegg, Mr Nuno Pinto, Mrs Catherine Plowright, Medway Maritime Foundation Trust BACKGROUND Delirium is a serious and common disorder in ICU patients. It is increasingly recognized that screening of ICU patients is a valuable tool for early detection and treatment of delirium. The presence of delirium will affect patients by increasing length of hospital stay, (McCusker 2003), morbidity (Moller 1998) and mortality (McCusker 2002) and will have long term quality of life affects (Inouye 1998). Delirium has become a more recognised condition within our Intensive Care Unit due to the implementation of the Intensive Care Delirium Screening Checklist (ICDSC) three years ago. Because of our awareness of the subject, and our growing Critical Care Research Team, we were invited to take part in a study to look at whether a prediction model for delirium, would facilitate the implementation of preventative measures. By taking part in the study, we had to introduce the use of the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) when screening for delirium. This meant that all the staff had to be trained to use this new tool and subsequently assessed during the trial period to look at the screening compliance and the accuracy of the screening.
AIM This presentation will discuss the problems and difficulties of introducing CAM-ICU.
METHOD A questionnaire was used to ask nursesâ€™ opinions and preference on the two delirium tools. Staff rated both the delirium screening tools and were asked to decide which of the tools they wanted to use.
FINDINGS We will present our findings looking specifically at the nursesâ€™ preference to ease of use and perceived effectiveness and why they had come to these conclusions.
References: Inouye, S. Rushing, J. Foreman, M. Palmer, R. and Pompei, P. (1998), Does Delirium Contribute to Poor Hospital Outcomes? Journal of General Internal Medicine, 13: 234-242. McCusker, J. Cole, M. Abrahamowicz, M. Primeau, F. Belzile, E. (2002) Delirium Predicts 12-month Mortality. Arch Intern Med. 2002;162:457-463. McCusker, J., Cole, M. Dendukuri, N. and Belzile, E. (2003), Does Delirium Increase Hospital Stay? Journal of the American Geriatrics Society, 51: 1539-1546. Moller, J. Cluitmans, P. Rasmussen, L. Houx, P. Rasmussen, H. Canet, J. Rabbitt, P. Jolles, J. Larsen, K. Hanning, C. Langeron, O. Johnson, T. Lauven, P. Kristensen, P. Biedler, A. van Beem, H. Fraidakis, O. Silverstein, J. Beneken, J. Gravenstein, J. (1998) Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. The Lancet, (351), 9106, Pages 857 - 861, 21 March 1998
C47: Therapuetic Hypothermia Following Cardiac Arrest: A review of the evidence Tim Collins, Maidstone & Tunbridge Wells NHS Trust Over the last decade there has been a number of research papers published focusing upon the use of Therapuetic Hypothermia (TH) following cardiac arrest. Within the literature and clinical practice there is controversy and debate in its use(Collins et al 2008). In March 2011 this led to NICE guidance being published and the Resuscitation Council (2010) advocating TH as an intervention to be used following cardiac arrest. However, despite this, Binks et (2010) found that the implementation of TH within critical care was varied with 86% of ICUs having adopted this treatment into practice with confusion on whether to provide TH for just shockable or non shockable post cardiac arrest patients. Collins et al (2008) & NICE (2011) state that the evidence supports the use of TH following VF cardiac arrest but there is limited research supporting its use following non-shockable cardiac arrest rythms. However, the UK Resuscitation Council (2010) advocate TH to non-shockable rhythms but do acknowledge this research limitation. This presentation aims to provide an evidence based review on the use of TH following cardiac arrest and will provide recommendations for enhancing practice based upon critiquing the literature. The presentation will have the following aims: 1. Critically review the current literature & evidence based behind TH following cardiac arrest. 2. Review the physiology behind how TH may improve outcome following cardiac arrest 3. Evaluate current cooling methods and approaches to TH. 4. Present my Trusts TH clinical guideline. 5. Discuss audit results that evaluate the validity and reliability of the Trusts TH guideline. The audit results found that patients were getting cooled within the appropriate time frame as advocated within the literature and that patients were receiving no untoward complications. This presentation will aim to provide a review of the literature and current recommendations on the use of TH following cardiac arrest.
References: Binks A, Murphy R, Prout R et al (2010) Therapuetic hypothermia following cardiac arrest- Implementation into UK Intensive Care Units. Anaesthesia. 65:260-265. Collins T & Samworth P (2008) Therapeutic Hypothermia following cardiac arrest: a review of the evidence. Nursing in Critical Care. 13:144-151. NICE (2011) Therapuetic Hypothermia following cardiac arrest: Interventional Guidelines. NICE. UK Resuscitation Council (2010) Advanced Life Support Manual. 6th Ed. Resuscitation Council.
C48: Prevalence, Management and Clinical Challenges Associated with Acute Fecal Incontinence (AFId) in the ICU and Critical Care Settings: The FIRST (Fecal Incontinence Re-Evaluation STudy) Programme Ms Rachel Binks, C Dierkes, G Niederalt, Duncan Wyncoll, E De Luca, A Franci, C BayinGarcia, E Gallart, Airedale NHS Foundation Trust, University of Regensburg, Guy’s & St Thomas' NHS Foundation Trust, Policlinico Tor Vergata, Rome, Italy Introduction: The management of fecal incontinence with diarrhea (AFId) in the critical care setting is a priority in order to reduce the risk of perineal dermatitis, skin breakdown and transmission of infection, 1, 2 but there is a lack of data on the prevalence.3
OBJECTIVES The FIRST Programme aims to collect data around AFId in the critical care setting in Europe; prevalence and clinical consequences, and the awareness, management, and challenges of AFId for healthcare professionals. Methods: A cross-sectional, descriptive survey, containing 20 questions for healthcare professionals and 6 for hospital pharmacists or purchasing personnel, was conducted in 11 European countries. A prospective, observational study is taking place in Germany, Italy, Spain and the UK. Approximately 15 ICUs/critical care units per country will enroll up to 15 patients with AFId and follow for up to 15 days, or until they leave the ICU. Daily observations of routine care will be recorded. In parallel, an international advisory board is developing an expert opinion on the management of AFId.
RESULTS 1695 surveys were completed by nurses (64%), physicians (27%) and pharmacists or purchasing personnel (9%). Estimated prevalence ranged from 9-29%. 60% of respondents estimated that 10-20 minutes are required for managing an AFId episode, requiring 2-3 healthcare staff. Reducing the risk of cross-infection and protecting skin integrity were rated as the most important clinical challenges. The key reported benefits of fecal management systems (FMS) were reduced risk of cross-contamination, and reduced risk of skin breakdown. Main reasons reported for not using FMS was lack of availability or that devices were not included in hospital guidelines. Preliminary data from the observational study will be presented.
Conclusions: AFId in the critical care setting may be an underestimated problem and further research is warranted. An observational study is set up to collect more robust data. References: 1. Bardsley A. More guidance on acute fecal incontinence is a priority.Continence UK. Management of fecal incontinence supplement; p4. 2. Padmanabhan A, et al. Clinical evaluation of a flexible fecal incontinence management system. Amer J Crit Care.2007;16:384-93.3. Ousey K, Gillibrand W. Using fecal collectors to reduce wound contamination. Wounds UK 2010; volume 6, number 1. Grant Acknowledgement. ConvaTec, Skillman, New Jersey.
C49: "An Apple a Day Keeps the Doctor Away" Mrs Deborah Higgs, Mrs Allyson Wren, East Kent Hospitals University NHS Foundation Trust EKHNT has invested in VitalPAC an electronic, wireless point of care system, using hand held Apple iPod touches /iPads which incorporates sophisticated decision support tools and is fully localised to the hospitals’ needs. It attempts to address the fundamental question of “who, where and how is my patient?” so that interventions can be started earlier, reducing complications and unnecessary mortality. The overall object of this investment is to improve patient safety and outcomes. Published research shows that patients face significant risks in the way that acute care in delivered: estimates suggest that in the UK each year up to 40,000 hospital inpatients die, 23,000 suffer cardiac arrests and 20,00 are admitted to ICU because of failure to identify and respond to signs of deterioration A VitalPAC benefits realisation dashboard has been developed to continually monitor performance against agreed metrics and this has identified significant improvements in the accuracy and timeliness of observations, and an improvement in the escalation process for acutely ill patients. It is anticipated that by September 2012 we will also see a reduction in cardiac arrest calls. This presentation will use Apple technology to demonstrate a live connection to the trusts VitalPAC performance data, provide an overview of the implementation process and describe the benefits realised to date.
C50: Developing a Critical Care SKIN Bundle - The North West Critical Care Networks Approach Andrea Berry, Lead Nurse Greater Manchester Critical Care Network, Andrea Baldwin, Network Director-Lead Nurse, Lancashire & South Cumbria Critical Care Network The nature of critical illness means patients are often at “higher risk” of developing pressure ulcers. The reasons for the increased risk are many. The national drivers to improve care are clear and abundant.
Local evidence was based on audit of critical incidents from 12 trusts across the North West, which provided an understanding of the size of the problem and specific areas which needed addressing.
Clinical relevance: Improving quality and patient safety are key to the work of Critical Care Networks; this project demonstrates the value of working across organisations to achieve benefits for patients.
The AIM of this project is to reduce overall incidence of pressure ulcers and eradicate grade 3 & 4 ulcers acquired in critical care. The project plan was to agree a Critical Care SKIN bundle plus tools and documentation; prepare an e-learning package to underpin the project and develop an audit tool. A working group was formed with representation from Critical Care Units across the North West.
References: NICE (2005) The prevention and treatment of pressure ulcers. Department of Health (2010) Essence of Care 2010 Benchmark for Prevention and Management of Pressure Ulcers. Tissue Viability Society (2012) Achieving Consensus in Pressure Ulcer Reporting. 2012
RESULTS Benchmark audit of compliance to the SKIN Bundle was undertaken to establish a
DISCUSSION The audit of critical incidents and compliance to the bundle have provided sufficient evidence to demonstrate that areas of practice that can be improved.
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VIPER Abstracts V01: Using Simulation to Assess
V02: Utilising Technology for
Clinical Skills: Sharing Experiences of an Intensive Care Nursing OSCE
Learning in Critical Care Mrs Hayley Gilbrook, West Suffolk Hospital
Heather Baid, Jessica Hargreaves, School of Nursing and Midwifery, University of Brighton BACKGROUND
Mrs Hayley Gilbrook, West Suffolk Hospital As we continually strive to make improvements in education, it seems unavoidable but to utilise and integrate current technologies into our teaching. As a Professional Development Sister within a Critical Care environment my role is to teach and educate individuals, teaching them the skills required to undertake clinical tasks and the theory to enhance their clinical practice. As patient care is obviously a priority the need to be creative with teaching opportunities is always a challenge.
Increasingly simulation is being used to supplement the practice-based assessment of clinical skills (Murray et al. 2008). The advantages of using simulation include standardising the assessment process, controlling the variables of exam conditions and providing a safe / familiar environment for students to demonstrate their knowledge and skills (Byrne and Smyth 2008). However, simulation and OSCEs (Objective Structured Clinical Examination) in particular are known to induce high levels of anxiety which may unduly hamper student performance. In addition, there are resource implications related to establishing credible scenarios and staffing. A further criticism is simulation does not reflect the reality and complexity of clinical practice (Walsh et al. 2009).
Following a successful research project looking at utilising video Podcasts for learning within Critical Care this poster presentation aims to highlight and encourage the use of technology to deliver bite-sized learning via Quick Response (QR) codes.
V03: Curriculum Design and
The purpose of this presentation is to share recent experiences of simulation assessments in order to:
Development of Critical Care Module Mrs Valerie Poole, Stockport Foundation NHS Trust
facilitate the appropriate use of this assessment tool by educators support students and their mentors preparing for OSCEs / simulation assessments
The simulation assessment was conducted as an objective structured clinical examination (OSCE). The nurse was given a patient scenario with a respiratory focus and asked to perform the following clinical skills: respiratory assessment and arterial blood gas analysis.
Recently the NHS has recognised the need for change to the education and training of the health care workforce, aiming for a system that is driven by employers where staff development is critical to the delivery of safe, high quality care (Field 2011). In light of National Health Service (NHS) reforms, critical care has a number of challenges in ensuring it has the ability to deliver services fit for purpose and if organisations are to meet the requirements of the National Institute for Clinical Excellence (NICE) there is a need for the development of a critical care programme that matches learners needs, values and aspirations.
RECOMMENDATIONS • • •
Preparation of examiners / students Clear assessment criteria Align assessment with learning outcomes
References: Murray, C., M.J. Grant, M.L. Howarth, and J. Leigh. 2008. The use of simulation as a teaching and learning approach to support practice learning. Nurse Education in Practice 8 (1):5-8. Byrne, E., and S. Smyth. 2008. Lecturers' experiences and perspectives of using an objective structured clinical examination. Nurse Education in Practice 8 (4):283-289. Walsh, M., P.H. Bailey, and I. Koren. 2009. Objective structured clinical evaluation of clinical competence: an integrative review. Journal of Advanced Nursing 65 (8):1584-1595.
A more recent review of critical care education highlighted concerns regarding significant variance in the quality and delivery of critical care educational programmes (National Standards for Critical Care Nurse Education 2008). The review by the Critical Care Network voiced concerns in relation to the variances developed in the types of courses offered by HEIs with no clear standards for competence, leading to disparity between levels of staff education in individual units. Furthermore, the review highlighted concerns from service managers who believe the fundamental differences and quality of critical care education, staff knowledge and clinical competency was having an impact upon recruitment and retention. The module was developed in partnership with, and at the request of the Critical Care Network, the vision an ongoing engagement with the region’s hospitals, Critical Care Skills Institute, HEIs, and the Critical Care Network working together to deliver a highly trained and educated acute and critical care workforce.
V04: Improving Oral Hygiene and Peristomal Care in ICU Using Anchorfast Shaun Maher, Marianne Mallice, NHS Forth Valley In order to improve patient safety and reduce healthcare costs the reduction of ventilator associated pneumonia (VAP) is currently a high priority in the Intensive Care Unit (ICU). Supporting breathing and maintaining the airway by means of an endo-tracheal tube (ETT) and obtaining access to the mouth to perform effective oral hygiene is vital for ICU patients. The most common method of securing the ETT is by tying it using cotton or applying adhesive tape. Both of these methods can be problematic because of the trauma they cause to the peristomal area and obtaining access to the oral cavity to perform effective hygiene. In November 2011 we evaluated the Anchorfast ETT securing system and found it beneficial in a number of ways: 1 2 3 4 5
held the ETT securely in place facilitated movement of the ETT without compromising the airway facilitated good access to the oral cavity to perform hygiene avoided damage to the peristomal area patients seemed to find Anchorfast more comfortable and families commented that they thought their loved one looked more comfortable.
Following evaluation we now routinely consider Anchorfast for patients invasively ventilated for >24hrs. Compared to the harm that can be caused by poor oral hygiene and to the peristomal area by traditional methods of securing the ETT, Anchorfast, in conjunction with an effective oral hygiene protocol, would seem to be a cost effective alternative and potentially beneficial for this group of patients.
V05: Tales from a Trauma Centre: Traumatic Brain Injury (TBI) Miss Joanna Hunter, King's College Hospital NHS Foundation Trust This presentation examines a case study of a young man following a scooter versus car collision, suffering extensive head injury. The immediate care of this patient on arrival to critical care is explored and national guidelines examined. The subsequent specialist neurological care that followed is based on current evidence and recommendations. Kingsâ€™ College Hospital NHS Foundation Trust became a Trauma centre in 2010. In our first two years of Trauma we have admitted 293 patients with traumatic brain injury. Many of these patients are between the ages of 16 and 40 and their mechanism of injury is through road traffic collision, fall or assault.
traumatic brain injury is classified as a head injury with a resulting Glasgow Coma Score of less than 9 (BTF 2007). Neurological damage following TBI does not just occur at the moment of impact (primary injury) but can occur later over hours and days (secondary injury). Patient outcomes improve when secondary injuries are prevented or when the patient is successfully responsive to early treatment (Hammell and Henning 2009). Extensive research is occurring within the field of TBI and this presentation will also discuss the studies Kingâ€™s College Hospital is involved in to evaluate clinical outcome and effectiveness of care of such a young patient population. References: Brain Trauma Foundation (2007). Guidelines for the Management of Severe Traumatic Brain Injury. Journal of Neurotrauma 24, Supplement 1. Hammell CL and Henning JD (2009) Prehospital Management of Severe Traumatic Brain Injury. BMJ Vol 38, 23 May 2009 Headway (2011) www.headway.org.uk
The use of Anchor Fast Endotracheal Tube Fastener in the safe and effective management of the proned patient Linda Gregson, Royal Blackburn Hospital
Aim/objective: To observe if the Anchor Fast Oral Endotracheal Tube Fastener provided a safe option to secure the ET tube while the patient was managed in the prone position. Intervention(s): The patient was admitted to the unit with a diagnosis of PCP(Pneumocystis carinii pneumonia). Within 6 hours of admission, the patient was fully ventilated at 90% FIO2(Fraction of Inspired Oxygen) with 10cm PEEP(Positive End Expired Pressure) and was extremely PEEP dependant. Following only 36 hours ventilation it was noted that a pressure sore was developing at the side of the patient's mouth due to the pressure from the ET tape. The decision was made to prone the patient and to apply the Anchor Fast before hand to secure the ET tube. Main Outcome: The patient was nursed in the prone position for 18 hours before returning supine. The Endotracheal tube was extremely secure and all medical and nursing staff felt that it made nursing this patient safer and easier. Conclusion: Use of Anchor Fast Endotracheal tube fastener proved to provide in this case a safe and secure option for the management of ET tubes while patients are nursed in the prone position.
Around 135,000 people a year are admitted to hospital due to the seriousness of their head injury (Headway 2011). Severe
V07: Use Of Interventional Lung Assist (ILA) in the Intensive Care Setting - Are We Following Best Practice Guidelines? Dr Sophie James, Dr Susannah Eyre-Brook, Oxford Radcliffe Trust PURPOSE Interventional lung assist (iLA) is a device used to improve gas exchange by removing carbon dioxide from the blood stream in critically ill patients, for example in acute respiratory distress syndrome (ARDS). Our aim was to assess whether iLA is being used appropriately and with the highest standard of care in the Oxford Radcliffe Hospitals (ORH). NICE have published guidelines for the use of extracorporeal membranous oxygenation (ECMO). No best practice guidelines for iLA exist.
DESIGN / METHODOLOGY: We have audited the use of iLA in the ORH adult intensive care unit (AICU). We adapted the existing ECMO guidelines to assess whether best practice is being acheived in terms of consent, patient safety and outcomes.
RESULTS Between 2007-2008 case notes were available for 3 patients who received iLA. All patients were hypercapnic; 2 attributable to ARDS, 1 to asthma. There was no evidece of written information or consent but discussion with family members was documented. In all 3 patients there was a trend of improving ventilatory parameters (PaCO2, PaO2 and FiO2:PaO2). 1 patient died in hospital and 1 patient died within 6 months. 1 patient required vascular reconstruction and amputation was recommended in another. There was no documentation of pressure sores in medical notes.
CONCLUSIONS: The application of iLA in the ORH AICU is not currently meeting the highest possible standards. We have developed an iLA-specific check-list to ensure appropriate patient selection, informed written consent, and guidance for monitoring to avoid complications such as pressure sores, vascular reconstruction and limb ischaemia.
V08: Organ and Tissue Donation: an Evaluation of Health Care Professionals’ Knowledge and Training and Implications for Education Tim Collins, Maidstone Hospital Abstract for VIPER presentation - Organ and tissue donation: an evaluation of health care professionals’ knowledge and training and implications for education Currently there is a national shortage of organs and tissues available for transplantation (DH 2008). An organ or tissue transplant has been proven to be an effective life enhancing
treatment for end-stage organ or tissue failure (Collins 2005). The UK has one of the highest transplant waiting lists in Europe, with currently 8,000 people in the UK waiting for a transplant with the figure rising by around 5% per year (NICE 2011). In 2008, the Department of Health (DH) recommended that all health care staff who potentially participate in the care of donor patients should receive appropriate education and training. This VIPER presentation aims to provide an overview of a doctoral thesis that is currently being undertaking as part of a Doctorate of Education (EdD) at the University of Greenwich. The poster shows the research aims, hypothesis, methodology, design and summary of current progress of the study. In January 2012, the study became a registered critical care portfolio study with the National Institute for Health Research (NIHR). With the study being enlisted onto the NIHR portfolio this provided the opportunity to gain recruitment from a sample of 1180 doctors, nurses & operating department practitioners working within critical care from 18 sites including transplant centres, trauma, neurological and general hospitals within England. This multi-site study aims to evaluate the impact of current education and training on organ and tissue donation at both pre-registration and post registration level and the degree to which this knowledge is subsequently applied to clinical practice by health professionals specifically to identify whether there is an impact on staff knowledge and perceived confidence in clinical practice when managing a potential organ donor patient. In doing so it is anticipated that this study will contribute to an understanding of the impact that education and training has in relation to health care professionals’ knowledge, attitude and practice towards organ and tissue donation. The poster presentation will provide a summary of the progress of this portfolio study. References: Collins (2005) Organ and tissue donation: a survey of nurse’s knowledge and educational needs in an adult ITU. Intensive & Critical Care Nursing, 21:226-233. Department of Health (2008) Organs for Transplants: A report from the organ donation task force. DH. London. NICE (2011). Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. www.nice.org.uk.
V09: Nurse Perception on the Introduction of Citrate Ms Simone Hunter, Mrs Rachel Fenton, Mr Christopher Bolwell, West Suffolk Hospital At the beginning of this year citrate therapy was introduced to our critical care unit for the purpose of Continuous Renal Replacement Therapy (CRRT). Current anticoagulants did not seem to be best practice, with many filter sets being disposed of shortly after starting. Despite a comprehensive algorithm, patients’ clotting was frequently affected too. The Renal Interest group based on Critical Care looked into changing the current use of anticoagulants for CRRT and found citrate was the forerunner in this area. The introduction of citrate was a completely new way for nurses to care for patients on CRRT. Therefore we wanted to know what nurses thought about using Citrate since implementation by sending out a questionnaire.
ViPER Abstracts The aim of this Viper is to show the finding of the questionnaire, showing what nurses thought about training, ease of use, patient benefits and any problems that have occurred and solutions to those problems. Above all this paper will hopefully demonstrate that with committed staff, change can happen relatively and ensure our patients receive best practice.
V10: Leading and Developing a Tool to Evidence the Effectiveness of a Critical Care Outreach Team
Gao H, Harrison D, Parry G, Daly K, Subbe C, Rowan K (2007) The impact of critical care outreach services in England: a multicentre interrupted time-series analysis. Critical Care. 2007; 11(5): R113. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556766/ (accessed 05 April 2012)
V11: Development and piloting of a Critical Care Follow-up Evaluation and scoring Tool (CCFU - TEST)
Joanna Wailing, Denise Hinge, Brighton and Sussex University Hospitals Trust
RGN Carolyn Barrett, Dr Jez Fabes, Dr John Griffiths, RODP Elizabeth Horwell, Mr William Seligman, Oxford University Hospital Trust
The principles and effectiveness of “critical care outreach” teams (CCOT) have been widely debated, with the only multicentre study unable to demonstrate a positive impact. (Gao et al 2007) There is a lack of benchmarking tools for CCOT's to evaluate their service, promote quality assurance and lobby for change or funding. There is a lack of understanding of what CCOT's “actually do” by those responsible for financial decision making. CCOT's are shrinking within the current financial climate, despite recognised higher patient acuity and throughput increasing their workload. CCOT's must be able to demonstrate effectiveness of service provision and impact on quality of patient care in this environment.
PROCESS A scorecard was developed incorporating local standards and those developed by the national outreach forum in 2007. The scorecard aimed to transparently evaluate service provision and provide meaningful data for interpretation by the team and the trust. We concurrently reviewed efficiencies of the team's data gathering to ensure that we upheld “lean” management principles.
CONCLUSION/DISCUSSION The tool provides evidence for the CCOT to be lead and managed more effectively. The tool provides easily understandable evidence which demonstrates the impact and effectiveness of the CCOT. The tool has benchmarked outcomes, including those which focus on patient quality, safety, and staff education and has provided cost savings. The tool allows demonstration of direct care time spent with patients, and identifies areas for improvement and business case evidence for headcount. This tool took weeks to develop and months to find the data to populate it. This highlights the need for trusts to evaluate evidence using transparent integrated systems. This unique tool is being evaluated by the national outreach forum for wider use. This ViPER aims to evaluate the results and discuss the positive and negative impact of this evidence base for service provision by a CCOT.
Goals of ICU follow-up are to promptly identify deteriorating patients after ICU discharge and try and prevent ICU readmissions. Two potential mechanisms of identifying patients at greatest risk of deterioration and subsequent ICU readmission are appropriate risk stratification at time of ICU discharge, and daily, targeted follow-up.
OBJECTIVES To generate a simple model to quantify individual patient risk of poor outcome after ICU discharge. To develop a quantitative tool to guide ICU follow-up care and track progress post-ICU discharge. To assess the 12-month impact of these tools on patient outcome
DESIGN A risk assessment model for post-ICU death and readmission has been locally validated and is being piloted. A discharge and daily follow-up tool incorporating physiological and laboratory parameters with other ICU-related factors has been developed. This tool includes flow sheets that monitor compliance with NICE guidelines CG83 (1) and attainment of goals detailed on the ICU discharge summary.
CONCLUSION Analysis of patient demographic and ICU-related data revealed multiple prognostic factors that were used to guide risk stratification and follow-up intensity. The follow-up tool is currently under assessment and development in a 12-month prospective cohort of ICU discharges. The first six months of data will be presented. References: National Institute for Health and Clinical Excellence (2009) Rehabilitation after critical illness. London: National Institute for Health and Clinical Excellence
References: Department of health critical care outreach forum stakeholders and national outreach forum (2007) Clinical Indicators for critical care outreach services http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalasse ts/@dh/@en/documents/digitalasset/dh_073187.pdf (accessed 05 April 2012)
V12: Non Invasive Ventilation Ms Laura Harvey, Mrs Joanne Howieson, Ayrshire & Arran Acute Hospitals For many patients, non invasive ventilation is their last hope of a successful outcome, particularly patients with end stage Chronic Obstructive Pulmonary Disease (COPD). This population of patients are not usually candidates for invasive ventilation or intensive care support due to the advanced stages of their disease. In Scotland, approximately 15% of this patient population will require NIV at some stage of their illness, usually when an infective exacerbation of their disease causes reduced ventilation and an increase in carbon dioxide beyond their usual compensatory limit. The aim of the ViPER is to discuss the pathophysiology of hypercapnia/ end stage COPD and advanced concepts of BiPAP (Biphasic Positive Airway Pressure ventilation) and improve nurses understanding of its use in more complex conditions. It will present our working protocols, based onBritish Thoracic Society Guidelines and explore the more advanced management of problematic conditions and issues around patient compliance, patient synchrony, respiratory drive, oxygen tolerance and arterial blood gas interpretation. The power point presentation will display our protocol, our audit database and audit results and details of popular equipment. The "expert" will verbally highlight the following themes; Patient Selection Arterial blood gas analysis NIV problem solving Advanced aspects of application - e.g. with asthma, pneumothorax The ViPER will be informative and of value to any nurse that has any knowledge/experience of using NIV, either in ICU, HDU or acute ward settings. References: BTS (2002) Non Invasive Ventilation in acute respiratory failure, Thorax 57:192 - 211 RCP/ BTS (2008) Concise Guideline on NIV in Chronic Obstructive Pulmonary Disorder: management of type 2 respiratory failure
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Poster Display Abstracts
POSTERS Abstracts P01: Retrospective study of 22 patients with de-compensated respiratory acidosis treated with non-invasive ventilation. Iain Wheatley, Phillippa Dibley, Taru Sairanen, Bagnos Cudiamat, Lani Santos, Bukola Olayanju, Emma Fryer, Stacey Starr, Frimley Park Hospital NHS Foundation Trust The purpose of this study was to examine the practice of using non-invasive ventilation (NIV) as a ceiling level of treatment in patients with decompensated respiratory failure. Time to normalise pH was analysed against the range of Inspiratory positive airway pressure (IPAP) utilised. The purpose to identify an average level of IPAP to normalise pH and the time period of which this was achievable in order to guide future patient management.
P02: Improving Global Health through Leadership Development a UK Fellows Cambodian Experience Ruth Butler, Royal Berkshire NHS Foundation Trust “There are a number of opportunities where the UK can contribute even more effectively to building health capacity in developing countries” (Lord Crisp, 2007) One such unique and innovative opportunity is the “Improving Global Health (IGH) through Leadership Development programme”. This partnership between NHS South of England (Central) Leadership team and the Innovation and Development team engages clinicians and managers of all professional groups. International Fellows undertake an overseas placement of up to 6 months, providing the opportunity to develop leadership skills through project work by utilising quality improvement methods. The scheme has three simple but very powerful objectives:
A retrospective study of 22 patients with decompensated respiratory acidoses (pH <7.35 and paCO2 > 6ka) treated with NIV between October 1st 2011 and December 31st 2011. All patients reviewed were strictly not for intubation and had a clinical decision that NIV would be the limit or ceiling of treatment. Considering each one as successful if pH normalised and unsuccessful if NIV failure or patient death. Results indicate that out of 22 patients (age ranges 51-94yrs) in the study 15 patients successfully normalised their pH. The length of time it took to normalise pH (range 7.14 - 7.34kpa) ranged from 5 hours to 96 hours with a mean of 23.4hrs and mode 24hrs. Patients were often started on an IPAP of 12 cmH2O (ranges between 10 and 20cmH2O). IPAP pressure was titrated in 2cmH2O increments to a mean 18cmH2O (ranges 12 - 28cmH2O). 7 patients or 31.8% of patients died, 3 of these patients after moving to the general ward. Reasons for failure were mainly due to an inability to tolerate noninvasive ventilation.
CONCLUSIONS The use of non-invasive ventilation in patients where intubation would not be appropriate can provide an alternative avenue of treatment. Low starting pressure with IPAP 12 cmH2O may aid compliance but increasing IPAP to at least 18cmH2O in 2cmH2O increments can assist in reducing the time necessary for NIV and hasten the normalisation of pH. The mortality rate in this study reflects the patients who had been commenced on NIV as this was their ceiling of treatment. This has prompted a more thorough prescription plan for patients treated with NIV in order to manage escalation and de-escalation of treatment.
• Support sustainable improvement in healthcare • Provide an unparalleled personal and leadership development experience • Create a cadre of skilled clinical leaders with quality improvement skills for the NHS Using the NHS Leadership Framework individuals are able to maximise their potential to contribute in a sustainable way to capacity building both in developing countries and also on their return to the NHS. This poster presentation will demonstrate my personal and professional development through experience gained working in Cambodia with the Maddox Jolie Pitt Foundation (MJP) and how this will inform and enhance my future work within the NHS. Reference: Nigel Crisp (2007) Global Health Partnerships: The UK contribution to health in developing countries NHS Leadership Framework: June 2011
P03: Holistic Rehabilitation from Intensive Care: Lessons from America Joanne McPeake, University of Glasgow The Winston Churchill Memorial Trust is a grant making trust established as a living memorial to Sir Winston Churchill. Each year the Trust offers Travelling Fellowships to study areas of topical and personal interest for the benefit of their profession, community and the UK as a whole. The aim of this presentation will be to discuss my recent travelling fellowship to the USA.
Poster Display Abstracts BACKGROUND AND PURPOSE OF FELLOWSHIP The purpose of this Fellowship was to explore rehabilitation from the ICU. North American researchers have made major steps in developing strategies to prevent morbidity, mortality and improve quality of life after an intensive care stay; therefore, the USA was picked as the destination for this travelling fellowship. The main aims of this fellowship and key discussion points for this presentation are: • Analyse the role of the social worker in ICU and examine how this impacts on ICU recovery; • To explore methods of early mobilisation in ICU; • Critically evaluate the use of delirium assessment tool and their use in ICU; • Explore the use of patient and family advisory groups within the critical care environment.
Development of a Business Case to Improve the Method of Securing Endo-Tracheal (ET) Tubes Within the Critical Care Unit at the Royal Blackburn Hospital
Mrs Linda Gregson, Royal Blackburn Hospital Et tubes are currently secured using cotton tape threaded through two foam sleeves and passed around the neck then knotted tightly close to the mouth.
Introducing a collaborative approach to ward rounds on a busy critical care unit Mrs Jessica Wadsworth, Critical Care, Kings College Hospital BACKGROUND Expansion of Critical Care services at Kings College Hospital NHS Foundation Trust led to a large recruitment drive of Band 5 nurses, impacting on the skill mix of the nursing staff. To maintain high standards of patient care and improve communication, a more collaborative approach to ward rounds was implemented.
AIMS AND OBJECTIVES The aim of this project was to promote the nurses role during ward rounds. Designing a more structured format would allow nurses to become actively engaged and subsequently more involved in clinical decision-making.
METHODS The trial ran over 2 weeks on the 18 bed surgical unit involving 4 consultants and over 100 nurses of varying experience. Nursing and medical staff were consulted and asked to participate in the trial. During this time, staff were asked to complete a questionnaire regarding their experience.
FINDINGS RISK FACTORS WITH THIS METHOD OF SECUREMENT: • Increased risk of pressure damage around the mouth • Inadequate oral hygiene due to difficult access • High frequency of change due to oral secretions.
The majority of nursing (95%) and medical (88%) staff reported the presence and input of the nurse during ward round was vital to enhance patient care. Participants agreed that communication between all parties had also improved.
CONCLUSION CASE FOR CHANGE There has been no review of current practice for several years. Current practice has resulted in several susceptible patients acquiring pressure damage to lips/mouth after a short period of time. The need to achieve ventilator acquired pneumonia (VAP),High Impact Intervention, care bundles to reduce VAP.
Staff felt this collaborative approach was beneficial and since the trial the collaborative ward round continues to be a success. More development is required to perfect the process, including gaining patient feedback.
P06: Developing a Protocol for
DESCRIPTION OF PROPOSAL
Nasal High Flow Therapy in Medical HDU
Following discussion, it was decided to use Anchor Fast endotracheal tube(ET) fastener on any patient expected to be ventilated for more than 48hrs.
Ms Laura Harvey, Mr David McCrone, Ayrshire & Arran Acute Hospitals
OPTIONS AVAILABLE • Do nothing. • Use Anchor Fast.
BENEFIT APPRAISAL • Anchorfast permits easier access to oral cavity to improve oral hygiene, part of high impact care bundle to reduce VAP. • Easier reposition of tube from side to side to relieve pressure. • No need for neck tie thus reducing pressure damage.
Nasal High Flow Therapy (NHF) is a relatively new respiratory therapy that is able to deliver up to 70 litres of flow and 100% oxygen therapy which is heated and humidified (up to 99.4% humidification). It allows comfortable delivery of gases to patients with high flow requirements via a nasal cannula. It offers many advantages over other options such as CPAP etc (Hart, 2006). It can be used for many different patients, for example; those with hypercapnic and hypoxaemic respiratory failure and also as a palliative therapy.
Poster Display Abstracts We set out to develop an appropriate clinical guideline and develop a training and competency framework to support its safe introduction and use in Medical HDU. A literature review was carried out and we also networked with other HDUs that we knew were using NHF. From this, the guideline was developed with a quick algorithm for ease of use. A competency framework was also developed and staff teaching was arranged away from the clinical area, to give staff a working knowledge of physiology and effects of humidification on mucociliary clearance, as well as the technical aspects of using the equipment. An audit tool was also developed and tested - the guideline algorithm and audit tool will be displayed on the poster. To date, the results show that this is a very useful therapy for a large population of HDU patients. Since January 2012 20 patients have received NHF and audit data shows no evidence of treatment failure or non compliance. Patient feedback has been on the whole, positive. Patients find the nasal cannula more comfortable than the tight fitting mask required to deliver Positive pressure and it allows patients with even the highest oxygen requirements to communicate, eat and drink with relative ease.
P07: Swallow Screening Mrs Vanessa Harradon, Mrs Nichola Raval, Southampton University Foundation Trust BACKGROUND Patients with tracheostomy tubes have altered motor and sensory functions that may decrease their swallowing efficiency. Failure to recognize disorders in deglutition may result in dangerous complications including aspiration and death. Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. It also decreases length of stay and increases patient experience by promoting timely oral intake whilst supporting the Speech and Language therapists
AIMS & OBJECTIVES: • To improve the patient experience, whilst ventilated with tracheostomies, by not being nil by mouth inappropriately • Improve the psychological aspects of ventilator weaning • Decrease the time patients spend waiting for an initial swallowing assessment by an already pressured Speech and language therapy team • To validate an appropriate swallow screen tool used by health care professionals who are not speech language therapists • To carry out nurse led swallow screen assessment, identify dysphagia and refer to speech language therapists within a 24hour period STANDARDS/AUDIT MEASURES USED • Southampton University Trust Bedside Swallow Screen Guideline updated • 2012 Adapted from St Georges Hospital Trust London • 6 monthly data collection, to ensure compliance, with guidelines
RESULTS In a Cardiac Intensive Care Unit a Bedside Swallow Screen tool has been implemented by nursing staff for all patients with Tracheostomies with no neurological deficit. Involve Speech and language therapy team with the implementation of the new tool, guidelines and training. The Nursing staff, within Intensive Care, were given training, competencies completed and Guidelines implemented
ACTIONS • Ongoing observation in practice by Senior Nursing Team • Yearly teaching updates for all ICU staff involved in swallow screen assessments • 6 monthly data collection to ensure compliance with feedback to Speech and Language therapy team • Individual assessment and completion of competencies of post intensive care course staff • Ongoing work in progress, looking at oral dietary intake for patients with tracheostomies and, ventilation weaning.
CONCLUSIONS The Swallow Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both normal swallow and dysphagia in critical care patients with tracheostomies. It has promoted inter professional working within the multi disciplinary teams external to the unit. It has also enhanced patient experience and ensured timely commencement of oral diet
P08: Research Secondment: A Trial or a Triumph. Miss Abby Brown, The Royal Berkshire NHS Foundation Trust The Intensive Care Unit at the Royal Berkshire Hospital has been involved in large multicentre Comprehensive Local Research Network (CLRN) portfolio and commercial studies since 1997. The team has built up a national and international reputation for conducting high quality research. Part time secondment opportunities are available to nurses in the clinical setting to broaden their knowledge and skills within the research field. After being fortunate enough to join the research team, it was evident that there were many advantages as well as some disadvantages to undertaking such a secondment. Literature often shows the advantages to secondments, for example Hamilton, J (2001) states: “Secondment is seen as a positive opportunity that allows individuals to develop new skills, progress their career and meet new people”. This is correct for some parts of the role, but there are also the disadvantages that the clinical team do not always think about or see, these include having to change working patterns, occasionally being required to be on call or having the distinction between the clinical role and the research role blurred. This poster was designed to show how exciting, challenging and fulfilling such an opportunity can be and to hopefully encourage others to give research a try.
Poster Display Abstracts Reference Hamilton J, Wilkie C (2001). An appraisal of the use of secondment within a large teaching hospital. Journal of Nursing Management; 9(315-320).
The SBAR communication tool was implemented to escalate concern on deterioration and life threatening blood results and Think Glucose was implemented to prevent harm from hypoglycaemia.
P09: Early warning system
For 11 months, there were no deaths from avoidable deterioration, a 37% decrease in incidents where deterioration was reported and no cases of serious harm from hypoglycaemia.
calculation accuracy and action plan compliance Mrs Pamela Munro, Barts Health NHS Trust, Mrs Angie Rock, Welch Allyn Failure to rescue patients whose condition is rapidly deteriorating is an area of significant unintended harm in the healthcare environment. Physiological track and trigger warning systems have been introduced to assist ward staff in the timely recognition and appropriate response to patients at risk of clinical deterioration. These systems rely upon periodic observation of selected basic physiological signs (“tracking”) with predetermined calling or response criteria (“trigger”) for requesting the attendance of staff with specific acute/critical care competencies. Triggering should also lead to an increase in clinical vigilance with an associated prescribed increase in physiological monitoring. Accuracy of vital sign recording is therefore an essential component of any track and trigger system. This study, which is due to report June 2012, will take place on acute medical and surgical wards of a district general hospital and will simultaneously evaluate two methods of assessing the vital signs documentation, one standard manual recording and the other automated collection using a vital signs monitor. In addition the rate of compliance to the early warning system (EWS) risk band will be estimated to ascertain if the frequency of observations are in line with the relevant risk band. References Gearing, P. et al. (2006) Enhancing patient safety through electronic documentation of vital signs. Jnl. Healthcare Information Management, 20: 40 - 45 National Institute for Clinical Excellence (2007) Acutely ill patients in hospital. CG 50. NICE Patient Safety First (2012) www.patientsafety.nhs.uk
P10: Learning From Errors Mrs Catherine Plowright, Dr Vicky McLelland, Medway NHS Foundation Trust Following a number of serious incident investigations where avoidable deterioration contributed to the deaths of 11 patients, the Medway NHS Foundation Trust implemented a preventing patient deterioration project incorporating the lessons learned. The Consultant Nurse Critical Care was part of this project group. The project included monthly auditing of patient physiological observation charts and fluid balance charts and implementing a training course for non registered nurses. These aspects of the project were maintained by the Consultant Nurse and the Critical Care Outreach Team.
Further information can be obtained at www.patientsafetyfirst.nhs.uk
P11: To NEWS or not to Use Linda Kent, Frances Clark, Linda Chu, Anne Carter, Kim Williamson, Dr Elaine Hipwell, Frimley Park Hospital NHS Foundation Trust The Royal College of Physicians produced “Standardising the assessment of acute Illness severity in the NHS” which recommended using the National Early Warning Score (NEWS) for all patients over 16. At Frimley Park Hospital Foundation Trust the early warning score used is the Medical Emergency Team (MET) score which has been utilised for 11 years. The scoring system has been repeatedly reviewed and updated and following some adverse patient safety incidents a urine output score was added in 2009, allowing earlier recognition and intervention. NEWS does not include urine output. The Critical Care Outreach Team at Frimley has, as an initial review, looked at all patients with a MET score â‰¥6 for 2 months and rescored them against NEWS score. We found that 5% of patients seen by the Outreach Team had a urine output issue. Of these patients 2 (20%) were admitted to ICU for haemofiltration and 2 (20%) were transferred to a specialist renal centre. Although this is a small sample, we are continuing to look at this data for a further four months to assess the impact the implementation of the NEWS will have on identifying patients with renal impairment and subsequently timely intervention and treatment.
P12: Benefits of a Bowel Management System in the Critical Care Unit - A case study Mrs Ali Kelly, The Christie Hospital Management of faecal incontinence can be distressing to patients and challenging to healthcare professionals, use of a bowel management system (BMS) can improve quality of care, patient experience, promoting comfort and dignity, drive efficiency savings and reduce waste.
AIM / OBJECTIVE Explore the benefits of utilising a BMS Share patients and nursing staff experience of using a BMS
Poster Display Abstracts CASE STUDY The CCU is an 8 bed medical and surgical unit in a specialist Oncology hospital. Patient X was diagnosed with Acute Myeloid Leukaemia, he was admitted to CCU for respiratory support due to an increase in shortness of breath, decreased oxygen saturations, increased respiratory rate and increasing Oxygen requirements. Whilst in CCU he developed diarrhoea in large, frequent volumes, due to Norovirus. When rolling for sheet changes he became unstable developing arrhythmias, and also found this very painful. The BMS was inserted in CCU and remained in situ when the patient was discharged back to the ward.
CONCLUSION A review questionnaire showed staff found the BMS easy to insert and maintain, and was tolerated by patients. • • • • •
Skin integrity maintained Improved patient experience, comfort and dignity Safety and quality of care increased Time saving Reduces cost
P13: Unplanned Transfers to HDU Ms Laura Harvey, Ayrshire & Arran Acute Hospitals Unplanned transfers to HDU/ICU is considered to be an adverse event by the Institute for Healthcare Improvement (IHI) in their Global Trigger Tool. Within our 12 bedded Medical HDU at Crosshouse Hospital, we wanted to audit all our admissions that came from any source except the Emergency Department, to ensure they were being transferred in a safe and timely manner, and that there was no evidence of failure to recognise critical illness, or failure to rescue. The model for improvement was used and PDSA cycles were employed to carry out small tests of change to ensure our audit tool was fit for purpose. We tested both an HDU audit collection tool, and the tool developed for SCNs in the general ward areas to complete. This promoted ownership of the data and ensured appropriate action plans. Learning plans were developed if any evidence of failure was identified. The results for inclusion in this poster will reflect HDU activity only: • Common reasons for HDU transfer • Source of Referrals • Out of Hour Activity - we have been identified for the fourth consecutive year as an outline in terms of out of hour activity & one of the busiest HDUs in Scotland (SICSAG, 2011). The results of the audit were very interesting and immediately flagged up that our biggest source of transfers was from the AMAU (Acute Medical Assessment Unit). This resulted in us looking at our current referral process and other parts of the patient journey to ensure critical illness was picked up quickly so patient outcomes could be improved. The poster will present all findings and include recommendations for further exploration.
P14: Experiential Learning ...... Is it “Old Hat” or Good Practice? Mrs Lorraine Bell, Mrs Debbie Wightman, Belfast Health and Social Care Trust, Royal Group Hospital INTRODUCTION Taking charge of a Cardiac Surgical High Dependency Unit (HDU) can be challenging and stressful for staff. To create support for self-directed learning, promote leadership skills and develop managerial experience experiential learning programmes offers a valuable approach to learning and development.
AIM To deliver a structured user friendly work-based experiential learning programme which promotes potential managerial and leadership development.
METHOD focus group - consisting of staff who had completed a former task orientated HDU programme, developed a new experiential learning model that was user friendly, supported by mentors and Clinical Educator (CE) via a triage system of support.
RESULTS Supporting nurses through individual reflections and regular meetings with mentors and CE, constructive learning objectives were set and action plans tailored to meet the needs of the individual.
CONCLUSION In these times of economic pressures, the NHS must find innovative ways to ensure professional development is cost effective, yet provide high quality of care. Experiential learning not only develops staff knowledge and skills but transforms patient care, maintains evidence based practice, and is value for money for the Trust. This programme has forged firm partnerships with existing managers and junior staff, thus concreting the dynamics within the team.
P15: Managing risk, responding with education Mr Daren Briscoe, Mrs Clare McGregor, Brighton and Sussex University Hospitals NHS Trust POSTER PURPOSE The purpose of the poster is to report an innovative management and education process of investigation of clinical incidents through six change management components.
AIMS To develop a process that creates a culture of meaningful learning from clinical incidents within critical care. Six components link together professionals involved in a clinical incident with the wider multi professional team.
Poster Display Abstracts METHOD
The Trust’s online Datix system is used to report patient incidents and can improve documentation, tracking of trends and development of themes. Learning through reflection and discussion can take place as part of the overall strategy. Education literature is then developed while informing the multi professional team of the serious incidents. This methodology is based on current guidelines of good reporting practice and feedback (NPSA and The NHS Confederation briefing 2008).
In order to facilitate nursing staff development of their clinical knowledge & skills in the care and management of ECMO patients, structured teaching was undertaken by the perfusion and practice education teams as part of the following:
PROCESS The six components that link this process are collect data; Datix system reporting; key investigators; feedback; newsletter; safety and risk meetings. These involve and engage all frontline staff, give feedback to staff and reporters and focus on learning to improve patient safety.
DISCUSSION/CONCLUSION The reporting of serious clinical incidents has increased during the implementation of the six components. This is seen as a positive measure of the success of the programme in terms of change management and an improved culture of reporting. This is an ongoing process of development to eliminate and reduce risk within our critical care units which requires further evaluation and audit to establish its effects. This process has enabled a total multidisciplinary approach to managing risk and has brought risk management to life! This method has been presented to senior members of the trust and there has been a decision to take this innovative process forward and implement on the wards and other departments in BSUH NHS TRUST. NPSA and The NHS Confederation briefing 2008. Act on reporting: Five actions to improve patient safety reporting). Welters D. Ingeborg et al. 2011. Critical Care. Major sources of critical incidents in intensive care. NPSA Manchester Patient Safety Framework (MaPSaF). Cooper D. et al. 2005. Changing personnel behaviour to promote quality care practices in an intensive care unit. Therapeutics and Clinical Risk Management. 1(4) 321-332.
P16: Evolving ECMO therapy in Clinical Practice: a Response to Service Development in a Cardiothoracic ICU Mr Allan Seraj, Mrs Moya Piper, Mr Bradley Pates, Miss Nicola Mackay, Royal Brompton & Harefield NHS Foundation Trust BACKGROUND Over the last 24 months, 48 patients had VA (veno-arterio) or VV (veno-veno) ECMO (Extracorporeal Membranous Oxygenation) therapy. In response to the increasing service provision, the education team reviewed existing education and training structures; subsequently developing educational initiatives to support 120 nursing staff with the evolving ECMO service within our Unit.
• • • •
Team days Weekly microteaching/wet lab/workshops Band 6 & 7 ECMO wet lab Perfusion Study day
Further to this, booklets & a resource folder were developed and circulated to all members of the team. An exchange programme with the Hannover Medical Centre Germany facilitated an opportunity to observe a standardised approach to the management of this patient group. The education team has also developed guidelines to clarify nursing care and most recently addressed the responsibility of members of the MDT during the repositioning of these patients.
DISCUSSION The increased utilisation of ECMO support in our unit has been a challenge to both the education and nursing teams. Anecdotally, staff have verbalised their increasing clinical confidence in providing nursing care for ECMO patients. The ECMO service continues to evolve; the team continues to respond by learning together, building skills and embracing the development of the service.
P17: The Effectiveness of a Multidisciplinary Recovery Pathway on the Physical Outcome for Critical Care Patients Miss Charlotte Burleigh, Brighton and Sussex Medical School, Sister Louise Skelt, Miss Rebecca Rowlands, Worthing Hospital-Western Sussex Hospitals NHS trust BACKGROUND In recent years, there has been increasing emphasis on early rehabilitation as a strategy to reduce the burden of longstanding physical disability in critical care survivors. The Critical Care Unit at Worthing Hospital is in the process of implementing a multidisciplinary recovery pathway, in accordance with the recent NICE guidelines.
AIMS To establish whether early physical activity is associated with improved outcomes.
METHODS Data was obtained retrospectively from the records of patients admitted between 1st January and 31st March 2010, 2011 and 2012. Physical outcome was assessed by the time taken
Poster Display Abstracts for patients to actively mobilise. APACHE II score, length of stay and number of days requiring mechanical ventilation were also recorded.
RESULTS Length of stay, time to activity and APACHE II score had not changed significantly from 2010-12. Across the years studied, time to activity was positively correlated with length of stay and ventilator days. Time to activity and length of stay were not found to be correlated with APACHE II score.
CONCLUSION Early physical activity was found to be associated with shorter length of stay and fewer ventilator days, regardless of APACHE II score. Time to activity could therefore be an important predictor of critical care outcomes.
Improving Safety for Patients with Limited English Proficiency Janis Smith-Love, Broward Health Medical Center; Fort Lauderdale, Florida Adverse outcomes are more likely related to communication errors for patients with limited English proficiency. As the United States immigrant population grows, there is an increasing need for resources to facilitate communication among patients and families and their healthcare providers. Broward Health Medical Centerâ€™s location allows for a diverse population of non-English speaking clients and uses a language line service to improve communication and cultural competence between patients and caregivers. Circumstances often require use of a face-to-face medical interpreter to safeguard patient rights. Use of a bilingual family member or visitor to act as an interpreter does not assure that interpretation is completely accurate. The organization sought to improve standards for language and cultural competence by providing employees with the training necessary to meet individual patient needs. The purpose of the training was to provide quality care and services to patients regardless of their language needs through the certification of licensed professionals as medical interpreters. Sixteen employees successfully completed the 4 week training, practice, and selfstudy program which concluded with both written and oral examinations. The certified medical interpreters include: five Creole, one French, one Portuguese, and nine Spanish licensed professionals that provide interpretation services to patients with limited English proficiency with demonstrated improved patient outcomes.
P19: Acute Illness Management in Uganda; Our Experiences of Teaching and Learning in a Resource Depleted Environment Mrs Samantha Cook, Greater Manchester Critical Care Network We are a group of Practice Based Educators who have had the opportunity to teach Acute Illness Management (AIM) in Gulu, Northern Uganda with University Hospital South Manchester. AIM in Greater Manchester is a well established one day scenario based course which engages staff in identifying, recording and taking appropriate action when dealing the Acutely Ill Patients primarily in a hospital setting with all modern resources available, our challenge was to take this course and deliver it to medical students and hospital staff in a resource depleted environment with the endeavour to improve safety and care delivered to patients in extremely demanding situations. The course comprises of short lectures, group based workshops and scenarios culminating in a â€œtestâ€? scenario and a pre and post course multi choice questionnaire which candidates must pass to achieve a certificate. Simulation is an unusual teaching concept to Ugandans. They have evaluated the experience extremely well. We have statistically analysed the results of the pre and post course MCQ and found significant improvements in knowledge post course. This experience has been positive for both recipients and providers, both teaching and learning how patient safety and excellence should be a priority to all globally.
P20: New Registrants:
Are they safe in Administration of Medicines In the Critical Care Setting? Mrs Gillian Reid, Mrs Lorraine Bell, Miss Laura Adair, BHSCT INTRODUCTION Caring for the critically ill patient incorporates many intricate procedures including the administration of medicines (AOM) and titration of complex drugs. Intensive care units have a high incidence of medication errors, safe and competent practitioners are essential. Therefore a standardised approach for safe AOM in adult Critical Care settings is essential within the amalgamated Belfast Health and Social Care Trust (BHSCT).
AIM To develop a theoretical framework, endorsing standards to ensure safe administration of IV medications for new registrants within Adult Critical Care.
Poster Display Abstracts METHODOLOGY
• Clinical Educators (CE’s) developed a standardised one and a half day training program for new registrants in AOM. • BHSCT Pre & Post Course work books were reviewed and adapted for critical care. • Utilising problem based learning and reflection as a method of assessing registrants’ knowledge & skills in AOM.
A group of critical care nurses at Kings College Hospital NHS foundation Trust designed a quantitive audit to monitor head elevation practice and also collected qualitative data from staff regarding their practice. The surveys were created to identify and assist in strategies to overcome the barriers to adequate head elevation, distinguishing whether nurses’ perceptions are a contributing factor to compliance.
On successful completion of the programme, registrants are issued with a certificate of competency in AOM which acts as a passport between critical care areas within the BHSCT; valid for three years.
Head elevation angles were audited and questionnaires were completed by 30 nurses, over a period of 6 weeks. 100% patients had head elevated- 57% of the patients audited were found to be positioned over 30. 44% of nurses overestimated the angle of their patients’ head elevation and of the nurses who had achieved adequate head elevation, 82% had used a measuring tool.
IMPLICATIONS FOR PRACTICE The AOM training package supports the implementation of best practice whilst enhancing the knowledge and skill of new registrants to the critical care setting. References: • Mansour, M. (2009) Critical Care Nurses’ Views on Medication Administration: An Organizational Perspective, Thesis July 2009, pages 1 - 396. • Moyen, E., Camire, E. And Stelfox, H. (2008) Clinical review; Medication Errors in Critical Care. Critical Care, Vol. 12 Issue, 2. (2008) pages 1 -7. • Nursing and Midwifery Council, (2010) Standards for Medicine Management, London, NMC. Santell, J., Hicks, R., Mcmeekin, J. and Cousins, D. (2003). "Medication Errors: • Experience of the United States Pharmacopeia (USP) MEDMARX Reporting System." Journal of Clinical Pharmacology 43(7): 760-767. As cited in Mansour, M. (2009) • Critical Care Nurses’ Views on Medication Administration: An Organizational Perspective, Thesis July 2009, pages 1 - 396. • Shawyer, V., Copp, A., Dobrijevic, J. and Goding, L. (2007) Nursing Students and the administration of IV drugs. Nursing Times. Net Vol. 103, issue: 4, Pages 32-33. Accessed 16:01:2012@ www.nursingtimes.net • Van Den Bemt, P., Fijn, R., Van Der Voort, P., Gossen, A. and Brouwers, J. (2002). "Frequency and determinants of drug administration errors in the intensive care unit." Critical Care Medicine. 30(4): pages 846-850
P21: Heads Up - Are Nurses Perceptions Decreasing Ventilator Care Bundle Head Elevation Compliance?
DISCUSSION There was a tendency to overestimate the angle of head elevation, which has also been found in existing studies (Hiner et al, 2010). This highlighted the importance of using a measuring tool when positioning patients, illustrated by the number of correctly positioned patients where a tool had been used. This poster describes our findings, how we encourage 30-45Â° head elevation and discusses the use of measuring tools and contraindications to head elevation. Audits will continue monthly to encourage 30-45Â° head elevation compliance. References: DOH (2010) High Impact Intervention; Care bundle to reduce ventilation-association pneumonia. [Accessed 16/04/2012] http://hcai.dh.gov.uk Hiner C, Kasuya T, Cottingham C, Whitney J (2010) Clinicians' Perception of Head-of-Bed Elevation American Journal of Critical Care 19(2):164-167. IHI (2012) How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge, MA: Institute for Healthcare Improvement. (Available at www.ihi.org).
P22: Is a Progressive Care Unit the future in Thoracic surgery? Mrs Gillian Reid, Mrs Lorraine Bell, Miss Laura Adair, Belfast Health and Social Care Trust INTRODUCTION
Suzy Hogg, Kings College Hospital NHS Foundation Trust
Patients who require complex lung or oesophageal surgery require intensive post-operative management. Due to demands on these beds, patients often had their surgery delayed. A two bedded Progressive Care Unit (PCU) was identified to prevent delays in treatment.
Head elevation is a well established element of the ventilator care bundle (IHI 2012, DOH 2010), however compliance with 30-45Â° is a problem across our critical care units, when it comes to raising the head of bed to the recommended level.
To provide direct access to post-op beds for patients with oesophageal and lung cancer. To reduce cancellations, a fast track service was provided in ward-based PCU beds with highly trained professional ward staff.
Poster Display Abstracts METHOD
P24: Leading the Way.
1 Education: - to introduce PCU Beds into the thoracic ward, a six week education experiential learning programme was commenced.
A leadership Development Programme in Intensive Care
2 Resources: - supported by management and the Cardiac Clinical Educator. Staff had placements on a Cardiac High Dependency Unit to develop their clinical skills.
Miss Nicola Wilson, Mrs Alison Stevens, Frimley Park Hospital; Major Cindy Lethbridge, Major Kerrie Pealin, Queen Alexander's Royal Army Nursing Corps
RESULTS Cancellations for patients with oesophageal and lung cancer who require a PCU bed are zero percent. All thoracic staff is highly skilled in caring for critically ill patients
CONCLUSION The government and Trust’s agenda to ensure the provision of high quality post-op care for cancer patients is provided by a dedicated team of highly skilled staff. Reduced pressure on ICU has resulted in huge improvements in the efficiency and effectiveness of thoracic surgery service.
P23: Development of clinical education for junior band five nurses Miss Lindsey Hockin, Guys and St Thomas' NHS Foundation Trust The transition from student nurse to staff nurse can be difficult; nurses are often left with little educational support after finishing university. Access to compulsory courses, such as mentorship can offer some professional development, however these courses offer little clinical development. Furthermore employment in a highly specialised area such as paediatric intensive care may leave nurses seeking more practical development. The Acute Care Skills course was developed as an educational opportunity for junior band five nurses. Teaching is provided as both mixed and speciality specific groups. Provision of mixed teaching allows for nurses from different clinical areas to share experiences and their expertise whilst developing skills and understanding of a variety of specialities. Furthermore teaching in mixed speciality groups can help promote cohesiveness within a large foundation trust. Student’s pre and post session evaluations and confidence scale scores have been collected. Data suggests that students find the days helpful in developing their knowledge of anatomy and physiology, system specific conditions that they may encounter in their clinical areas and clinical skills. Delegate feedback has been used to modify future occurrences of the course to ensure all learning needs are met.
Military and civilian nursing staff work together at Frimley Park NHS Foundation Trust Hospital leading to shared learning and integrated best clinical care for all patients. Within the Intensive Care Unit the opportunity was made for the military staff to join a structured Development programme facilitated and developed by the Unit. This leadership programme offers experienced ICU nurses (Band 6 and above) the opportunity to experience three main areas within a year’s programme. These main areas are: • Operational Management Experience • Professional Development • Critical Care Outreach There are also opportunities to participate and gain insight into corporate and national agenda's as well as experiencing site management. Military nurses have embraced these opportunities to gain senior nurse NHS experience, which is normally limited due to increased mobility and frequent deployments. Whilst the military bring a breadth of experience from multiple NHS trusts and operational environments, they are able to develop leadership skills as well as issues faced with management of an NHS ICU within the programme. Giving them insight into resource management, inter hospital working and staff development. This poster demonstrates the process of civilian and military leadership development, outlining a concept that could be applied to any NHS trust.
P25: Supporting A Healthy Work Environment: Transforming frustrations into accomplishments Janis Smith-Love, Yola Dorvil, Belinda Faustin, Broward Health Medical Center PURPOSE The Unit Council purpose is to enrich nursing practice through our bold voices and the use of evidence-based practice and acts as a vehicle for all staff to transform their frustrations into accomplishments. Our shared governance practice model allows employees to make decisions about things that affect their work.
DESCRIPTION A shared governance nursing practice model was adopted in 2011 by our PCCU to provide structure and context to organize care delivery. Use of the model ensures that clinically
Poster Display Abstracts based nurses along with the management team have a voice in decision making and a role in shaping policies in their area of expertise. The Unit Council develops unit leaders, improves staff decision making skills, and promotes cohesiveness in the workplace.
Fernandez et al 2008, Mace et al 2006, Norwood et al 2003). The Critical Care Outreach Team (CCOT) believed a TST could assist with the necessary support, education, continuity and decision consensus that this patient group and ward staff, needed.
The Unit Council leadership includes the Chair, co-Chair, Team Leader, Time Keeper, Secretary, Communication Director, and five voting members who are responsible for clinical practice as supported by evidence-based research and process improvement, education, team building, service excellence, unit operations, and community service. Monthly meeting agendas are driven by staff issues, concerns, and identified opportunities for improvement.
A literature review confirmed the need for multidisciplinary tracheostomy support teams on general wards (Arora et al 2008, Cameron et al 2009, Norwood et al 2003, Tobin & Santamaria 2008). Utilizing the evidence, a multidisciplinary focus group was formed to review current practice and set an agenda for best clinical practice.
EVALUATION/OUTCOMES Accomplishments include: a staff-directed fall elimination program with 0% fall related injury (FY 2012), bedside shift report with improved patient/family satisfaction above national average, self-directed work groups for point of care testing, hospital acquired pressure ulcers, and restraint use with 0% errors, employee-driven peer recognition, and participation in three community service projects. Our employee partnership scores as an indicator of employee satisfaction rose 12.1 to a mean of 76.8%. Teamwork and employee engagement scores improved with favourability ratings of 82.5% and 93.3%, respectively. Employee satisfaction including “...opinions asked before decisions made” significantly improved (p<.01) with a mean score of 70.6% (Press Ganey Associates, Inc. 2011). The PCCU Unit Council is successful in supporting a healthy work environment that transforms frustrations into accomplishments. References: Broward Health Medical Center, 4 Atrium-Progressive Cardiac Care (2011). Shared governance unit council bylaws. Hendren, R. (2011, May 31). Boost nurse responsibility with shared governance. HealthLeaders Media. Kent State University College of Nursing (2004). From bedside to boardroom-Nursing shared governance. Online J Issues Nurs; 9(1). Kramer, M. & Schmalenberg, C. (2008, April). Confirmation of a healthy work environment. Critical Care Nurse; 28(2), 56-63.
P26: Introducing a Tracheostomy Support Team; A trust wide initiative Mrs Hannah Saunders, Mrs Sue Moorse, Mrs Tash Arnott, Mrs Aileen Parry, Portsmouth Hospitals NHS Trust Lack of a co-ordinated approach and a subsequent Serious Untoward Incident (SUI) urged investigation into a prospective trust wide Tracheostomy Support Team (TST). Patients with temporary tracheostomies are routinely discharged from Critical Care and managed on general wards (Russell 2005, Hunt and McGowan 2005). This is despite evidence to suggest staff on general wards are not always equipped to care for this potentially “high risk” patient group (Cameron et al 2009,
In the eighteen months since the inception of the focus group, many aims have been achieved. Patients now have double lumen tracheostomy tubes. Trust wide guidelines and care bundles have been implemented. Furthermore, a comprehensive education programme commenced plus weekly ward rounds undertaken with a Critical Care consultant. To date nineteen patients have been reviewed, sixteen have been successfully decannulated the remaining three discharged to other care areas outside the trust. Mean time to decannulation is forty one days. Three potentially serious complications have been identified and treated by the team. Unfortunately no audit was undertaken prior to the changes made but anecdotal evidence suggests that the TST has improved tracheostomy care and patient safety within the trust. References: • Arora, A., Hettige, R., Ifeacho, S. and Narula, A. (2008) Driving standards in tracheostomy care: a preliminary communication of the St Mary’s ENT-led multi disciplinary team approach. Clinical Otolaryngology, 33, pp 596-599. • Cameron, T., McKinstry, A., Burt, S., Howard, M., Bellomo, R., Brown, J., Ross, M., Sweeney, J. and O’Donoghue, J. (2009) Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team. • Critical Care and Resuscitation, 11 (1), pp 14-19. • Frenandez, R., Bacelar, N., Hernandez, G., Tuban, I., Baigorri, F., Gilli, G. and Artigas, A. (2008) Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient’s vulnerability, Intensive Care Medicine, 34, pp 1878-1882. • Hunt, K. and McGowan, S. (2005) Tracheostomy management in the neurosciences: A systematic multidisciplinary approach, British Journal of Neuroscience Nursing, 1 (3), pp 122-125. • Mace, A.D., Patel, N.N. and Mainwaring, F. (2006) Current standards of tracheostomy care in the UK, The Otolaryngologist, 1, pp 37-39. • Norwood, M., Spiers, P., Bailiss, J. and Sayers, R. (2004) Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond, Journal of Postgraduate Medicine, 80, pp 478-480. • Russell, C. (2005) Providing the nurse with a guide to tracheostomy care and management, British Journal of Nursing, 14 (8), pp 428-433. • Tobin,A. and Santamaria, J. (2008) An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study, Critical Care, 12 (2), R48.
Poster Display Abstracts
P27: The Introduction of a Protocol
to Manage Faecal Incontinence in Critical Care
Pollock (2006) emphasises the research gap and lack of published guidelines in this area. There is a need to develop an educational package for ICU nurses consisting of guidelines tailored to critical care that encompass physical and psychological considerations of care, supported by evidence based practice and real patient experience.
Liz Ellis, Intensive Care Unit, Pinderfields Hospital, Mid Yorks NHS Trust In 2009 a decision was made in my Trust to introduce Hollister’s ActiFlo Bowel Management System to manage faecal incontinence within critical care. Working closely with Hollister’s Clinical Educator, myself and some colleagues produced a protocol for the use of ActiFlo within critical care. It was indentified that we needed to meet the education and training requirements of staff for the protocol to be successful. The protocol was launched in May 2010 and we held drop in training sessions for staff to become familiar with the product and protocol. Since then we have introduced the use of the InstaFlo bowel catheter system to critical care and further work has been undertaken by myself to produce a guide for bowel management products within critical care and a drug management guide to complement the use of the ActiFlo bowel management system. Approximately 100 staff across the Trust have used the protocol since its introduction. Education and training remains ongoing by myself with support from Hollister’s education team.
P28: Post Partum Haemorrhage in ICU- A Holistic Approach Laura Watson, Mrs Jenny Davis, Intensive Care Unit, Royal Berkshire NHS Foundation Trust BACKGROUND Post partum haemorrhage is the second most common reason for admission to intensive care (Bauer et.al.2009). This is reflected at the Royal Berkshire NHS Foundation Trust where over the past 4 years of all the obstetric admissions 75% were following post partum haemorrhage.
PROBLEM Observation within practice identified a lack of knowledge in managing these patients by ICU nurses. There are existing locally published guidelines regarding management of post partum haemorrhage, but are tailored to a maternity setting. It was noted that psychological aspects of their care were lacking as due to physiological instability their physical needs take priority. Evidence from the intensive care follow up service and the ICU patient support group further support the importance of addressing the psychological issues that often continue to affect their rehabilitation following critical illness, such as enabling bonding with their baby and facilitating family privacy.
References: Pollock,W.E.(2006) Caring for pregnant and post natal women in intensive care: What do we know? Australian Critical Care. 19 (2) 54-63. Bauer, S.T, Bonnano, C. (2009) Abnomal placentation.Semin Perinatol. 33.88-95.
P29: Academic Health Science Centres and Critical Care: Opportunity or Threat? Joanna Hunter, King's College Hospital NHS Foundation Trust; Alex Avens, Guys and St Thomas NHS Foundation Trust Kings Health Partners is one of five Academic Health Science Centres set up in the UK which comprise of health and academic partners to focus on world-class research, teaching and patient care (DH 2009). Critical Care at Kings College NHS Foundation Trust and Guys and St Thomas NHS Foundation Trust have joined together with Allergy, Respiratory and Anaesthetics to become a Clinical Academic Group (CAGS). The idea of the CAG is to bring high quality care, excellence and the very best in research and evidence to improve clinical services. The nursing staff have created their own CAG and a nursing education limb which feeds into the operational CAG. This poster describes our nursing journey of joining forces and the commencement of standardising practice across two large teaching hospitals with very different cultures and practices. Our immediate projects started with joint recruitment, induction packages, foundation courses and training with uniform educational pathways whilst maintaining each unit’s identity and independence which makes each Trust unique. Good communication and regular meetings with a shared vision has made this journey exciting and engaging, the challenges and achievements and lows and highs are described in our quest to achieve and deliver excellence in care and global recognition. Reference: DH (2009) High Quality Care for All 2009 www.dh.gov.uk
Poster Display Abstracts
P30: Assessment and Management of Alcohol Related Admissions to Intensive Care: A National Survey Joanne McPeake, University of Glasgow BACKGROUND The intensive care environment has felt the overwhelming impact of the growing problem of alcohol misuse (O'Brien, Lu, Ali, et al 2007). Accordingly, the use of appropriate screening and management instruments is crucial in order to identify problems and offer early treatment (Pilling, Yesufu-Udechuku, Taylor et al 2011).
PURPOSE This research aimed to explore the use of assessment and management tools utilised for alcohol related admissions to intensive care in the UK.
DESIGN A 10 point web based survey was sent to 248 lead intensive care consultants across the UK. Consultants were asked to complete information about level three patients only.
RESULTS The response rate for the survey was 42% (n=103). 95% of ICUs use no alcohol assessment tool, or use the volume of units consumed per week, to assess alcohol consumption. 77% of ICUs use no tool for the management of alcohol withdrawal.
A CQUIN target is to reduce all preventable p.u. (Newton H. Wounds UK 2010). A quality goal for the West Suffolk Hospital is 'to reduce the number of avoidable grade 3 and 4 pressure ulcers by 80% by April 2012' (Quality Improvement Strategy 2011-2014). We looked at a leaflet devised by ward staff and reviewed the patient booklet produced by the National Institute for Clinical Excellence (NICE) which was comprehensive, containing too much information for patients recovering from a critical illness. The purpose of our leaflet is to provide Critical Care patients information in an easy to read format about p.u. prevention. Following discussion with our manager and the Tissue Viability nurse specialist we decided what information to include in our patient leaflet. References: Department of Health (2010) Essence of Care 2010, pp. 1-18 TSO@Blackwell and other Accredited Agents Executive Chief Nurse (2011) Quality Improvement Strategy 2011-2014, pp.1-11 Newton H. (2010) Reducing pressure ulcer incidence: CQUIN payment framework in practice. pp.38-45, Wounds UK, 2010 Vol 6, No3 National Institute for Clinical Excellence (NICE) (2003) Pressure ulcers: prevention and pressure-relieving devices. pp.1-23, NICE
P32: The role of subglottic suction in reducing ventilator associated pneumonia
CONCLUSIONS This survey has highlighted that more a systematic approach to the assessment and management of alcohol use disorders may be required in the ICU environment. Further research is warranted in this particular area. References: O'Brien, JM. Lu, B. Ali, NA. Martin, GS. Aberegg, SK. March, CB. Lemeshow, S. Douglas, IS. (2007) Alcohol dependence is independently associated with sepsis, septic shock and hospital mortality among adult intensive care unit patients. Critical Care Medicine; 35(2):345-350. Pilling, S. Yesufu-Udechuku, A. Taylor, C. Drummond, C. (2011) Diagnosis, assessment and management of harmful drinking and alcohol dependence: summary of NICE guidance. British Medical Journal; 342:490-492.
Lucy Morgan, Hannah Little, Kings College Hospital We are currently trialling the use of soft suction catheters to drain subglottic secretions, as opposed to ET tubes that have inbuilt subglottic suction, as these are an additional cost and impossible to regulate in a unit that has so many tertiary referrals. In addition to this a new oral assessment score has been implemented, as well as a mouthcare protocol update. This poster will present our findings and experiences to date.
P31: Do the Patient No Harm! Denise Smith, Rachel Midforth, West Suffolk Hospital As Tissue Viability link nurses on Critical Care we undertook an audit based on Essence of Care 2010. This highlighted that patient education was weak with regards to written information concerning pressure ulcer (p.u.) prevention. On our Critical Care unit it is usual practice to inform our patients of any care we are about to give i.e. repositioning. However, we do not provide written information regarding this important aspect of nursing care to awake patients.
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Contain faecal contamination, maintain a healthy patient environment SECCO FMS is a closed catheter system for the management of episodic faecal incontinence of liquid and semi-liquid faeces
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FFaecal aecal management system system with sup erabsorbent technology technology superabsorbent
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