User Centered Design and Rapid Prototyping supported by a Wiki to develop a Decision Aid for CPR and Mechanical Ventilation adapted to the Context of an Intensive Care Unit
This document discusses hourly rounding, a quality improvement project to improve patient satisfaction and outcomes. It describes who can perform hourly rounding, which involves assessing patients' pain, bathroom needs, possessions, mobility, and other needs every hour. Studies show hourly rounding can increase patient satisfaction scores, decrease call light usage and falls, and improve the work of nurses and other staff. Proper staff training and support is needed to successfully implement hourly rounding.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
1) Two hospitals implemented regular hourly rounding programs to improve patient experience.
2) Rounding involves checking on patients' needs, pain levels, comfort and safety every 1-2 hours.
3) Early results show reductions in falls and improvements in HCAHPS scores for nursing communication and responsiveness.
Prehabilitation refers to physical therapy treatment in the pre-operative setting, with the goal of reducing post-operative complications and costs. Studies have found that prehabilitation can reduce hospital stays and complication rates for cardiac and abdominal surgeries through inspiratory training. For joint replacements, prehabilitation is associated with a 29% reduction in post-acute care services. Limitations include a lack of supportive research and physician referrals, but future programs aim to expand prehabilitation's benefits.
Wood County Hospital scored 72.3% on patient responsiveness according to HCAHPS surveys, below the 80% CMS requirement. A study was conducted to analyze call light response times, who answers call lights, and hourly rounding adherence. Recommendations include implementing individual nurse communication devices to improve response times and patient satisfaction scores, helping the hospital meet CMS standards and increase reimbursement. Changing to a new communication system requires using the Transtheoretical Model of behavior change to successfully adopt the new approach.
The document proposes an International Family Medicine Fellowship to provide additional training to family medicine residents interested in practicing internationally. The fellowship would include 2 months of rural health training, 4 months at an international hospital, and 6 months of rotations in trauma, tropical medicine, wound care, and other specialties. The goal is to equip physicians with the skills needed to practice in developing countries by addressing common issues like maternal mortality, infectious diseases, burns, and blindness. The fellowship aims to fulfill a need for trained physicians and establish a sustainable program through clinical support.
- The researchers modified a validated Patient Reported Experience Measure (PREM) tool originally developed for rheumatoid arthritis (RA) patients to be used for patients with other rheumatic conditions. [1]
- They administered the modified PREM across 11 UK sites to 110 patients with various rheumatic conditions other than RA. The modified PREM demonstrated good construct validity and reliably captured patient experiences across different rheumatic conditions. [2]
- Some domains like needs/preferences and emotional support had higher agreement with patients' overall experience ratings. Both the original RA PREM and modified versions are valid tools for measuring patient experience in rheumatology. [3]
NHS Improvement worked with clinical teams across health and social care to find examples of equality of treatment and outcome regardless of the day of the week.
This guide and case studies give examples ofservice delivery models that are being used across the NHS to deliver clinical services outside the standard working hours and across the weekend period, in many instances.
The service delivery models described respond to service, patient or carer demand and provide benefitsfor both patients,staff and carers. There are three emerging principlesthat could be used to categorise the models being adopted under the following headings:
1. Admission prevention
Servicesthat are designed to care for patientsin their usual place of residence during times of poor health or mental illness.
2. Early diagnosis and intervention
No delay sin assessment, diagnostics and treatment leading to an earlier diagnosis and intervention.
3. Early supported discharge
Patients returning home once they are able to be supported in their own home by services.
This document discusses hourly rounding, a quality improvement project to improve patient satisfaction and outcomes. It describes who can perform hourly rounding, which involves assessing patients' pain, bathroom needs, possessions, mobility, and other needs every hour. Studies show hourly rounding can increase patient satisfaction scores, decrease call light usage and falls, and improve the work of nurses and other staff. Proper staff training and support is needed to successfully implement hourly rounding.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
1) Two hospitals implemented regular hourly rounding programs to improve patient experience.
2) Rounding involves checking on patients' needs, pain levels, comfort and safety every 1-2 hours.
3) Early results show reductions in falls and improvements in HCAHPS scores for nursing communication and responsiveness.
Prehabilitation refers to physical therapy treatment in the pre-operative setting, with the goal of reducing post-operative complications and costs. Studies have found that prehabilitation can reduce hospital stays and complication rates for cardiac and abdominal surgeries through inspiratory training. For joint replacements, prehabilitation is associated with a 29% reduction in post-acute care services. Limitations include a lack of supportive research and physician referrals, but future programs aim to expand prehabilitation's benefits.
Wood County Hospital scored 72.3% on patient responsiveness according to HCAHPS surveys, below the 80% CMS requirement. A study was conducted to analyze call light response times, who answers call lights, and hourly rounding adherence. Recommendations include implementing individual nurse communication devices to improve response times and patient satisfaction scores, helping the hospital meet CMS standards and increase reimbursement. Changing to a new communication system requires using the Transtheoretical Model of behavior change to successfully adopt the new approach.
The document proposes an International Family Medicine Fellowship to provide additional training to family medicine residents interested in practicing internationally. The fellowship would include 2 months of rural health training, 4 months at an international hospital, and 6 months of rotations in trauma, tropical medicine, wound care, and other specialties. The goal is to equip physicians with the skills needed to practice in developing countries by addressing common issues like maternal mortality, infectious diseases, burns, and blindness. The fellowship aims to fulfill a need for trained physicians and establish a sustainable program through clinical support.
- The researchers modified a validated Patient Reported Experience Measure (PREM) tool originally developed for rheumatoid arthritis (RA) patients to be used for patients with other rheumatic conditions. [1]
- They administered the modified PREM across 11 UK sites to 110 patients with various rheumatic conditions other than RA. The modified PREM demonstrated good construct validity and reliably captured patient experiences across different rheumatic conditions. [2]
- Some domains like needs/preferences and emotional support had higher agreement with patients' overall experience ratings. Both the original RA PREM and modified versions are valid tools for measuring patient experience in rheumatology. [3]
NHS Improvement worked with clinical teams across health and social care to find examples of equality of treatment and outcome regardless of the day of the week.
This guide and case studies give examples ofservice delivery models that are being used across the NHS to deliver clinical services outside the standard working hours and across the weekend period, in many instances.
The service delivery models described respond to service, patient or carer demand and provide benefitsfor both patients,staff and carers. There are three emerging principlesthat could be used to categorise the models being adopted under the following headings:
1. Admission prevention
Servicesthat are designed to care for patientsin their usual place of residence during times of poor health or mental illness.
2. Early diagnosis and intervention
No delay sin assessment, diagnostics and treatment leading to an earlier diagnosis and intervention.
3. Early supported discharge
Patients returning home once they are able to be supported in their own home by services.
This document discusses hourly rounding, which involves nurses checking on patients on an hourly basis. It presents national averages for HCAHPS scores and outlines several improved outcomes associated with hourly rounding such as patient satisfaction, safety, and reduced call light usage. The 6P protocol is described which involves greeting the patient and addressing their pain, personal needs, positioning, bathroom needs, and environment. Benefits of hourly rounding include increased HCAHPS scores, hospital reimbursement, and nurse satisfaction and efficiency.
The study is based on the data from the Swedish Obese Subjects (SOS) study, which was conducted at 25 surgical departments and 480 primary health care centers in Sweden.
This document provides information on Joyce Neumann, including her professional background working as an advanced practice nurse and manager in stem cell transplantation. It then outlines her presentation on the nurse's role in the interprofessional team caring for hematologic malignancy patients. The presentation discusses various nursing roles to improve patient care, including clinical nursing, research nursing, and nursing administration. It also covers topics like traditional nursing roles, advanced practice registered nursing, quality of care measurements, and the importance of interprofessional collaboration.
Can Primary Care Provide Effective Management of Chronic Pain?epicyclops
This lecture was given by Professor Gary Macfarlane, Professor of Epidemiology at the University of Aberdeen, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Professor Macfarlane is introduced by Dr Colin Rae. The lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
www.wspg.org.uk
1. As surgeons age, their physical, cognitive, and technical skills gradually decline which can increase surgical risks and complications for older patients. Several studies show increased postoperative morbidity and mortality for elderly patients operated by older surgeons.
2. Valid assessment methods of aging surgeons are needed to objectively measure physical, cognitive, and technical skills to ensure patient safety and identify surgeons who may need retraining or early retirement.
3. Properly planned retirement allows aging surgeons to continue contributing to the medical community through teaching, mentoring, and non-clinical roles that utilize their experience and knowledge.
- The document discusses the importance of nutrition counseling in primary care and barriers to its implementation. It provides an effective 5 step approach ("A5 Algorithm") for physicians to provide brief but effective nutritional counseling.
- Case studies demonstrate how the approach can be used to address different patient nutritional issues like metabolic syndrome, lipid levels, and weight management.
- Effective nutrition counseling in primary care has potential to improve health outcomes and prevent deaths from diseases like obesity, hypertension and stroke. Tools and a team approach are needed to successfully incorporate it into short patient visits.
Bedside shift report involves nurses providing report at the patient's bedside in order to improve safety, communication, and patient satisfaction. Statistics show that poor communication contributes to many medical errors, yet traditional shift report away from the bedside risks missing critical information and distractions. Bedside report gives patients and families an opportunity to participate in the discussion of their care plan and ensures a safe handoff between nurses. While some nurses are initially uncomfortable or concerned with confidentiality, studies demonstrate that bedside report improves outcomes for both patients and nurses.
Mind the gap: ways to enhance therapy provision in stroke rehabilitation
This document, being launched at the UK Stroke Forum this week, explores some of the different models adopted by therapy services to deliver more rehabilitation and provides further detail about 45 minutes, process and outcomes.
(Published November 2011)
An opportunity to hear how service redesign positively impacts on the patient experience and improves outcomes for both the patient and NHSScotland. Showcasing examples of changes to pathways of care in orthopaedics and community support for people with complex and chronic conditions.
This document discusses the benefits of bedside nurse reporting to improve patient care. It begins by noting that traditional handoff reporting takes nurses away from patient care and can lead to missed information. Bedside reporting allows for a more organized transfer of information between nurses and increases patient involvement and satisfaction. Research supports the use of bedside reporting in improving outcomes such as increased patient satisfaction, decreased delay in starting nurse shifts, and improved nurse satisfaction. The document provides an example of a bedside reporting form and addresses some common concerns with implementing bedside reporting.
Patient-Centered Strategies for HCAHPS ImprovementEngagingPatients
This document discusses strategies for improving patient experience scores on the HCAHPS survey through patient-centered care. It notes that HCAHPS performance is becoming increasingly important for hospital reimbursement. The document recommends partnering with patients, creating a healing physical environment, making data meaningful to staff, focusing on care transitions beyond the hospital, and prioritizing compassionate care. Planetree is introduced as an organization that advocates for these patient-centered approaches and certifies hospitals that meet standards for patient-centered culture and environments.
Julio C. Baquerizo is seeking a position as an Adult Nurse Practitioner with over 15 years of clinical experience in various settings including ICU, emergency department, private practice, home health care, and more. He has a Master's Degree in Nursing and is certified as an Adult Nurse Practitioner with experience assessing, diagnosing, and treating a wide range of acute and chronic conditions. He is proficient in primary care delivery, medication management, and ensuring quality of care.
The Surgical Initiative concluded on March 31, 2014; the first system Hoshin to “graduate” to everyday work. Join us for an interactive discussion of the lessons learned over four years of transformational change.
* Patient-level & wound-level parameters influencing wound
healing were identified from prior research and clinician input
* Probability of wound healing can be predicted with reasonable
accuracy in real-world data from EMRs
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Bedside reporting involves including the patient in shift change reports between nurses. It has benefits like increased patient empowerment and safety due to improved communication of the patient's status and care plan. Implementing bedside reporting has shown positive results like higher patient and staff satisfaction, improved accuracy of information, and encouragement of teamwork. However, challenges include the time it takes and engaging reluctant patients. Studies have found that encouraging patient participation, using plain language, and allowing more time can help address these challenges.
University of sydney BDent1 - Finding the best evidence. Presentations goes over How to formulate a clinical question using PICO, How to find a systematic review in Cochrane & Medline, and how to find primary studies using the Ovid clinical queries limit in Medline. Contains links to the Sutherland Evidence-based Dentistry articles from the Journal of the Canadian Dental Association.
The document describes a quality improvement project to develop and implement a handover checklist to standardize communication between the Trauma Team Leader and neuro-trauma ICU team when transferring trauma patients. Feedback indicated the checklist reduced information omissions. Metrics showed increased checklist use and no suggested changes after implementation, demonstrating improved handovers and patient safety.
The Wellness Beyond Cancer Program at The Ottawa Hospital aims to provide colorectal cancer patients with appropriate follow-up care after treatment completion through a survivorship care plan. The program includes a needs assessment, education classes, discharge letters to primary care providers, and three levels of follow-up care. An evaluation of the first year found high patient satisfaction with education and empowerment. The program aims to improve cancer survivor care coordination and transition patients to wellness. Key lessons include considering incentives and barriers to ensure long-term sustainability and appropriate use of health resources.
What does a palliative approach look like in residential careBCCPA
This document provides an overview of a palliative care pilot project in residential care facilities. The goals were to enhance end-of-life care for residents and their families, improve the care team experience, and reduce hospitalizations. The project team implemented educational sessions, palliative care rounds, and engaged physicians. Early results found decreased hospital admissions and increased confidence in conversations about palliative care. Evaluation included focus groups with staff, families and the project team to assess the impact and identify factors for successful implementation.
This document summarizes a webinar for selecting topics for a national ICU collaborative initiative in 2016-17. It discusses the results of a survey where pain, agitation, and delirium (PAD) and end-of-life care were the top choices. Potential Topic 1 provides an overview of how end-of-life care could be improved across the ICU continuum. Potential Topic 2 reviews evidence that consistent pain assessment and management paired with sedation protocols can reduce length of stay and complications. The webinar participants then decided to focus on improving PAD management in 2016-17.
This document discusses strategies to prevent and manage delirium in critically ill patients. It outlines the ABCDEF bundle which includes assessing, preventing, and managing pain, both spontaneous awakening and breathing trials, minimizing sedation, assessing and preventing delirium, early mobility and exercise, and engaging family members. Screening for delirium using the CAM-ICU tool and implementing non-pharmacological interventions can reduce length of hospital stay, duration of mechanical ventilation, and mortality. Widespread use of protocols and bundles that incorporate these strategies may help address the high cost and poor outcomes associated with delirium.
This document discusses hourly rounding, which involves nurses checking on patients on an hourly basis. It presents national averages for HCAHPS scores and outlines several improved outcomes associated with hourly rounding such as patient satisfaction, safety, and reduced call light usage. The 6P protocol is described which involves greeting the patient and addressing their pain, personal needs, positioning, bathroom needs, and environment. Benefits of hourly rounding include increased HCAHPS scores, hospital reimbursement, and nurse satisfaction and efficiency.
The study is based on the data from the Swedish Obese Subjects (SOS) study, which was conducted at 25 surgical departments and 480 primary health care centers in Sweden.
This document provides information on Joyce Neumann, including her professional background working as an advanced practice nurse and manager in stem cell transplantation. It then outlines her presentation on the nurse's role in the interprofessional team caring for hematologic malignancy patients. The presentation discusses various nursing roles to improve patient care, including clinical nursing, research nursing, and nursing administration. It also covers topics like traditional nursing roles, advanced practice registered nursing, quality of care measurements, and the importance of interprofessional collaboration.
Can Primary Care Provide Effective Management of Chronic Pain?epicyclops
This lecture was given by Professor Gary Macfarlane, Professor of Epidemiology at the University of Aberdeen, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Professor Macfarlane is introduced by Dr Colin Rae. The lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
www.wspg.org.uk
1. As surgeons age, their physical, cognitive, and technical skills gradually decline which can increase surgical risks and complications for older patients. Several studies show increased postoperative morbidity and mortality for elderly patients operated by older surgeons.
2. Valid assessment methods of aging surgeons are needed to objectively measure physical, cognitive, and technical skills to ensure patient safety and identify surgeons who may need retraining or early retirement.
3. Properly planned retirement allows aging surgeons to continue contributing to the medical community through teaching, mentoring, and non-clinical roles that utilize their experience and knowledge.
- The document discusses the importance of nutrition counseling in primary care and barriers to its implementation. It provides an effective 5 step approach ("A5 Algorithm") for physicians to provide brief but effective nutritional counseling.
- Case studies demonstrate how the approach can be used to address different patient nutritional issues like metabolic syndrome, lipid levels, and weight management.
- Effective nutrition counseling in primary care has potential to improve health outcomes and prevent deaths from diseases like obesity, hypertension and stroke. Tools and a team approach are needed to successfully incorporate it into short patient visits.
Bedside shift report involves nurses providing report at the patient's bedside in order to improve safety, communication, and patient satisfaction. Statistics show that poor communication contributes to many medical errors, yet traditional shift report away from the bedside risks missing critical information and distractions. Bedside report gives patients and families an opportunity to participate in the discussion of their care plan and ensures a safe handoff between nurses. While some nurses are initially uncomfortable or concerned with confidentiality, studies demonstrate that bedside report improves outcomes for both patients and nurses.
Mind the gap: ways to enhance therapy provision in stroke rehabilitation
This document, being launched at the UK Stroke Forum this week, explores some of the different models adopted by therapy services to deliver more rehabilitation and provides further detail about 45 minutes, process and outcomes.
(Published November 2011)
An opportunity to hear how service redesign positively impacts on the patient experience and improves outcomes for both the patient and NHSScotland. Showcasing examples of changes to pathways of care in orthopaedics and community support for people with complex and chronic conditions.
This document discusses the benefits of bedside nurse reporting to improve patient care. It begins by noting that traditional handoff reporting takes nurses away from patient care and can lead to missed information. Bedside reporting allows for a more organized transfer of information between nurses and increases patient involvement and satisfaction. Research supports the use of bedside reporting in improving outcomes such as increased patient satisfaction, decreased delay in starting nurse shifts, and improved nurse satisfaction. The document provides an example of a bedside reporting form and addresses some common concerns with implementing bedside reporting.
Patient-Centered Strategies for HCAHPS ImprovementEngagingPatients
This document discusses strategies for improving patient experience scores on the HCAHPS survey through patient-centered care. It notes that HCAHPS performance is becoming increasingly important for hospital reimbursement. The document recommends partnering with patients, creating a healing physical environment, making data meaningful to staff, focusing on care transitions beyond the hospital, and prioritizing compassionate care. Planetree is introduced as an organization that advocates for these patient-centered approaches and certifies hospitals that meet standards for patient-centered culture and environments.
Julio C. Baquerizo is seeking a position as an Adult Nurse Practitioner with over 15 years of clinical experience in various settings including ICU, emergency department, private practice, home health care, and more. He has a Master's Degree in Nursing and is certified as an Adult Nurse Practitioner with experience assessing, diagnosing, and treating a wide range of acute and chronic conditions. He is proficient in primary care delivery, medication management, and ensuring quality of care.
The Surgical Initiative concluded on March 31, 2014; the first system Hoshin to “graduate” to everyday work. Join us for an interactive discussion of the lessons learned over four years of transformational change.
* Patient-level & wound-level parameters influencing wound
healing were identified from prior research and clinician input
* Probability of wound healing can be predicted with reasonable
accuracy in real-world data from EMRs
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Bedside reporting involves including the patient in shift change reports between nurses. It has benefits like increased patient empowerment and safety due to improved communication of the patient's status and care plan. Implementing bedside reporting has shown positive results like higher patient and staff satisfaction, improved accuracy of information, and encouragement of teamwork. However, challenges include the time it takes and engaging reluctant patients. Studies have found that encouraging patient participation, using plain language, and allowing more time can help address these challenges.
University of sydney BDent1 - Finding the best evidence. Presentations goes over How to formulate a clinical question using PICO, How to find a systematic review in Cochrane & Medline, and how to find primary studies using the Ovid clinical queries limit in Medline. Contains links to the Sutherland Evidence-based Dentistry articles from the Journal of the Canadian Dental Association.
The document describes a quality improvement project to develop and implement a handover checklist to standardize communication between the Trauma Team Leader and neuro-trauma ICU team when transferring trauma patients. Feedback indicated the checklist reduced information omissions. Metrics showed increased checklist use and no suggested changes after implementation, demonstrating improved handovers and patient safety.
Making handover safer for trauma patients admitted to the neuro trauma icu st...
Similar to User Centered Design and Rapid Prototyping supported by a Wiki to develop a Decision Aid for CPR and Mechanical Ventilation adapted to the Context of an Intensive Care Unit
The Wellness Beyond Cancer Program at The Ottawa Hospital aims to provide colorectal cancer patients with appropriate follow-up care after treatment completion through a survivorship care plan. The program includes a needs assessment, education classes, discharge letters to primary care providers, and three levels of follow-up care. An evaluation of the first year found high patient satisfaction with education and empowerment. The program aims to improve cancer survivor care coordination and transition patients to wellness. Key lessons include considering incentives and barriers to ensure long-term sustainability and appropriate use of health resources.
What does a palliative approach look like in residential careBCCPA
This document provides an overview of a palliative care pilot project in residential care facilities. The goals were to enhance end-of-life care for residents and their families, improve the care team experience, and reduce hospitalizations. The project team implemented educational sessions, palliative care rounds, and engaged physicians. Early results found decreased hospital admissions and increased confidence in conversations about palliative care. Evaluation included focus groups with staff, families and the project team to assess the impact and identify factors for successful implementation.
This document summarizes a webinar for selecting topics for a national ICU collaborative initiative in 2016-17. It discusses the results of a survey where pain, agitation, and delirium (PAD) and end-of-life care were the top choices. Potential Topic 1 provides an overview of how end-of-life care could be improved across the ICU continuum. Potential Topic 2 reviews evidence that consistent pain assessment and management paired with sedation protocols can reduce length of stay and complications. The webinar participants then decided to focus on improving PAD management in 2016-17.
This document discusses strategies to prevent and manage delirium in critically ill patients. It outlines the ABCDEF bundle which includes assessing, preventing, and managing pain, both spontaneous awakening and breathing trials, minimizing sedation, assessing and preventing delirium, early mobility and exercise, and engaging family members. Screening for delirium using the CAM-ICU tool and implementing non-pharmacological interventions can reduce length of hospital stay, duration of mechanical ventilation, and mortality. Widespread use of protocols and bundles that incorporate these strategies may help address the high cost and poor outcomes associated with delirium.
Acute hospitals end of life care best practiceNHSRobBenson
Delivering reliable best practice in an acute hospital setting for patients whose recovery is uncertain. Including details of the AMBER care bundle. Presentation from Anita Hayes and colleagues from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
Hospital Discharge planning for Spinal cord injured patients.Vishnu P.V
The document discusses discharge planning for spinal cord injured patients. It emphasizes engaging patients and families in the process to safely transition care from hospital to home. The discharge plan involves assessing the patient's clinical history and prognosis, coordinating home services and equipment needs, and setting up follow-up appointments with healthcare providers to monitor recovery. Effective discharge planning is a collaborative process that aims to improve outcomes and prevent hospital readmissions.
Ipposi conf 2018 - Eidin Ni She, University College Dublinipposi
This document summarizes a research project that aims to improve care for frail older patients through a co-design approach. Key points:
- Researchers from University College Dublin are partnering with healthcare practitioners and patient advocacy groups to design and test a frailty care pathway at St. Vincent's University Hospital.
- Five co-design workshops over two years have brought together stakeholders to share perspectives and collaboratively develop solutions. This has helped build a shared understanding of challenges from all viewpoints.
- Emerging ideas from workshops include improved communication, mobility, nutrition, hydration and information for patients. Intentional rounding is being tested as a method to regularly check on patients' needs.
- The pilot of
- MK, a 67-year-old male, was diagnosed with stage IV lung cancer after presenting with cough, shortness of breath, and shoulder pain. He underwent chemotherapy and radiation but his functional status declined rapidly with each treatment cycle.
- Discussions eventually shifted to palliative care and hospice. MK was enrolled in hospice and received pain management, social support, and end-of-life counseling. He was able to spend his final days at home surrounded by family.
- Early integration of palliative care can improve quality of life for advanced cancer patients by aligning treatment with patient goals and allowing patients to die peacefully at home.
Recommendations for end-of-life care in the intensive care uni.docxdanas19
This document provides recommendations for end-of-life care in the intensive care unit (ICU). It discusses preparing both the patient and family for withdrawal of life-sustaining treatments by clearly explaining what to expect and ensuring pain and suffering are minimized. It also emphasizes the importance of addressing the needs of families through open communication, allowing them to be present and helpful, and providing emotional support. The overarching goal is to integrate palliative care principles to ensure a dignified and comfortable death for patients in the ICU.
When Decision-Making Is Imperative: Advance Care Planning for Busy Practice S...VITAS Healthcare
Complex, chronically ill patients present an opportunity to discuss and implement hospice and palliative care. Many elderly patients who present to the ED and other busy practice settings are hospice-eligible because of functional decline and multi-morbidity. Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid time constraints and high-acuity challenges.
The document discusses lessons from the United States on caring for patients with chronic illnesses. It outlines three key functions of primary care teams: panel management to ensure patients receive evidence-based care, health coaching to support behavior change and medication adherence, and complex care management for high-needs patients. High-functioning teams with roles like registry use, panel managers, and health coaches are shown to improve health outcomes and lower costs compared to usual individual physician care.
The document discusses lessons from the United States on caring for patients with chronic illnesses. It outlines three key functions of primary care teams: panel management to ensure patients receive evidence-based care, health coaching to support behavior change and medication adherence, and complex care management for high-needs patients. High-functioning teams with roles like registry use, panel managers, and health coaches are shown to improve health outcomes and lower costs compared to usual individual physician care.
Person Centered Care through Integrating a Palliative Approach: Lessons from ...BCCPA
Aging adults are entering residential care facilities with more advanced disease than in the past and their length of stay is shorter. Most health care providers in these facilities do not receive targeted education and training in palliative care, nor are they confident to have crucial conversations about goals of care and end of life challenges with residents and their families. Due to limited capacity to manage predictable symptoms related to end of life and insufficient planning, many residents are transferred to hospital in crisis and die in the Emergency Department or acute care wards.
This presentation will showcase some of the initiatives by identifying common themes, unique features of each and strategies for success. Opportunity will be given for delegates to ask questions and brainstorm how lessons learned from these initiatives could inform the care provided at their own facility.
Presented by:
- Jane Webley, RN LLB Regional lead, End of Life, Vancouver Coastal Health (EPAIRS and the Daisy project)
- Dr Christine Jones, Island Health (SSC project: Improving end of life outcomes in residential care facilities: A palliative approach to care)
- Kathleen Yue, RN, BSN, MN, CHPCN (c) Education Coordinator, BC Center for Palliative Care
The comprehensive geriatric assessment pcp slidesMarc Evans Abat
This document discusses the comprehensive geriatric assessment (CGA). It begins by defining the CGA as a multidimensional, interdisciplinary diagnostic process that develops a coordinated treatment plan emphasizing quality of life, functional status, and prognosis.
It then identifies the key components of a CGA as including medical history, physical and functional status, behavioral and emotional status, environmental and social support, and spiritual well-being. Common tools used include assessments of activities of daily living, cognition, nutrition, and fall risk.
The document explains that a CGA is recommended for older adults who are frail or have geriatric syndromes like falls or polypharmacy. Evidence shows that CGA can reduce mortality, institutionalization
This document provides a summary of a presentation about palliative care efforts in Delaware. It discusses the difference between palliative care and hospice, current palliative care programs available in Delaware, and opportunities for expansion. Key points include:
- Palliative care aims to improve quality of life by relieving symptoms for patients with serious illnesses, while hospice focuses on the last 6 months of life after curative treatments stop.
- Delaware has several palliative care programs in hospitals, home care, and long-term care settings, but access could be expanded by having palliative specialists in all hospitals and outside of hospitals.
- Opportunities remain to improve palliative care in Delaware through increasing the number of board
What does the public think about assigning priority to end-of-life treatment? In this presentation, OHE's Koonal Shah describes the results of research intended to tease out both preferences and, where possible, the reasoning behind them. The findings may surprise some -- for example, that priority is not given to end-of-life treatments when the treatments they would supplant offer greater health gains.
This document discusses palliative care and end of life care. It defines palliative care as an interdisciplinary approach to relieve suffering and improve quality of life for patients with serious illnesses. The goals of palliative care are to control pain and other physical symptoms while providing psychological and spiritual support to patients and families. A multidisciplinary team approach is emphasized to address all aspects of care. Barriers to providing palliative care include fragmented care and ineffective communication, which can be overcome with education, focus on patient goals, and inclusion of families in the process. The document also reviews end of life care, including allowing natural death, advance care planning, and nursing interventions to keep patients comfortable as death approaches.
Similar to User Centered Design and Rapid Prototyping supported by a Wiki to develop a Decision Aid for CPR and Mechanical Ventilation adapted to the Context of an Intensive Care Unit (20)
13e Journées de formation interdisciplinaire 2020: Atelier décision partagéePatrick Archambault
La prise de décision partagée (PDP) se définit comme un processus nécessitant la participation conjointe du patient
et de son médecin. Ce processus décisionnel doit reposer sur des données scientifiques éprouvées et mettre en
évidence les risques et les bénéfices de toutes les options disponibles, y compris celle de s’abstenir associée à une
observation prudente. Intégrer la PDP dans sa pratique clinique permet d’améliorer la qualité de sa pratique et
d’évaluer la pertinence d’un acte médical. Instruite par plus de 20 ans d’études et de programmes de formation dans
ce domaine, les conférenciers présenteront les étapes essentielles à la prise de décision, pour qu’à la fin de l’atelier
les participants puissent discerner les cas cliniques qui lui sont propices. Pendant l’atelier, les participants utiliseront
un outil d’aide à la décision et avec lequel ils seront tous interpellés à jouer un rôle fondé sur des cas cliniques issus
de la pratique médicale spécialisée (p. ex. : urgence, soins intensifs, pneumologie). D’autres outils d’aide à la décision
seront également présentés (p. ex. : recours à des antibiotiques, prescription de statines, traitement de l’asthme) et
la séance se terminera par une discussion réflexive.
This document summarizes recommendations from a panel discussion on engaging patients in emergency medicine (EM) research. The panel reviewed literature on patient engagement and conducted interviews with EM researchers. They recommend that EM researchers adopt patient engagement to improve research relevance and impact. Specifically, they recommend that the Canadian Association of Emergency Physicians (CAEP) create resources and guidelines to support patient engagement at all stages of research. This includes establishing a national patient council, training materials, and making patient engagement eligible for funding. The panel also provides best practices for the preparatory, execution and translation phases of research that engages patients.
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Poster presented at the 2016 Canadian Association of Emergency Physicians conference about the adaptation of the Decision+ program about using antibiotics for upper respiratory infections developed in primary care for the context of Emergency Medicine
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Rural physicians in Quebec predominantly use social media amongst themselves, mainly email, for administrative purposes. They use social media cautiously to avoid impacting the patient-physician relationship, which they see social media as not well-suited for. Only 30% use social media, mainly email, with patients. While some physicians see value in practice guidelines for social media, others feel current professionalism standards suffice or are unsure if extra guidance is needed.
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Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
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User Centered Design and Rapid Prototyping supported by a Wiki to develop a Decision Aid for CPR and Mechanical Ventilation adapted to the Context of an Intensive Care Unit
1. Plaisance A, BSc1,2
; Witteman HO, PhD3,4,9
; Heyland DK, PhD5,6
; Ebell MH, MD, MS7
; Dupuis A, MA2,8
; Lavoie-Bérard CA, MD2
; Légaré F, MD, PhD4,9
; Archambault PM, MD, MSc, FRCPC2,4,9
1 Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC ; 2 Centre de recherche du Centre hospitalier affilié universitaire de l’Hôtel-Dieu de Lévis, Lévis, QC ; 3 Vice-décanat à la pédagogie et au développement professionnel continu, Faculté de médecine,
Université Laval, Québec, QC ; 4 Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, QC ; 5 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON ; 6 Department of Medicine, Queen’s University, Kingston, ON ; 7 Health
Sciences Campus, University of Georgia, Athens, GA ; 8 Département d’information et de communication, Faculté des lettres et des sciences humaines, Université Laval, Québec, QC ; 9 Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec, QC.
DEVELOPMENT OF A CONTEXT-ADAPTED DECISION AID FOR GOALS OF CARE
INVOLVING ICU PATIENTS' AND HEALTH PROFESSIONALS' PARTICIPATION
INTRODUCTION Intensivists face difficult situations which raise questions
about the informed nature of decision making about life-sustaining therapies.
METHODS Ethnography and user-centered design.
RESULTS We created a novel paper and wiki-based decision aid (DA) about
goals of care adapted to the needs of a local ICU. We identified multi-level barriers
to making end-of-life decisions in the ICU that are congruent with patients’ values
and preferences.
CONCLUSIONS We produced a DA about goals of care adapted to the local
context of a single ICU. Many steps still need to be done before its implementation
in this ICU and before scale-up to other care settings.
ABSTRACT
BACKGROUND
• Many frail elderly are being admitted to ICUs. Upon admission, they need
to clarify their goals of care.
• Inability to engage patients in discussions about their goals of care can
lead to the use of aggressive life-sustaining therapies.
• Shared decision-making (SDM) can improve congruence of decision
making with patients’ values and decreases overuse.
OBJECTIVES
• To identify patients’ and clinicians’ needs for end-of-life decisions that
are congruent with patients’ values and preferences (e.g. CPR or no CPR)
• To adapt an existing DA to the context of a single ICU.
INTRODUCTIONMETHODS
ACKNOWLEDGMENTS
We thank all participants, including the critically-ill patients
who contributed to improving our decision aid for the benefit of future patients.
RESULTS
• A context-adapted DA about goals of care was produced
with the participation of clinicians, patients, and family
members.
• DA available online at www.wikidecision.org
• Upcoming steps : video for patients, clinician training on
the subject of SDM in the ICU, evaluation of the clinical
impact of our intervention.
CONCLUSIONS
PREPARATION
• 3 weeks of ethnographic information of daily interactions between
patients, families, intensivists and other allied health professionals
• 4 semi-structured individual interviews with intensivists
• 5 observations of patient-intensivist discussions about goals of care
• Content analysis
1
2
3
DEVELOPMENT OF THE WIKI & ADAPTATION OF THE DA
• Creation of www.wikidecision.org
• Translation and adaptation of a DA about CPR
• Translation and integration of the Good Outcome Following Attempted
Resuscitation (GO FAR) score to predict neurologically intact survival
after in-hospital cardiopulmonary resuscitation into the wiki-based DA
RAPID PROTOTYPING
• 3 cycles of rapid prototyping (5 dyads by cycle, 15 participants in total)
• Observations of prototype use with a structured observation grid
• Short interviews with patients and intensivists and content analysis
• Modification of the DA prototype in response to the comments addressed
prior to the next cycle in each iteration of the prototype
MEDICAL STAFF
Intensivists
Medical residents
Nurses
N = 10
6
2
2
PATIENTS
Age mean (SD)
Women, N (%)
High school education not completed, N (%)
Medical reason for admission, N (%)
Length of stay in the ICU (days), mean (SD)
Catholic faith (practicing or not), N (%)
Mortality post-3 months
N = 15
67 (16)
8 (53)
4 (27)
13 (87)
5 (3)
12 (80)
3 (20)
More information
about alternative
options (e.g.
palliative care)
was added
Focus of the
questions on current
& acceptable
future functional
autonomy
It does !
in 100% of cases
The GO FAR rule
and Icon Array
software to illustrate
patients’ chances
of survival with
and without
CPR was
programmed
into the wiki
What will happen
to me if I refuse those
interventions ?
What are the risk
to loose my
functional
autonomy ?
Untreated
cardiac arrest
can not lead
to death...
SOLUTIONS CREATED ACCORDING TO COMMENTS
COLLECTED THROUGH PROTOTYPING
FIRST AND SECOND PAGES OF THE PAPER DA
DECISION AID CONTENT
• International Patient Decision Aid Standards
(IPDAS) criteria (20/30)
• Values clarification section
• General information about procedures
• Risks and benefits
• Population-level statistics
• Deliberation section
• Online only : GO FAR calculator for
individualized statistics linked to Icon Array
Cet outil a été produit grâce
à la collaboration de
... et de patients admis à l’Unité des
soins intensifs de l’Hôtel-Dieu de Lévis
et de leurs proches.
Dernière mise à jour
le 20 mai 2016
Outil d’aide à la décision
sur les objectifs de soins
Version destinée aux patients aptes
admis à l’unité des soins intensifs
de l’Hôtel-Dieu de Lévis
Introduction
Lors d’une hospitalisation, l’équipe soi-
gnante discutera avec vous et vos proches
corresponde à vos objectifs de soins.
Il sera plus particulièrement question de vos
valeurs et de votre niveau d’autonomie actuel
et de deux interventions :
la réanimation cardiorespiratoire (RCR)
la ventilation mécanique
Ce document a été conçu pour vous aider
à prendre une décision éclairée à ce sujet.
2
Que se passera-t-il après
que j’ai discuté de mes objectifs
de soins ?
Vos objectifs de soins seront inscrits à votre
dossier et votre plan de traitement sera
ajusté en conséquence.
Si vous changez d’idée, faites-le savoir
à un membre de l’équipe.
Si vous avez des questions ou des pré-
occupations à propos de l’information
fournie dans cette brochure, sentez-vous à l’aise
d’en discuter avec l’équipe soignante.
11
SURVIE
À TOUT
PRIX
CONFORT
Prolonger la
vie par tous les
soins nécessaires
Prolonger
la vie par
des soins
limités
Assurer le confort
prioritairement
à prolonger
la vie
Assurer le confort
uniquement sans
viser à prolonger la vie
BARRIERS
Multi-level barriers leading to an end-of-life in the ICU that is incongruent with patients’ values and preferences
Individual
Patient/Doctor
relationhsip
Microsystem
(clinical practices, team culture)
Mesosystem
(institutions, healthcare system)
Macrosystem (community)
• Lack of
knowledge
of intensive care
and interventions
that are offered
• Lack of data about
our population
• No decision aid available
• Patients transferred from
the ED to the ICU without
having discussed goals of care
• No centralized patient health record
• Medical doctor fee-per-service system
• Healthcare system bias towards keeping people alive
• The DA could not address all needs
(video explanation, better information
about how non-survivors die)
• The DA is adapted to the local context
of an ICU serving an aging Caucasian
French Canadian population. It would need to be
culturally adapted before being used with
patients from other cultures.
LIMITATIONS
EXAMPLE OF THE GO FAR CALCULATOR FOR INDIVIDUALIZED
STATISTICS AVAILABLE ONLINE
ImagescreatedbyIconarray.com
www.wikidecision.org/comments
arianeplaisance@gmail.com
CONTACT
GRAPHIC DESIGN | depicsci@gmail.com