bullet rounds: let’s set the clock to walk in the icu
TRANSCRIPT
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Bullet Rounds: Let’s set the Clock to Walk in
the ICU
Senior Friendly Hospital & Rehab
Network Symposium
February 25th 2016
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Context
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What the ICU team has done well
• Engaged stakeholders early on
• Created a interprofessional and intersectorial
working group
• Selected project measures (based on our
mobility clock)
• Adopt and implement best practices related to
sedation, delirium and pain
• Trained staff using the In-house simulation lab
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Simulation lab to train the ICU staff
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Adapted Tool
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Project measures
Increase by January 2016 the percentage of critically ill patients who ambulate
while in the ICU to 50 % (baseline 20% ).
Process :
a) # of patients admitted to ICU evaluated with the standardized tool (clock) in first 24h
Outcome:
c) # of days before chair transfer (≥2 on the ICU Mobility Scale)
d) # of days before ambulation (≥ 5 on the ICU Mobility Scale)
e) Length of stay in ICU
Balancing:
i) Incidence of falls (# of falls for every 1000 days of presence) in ICU.
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Results
0%
20%
40%
60%
80%
100%
0
5
10
15
20
25
2014-12 2015-06 2015-12 2016-01
Pou
rcen
tage
(%
)
Nom
bre
de
jou
rs
nombre de jours avant transfert à la chaise nombre de jours avant première ambulation
% patients ambulés
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Balancing measure
Falls in the ICU
• December 2014: 3 falls
• Decembre 2015: No reported falls in the
ICU.
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What this really looks like
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LESSONS LEARNED • Importance of communication about the project often
and loud
• Patient advisor is a critical part of the team
• Importance of having interprofessional and intersectorial
team members
• The imortance of empowering champions to make small
but meaningful changes
• Training sessions should be all within a month not to lose
momentum
• Make sure the right players are at the table from the
beginning
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Next steps
• Mandatory mobilization training for new ICU
employees (integrated into specific nursing
orientation)
• Review sedation practices with physicians
• Discuss sleep hygiene practices in the ICU
• Reinforce mobility documentation practices
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NEXT STEPS • Mandatory mobilization training for new
ICU employees (integrated into nursing
orientation)
• Review sedation practices
• Discuss sleep hygiene practices in the ICU
• Reinforce mobility documentation
practices
• Perform a Gap analysis in ICU regarding
pain assessment and treatment
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