10 Things ICUs Must Do Better Organ Donation: An Update

“Keeping you in touch with our
collective critical care team”
10 Things ICUs Must Do Better
Recently, in his plenary address at the Society
of Critical Care Medicine Conference, R. Phillip
Dellinger (MD) reflected on the “10 Things ICUs
Must Do Better”, based on 35 years of Critical
Care
experience.
(Medpage
Today,
http://www.medpagetoday.com/MeetingCov
erage/SCCM/49606)
While not necessarily evidence-based topics,
all of them represent plain ol’ common sense!
They are worth taking a look at:
1. Add a bigger dose of compassion
2. Employ
2-way
communication
with
patients and their families
3. Remain vigilant about good Sepsis care,
which has brought about dramatic
improvements in mortality (despite recent
trials
eschewing
protocolized-based
treatments): “we should not rest on our
laurels”
4. Recognize the importance of Post-ICU
Syndrome (e.g., PTSD, depression, cognitive
and physical challenges), and implement
strategies to reduce the impact, such
as, using
fewer
restraints,
promote
sleep, ambulate early and carefully
consider
medication
choices
for
agitation and delirium.
5. Improve/recognize the more urgent need
for pre-ICU Care
6. Align research and healthcare changes
7. Do more physical exams (“lay hands”!) and
model this behaviour for fellows and
residents.
8. Standardize and streamline multidisciplinary
ICU rounds
9. Focus on Patient Safety, to decrease
lengths of stay and improve patient
experiences (e.g., improved hand washing
rates, decreased pressure ulcers, minimize
delirium rates, etc)
10. Employ
electronic
medical
record
documentation
Page 1
Organ Donation: An Update
As you are all aware, CDHA is a national leader in terms of Organ
Donation. We have an active team, made up of an extremely
passionate and dedicated group of individuals.
The medical director for Organ Donation is Dr. Stephen Beed
(Critical Care & Anaesthesia) and the manager is the Health
Services Manager for 5.2 MSNICU (currently in transition), where
all potential donors are admitted for assessment and workup.
The four Organ Donor Coordinators are: Tami Murphy, Jane
Franklin, Mark Bonin and Janet Ballem. They work on a rotating
call schedule and can be reached 24/7 for any question and/or
assessment of potential donors.
In addition to donation after neurological declaration of brain
death (NDD), at CDHA, we are now practicing donation after
cardiac death (DCD). There are strict criteria for both, in
addition to protocols for care of the potential organ donor
patient.
The table below lists the organ donation statistics for chart audits
from January 1, 2014 through December 31, 2014*:
Referrals to Critical Care Organ
Donation (CCOD)
43
Actual Donors
12 NDD, 5 DCD (17 Total)
Family Declines
11
Missed Referrals
10
* Chart audits on all death charts (433 charts) in Critical Care and
Emergency Department at QEII, VG, Dartmouth General and IWK.
Thank you to everyone for your continued vigilance and hard
work; donation is often the only bright spot for families during a
tragic time in their lives.
One donor can benefit more
than 75 people and save up
to 8 lives – cantransplant.ca
Critical Care Quality News ● March 2015 ● Issue 3
Delirium & Pressure Ulcers
Many dedicated people are
working hard to make patient DELIRIUM IN THE ICU:
safety a top priority. Current a. In August 2014 data collection about the number of CAM-ICU positive (i.e.,
initiatives of the QA group
Delirious patients) began. Some important findings have emerged:
(through various working groups)
i. 66% of our patients are mechanically ventilated (which is a major risk
include DELIRIUM PREVENTION (in
factor for the development of delirium);
conjunction with the Mobility
ii. There has been great uptake with daily CAM-ICU data collection by
Project) and PRESSURE ULCER
Charge Nurses & Staff Nurses! THANK YOU AND KEEP UP THE GREAT WORK!
PREVENTION.
b. What next?
i. We are aiming to discuss delirium EVERY DAY ON ROUNDS!
ii. We are aiming to INCLUDE pain, agitation and sleep assessments daily
also!
iii. We will be moving forward with a Practice Grant looking at the Sleep
Promoting Environment in ICU: PLEASE VOLUNTEER TO HELP!
iv. THERE WILL BE A PRACTICE COUNCIL EDUCATION EVENT APRIL 1, including
a presentation on Delirium & Medications - don’t forget to register and
attend! (Information regarding event can be found on Page 4)
PRESSURE ULCER PREVENTION:
a. Pressure ulcers are neither glamorous nor sexy
(see image above), but they are important risks
to patient safety and wellbeing, and have also
been identified by Accreditation Canada and
provincial bodies as a priority area of focus in
Critical Care.
b. In order to improve pressure ulcer prevention, we
need to ramp up AWARENESS OF THE SCOPE OF
THE PROBLEM – toward that end, pressure ulcer
screening (3x/month) began in August 2014.
c. WHAT ARE THE NEXT STEPS?
i. We will be continuing to collect ICU pressure
ulcer data at least 3 times per month
ii. Continue ongoing education through
various methods, and participate in local
and national prevalence studies
iii. Continuing with the mobility project
iv. We will be getting pressure-redistributing
chair cushions for use with high-risk patients
Family Survey’s
PRESSURE ULCERS IN CRITICAL CARE – 3A/5.2
Between August 2014 & February 2015, screening was
completed on 51 days!
A total of 420 ICU patients were assessed.
The most common location for ulcers is the coccyx (59%),
followed by heels (25%).
Number of Pressure Ulcers known to be ICU Acquired - 11
Number of Pressure Ulcers Possibly ICU Acquired - 9
ICU Acquired Pressure Ulcers are present in between 2.6%
and 4.8% of the patients assessed.
The CDHA Pressure Ulcer Prevention Committee would like to
hear from staff to be able to develop effective improvement
strategies. They want to hear from Critical Care:
- What are the current barriers for your team in preventing or
treating pressure ulcers?
- What are the current enablers that allow you to effectively
prevent, or care for existing ulcers?
Please email karen.webb-anderson@cdha.nshealth.ca to
contribute to our response. There will also be postings on the
units to capture people’s thoughts.
What do families tell us?
Overall, families tell us how satisfied they are with the clinical expertise and care provided in our units.
As a family we were very pleased with the professional service provided. Above this, one thing was very
evident, the staff showed a very caring attitude that we appreciated. Thank You.
A top priority repeatedly identified is communication.
Families need information in an understandable manner
that is open, honest, and consistent across professions.
Please encourage family feedback!
There are family surveys available in the main Waiting
Rooms on both 3A & 5.2. Please encourage families to
complete the surveys. They can place them in the
locked box, or they can mail them back to us.
Page 2
Critical Care Quality News● 2014 ● Volume 1, Issue 1
Critical Care Quality News ● March 2015 ● Issue 3
Organizational Health
Grants Competition!
Congratulations to our Teams on 3A & 5.2 for submitting
successful applications to the Organizational Health Grants
competition! More information about participating will be
circulated & posted on the units.
The 3A submission was entitled I.C.U….Do U.C. ME?, the goal
is to build inter-disciplinary team capacity, cohesiveness and
resilience. They will plan an event at OnTree Fun and
Adventure Park in Windsor, NS where they will learn to push
their boundaries by trying a new activity, laughing and
sharing new challenges as they get to know each other
better along the way. OnTree Fun and Adventure Park offers
fun for people of all ages and abilities with 13 different
exciting course events, 350 foot zip lines, a bike on a wire,
tarzan ropes, spider webs, and a 50 foot base jump!
The 5.2 submission was entitled Do you want to run away and Join the Circus?. From their submission: “there are many
different people of various professional educations and support services who come together every day to provide
holistic care to the sickest of the sick in the 5.2 Intensive Care Unit. The toll on the team can be physically and mentally
exhausting. We would like to provide a chance to these hard-working men and women to laugh, participate in group
activities and interact outside the workplace. The setting would allow an environment free from work roles, hierarchy
and job descriptions”. They will plan a team event hosted by Atlantic Cirque, in Dartmouth. It will be designed to involve
people of varying physical abilities, using circus apparatus, acrobatics, trampoline, human pyramids, and juggling.
Try to get some rest.
I’ll be in every few
minutes to ensure you
don’t.
Sleep Promotion in the ICU: Fact or Fallacy?
Nurses from 3A & 5.2 received a Nursing Practice Grant to examine the
sleep promoting environment in the ICUs. In February, a survey was done
to better understand barriers and to inform an initial plan for
improvement. Thanks to all who participated in the survey! Everyone that
completed the survey had an opportunity to put their name in a draw for
2 tickets to a taping of This Hour Has 22 Minutes. Congratulations to our
winners!
From the 3A ballot envelope: Clinton Lewis
From the 5.2 ballot envelope: Chris White
Critical Care Research!
Critical Care research coordinator Lisa Julien works
closely with professors Dr. Richard Hall and Dr. Robert
Green to conduct a wide range of studies (industry and
grant funded) involving patients admitted to the Intensive
Care Units at the QEII Health Sciences Centre. With as
many as six studies going on at any one time, they are
testing new medications for treating severe sepsis and
hospital acquired pneumonia, new approaches to
preventing blood clots, and new ways of assessing and
treating injuries to the kidneys, lungs, brain and other
organs. The QEII/Capital Health organization is one of the
top-recruiting sites in the Canadian Critical Care Trials
Group. Involving more than 40 hospitals across Canada,
this is one of the most active and successful critical care
research groups in the world.
Page 3
Current studies we are recruiting into are:
1) Industry: A randomized, double-blind, placebo
controlled, phase 3 study to assess the safety and
efficacy of ART 123 in subjects with severe sepsis and
coagulopathy
2) Grant: Early Determination of Neurological Prognosis
in ICU patients with Severe Traumatic Brain Injury: TBI
-Prognosis Multicenter Prospective Study
3) Grant: Re-Evaluating the Inhibition of Stress Erosions:
Gastrointestinal Bleeding Prophylaxis In ICU (REVISE):
A Feasibility Pilot Trial
4) Grant: Bacteremia Antibiotic Length Actually
Needed for Clinical Effectiveness: (BALANCE)-Pilot
5) (Non-Funded): Effect of inflammation on the bloodspinal barrier. A sub-study of the CAMPER Study.
6) (Industry):A Phase 3 Randomized Double-blind Study
Comparing TR-701-FA and Linezolid in Ventilated
Gram-positive Nosocomial Pneumonia
Critical Care Quality News ● March 2015 ● Issue 3
Upcoming Events:
Critical Care Nursing Practice Council Educational
Event!
Wednesday April 1st @ 0800-1200
Weather Watch Room, Dickson Bldg
Presenters:
-Dr. Meghan Mackenzie & Clinical Pharmacists –
Delirium & Medications
-Dr. Rob Green – Resuscitation before Intubation:
Lessons Learned
-Dr. Babar Haroon – Patient Safety through Team
Communication
-Carol Meade-Corkum – ECG Rhythm Interpretation
To register please email Karen.webbanderson@cdha.nshealth.ca
Blood and Beyond 2015: Issues in Trauma, Bleeding,
Coagulation and More!
April 18th & 19th 2015
The Prince George Hotel, Halifax, NS
Presented by Perioperative Blood Management
Services, Department of Anesthesia, Dalhousie
To learn more and/or to register visit
http://nsanesthesia.ca/s/blood-and-beyond
CANN: Neurology at a Glance
May 4th 2015 0900-1530
Royal Bank Theatre, Halifax Infirmary
“All Healthcare professionals &
Students are invited to join us for
a day of Neuroscience Learning”.
Register by April 24th 2015, email
CANN-NS Councillor Joan Pacione at
d.pacione@bellaliant.net
COMING SOON!
Daily Rounds Tool
As we know, one of the key’s to patient safety is team
communication. In ICU, BEDSIDE ROUNDS represents the
main opportunity dedicated to interdisciplinary team
communication. We are going to be starting to use a Daily
Rounds Tool, to help us ensure key components are being
addressed. This Daily Rounds Tool is a simple electronic
survey on the ICU portable computers that can be
completed by any team member, and can be passed
back and forth between team members during rounds. It is
meant to support, not impede, our teamwork! Any
feedback, as this is implemented, should be passed along
to Sarah McMullen or Karen Webb-Anderson so that we
can ensure it is as efficient and user-friendly as possible.
Medication Safety Huddles
Medication Safety Huddles are being re-introduced on
both 3A & 5.2. They will be held each Thursday at 1415 and
co-lead by the Clinical Pharmacist & Charge Nurse. Topics
to consider:
What are your concerns about medication safety?
What strategies can be put in place to prevent errors
/ near misses?
What is new in our critical care pharmacy world?
"Alone we can do so little,
together we can do so much."
~Helen Keller~
Critical Care Grand Rounds @noon Rm 378 Bethune:
Tues March 31st – Dr. Marion Cornish
Tues April 7th – Dr. Emily Rowsell
Tues May 5th – Critical Care Research Group
Tues June 2nd – Dr. Tobias Witter
*specific topics TBA/All teams welcome to attend!!
Changes to our Critical Care Family
Welcomes! & Thank Yous!
We have had a new addition to our ICU family. WELCOME!
 5.2 New Staff: Brent De Young
With the coming of new staff we have seen some amazing
members of our family leave. A BIG thank you for your
dedication and hard work! You will be missed!!
 3A RETIREMENTS: Debbie Labrech
 5.2 RETIREMENTS: Katy MacAulay & Eleanor Tinkham
Page 4
Our Critical Care Quality
Team would like to thank
Dawnelda Murray for her
commitment to our Team's
success. We wish her all
the best as moves into her
new role in 3 IMCU and we
look forward to future
opportunities to
collaborate!
Produced by
Department of Critical
Care
1276 South Park St
Rm 377 Bethune Bldg
Halifax, Nova Scotia
B3H 2Y9
Phone:
(902) 473-3486
Fax:
(902) 473-3610
Email:
kristen.griffiths@cdha.
nshealth.ca
Critical Care Quality News ● March 2015 ● Issue 3