Improving the quality of nurse‐influenced patient care in the intensive care unit

Sutton-Smith, Lynsey; Jarden, Rebecca

doi:10.1111/nicc.12266

Cited by 14 publications

(11 citation statements)

References 87 publications

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“…We have found, through previous project initiatives, that shorter, face-toface, small group sessions are much more effective in engaging staff rather than large-group, didactic presentation-led teaching sessions. 16,17 These strategies are also supported in the literature. 19 Overall, 80% of the nursing and health care assistant team (n = 120 staff) completed face-to-face education from the "delirium team" during June 2018 (figure 2).…”

Section: What This Paper Addssupporting

confidence: 55%

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A quality improvement project to improve the identification and management of delirium

Sutton-Smith

2020

Nursing in Critical Care

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Background: Efforts to reduce delirium burden through screening, identification, and prevention is considered one of the major public health priorities of the last decade.In 2017, an audit of delirium screening in our unit revealed suboptimum assessment of our patients, with compliance with the Confusion Assessment Method for the ICU (CAM-ICU) assessments highly variable and ad hoc, and sometimes not at all. A separate sedation audit also revealed that our sedation practices did not align with current critical care guidelines emphasizing light sedation strategies.Aim: The aim of this project was to develop resources to educate the unit on delirium, improve the management of sedation with a sedation algorithm, formalize the elements of delirium prevention and care into a delirium pathway, and improve the compliance with delirium screening.Methods: We developed a delirium clinical pathway and sedation algorithm, a delirium resource book, and an online educational module on the district health board (DHB) intranet. We provided extensive teaching of all these resources over delirium month. We used pre-and post-auditing of sedation practices and delirium screening compliance to inform the success of this project.Results: Of the 140 members of staff, 85% (n = 120) received delirium education. In 2018/2019, 84% of 145 patient charts reached the unit standard of four to six hourly CAM-ICU assessments compared with 45% in 2017. The sedation audit revealed a slight improvement in the trend towards lighter sedation, with Richmond Agitation Sedation Scoring (RASS) scores reflecting light sedation, increasing from a mean of 31% in 2017 to 41% in 2019 from 41 patient charts. Conclusions:This project provides a useful framework to enable future quality improvement work around delirium and sedation management. The clinical pathway and sedation algorithm have been a useful tool to introduce to the unit as a way of formalizing the elements of delirium care and assessment.

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Section: What This Paper Addssupporting

confidence: 55%

“…The adapted Plan-Do-Study-Act (PDSA) 15 quality improvement model provided a framework for this project with previous success. 16,17 The WHAT IS KNOWN ABOUT THIS SUBJECT?…”

Section: Interventionmentioning

confidence: 99%

A quality improvement project to improve the identification and management of delirium

Sutton-Smith

2020

Nursing in Critical Care

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“…One stated optimisation to be achieved once a predefined question has been sufficiently answered [38]. Almost one third (n = 6) of the frameworks [20,34,[39][40][41][42] were identified as being modified, or incorporating components from a prior framework.…”

Section: Resultsmentioning

confidence: 99%

How to optimise public health interventions: a scoping review of guidance from optimisation process frameworks

et al. 2020

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Background Optimisation processes have the potential to rapidly improve the impact of health interventions. Optimisation can be defined as a deliberate, iterative and data-driven process to improve a health intervention and/or its implementation to meet stakeholder-defined public health impacts within resource constraints. This study aimed to identify frameworks used to optimise the impact of health interventions and/or their implementation, and characterise the key concepts, steps or processes of identified frameworks. Methods A scoping review of MEDLINE, CINAL, PsycINFO, and ProQuest Nursing & Allied Health Source databases was undertaken. Two reviewers independently coded the key concepts, steps or processes involved in each frameworks, and identified if it was a framework aimed to optimise interventions or their implementation. Two review authors then identified the common steps across included frameworks. Results Twenty optimisation frameworks were identified. Eight frameworks were for optimising interventions, 11 for optimising implementation and one covered both intervention and implementation optimisation. The mean number of steps within the frameworks was six (range 3–9). Almost half (n = 8) could be classified as both linear and cyclic frameworks, indicating that some steps may occur multiple times in a single framework. Two meta-frameworks are proposed, one for intervention optimisation and one for implementation strategy optimisation. Steps for intervention optimisation are: Problem identification; Preparation; Theoretical/Literature base; Pilot/Feasibility testing; Optimisation; Evaluation; and Long-term implementation. Steps for implementation strategy optimisation are: Problem identification; Collaborate; Plan/design; Pilot; Do/change; Study/evaluate/check; Act; Sustain/endure; and Disseminate/extend. Conclusions This review provides a useful summary of the common steps followed to optimise a public health intervention or its implementation according to established frameworks. Further opportunities to study and/or validate such frameworks and their impact on improving outcomes exist.

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“…Nurses are strongly positioned to positively influence patient care at a local level through quality improvement strategies (e.g. see Sutton and Jarden, , Jarden and Sutton, , Jarden and Quirke, ). This study highlights a significant opportunity to enhance the provision of oral nutrition at a local level, both in an ICU and post‐ICU setting.…”

Section: Resultsmentioning

confidence: 99%

Oral intake evaluation in patients following critical illness: an ICU cohort study

Jarden

Sutton-Smith

Boulton

2018

Nursing in Critical Care

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Timely and adequate nutrition improves health outcomes for the critically ill patient. Despite clinical guidelines recommending early oral nutrition, survivors of critical illness experience significant nutritional deficits. This cohort study evaluates the oral nutrition intake in intensive care unit (ICU) patients who have experienced recent critical illness. The oral nutrition intake of a convenience sample of ICU patients post-critical illness was observed during a 1-month period. Data pertaining to both the amount of oral nutrition intake and factors impacting optimal oral nutrition intake were collected and analysed. Inadequate oral intake was identified in 62% of the 79 patients assessed (n = 49). This was noted early in the ICU stay, around day 1-2, for most of the patients. A significant proportion (25%) of patients remained in the hospital with poor oral intake that persisted beyond ICU day 5. Unsurprisingly, these were the patients who had longer ICU stays. Critical illness weakness was a factor in the assessment of poor oral intake. To conclude, patients who have experienced critical illness also experience suboptimal oral nutrition. The three key factors that were identified as impacting optimal oral nutrition were early removal of nasogastric tubes, critical illness weakness and poor appetite post-critical illness. Seven key recommendations are made based on this cohort study. These recommendations are related to patient assessment, monitoring, documentation and future guidelines. Future research opportunities are highlighted, including the investigation of strategies to improve the transition of patients' post-critical illness to oral nutrition.

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Improving the quality of nurse‐influenced patient care in the intensive care unit

Cited by 14 publications

References 87 publications

A quality improvement project to improve the identification and management of delirium

A quality improvement project to improve the identification and management of delirium

How to optimise public health interventions: a scoping review of guidance from optimisation process frameworks

Oral intake evaluation in patients following critical illness: an ICU cohort study

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