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Leading the way in Critical Care Nursing www.baccnconference.org.uk Poster Abstracts 2010 13 th – 14 th September 2010 Southport Theatre and Convention Centre
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Page 1: BACCN 2010 Poster Abstracts

AnnualConference 2011First class critical care: Using evidence to create the future

Key Themes

• Education & training innovation • Role advancement and workforce development • Clinical practice and quality • Collaboration and creative leadership • Family & cultural issues

Key Deadlines

22nd April 2011: Abstract Submission24th June 2011: Early Booking

www.baccnconference.org.uk

Photograph courtesy of Richard Bryant

12th – 13th September 2011Newcastle Racecourse

BACCN Conference O� ce

Benchmark Communications14 Blandford SquareNewcastle upon TyneNE1 4HZ – UKT: +44 (0)191 241 4523F: +44 (0)191 245 3802E: [email protected]

Leading the way in Critical Care Nursingwww.baccnconference.org.uk

PosterAbstracts 2010

13th – 14th September 2010Southport Theatre and Convention Centre

Page 2: BACCN 2010 Poster Abstracts

Poster Walk 1

Conference themeExcellence in Practice

S. De Silva1 1Heatherwood and Wexham Park NHS Foundation Trust

AimTo identify areas where the EOLC service can be developed. 

Objectives1) To investigate how EOLC is delivered. 2) To assess the standard of EOLC. 3) To evaluate the level of support junior nurses receive from senior staff when providing EOLC.

MethodsQuestionnaires regarding EOLC delivery and support received from senior staff were given to all nurses working on the ICU. The questionnaire included open and closed questions and where appropriate, a Likert scale.

FindingsOverall, nurses felt that the standard of EOLC is adequate. They stated that time pressure and clinical demands negatively impacted on the standard of EOLC. It was suggested that care could be improved by increasing the number of side rooms available for dying patients and developing guidelines on delivering EOLC. Although senior nurses felt that junior staff where well supported when providing EOLC, junior staff did not always feel supported.

ConclusionThis evaluation has highlighted areas in which the EOLC service is succeeding and areas which require development. Findings have been fed back to staff and following implementation of some of the recommendations, the service will be re-evaluated.

PO1EVALUATION OF END OF LIFE CARE (EOLC)

ON THE INTENSIVE CARE UNIT (ICU)

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Conference theme:Excellence in Practice

L Franklin1, J Carpenter1, L Watson 1ICU, Royal Berkshire Hospital, Reading

The Liverpool Care Pathway (LCP) is the gold standard for end of life (EOL) care (Ellershaw and Wilkinson 2003). As critical care is a specialist setting, the LCP was adapted as a care bundle to meet the needs of dying patients (Berenholz et al 2002). 

Reasons for adapting the LCP included:1. Computerised documentation 2. Provision of checklist to   a. Address active withdrawal of treatment (WDT)   b. Ensure high quality EOL care   c. Quick reference when EOL comes rapidly 3. Audit tool

Our EOL care bundle was introduced in 2007 to guide nurses to meet EOL goals, as set out in the LCP.

The Care Bundle is audited monthly ensuring best practice, demonstrating lack of knowledge in specific areas which are addressed in an ongoing educational programme.

The introduction of the EOL care bundle, with associated protocols and teaching, ensures high quality care for the dying patient, effective support for relatives and empowers staff to be confident in their practice.

Conference theme:Excellence in Practice

J Tillman1, E J Flynn1 1Guys and St Thomas’ NHS Foundation Trust

At Guys and St Thomas’ Hospital there is an interest in advancing clinical practice. To facilitate best practice within ICU in relation to End of Life Care (EoLC) a ‘Withdrawal of Treatment’ (WoT) form was produced. The aim of this form was to produce guidance to the multidisciplinary team when making EoLC decisions. It was also to encourage good documentation so that the nurses caring for the patients were confident and clear of the plan.

In an aim to improve EoLC for patients in hospital the Liverpool Care Pathway (LCP) for the dying patient was introduced with the plan to implement it in all Trusts to provide a National standard for the care of these patients. It was felt that the original LCP was not appropriate for use within ICU, however, it was acknowledged that an adapted version would be essential to comply with

PO2 AN ADAPTATION

OF THE LIVERPOOL CARE PATHWAY FOR THE CRITICAL CARE

SETTING

PO3 IMPROVING END OF

LIFE CARE WITHIN THE INTENSIVE CARE

UNIT

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National guidelines and to ensure best practice.

As a result an EoLC form was introduced into practice. This fused the appropriate areas from the LCP and the old WoT form to produce a form that was considered to best meet the needs of our patients. The use of the EoLC form has been audited to allow a re-evaluation of practice. This allowed recommendations for future practice.

Conference theme:Patient & Carers Experience of Critical Care

C. Horsfield1, A Kirkham1 1Lancashire & South Cumbria Critical Care Network

PurposeImproving end of life (EOL) care throughout the United kingdom has become a priority across all sectors of the healthcare community following the publication of the End of Life Care Strategy (Department of Health, 2008). The whole health economy approach to promoting high quality care for all adults at the end their life, includes the provision of care to those patients who are admitted to critical care, but for whom treatment to sustain life fails or becomes futile. This project aims to examine current service provision for end of life care within the critical care units of Lancashire and South Cumbria (L&SCCN), and to improve this provision in conjunction with key stakeholders. ProcessLocal Critical Care Service Improvement Lead Nurses are engaged to perform a programme of audit and feedback, supported by a project lead. Improvement works follow a ‘plan, do, study, act’ methodological framework, which is commonly employed by this network for service improvement activities.

Results The outcomes of this project will provide a network-wide consistent approach to end of life care within L&SCCCN Critical Care Units. Through a collaborative approach, each patient approaching end of life within critical care, can expect care that is high quality, individualised, respectful and dignified.

PO4 A NETWORK WIDE

APPROACH TO IMPROVING END OF

LIFE CARE ACROSS LANCASHIRE AND SOUTH CUMBRIA

CRITICAL CARE UNITS

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Conference theme:Research & Development

O. Dampier1, J Noble1, C Rumble2, C Shipman2, J Koffman2, P Hopkins1, S Leonard1, W Bernal1 1King’s College Hospital NHS Foundations Trust London 2King’s College London

BackgroundAn ethnographic study was conducted to research and develop an end of life care pathway in the adult ICUs of an inner city hospital. 

AimTo develop a protocol for End of Life care ethnographic research in ICUMethods: Data collection methods were sensitive to the setting and consequent ethical issues and comprised (1) semi-structured interviews with ICU staff and referring doctors; (2) focus groups with ICU staff; (3) interviews with relatives and patients alongside direct observation of care and clinical note review; and (4) interviews with bereaved relatives.

ResultsInterviews with staff provided data for the study as well as securing support for accessing interviews with relatives. A strategy was developed to allow nursing staff to be released from one-to-one patient care. Key ICU staff collaborating with the research provided ongoing education and awareness-raising about the importance of the study. Consent procedures for patients and relatives were often complex and required commitment and handover from nursing and medical staff. Support of senior staff was critical.

ConclusionsSuccess with recruitment, data collection and the pilot of the intervention required incorporation of the research processes into the routine daily working of the unit.

Conference theme:Research & Development

J. Noble1, O Damiper1, C Rumble2, C Shipman2, J Koffman2, P Hopkins1, S Leonard1, W Bernal1 1King’s College Hospital NHS Foundation Trust, London 2King’s College London

AimTo develop an end-of-life care pathway for the intensive care unit 

Methods

PO5 FACILITATING

ETHNOGRAPHIC RESEARCH IN AN INTENSIVE CARE

UNIT (ICU)

PO6 DEVELOPING AN

END OF LIFE CARE INTERVENTION FOR

INTENSIVE CARE (ICU)

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A research and development project focusing on end of life care in a 28-bed ICU in an inner-London hospital. Nursing staff formed an End of Life Group and with ICU consultants and the palliative care team considered changes to improve care. Together with audit findings this prompted development of a withdrawal of treatment document. An NIHR funded collaborative project was developed with an academic department of palliative care. Data collection included: (i) semi-structured interviews with staff and relatives; (ii) observation of care and decision-making and (iii) clinical note review.

ResultsThe initial audit demonstrated a need for greater information provision and staff support. Results from the collaborative project supported the use and refinement of guidance documents and greater psychosocial support. A complex intervention was developed comprising an amended withdrawal document; a psychosocial assessment; education and awareness-raising; palliative care team input and increased psychosocial support. Initial evaluation showed greater awareness of end of life issues and the collaborative research process has improved communication between ITU and palliative care staff.

ConclusionsFormal evaluation of this intervention is planned although changes to practice and improved communication are already evident.

Conference theme:Patient & Carers Experience of Critical Care

R. Zeilani1, M. Abdalraheem1, J. Seymour2

1The University of Jordan 2The University of Nottingham

AbstractA small number of existing studies shed light on the women’s experiences and needs as patients in the intensive care units (ICU). Narrative research examining the ways in which individual experiences are challenged and changed through the impact of traumatic life events, such as being a critically ill patient.

AimThis study describes Jordanian Muslim women’s experiences and needs during critical illness.

PO7 MUSLIM WOMEN’S EXPERIENCES AND

NEEDS IN THE INTENSIVE CARE

UNITS: A NARRATIVE STUDY

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Methodology and methodsThe study adopts a narrative approach to collect data from 16 women who were welling to share their experiences. Two to three in-depth interviews were conducted with each woman after they have been discharged from the ICU. Narrative Analysis of data was applied using Riessman’s method.

ResultsThree main themes emerged from the data; 1) women emotionally attached to family, 2) the need to preserve the sanctity of exposing the body, 3) the need to practice the religious rites.

Discussion and conclusionsFamily support and covering the body were the most crucial concern for critically ill Muslim women. Nurses’ gender should be taken into consideration when providing care for Muslim women in the ICU. Results of this study might have implication in caring for Muslim women in many western countries such as the UK.

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Conference theme:Patient & Carers Experience of Critical Care

R. Zeilani1, M. Abdalraheem1, S. Al-Bloushi1 1The University of Jordan

AbstractThere is lack of studies that investigates the effectiveness of nursing care and support for Muslim women mainly in the Intensive Care Unit (ICU). This study is based on findings from previous study that describes Muslim women’s experiences in the ICU. The aim of this study is to develop supportive care strategies to critically ill Jordanian Muslim women in the ICU. A total number of 18 nurses, who have more than 5 years experience in the ICU, agreed to share their expertise in developing the strategies. Four focus group discussions were conducted in two hospitals. Content analysis was applied using Burnard’s method of analysing transcripts in qualitative research.

ResultsThe analysis revealed three strategies that were suggested by the nurses; these were: 1) finding ways to protect the women’s bodies, 2) facilitating family unity, 3) promoting circumstances meeting religious needs. Sharing experienced nurses in developing strategies related to patients’ care is a successful approach in planning care. These strategies are likely to be transferable to other Muslim women who are admitted into the ICU in many western countries in the world. 

Conference theme:Excellence in Practice

C. Hui Chi1, C. Shu Ying1

1Department of Nursing, Central Taiwan University of Science and Technology

Emergency department is responsible for treating individuals who suffer from diseases or experience abrupt events which require proper medical attention. Its objective is to save lives, relieve pains, preserve limbs and maintain physiological functions. The aim of this research is to examine the importance of patients’ needs, their levels of satisfaction and compare the discrepancies in recognizing patients’ needs among nursing staff members, patients and family members in the emergency rooms. This study conducted a questionnaire where the Critical Care Family Needs Inventory (versions for patients, family members and nursing staff) was used as a research tool and the subjects were recruited from patients, family members and nursing staff at a regional teaching hospital in central Taiwan. The questionnair explored

PO8 SUPPORTING

MUSLIM WOMEN IN THE INTENSIVE

CARE UNIT: NURSE EXPERTISE

RECOMMENDATIONS

PO9 ARE YOU AWARE OF

PATIENTS’ NEEDS? RECOGNITION

DISCREPANCIES ABOUT THE

CARE NEEDS OF EMERGENCY

DEPARTMENT PATIENTS FROM

THE PERSPECTIVES OF NURSING STAFF

MEMBERS, PATIENTS AND FAMILY

MEMBERS

Poster Walk 2

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the perceptions in terms of the importance of patients needs and the levels of need satisfaction. The results suggest that there is a significant positive correlation between recognizing the importance of care needs and the levels of need satisfaction among patients, family members and nursing staff, i.e. a higher recognition score comes with a higher satisfaction score. The research results support emergency care system in recognizing patients’ and family members’ needs and offer future reference to patient care. KeywordsEmergency Room, patients, family members, nursing staff members, patients’ needs

Conference theme:Patient & Carers Experience of Critical Care

J. Thomas1, P. Chrispin1, J. Stannard1

1 West Suffolk Hospitals NHS Trust

BackgroundFor most patients admission to critical care is a catastrophic event and return to normal life can be a long journey. Everyone’s journey is unique, and recovery and rehabilitation an individual experience. Physical and psychological problems associated with recovery after critical illnesses are well documented in the literature. However, written text often has little ‘feeling’ and does not really reveal the human factor involved in recovery post critical illness. It does not tell the personal story.

AimsThe aim of the poster is to describe in patients’ own words their journey and experiences from when they first became ill, then during and after critical illness. Their words are matched to the literature and give feeling and humanity to written text. Producing this poster has added a human element to recovery and rehabilitation after critical illness. The journey concludes with what this actually means to the patients. It is about who you are, connections with your environment and achieving personal goals, hopes and aspirations [1] after critical illness.

Conference theme:Research & Development

S. James1 1Capital and Coast District Health Board

BackgroundPoor quality patient handover is a risk to patient safety (WHO, 2007). The quality of information exchange between ICU and ward nurses when patients are transferred out of Intensive Care is key to the continuity of safe care. There is limited research which addresses ward and ICU nurses experience of the

P10 THE PATIENT’S

JOURNEY

P11 NURSE PERCEPTION

OF PATIENT DISCHARGE FROM

ICU TO WARD BASED CARE: A COMPARATIVE

SURVEY

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discharge process. By exploring nurses’ experiences of the discharge process this research aimed to identify opportunities to improve patient safety

MethodThis study took place in a New Zealand Metropolitan hospital. Using an exploratory descriptive design we adapted a questionnaire based on Whittaker and Balls’ (2000) research on ICU patient handover from the ward nurse perspective. The questionnaires were then analysed using a descriptive thematic approach.

ResultsThe questionnaire response rate of 48% included 45 ICU and 47 Ward nurses. Key findings included that the written and verbal communication needs of each group differ dependent upon setting also the timing of a discharge needs to be negotiated. Negative attitudes to ICU nurses from ward nurses were highlighted as an issue on transfer. ICU nurses viewed giving patients realistic information about the ward setting as important.

ConclusionsStandardised hand over with content and process that is mutually agreed is recommended.  Conference theme:Patient & Carers Experience of Critical Care

C. Plowright1

1Medway NHS Foundation Trust

BackgroundCritical care nursing focuses on the care that is provided when patients and their families are in intensive therapy units, and often there is little concern for what happens to them after they leave these environments. Following the NICE Clinical Guideline (2009) many more patients are being followed up after their critical illness experience, but the same may not be occurring with their families.  ObjectivesTo explore the experiences of caring for a patient following a critical illness when discharged home. 

MethodsThis study used a phenomenological methodology, within the tradition of hermeneutics and the theoretical perspective of interpretivism as an approach to capture the essence and meaning of relatives’ experiences of caring for patients when they are discharged home. Seven relatives where interviewed who cared for patients when they were discharged home.

P12 WHEN PATIENTS GO

HOME

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ResultsRelatives are affected by the illness of their relatives and are also affected when they take the patients home. They experience a number of “burdens of care” both physical and psychological and these will be shared.  ConclusionsCritical care nurses need to consider the experiences of relatives when they are at home and assist them in preparation for this. The only way we can do this is by understanding relatives’ experiences.

Conference theme:Patient & Carers Experience of Critical Care

T. Chiu-Feng1

1Graduate Student Chung Shan Medical University Hospital

ObjectivesPatient safety is one of the most imperative issues in healthcare. In particular, the transfer of patients between departments deserves special attentions. This paper highlights the hazards that may occur in moving patients in the hospital.

MethodsLiterature review was conducted from Medline, Pubmed, CINAHL and the Cochrane Library by using systematic engine search.

ResultsThese guidelines discussed the measures to ensure safe patient transport. According to the guidelines, the transfer system, the personnel, the facility and the monitoring were factors that could influence intrahospital transport.

ConclusionAfter acute stage, patients are often transferred to the other unit for continued care and treatment .The transport of critically ill patients carries inherent risks. Thus, nurses participating in transferring patients should be aware of the issues in order to ensure patient safety. Nurses in the transport of patients should be suitably competent, trained and experienced. The facility should be intact articulate, with regular maintenance. Monitoring needs to set-up before the transfer.

P13 PATIENT SAFETY

- INTRAHOSPITAL TRANSPORT FROM ANESTHESIOLOGY

DEPARTMENT

125 Poster Abstracts

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Conference theme:Education

N. White1

In February 2009 the UK Government announced that from 2013 all nurses must be educated to degree (graduate) level as part of Modernising Nursing Careers.  As nurses and educators a serious question must now be asked; what will be the pedagogical impact on educators and learners?

In this paper the author will define and explore ‘graduateness’ and also examine the main academic differences between diplomates and graduates and the distinctions, if any, of ‘fitness to practice’ is assessed by the NMC at the point of registration. At present there appears to be no clinical competence demarcation between the two academic levels of diploma level and degree, only a demarcation in the assessment of academic study. The two key areas of graduateness; critical thinking and decision-making will be explored. Problem-Based Learning and High-Level Questioning are both pedagogical principles that can be applied in the classroom and that relate directly to enhanced critical thinking and decision-making skills in the clinical practice within Critical Care. If these pedagogical principles are to be implemented into a Work-Based Learning environment then financial investment and study time are required for further training nurses as educators within Critical Care.

P14 WHAT PEDAGOGICAL

PRINCIPLES CAN BE UTILISED TO

FACILITATE NURSING STUDENTS WITHIN CRITICAL CARE, IN

THE DEVELOPMENT OF CRITICAL-

THINKING AND DECISION-MAKING

SKILLS IN AN ALL-GRADUATE ENTRY

PROGRAMME?

126 Poster Abstracts

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Conference theme:Staffing and The Critical Care Team

S. Potts1, M Beckenham1, p 1Adult Critical Care, Nottingham University Hospitals

The aim of recruitment is to ensure the organisations demand for employees is met by attracting potential employees in a cost effective and timely manner.The recruitment and retention of staff are an important part of managing any successful business, in the NHS the impact of staffing critical care areas has increased initially with the Comprehensive Critical Care (2000) document and the general status of health requirements and fulfilling the needs of patients ensuring their safety and best practice prevails.

The legislative framework which encompasses many aspects of employment law which if it were not in place could leave many people at an unfair disadvantage are paramount to the process.

CIPD research (2005) showed that one in seven employees leave after less than six months and 40% of the leaving population have only two years service. It is therefore vital that an established induction programme exists to make people feel welcomed and valued.

Workforce planning also needs to look at the risk of loosing experienced critical care staff through retirement and therefore development of staff already in post and developing staff to reach their full potential.Offer: Recruitment days, induction programme, competency packages, access to university modules, team days twice year, service improvement, web page, management of staff and appraisals, mentoring, clinical nurse educators.

Conference theme:Education

D. Rowland1

AimsIdentify deficiencies in intra-hospital transfer of critically ill patients.

MethodsProspective audit of transfers (n=32) on 19 clinical areas.

Data collectedEarly Warning Score (EWS); components of monitoring, escorts, time of

P15 THE 3 R’S IN CRITICAL

CARE STAFFING

P16 QUALITY OF

TRANSFERS OF CRITICALLY ILL

PATIENTS WITHIN THE HOSPITAL (2009)

Poster Walk 3

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transfer. Theoretical audit of trained nurses (n=19), relating to a ‘sick patient’ scenario, monitoring and escort requirement also undertaken.

ResultsProspective audit: 22%  patients received non-invasive blood pressure (NIBP); 44% pulse oximetry (SpO2) ;44% cardiac rhythm monitoring (ECG). No correlation between severity of illness  and components of monitoring applied. Registered Nurse present for all transfers.  The Critical Care Outreach Team or doctors included all 3 components of monitoring. 21% of transfers occurred out of hours (18.00 - 08.00).The theoretical audit revealed SpO2 monitoring  used in theory (74%) and in practice (44%), however ECG used in theory (32%) in practice (44%)Recommendations: Additional investment in equipment and training. Implementation of a comprehensive guideline, incorporating a risk assessment tool utilising the EWS, to effect safer patient transfer.

Conference theme:Research & Development

CE Howie1-2, AJP Robb2, WH Gilmour2 1NHS Greater Glasgow and Clyde NHS Trust 2University of Glasgow

Comparing Withdrawal of Treatment Experiences of ICU Staff: Does a framework make a difference? AimA framework to aid staff in treatment withdrawal is the Liverpool Care Pathway (LCP) (Chapman, 2009). Exploration of the experiences of ICU staff within 2 units, one using the LCP and one not, is underway to ascertain if the framework provides improved experiences for those involved in treatment withdrawal. Design and MethodologyUtilising a mixed methods approach, of a validated questionnaire and one-to-one interviews, data collection commenced in February 2010 and is due to finish in May 2010. Purposive and convenience sampling of medical and nursing staff within 2 ICUs, is being used. Questionnaire responses will be analysed using the statistical software minitab. Interview data analysis is currently using a thematic content analysis approach. Completion of this study will be in July 2010. Results and findingsResults and findings from this study shall be reported. The differences in experiences of ICU staff using the LCP, and those not using it, in treatment withdrawal will be discussed.

P17 COMPARING

WITHDRAWAL OF TREATMENT

EXPERIENCES OF ICU STAFF: DOES A

FRAMEWORK MAKE A DIFFERENCE?

128 Poster Abstracts

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ConclusionsComparing experiences of staff using the LCP in treatment withdrawal, with those who do not, will highlight what areas of this aspect of end-of-life care have improved from staff’s perceptions.

Conference theme:Staffing and The Critical Care Team

P. Doyle1, L Bailey1, A Seraj1, K Goon1, F Cox1, R Tollyfield1, N Mackay1, V Kendle1

1Department of Critical Care, Harefield Hospital, Royal Brompton and Harefield Foundation Trust

BackgroundIn 2007 funding was secured for a 7 bed level 3 Recovery Unit to supplement our 18 bed ITU. This expansion resulted in the need for additional shift leaders.

AimTo explore the impact of a revised training programme on shift leader confidence and competence.

InterventionOur shift leader training programme was revised by senior staff and potential shift leaders were identified. During the twelve month programme participants complete objectives based on the band 6 knowledge and skills framework (DOH 2003). At the end of the programme staff can act as shift leader without on-site senior nursing support. At this point they become a senior staff nurse and can progress through the upper band 6 gateway.

ResultsFive staff have so far successfully completed the programme after summative assessments, whilst four continue to consolidate their practical experience. Progress meetings with team leaders suggest that the programme leads to increased confidence and competence. Validation has been undertaken using an anonymous questionnaire (results pending).

Discussion/ConclusionA structured training programme, combined with practical experience, equips staff with the skills and knowledge required to act as shift leaders within critical care. The formal evaluation will guide the future development of the programme.

P18 THE PROVISION

OF A SHIFT LEADER TRAINING

PROGRAMME IN RESPONSE TO THE

EXPANSION IN LEVEL 3 BEDS WITHIN A

CARDIOTHORACIC CRITICAL CARE UNIT

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Conference theme:Staffing and The Critical Care Team

R. Tollyfield1, H Nair1, K Goon1, L Bailey1, V Kendle1, N Mackay1, A Munro1, P Doyle1 1Royal Brompton & Harefield NHS Trust

In a large critical care unit ensuring all nursing staff remain up to date with current practices and developments is a continuing challenge. However nursing staff who are informed, involved and empowered have all the ingredients necessary to improve the quality of care provided (DoH, 2009). At Harefield Hospital there are 7 teams of nurses each led by a Band 7 Sister. Over the last 2 years regular organised team days have enabled each nurse to meet their educational and developmental needs. Each team has also undertaken a project to enhance practice and improve the patients’ experience and outcomes.

Collectively the teams decided their priorities were to review and standardise basic nursing care practices. They produced evidence based guidelines and protocols on eye, mouth and bowel care as well as on timely bed bathing. Further guidelines on correct suctioning and sepsis management are being developed. One team devised an aid to ensure that allocation to side rooms was fair, resolving an organisational issue.

Utilizing team days and team projects has led to staff feeling valued and supported. This concept has been most beneficial, having had a real impact on the working environment, and is one that will continue to be adopted.  Conference theme:Education

L. Chu1, A Carter1, L Kent1, F McGuigan1, C Sizmur1, DR K Wright1

1Frimley Park Hospital NHS Foundation Trust

In today’s current financial climate, where we must be mindful of resources, we are continuously facing new challenges in providing a critical care outreach service. This includes dedicated clinical cover on critical care and meeting the educational needs of the trust..

Learning, education and staff support is at the forefront of our service. We provide trust induction, in-depth sessions on patient safety days, ALERT, and critical care skills days. Members of the multidisciplinary team shadow us on a weekly basis. As a team we are involved in the development and implementation of policies in order to influence change in practice and set standards.

P19 INFORMING,

INVOLVING AND EMPOWERING: THE DEVELOPMENT OF

TEAM DAYS AND TEAM PROJECTS

TO ENHANCE CARE DELIVERY

P20 SERVICE VERSUS EDUCATION: AN

INCREASINGLY COMMON DILEMMA.

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The number of hours we have provided in education has more than tripled since 2005. We at Frimley Park Hospital NHS Foundation Trust are continuously looking at innovative was of addressing the issue of education versus service provision.

We have developed an e-learning package on our modified early warning score which medical and nursing staff will need to complete on joining the trust. This will be accessible to all staff at all times.

Conference theme:Education

G. Beer1 1Sheffield Teaching Hospitals NHS Foundation Trust

BackgroundTo assist Critical Care nurses remain competent and up-to-date with new information: new, effective and innovative ways of facilitating learning in the clinical environment are needed. To augment education provision, a ‘learning zone’ was integrated into a CIS and developed using ‘Action Research’.

AimsTo expand practitioners’ knowledge/understanding, assist staff maintain/advance competence and help improve information dissemination.

MethodIntroduction to the resource was by a quiz. Data of participation and perception of the resource was collected by questionnaire from a purposive sample n=79 nurses (overall sample n=240). Quantitative and qualitative data were generated on factors such as compliance, ideas and learning needs. Analysis was by statistical and thematic content analysis approaches.Results :67% completed the quiz and 61% completed the questionnaire. 100% commented positively on the resource- “easy to use, informative and accessible”. Suggested topics included: A&P, BiPAP, woundcare, intubation and pharmacology. Preferred tools were MCQs, scenarios and case studies. Ideas included competencies and students sections, automatic feedback and proof of learning.

DiscussionThe learning zone was positively received and the action research participative approach gave ownership to staff. The resource is seen by staff as being very accessible and as having great potential for future education and information provision.

P21 THE INTRODUCTION

OF A LEARNING ZONE FOR NURSES

INTEGRATED INTO A CLINICAL

INFORMATION SYSTEM (CIS) IN CRITICAL CARE USING ‘ACTION

RESEARCH’.

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Conference theme:Education

J. Coward1, L. Durham1, I. Gonzalez1

1North of England Critical Care Network

BackgroundCritical Care Networks were established following recommendations by the DH over 10 years ago (DH, 2000; DH, 2005). Aiming to provide support to Critical Care Delivery Groups to achieve common standards and protocols for critically ill patients within a specific geographical area.  InterventionWithin the last year there have been significant developments in the educational opportunities led by the North of England Critical Care Network (NoECCN). This initiative has been very successful providing 16 workshops focusing on practical training (transfers) clinical assessment (Acutely Ill Patient) and staff development, and the Critical Care Outreach Course compromising of 9 study days over a year. Each workshop is made up of faculty from expert staff across the region, which has enhanced communications and augmented learning across Trusts within the NHS and Independent sectors. Additionally a culture of collaboration and learning has developed.  Future DevelopmentsThe success of these workshops has prompted an increase in the range of topics proposed for future education using this style. This aims to build upon and strengthen cross organisational education and provide effective usage of resources, standardisation of practice and sharing of common goals to provide a shared governance approach to driving forward safe, quality care.

Conference theme:Excellence in Practice

Y. Gao1

1Central Taiwan University of Science and Technology

IntroductionEfficient management of medical material is significant for hospitals. Highly efficient medical material management saves manpower, reduces inventory and costs, and avoids expired material. Therefore, the aim of this research attempts to streamline the management of medical material.

P22 NOECCN:

FACILITATING EDUCATION ACROSS

ORGANISATIONS

P23 THE EFFECTIVENESS

OF THE IMPLEMENTATION

OF 5“S” TO PROMOTE MEDICAL MATERIAL

MANAGEMENT IN WARD

Poster Walk 4

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MethodsCause-Effect Diagram analysis demonstrates the causes of inefficiency: categorization and quantity of medical material, labeling, location. The 5S (Seri, Seiton, Seiso, Seikutsu, and Seiitsuke) management is then carried out as a resolution. In addition, a satisfaction questionnaire concerning medical material management was conducted. ResultsResults showed that 5S management ameliorated the arrangement and labeling method. The satisfaction rate has risen by 10%; convenience of utilization has risen by 55.3%; the percentage of agreement with the implementation of 5S management has risen by 40.6%. 36 out of the 116 categories were rearranged and the cost of inventory has been reduced by 27.9%.

Conclusions5S management reduces the cost of medical material, builds up a highly efficient working environment, and raises satisfaction rate while still catering for the needs of patients. For further understanding of the effect of 5S management, a longer assessing time frame and a questionnaire concerning health care personnel’s cost concepts are suggested. Conference theme:Research & Development

N. Pinto1

1Medway NHS Foudnation Trust

In Human Sciences, Research and Development are closely linked. The Organization for Economic Cooperation and Development defines this practice as the”creative work undertaken on a systematic basis in order to increase the stock of knowledge, including knowledge of man, culture and society, and the use of this stock of knowledge to devise new applications” (OECD Factbook 2008: Economic, Environmental and Social Statistics) In the UK, “Considerable progress has been made in addressing issues that were having a detrimental effect on health research” (UK Clinical Research Collaboration) Part of this progress in the NHS its in part, due to the role of the Clinical Research Nurses. Which position has been growing importance both in numbers and relevance with the implementation and development of the several Clinical Research Networks. At the Medway Hospital Intensive Care Unit we are involved in several Multicentre Critical Care studies. The Critical Care Research Nurse position is a new one and I propose to critically reflect on my role expectations and relevance for the work of all

P24 CLINICAL RESEARCH

NURSE IN CRITICAL CARE – WHAT TO

EXPECT?

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involved in patient care. This will be supported by a literature review and a questionnaire will be used to discover healthcare professionals thoughts about the role of research within this ITU.

Conference theme:Research & Development

C. Coulter1 1Newcastle upon Tyne Hospitals NHS Foundation Trust

Learning objectivesTo share experiences of reducing infection rates in ICU by implementing the Matching Michigan technical and non-technical interventions.

BackgroundCentral lines are responsible for the majority of hospital-acquired bacterial bloodstream infections which are associated with substantially increased morbidity and mortality. Matching Michigan is a quality improvement project to reduce Central venous catheter (CVC) blood stream infections (BSI), based on a model developed in the United States which, over 18 months, saved around 1,500 patient lives.

MethodsInitially baseline rates of CVC-BSI/1000 patient days were established. Data was collected from May 2009 for 5 months then a package of technical interventions (changes in clinical practice) and non-technical interventions (linked to leadership, teamwork and culture change), were applied together to reduce the incidences of CVC-BSIs.

This included:• Assembling a Unit Patient Safety Team• Devising a suitable inventory for the CVC line trolley• To adapt and implement the CVC checklist• Staff completion of an on line staff culture survey ResultsUnit baseline CVC-BSI was 2.0/1000 catheter days and was reduced to 0/1,000 catheter days.

ConclusionsTo continue to address patient safety issues identified at regular monthly patient safety team meetings to stop patient harm.

P25 MATCHING

MICHIGAN- A NORTHEAST

ICU PILOT SITE EXPERIENCE

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Conference theme:Research & Development

F. McGuigan1, N Castle2, S Tote1, K. Wright1 1Frimley Park Hospital 2Durban University of Technology

ObjectiveTo evaluate patient scoring 10 years after its introduction and to review current parameters now that patient scoring occurs after each set of vital signs observations.

Methodology137 ward-based staff were anonymously surveyed to ascertain their experiences of patient scoring. 66% were qualified nurses and 44% were Health Care Assistants (HCA).

Results95% found patient scoring to be useful and 98% believed it improved patient safety. 50% of all patients scoring was performed by HCA’s and 42% of participants believed that the patient-scoring system needed up-dating. The most commonly identified issues were replacing GCS with AVPU, altering individual patient parameters in the management of patients with chronically high scores as well as at what point to call for help.

ConclusionPatient scoring is well embedded within our hospital and it is commonly recorded by HCA’s. Minor changes were identified that can be easily introduced but the change in emphasis of recording a patient score at every set of observations has highlighted the need to review application of a scoring system to patients with a chronically high base-line score due to chronic illness.

Conference theme:Excellence in Practice

J. Strachan1, J. Roulston1

1NHS Greater Glasgow and Clyde

The outcome of critically ill patients is improved by the use of dedicated transfer teams (Intensive Care Society 2002). The Shock Team Transfer Service in Glasgow was the first adult critical care transfer team to be established within the United Kingdom. Since its inception in 1974, the structure and

P26 MET SCORING 10 YEARS ON HAVE

YOUR SAY…

P27 INTEGRATING A DEDICATED

TRANSFER SERVICE WITH CRITICAL

CARE OUTREACH: A SERVICE DELIVERY

MODEL

Poster Walk 5

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function of the Shock Team has developed to support the unique needs of critical care services within the West of Scotland by providing a dedicated secondary transfer service. The service has evolved and from 2003 has incorporated experienced intensive care nurses as part of the transfer team. The Shock Team nurses also have an additional remit of providing a Critical Care Outreach (CCO) Service as part of an integrated service. As an inimitable model of service delivery there are many challenges involved in providing both a dedicated transfer service and a CCO team simultaneously. As a team of 8 WTE nurses we undertake on average 485 transfers and visit 3294 outreach patients across multiple sites on an annual basis. The aim of this piece of work is to describe how the critical care outreach and shock team transfer service is delivered and to highlight the implications this service has for practice.

Conference theme:Education

G. Walton1, A Sharpe2, J Rees2

1Northumbria University 2The Newcastle upon Tyne Hospitals NHS Foundation Trust

The provision of nurse education and training in demanding clinical locations such as critical care is complex and challenging for educationalists. The introduction of new products for patient comfort such as the Actiflow bowel management system brings with them the need for skilled capable practitioners. Delivering safe proficient care is paramount. The use of clinical competencies is recognised to be an accepted form of assessing nurse’s ability to perform work activities (Watson 2002). It is acknowledged in the literature that competencies for professional nursing should reflect the multifaceted nature of nursing practice, the broad range of practice settings and cultural differences (Watson 2002) With this in mind, we developed a competency based framework for use with the Actiflow bowel management system which could be integrated into the practitioners professional development plan and provide the basis for clinical assessment. The bowel management competencies incorporate the relevant practice skills competencies as demonstrated in the NHS Knowledge and Skills Framework (Department of Health, 2004), Skills for Health and Competency Framework (Sector Skills Council, 2002).

The overall aim of the competency framework is to:• Ensure the nurse practices safely and efficiently• Enhance quality of care and risk management• Develop and empower nurses working within the speciality

 

P28 THE DEVELOPMENT

OF EDUCATIONAL COMPETENCIES

FOR SAFE PRACTICE IN BOWEL

MANAGEMENT

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Conference theme:Education

C. Nicholson1, J Mundy1, p, J McNulty1, M Gillies .G Nimmo1

1NHS Lothian

Developing the Advanced Nurse Practitioner Role in Critical Care.

AimNHS Lothian in June 2008 supported the option to combine enhanced roles of non-medical staff with additional medical staffing to fill gaps from reduced trainee numbers. This workforce model would replace lost junior trainee hours with advanced nurse practitioner hours. To meet these changing demands, it is essential that health care professionals are offered opportunities to access up to date and relevant education.

MethodologyThis poster will demonstrate the collaboration and partnership between key stakeholders in service and education, to develop a trainee advanced critical care practitioner education pathway.This is a novel advanced practice development which combines a robust academic component with a rigorous clinical programme.The curriculum, learning objectives and assessment processes have all been aligned to the Advanced Practice Toolkit (NHS Education for Scotland www.advancedpractice.scot.nhs.uk) and to the Department of Health Framework for Advanced Critical Care Practitioners March 2008.  OutcomesIn this poster we have described the process whereby this training, teaching and educational assessment will be delivered.

ConclusionThe poster will draw on the experiences of the authors highlighting issues such as resource implications, writing, editing and student support. Finally examples of the course materials and assessment strategies will be presented.

P29 DEVELOPING THE

ADVANCED NURSE PRACTITIONER ROLE

IN CRITICAL CARE.

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Conference theme:Education

A. Baldwin1

1Critical Care Networks - National Nurse Leads (CC3N)

BackgroundFollowing the demise of the English National Board (ENB) Lead Nurses across the Networks along with other critical care stakeholders believe there is inequity of educational outcomes and standards in relation to critical care nurse training. This is leading to difficulties associated with transferability of the nursing workforce across conurbations.

AimCC3N established a subgroup to identify and articulate adult critical care nurse core educational outcomes. In collaboration with colleagues from the BACCN, RCN and educational purchaser/provider organisations, the forum aimed to make recommendations for national standards of education that reflect the varied needs of service provision as identified in Comprehensive Critical Care (2000).

ProcessThe Forum completed the following activities to recommend a curriculum and standards for critical nurse education: Identify a framework of related educational activity A survey of the use of competency based training programs in adult critical care units across the Networks.A review of related literature. An inventory of the critical care nurse training programs. Analysis of cost of current critical care training models.

ImplicationsRecommended standards will be comprehensive, realistic and easily applied. Their use should be encouraged as a framework to assist commissioning processes and develop local critical care programmes resulting in an equitable, transferable nursing workforce that is fit for purpose.

P30 STANDARDS FOR ADULT CRITICAL

CARE EDUCATION

Poster Walk 6

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Conference theme:Education

G. Dewhurst1, A Berry1 1Greater Manchester Critical Care Network

July 2009 saw the start of the first cases of pandemic flu in Great Britain. Similarities with the Spanish Influenza pandemic of 1918 and the numbers affected, ensured that strategies were drawn up and implemented to guarantee the most effective use of healthcare services and limit spread. Bed capacity, escalation, staffing issues, equipment and education in Greater Manchester, as in the rest of the country, were of paramount concern to the Critical Care Network. Through the lead nurses and Critical Care Skills Institute, educational programmes were instigated to increase the number of nursing staff available to critical care areas and introduce the concept of caring for children in adult intensive care units. Evaluations showed that the programmes up skilled staff and were invaluable in reducing stress and fear about the potential impact of a major incident. In Greater Manchester communication and teamwork with colleagues from other specialities was pivotal in achieving our aim. The Department of Health’s pandemic workforce has now been disbanded and the threat of H1N1 causing massive disruption to the NHS has passed. However, a legacy of work and relationships remain in Manchester which can be accessed as part of resilience planning for future emergencies. Conference theme:Education

G. Dewhurst1, N Parkin1, S Cook1, M Taylor1

1Critical Care Skills Institute

To realise Darzi’s (2008) vision of high quality care for all, education and training is vital in providing healthcare staff with the necessary knowledge and skills. The National Institute for Clinical Excellence (NICE) (2007) recommends that staff should be competent to respond to the needs of patients appropriate to the level of care they are providing. Staff in areas such as Accident and Emergency, theatre and “stand alone” high dependency units often finds they are temporarily caring for patients awaiting transfer to a level three facility due to pressure on critical care beds. The Prime Minister’s Commission (2010) suggest that nurses and midwives will be expected to adopt new ways of working and in some instances new roles to ensure that patients receive high quality care. The Developing Invasive Respiratory Care Skills study day was introduced in October 2009. The day incorporates theory and simulated practice to support the skills and knowledge base required to care for ventilated patients. Three study days to date have been well attended and produced positive

P31 GREATER

MANCHESTER’S EDUCATIONAL RESPONSE TO

PANDEMIC FLU

P32 PREPARING STAFF TO

CARE

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evaluations. We believe that this study day fulfils the NHS QIPP philosophy and prepares healthcare staff for the challenging changes ahead (Prime Minister’s Commission, 2010). Ultimately, it improves the standard of care when it is needed most. Conference theme:Excellence in Practice

A. Hornby1

1Salford Royal NHS Foundation

How many mls of blood do you need to perform a blood glucose test? This simple blood test is performed by healthcare professionals and Patients on a daily basis by the process of a finger stab; facilitating the Release of a small droplet of blood from which a blood glucose level isEstablished. I had often wondered why we as nurses within the Intensive care unitAt Salford Royal NHS trust hospital would routinely; on a daily basis send5.5 mls of blood to the laboratory for a random blood glucose level. Each bed area within the ICU had a Glucometer machine which was Calibrated daily; and from which all blood glucose levels and insulin infusion Rate changes would be facilitated. There was also a blood gas analyser Within the ICU that was auto calibrated throughout the day which gave a Blood glucose reading with every blood gas analysis. We as a trust where set the task of saving £16 million and staff where Encouraged to identify ways in which to save money without compromising Clinical excellence. Through audit and data analysis I successfullyImplemented a change in this ‘routine’ practice which resulted in an annualSaving of almost £5000.

Conference theme:Research & Development

J McPeake1, G Macintosh1 1NHS Greater Glasgow and Clyde/ University of Glagsow

AimA study to explore the impact of implementing a Bowel Management Protocol (BMP) in a tertiary referral Intensive Care Unit (ICU). 

P33 OUTINE BLOOD

GLUCOSE SAMPLE COSTING

P34 THE

IMPLEMENTATION OF A BOWEL

MANAGEMENT PROTOCOL IN THE

INTENSIVE CARE UNIT

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MethodsA three phased mixed method study design was utilised. Phase One- A baseline audit reviewing patient’s medical notes, and a baseline focus group reviewing the Multi – Disciplinary Team’s (MDT) opinions with regards to bowel care in the ICU. Phase Two – Implementation of a BMP, updated bowel care chart and education sessions for members of the MDT. Phase Three – An end of study audit reviewing patient’s notes after the implementation of the BMP. Additionally, a further focus group examined the MDT’s experiences of the BMP in practice. Results & FindingsDuring phase one of the data collection period it was evident that there was a haphazard approach to bowel care in the ICU, resulting in poor bowel care documentation, and a high incidence of constipation and diarrhoea. After the interventions of phase two, bowel care documentation days increased by 13% (p=0.0003), constipation incidence decreased by 20.7% (p=0.13) and diarrhoea days reduced by 15.2% (p=0.18). ConclusionWhile further evaluation is planned, the BMP implemented appears to be a useful tool in the delivery of bowel care in the ICU.

Conference theme:Education

C. Nolan1, M Lowe1, S Shah1, H Gilliland1, S Allen1 1CSICU Royal Victoria Hospital

Acute kidney injury during cardiac surgery is related to a variety of factors, has an incidence of 5% to 20% and causes significant morbidity and mortality. The need for renal replacement therapy, whether intermittent haemodialysis (IHD) or continuous (CRRT), is associated with poorer short and long term outcomes.

MethodWe conducted a prospective audit in the Cardiac Surgical Intensive Care Unit, Royal Victoria Hospital, Belfast. We recorded patient and perioperative demographics, reasons for development of renal failure and commencement of CRRT, total duration of CRRT, recovery of renal function, need for continuing IHD and 30 day mortality. Those continuing on IHD were followed up for 90 days.

Discussion and Conclusion This audit of renal support in our unit highlighted the following. Firstly, the reasons for commencing CRRT were diverse. Secondly, the majority of patients 44/ 86 (51%) made a complete renal recovery within 30 days. Finally, for patients who transitioned from CRRT to IHD, outcome was less good with only 45% surviving to 90 days (albeit with complete recovery of renal function).

P35 DAWNING OF

AQUARIUS

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Our outcomes are consistent with reported mortality rates in patients receiving CRRT post cardiac surgery [1]. The poorer outcomes with requiring prolonged renal support suggest further work is required to identify which patients are particularly at risk of requiring longer term renal support. Conference theme:Education

E. Hargest1, A Neumann1, J Rowley2

1Salford Royal NHS Foundation Trust 2Convatec

AimTo develop the policy, introduce into practice and then to locate any knowledge gaps by completion of audit.

Background Faecal incontinence (FI) has been managed in various ways over years, one of the issues identified was that they did not had evidence to support their use, no policy guidance on their use with patients, which has left both patients and staff vulnerable if the patient suffered adversely. Currently on the unit we use three methods in management of FI, incontinence pads, external faecal collection bags and flexiseal. Results The audit failed to capture enough staff over the four week time period allocated, despite this it did show a gap in staff knowledge. It did show how we managed FI on the unit and captured the number of patients with FI. It showed that staff used the external faecal collection bags with majority of patients. Implications Providing an evidence base for staff to assist in maintaining patient safety and improving staff knowledge. Due to failure to capture enough staff during the audit, we went on to provide staff with questionnaires. The questionnaires have asked staff directly concerning their knowledge and what training or teaching they would like. We have also looked for staff attitudes in their choice of management with patients with FI.

P36 THE PROCESS

SURROUNDING THE DEVELOPMENT OF

A CLINICAL POLICY FOR USING THE

FLEXISEAL FAECAL MANAGEMENT

SYSTEM FROM THE DRAWING BOARD

AND TRANSLATING THIS INTO CLINICAL

PRACTICE.

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Conference theme:Excellence in Practice

H. Beard1, C Merchant1

1Critical Care Services, West Suffolk Hospital NHS Trust

The risk of re-feeding syndrome can easily be overlooked in the enthusiasm to initiate early nutritional support to critically ill individuals, especially when initiated without dietetic input. Following a robust review of the established Nutrition Care Bundle, the Nutrition Interest Group, working collaboratively with the critical care Dietician, Pharmacist and senior nurse and medical team, developed a simple, easy to follow protocol for initiating nutritional support safely out of hours or at weekends. The purpose of this protocol was to highlight the risks and prevent re-feeding syndrome occurring in this vulnerable group of patients. A strategy of education and training was engaged and executed by members of the Nutrition Interest Group and the Dietician to ensure the agreed protocol was implemented successfully. This poster presentation portrays this journey of protocol development, implementation and proposed evaluation and demonstrates how collaborative working between all disciplines in the critical care unit can improve patient safety, prevent avoidable complications and ensure evidence-based practice and care.  Conference theme:Excellence in Practice

G Y Y Lau1, L P Kwok1, L F Chang1, H Y Wong1, S K Liu1, W P Lo1 , Y F Tam 1Pamela Youde Nethersole Eastern Hospital, Hong Kong, China

Background Fecal incontinence is one of the most common associated risk factors for pressure ulcer. Pressure ulcer results in patient suffering, longer the length of ICU stay. A Standard Incontinence Skin Care (SISC) has been developed and implemented in an ICU in Hong Kong. 

Aims To evaluate the effectiveness of SISC (1) to reduce the incidence of excoriated skin on the patients with diarrhea in ICU; (2) to compare the incidence of pressure ulcer before and after the intervention of SISC. (3) to evaluate the nurses’ acceptability of the SISC.

P37 REDUCING THE RISK

OF RE-FEEDING SYNDROME -

DEVELOPING AND IMPLEMENTING

A PROTOCOL FOR COMMENCING NUTRITIONAL SUPPORT OUT

OF HOURS IN THE CRITICAL CARE UNIT

P38 EFFECT OF THE

STANDARD INCONTINENCE

SKIN CARE (SISC) ON CRITICALLY ILL

PATIENTS WITH DIARRHOEA IN

INTENSIVE CARE UNIT (ICU)

Poster Walk 7

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Methods A repeated cross-sectional design was employed to test the effect of SISC on the patient with diarrhea. Moreover, a retrospective cohort design was used to collect the incidence of pressure ulcer before and after the intervention.Results and implication : After the intervention, the incidence of excoriated skin was reduced from 25 (57%) to 13 (25%) (p = 0.002). On the other hand, result also found that incident rate of pressure ulcer was reduced from 5.7% (n =7) to 0.7% (n = 2). Finally, 80% of nurses agreed that that the SISC was beneficial to reduce nursing workload as a result of reduction of excoriated skin and pressure ulcer management.  Conference theme:Excellence in Practice

L. Leighton1 1Kings College Hospital NHS Foundation Trust

BackgroundDiabetic Ketoacidosis (DKA) has a significant mortality but the improved understanding of its pathophysiology and better management of electrolyte and fluid resuscitation within a critical care setting has helped to reduce this figure significantly. 

There are several national and international guidelines available for the management of DKA. Following the development of new technology, the Joint British Diabetes Society (JBDS) has suggested shifting the focus of management to the now available near-patient blood ketone monitoring.   AimFollowing the introduction of the updated JBDS (2009) guidelines, a multiprofessional specialist interest group was set up. A suitable DKA guideline was created for a critical care environment, with the emphasis of therapy directed at normalising blood ketone levels with fixed rate insulin infusions, rehydration and separating glucose control. The overall purpose of the guideline was to safely improve the patient’s quality of care and reduce lengths of stay in critical care. 

Results and ImplicationsThe guideline has ensured parity of care for all patients admitted with DKA.  Nurses follow a standardised treatment plan with a structured approach to insulin, fluid and electrolyte management. The use of this guideline has allowed a quicker normalisation of blood sugars and correction of acidosis and shortened critical care stays. 

P39 THE DEVELOPMENT

AND IMPLEMENTATION

OF A NEW DKA GUIDELINE INTO

A CRITICAL CARE SETTING

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Conference theme:Patient & Carers Experience of Critical Care

H. Beard1, H Gilbrook1 1BACCN Anglia

‘What the patient says’ - What impact do ‘Patient Experience’ sessions have on critical care nurses and their practice?Since re-launching the Anglia Region BACCN back in 2005 , a key component of every study event organised by the region has been incorporating the ‘Patient Experience’. This is an opportunity for patients, or relatives, to share their individual experiences of critical illness, with professionals who plan, organise and deliver care in the critical care environment. The ‘Patient Experience’ is usually the final session of the study event, and whatever the theme of the day, and however complex the content, these humbling sessions emphasise the main reason why, we, as critical care nurses, do what we do. Following a review of the effectiveness of these sessions by the Anglia Region BACCN committee, this poster presentation highlights the positive impact the ‘Patient Experience’ has on nurses who work in the demanding, challenging and highly technical speciality of Critical Care and discuss the effect it has on their practice, perceptions and patient care.  Conference theme:Patient & Carers Experience of Critical Care

A. Domingo1, C Jones1, D Dawson1 1St George’s Hospital General Intensive Care Unit

Aims and ObjectivesThe aim was to explore our patients’ experiences of sleep. The objective was to identify factors preventing sleep and to improve our patient’s experience of sleep.

MethodologyA prospective pre/post intervention audit commenced in 2008. The pre-intervention group (n=50) were asked about their perceptions of quality/quantity of sleep and factors that were preventing and promoting sleep. A re-audit was conducted in 2009. Patients were offered the opportunity to wear eye masks and earplugs. Those patients who accepted (n=50) were included in the post-intervention group.

ResultsMore patients reported that they had slept longer using the eye masks, but they did not report an improvement in the quality of their sleep.• Noise was identified as a significant factor preventing sleep in the pre

intervention (50%) and post intervention (52%) group. • The pre-intervention group identify medication (26%) and simply ‘nothing’

P40 ‘WHAT THE PATIENT

SAYS’ - WHAT IMPACT DO ‘PATIENT

EXPERIENCE’ SESSIONS HAVE

ON CRITICAL CARE NURSES AND THEIR

PRACTICE?

P41 DO EYE MASKS

AND EARPLUGS IMPROVE PATIENTS’

PERCEPTION OF SLEEP IN A

CRITICAL CARE ENVIRONMENT?

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(24%) as factors promoting sleep.• The post-intervention group identify earplugs (22%) and eye-masks (28%)

showing a good evaluation of this intervention.

ConclusionWe feel that it is highly appropriate to offer eye-masks and earplugs to our patients based on their perception that it has a positive impact on sleep.  Conference theme:Education

J. Nicholls1, S Heuer1

1Guys and St Thomas’ NHS Foundation Trust

Introduction• An audit was undertaken looking at delirium, using the CAM-ICU and

ICDSC.• A Richmond Agitation and Sedation Score (RASS) forms the first part of the

CAM-ICU• More awake the patients are the quicker it is to wean off the ventilator1.• There were discrepancies between the expert assessors and bedside

nurses in the RASS scoring. • The bedside nurse documented the patient less sedated than the

assessors.• Re-education in RASS scoring was undertaken and improvement was

noted in a post-audit study

Method • The expert assessors undertook RASS teaching • This included bedside teaching, group sessions and new starter training• Each assessor RASS scored patients and compared them with the bedside

nurse’s documentation.

Results Significant improvement was seen as is shown below: 

  Agree Disagree %Pre-training 29 50 38Post training 43 13 77Non trained 16 28 36

 There was similarity seen in the pre-trained and the non-trained nurses.

Conclusion• Unit teaching significantly improved the RASS scoring.• Further work needs to be done to see if there is a correlation between

improvement of RASS scoring and reduction of ventilator days.

P42 DELIRIUM AUDIT

IDENTIFIED NEED FOR SEDATION

SCORING RE-EDUCATION

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Conference theme: Excellence in Practice

P. Munro1, F. Keane1 1Whipps Cross University Hospital Trust

BackgroundNon-invasive ventilation (NIV) is treatment of choice for acute on chronic hypercapnoeic respiratory failure. A ward-based NIV service is well-established. The optimisation of therapy requires frequent analysis of arterial carbon dioxide tension and oxygenation. The ‘gold standard’ for measuring carbon dioxide levels is arterial blood gas analysis. This is an invasive, sometimes difficult procedure which is often uncomfortable for the patient, particularly when repeated samples are required to monitor treatment. Arterial catherisation can facilitate multiple blood gas samples but is not without complications and requires specialist trained staff. This type of monitoring therefore is only feasible within designated critical care environments.

Trancutaneous carbon dioxide tension (PtcCO2) measurement provides a non-invasive method of continuously monitoring carbon dioxide tensions.

MethodMeasurements of PtcCO2 from a transcustaneous ear sensor) were compared with those obtained from arterial blood gas measurements in 10 randomly selected ITU patients.

ResultsNo significant difference was found the CO2 tension between the two different methods. The TcPCO2 monitor was easy to used and required minimal training.

ConclusionTranscutaneous carbon dioxide monitoring provides a reliable alternative to arterial blood gas sampling. It may be particularly beneficial to those patients receiving NIV outside of designated critical care units.

P43 EVALUATION OF

TRANSCUTANEOUS PCO2 MONITORING

Poster Walk 8

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Conference theme:Excellence in Practice

A. Reeve1

1 Kings College Hospital

BackgroundThe relationship between oropharyngeal colonisation of bacteria and aspiration pneumonia has long been established (Kunis et al 2006). Ventilator associated pneumonia (VAP) is the most common acquired infection in an intensive care unit (Vincent et al 1995) and it has been identified that effective mouth care can reduce the risks of developing VAP.

AimTo explore the most-up-to-date evidence that underpins the aspect of mouth care for ventilated patients, identifying the best practice.

FindingsEffective mouth care consists of three main components: dental plaque control; solutions for oral decontamination; and oral secretion aspiration. There are discrepancies in the evidence from the trials but the most effective way of managing and removing dental plaque is toothbrushing. There is consensus that chlorhexidine is the most effective solution to use for oral decontamination, however, the optimal concentration and frequency of application is unclear. Aspiration of oral secretions has only been truly examined in a single trial which found benefits in reducing VAP.

ConclusionMouth care in the ICU is an aspect of nursing care often given low priority. Meticulous mouth care is necessary to ensure effective and thorough oral decontamination. However, findings highlight discrepancies in the evidence and a need for further research and to standardise practice.

Conference theme:Excellence in Practice

Y. Mai1

1Central Taiwan University of Science and Technology

The patients hospitalized often need fasting during hospitalization, and the failure rate of fating is high in our wards. The special committee expects to improve this present situation and build care system on the basis of safety. Check list was found that there were 288 cases of fasting and 37 of loss 12.28% of failure rate. According to statistical analysis, we found several problems, including 1.insufficient quantity of placards 2.placards too small to eye-catching 3.the staff can not explain clearly 4.patients apt to forget 5.patients illiterate. Innovation of fasting placards, SOP establishment and improving strategies decreased 1.83% of will achieve the purpose that patients practice fasting exactly, and safety in hospital will be maintained. 

P44 MOUTH CARE IN THE

ICU

P45 THE IMPROVEMENT

STRATEGY FOR VIOLATION OF

FASTING

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R. Hill1, R Le Cordeur1, p 1Chelsea and Westminster Foundation Trust Intensive Care Unit

Admission to an Intensive Care Unit can be a life threatening situation. Patients are often already unconscious, or sedated and ventilated shortly after admission, denying them preparation that may reduce stress; coupled with the unique environment intensive care, patients are exposed to a wide range of unpleasant experiences that can remain with them for many years (Rattray et al 2004, Storli et al 2008, Williams 2009). At the Chelsea and Westminster Foundation Trust Intensive Care Unit focus groups are run to help improve the quality of care the patient experiences and assist the patient understand their time in Intensive Care. The poster describes patient experiences and the Unit’s response. Patients are invited back to the hospital some months following discharge from hospital. Memories of their experiences during their stay are discussed, and difficulties they encounter when discharged home. Many themes emerge including weakness, hallucinations and feelings of entrapment. These are shared with the Unit staff in group discussions, and processes changed to make efforts to improve the patients’ experience. The most gratifying outcome is that patients have described the Focus groups as a cathartic experience, liberating them from often private anxieties and realising they are not alone.

Conference theme:Education

D. Hadfield1, P. Hopkins1, L. Colorado1 1King College Hospital

Respiratory failure is the commonest indication for ICU admission within our trust. Recent studies have demonstrated increased morbidity and mortality associated with overzealous or inadequate ventilation, failure to expedite weaning, and prolonged patient-ventilator dyssynchrony (Levine et al 2008, The ARDS Network 2000, Esteban et al 2004). Senior nurses, physiotherapists and doctors within our 32 bed ICU work together to manage ventilation and to expedite weaning, therefore these concerns are entirely relevant to the whole MDT. To address these issues, our unit recently invested in the use of Neurally Adjusted Ventilatory Assist (NAVA), an innovative ventilatory support mode which delivers pressure which is proportional to inspiratory diaphragmatic electrical activity (Edi). The Edi is measured via a naso-gastric catheter and is utilised to both monitor central respiratory drive and to trigger and drive pressure-supported breaths. The limited literature together with our own experience suggests that use of NAVA should improve patient comfort and

P46 FOCUS GROUPS AS A WAY OF IMPROVING

QUALITY OF CARE WITHIN THE

INTENSIVE CARE UNIT.

P47 NEURALLY ADJUSTED

VENTILATORY ASSIST (NAVA) -

INTRODUCTION OF A NEW VENTILATION

MODE TO A 32 BED GENERAL CRITICAL

CARE UNIT

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ventilator synchrony; reduce use of sedation; allow the earliest possible use of a triggered spontaneous ventilatory support mode; protect respiratory muscles and lung tissues; and lead to earlier spontaneous breathing trials and extubation (Sinderby and Beck 2007).

My poster will present an overview of the MDT’s experience of NAVA and results of preliminary studies in to NAVA and Edi monitoring.

Conference theme:Research & Development

D. Hadfield1, L. Colorado1, P. Hopkins1 1Kings College Hospital

BackgroundNAVA (Neurally Adjusted Ventilatory Assist) is a new ventilatory support mode used on the Maquet Servo-i ventilator. The electrical activity of the diaphragm (Edi) is measured via a naso-gastric catheter and can be utilised to trigger and drive pressure-supported breaths. Literature has suggested that in addition to driving a ventilator, the Edi values can provide vital information about central respiratory drive and breathing pattern (Sinderby & Beck 2007). If used correctly by the MDT, Edi monitoring could lead to reduced use of sedation, earlier spontaneous breathing trials and faster weaning from ventilators.Aims :To establish the Edi signal as a useful monitoring tool, an audit was performed to assess the stability of the Edi maximum signal during interventions (ventilation changes and physiotherapy) in patients who were intubated due to respiratory failure. All ventilator data was recorded automatically via computer from 5 minutes prior to 30 minutes post intervention. ResultsPreliminary results show that although strength of Edi varies between patients, the signal is stable and responds predictably – i.e., the signal rises in response to increased load and decreases when load is reduced. The signal trend is therefore a useful guide, particularly during weaning as it reliably indicates both immediate and long term changes in central respiratory drive.

P48 NEURALLY ADJUSTED

VENTILATORY ASSIST (NAVA)

– ESTABLISHING THE EDI SIGNAL

AS A USEFUL MONITORING TOOL

DURING WEANING FROM MECHANICAL

VENTILATION

150 Poster Abstracts

Page 37: BACCN 2010 Poster Abstracts

Conference theme:Excellence in Practice

M. Lygoura1, M. Martínez Queipo1, H. Jones1 1Intensive Care Unit, Kings College Hospital

BackgroundPain needs to be assessed to be effectively managed (Puntillo, 2007). The project’s aim was to improve pain assessment and management in the critically ill patient. A small working group of nurses developed and piloted an audit tool to evaluate pain assessment and management in practice. The results revealed a lack of consistency in pain assessment and management practice.

MethodThe second stage of the process involved a literature search of current pain assessment tools specific for sedated patients. The introduced tool was the Critical-Care Pain Observation Tool (CPOT) (Gélinas et al, 2006), which assesses pain presence using behavioural indicators in patients unable to communicate. The Numeric Pain Scale (NPS) (Jensen et al, 1986) was identified for use to assess pain intensity in communicating patients.

Results and ImplicationsBoth tools were introduced over a period of three months. Pain assessment and management was then re-audited. Although there was a positive impact on assessment, there was still scope for improvement. Pain management remained inconsistent. To remedy this, in conjunction with the multidisciplinary team, a local protocol is being developed to establish safe and consistent high standards of care in pain management.

P49 IMPLEMENTING A

PAIN ASSESSMENT TOOL IN CRITICAL CARE: ACHIEVING EXCELLENCE IS A

PROCESS

151 Poster Abstracts


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