Dayton ICU Consulting

We're thrilled to welcome the NurseApproved @ HLTH USA 2024 cohort! This incredible group of innovative nurses and companies are going to transform the future of healthcare for the better. We couldn’t fit them all in one photo—just wait until HLTH USA! We can’t wait for the world to meet them there! Cloud9 Care LLC Avail Health Safe Seizure Humla Health Nursesbnb Inc RescueRN Galena Innovations The Bullish Nurse Rx for Growth Fifth Window ANP Health Primary Record Advocates for Nurses PocketRN NurseBrain® (Google Accelerator '24) Corstrata Streamline Flow Nurses United Against Human Trafficking, P.A. CLARA Access Threads Laxo Dayton ICU Consulting Commodore Concierge Nurse Management Commission for Nurse Reimbursement True Concepts Medical Technologies FASSsyringe M7 Health Florida State University - College of Nursing IntellaTriage #NursesOnLinkedin #HealthcareOnLinkedin #NurseApproved #HLTH2024

What You Need to Create an Awake and Walking ICU: Part 5 Physician Leadership When physicians are not bought-in and trained to lead their teams to master the ABCDEF Bundle, an ICU cannot become an Awake and Walking ICU. Unfortunately, I have seen MDs be a barrier. I have also seen that when physicians are determined to provide best-practices and initiate true leadership to guide and support their teams, magic happens. One physician told me that when a patient self-extubated and didn't need to be re-intubated he was sure to jump in and help the nurse understand the success of the situation. A nurse told me that her physician protected her when her RN management was about to punish her for having a patient awake. THIS is what physicians do for their teams to change practices. Listen to the podcast episodes in the comments to hear from visionary physicians who led their teams to become Awake and Walking ICUs. Physicians need: EDUCATION: We are all molded by our training and experiences. Most physicians have been trained in the "conveyor belt" approach of automatic sedation and immobility. Like other clinicians in the ICU, physicians need to understand the "why" and "how" of the ABCDEF bundle. They need training that prepares them to lead their teams to keep patients awake and mobile. ROLE CLARITY: I commonly see physicians verbally declare their support for the ABCDEF bundle but seem to perceive this initiative as an "RN/rehab thing" that they don't really need to be involved with. Physicians must understand their role in critical thinking, bedside assessment, interdisciplinary collaboration, hands-on support, leadership, orders, etc. SUPPORT: Physicians need support while learning a radically new approach to critical care medicine. They need mentorship and guidance as they learn how to troubleshoot management of sedation, delirium, and mobility during critical illness. They need expert guidance to whom they can ask questions and get ideas for these new circumstances they will face with patients being awake and mobile. A PREPARED ICU TEAM: I have witnessed physicians who are eager to have their ICUs transformed to best-practices, but then struggle to have the rest of team be bought-in and prepared to make these changes. Physicians need each discipline and member of the ICU team to have the foundational knowledge and skills to keep patients awake and mobile. If 1 physician is the only one that understands how dangerous continuous sedation is and wants their patients to benefit from early mobility but the rest of the ICU team still believes sedation is "humane, safe, and best" then the physician will never be able to lead their team. When physicians are bought-in, educated, supported, and part of a prepared team then they can truly collaborate to become an Awake and Walking ICU. Picture provided by Dr. Mikita Fuchita. His story is featured in episode 133. #delirium #earlymobility #abcdefbundle #icu #rrt

What you need to create an Awake and Walking ICU: Part 2 You have to help nurses thrive. In 2019, I shared with a medical director of an ICU that my ICU walked most patients on ventilators. He scoffed and said, "Yeah, the research supports that stuff, but you'll never get our nurses to do that." As a nurse and nurse practitioner, that sparked a rage within me and continues to inspire me on this journey of training teams to become "Awake and Walking ICUs". I suspected then and KNOW now that it is RARELY that nurses "won't" keep patients awake and mobile. It is that they need to have the right pieces in place to be able to do so. I have faced incredible resistance, hostility, and even persecution from nurses throughout this journey. In the end, I have seen the loudest "naysayers" become the most passionate advocates for having patients awake and mobile. This only happens when they have what they need. Nurses need: - SAFE STAFFING The ABCDEF bundle is impossible if staffing ratios exceed 1 nurse for 2 patients. CNAs/techs/secretaries and sitters can have brilliant return on investment to provide the support and safety nurses need to be able to execute the high-touch and higher level care patients need. - EDUCATION Nurses need to first know the "why" in order to find their "how" to master the ABCDEF Bundle. ICU Liberation needs to be more than a "task list" with boxes to quickly check-off in charting. Nurses have to understand how the ABCDEF bundle drastically saves lives and quality of life. When I share survivor testimonials, statistics about mortality, PTSD, and brain injuries from sedation with nurses they are shocked. Without proper education, we are expecting a change in practices without a change in perspective and knowledge. - HANDS-ON TRAINING Mobility is within the RN scope of practice, but have they had the opportunity to learn how? When else do we expect any clinician to safely perform a brand-new skill without mentorship and opportunities to practice before doing it with a real patient? The ABCDEF bundle deserves the same training as other high-level skills. - INTERDISCIPLINARY COLLABORATION Nurses should not be left alone with the burden of navigating sedation, delirium, and mobility management. They need the support of MDs, RTs, PTs, OTs, CNAs, and families to help identify and meet patients' needs. -EXPERIENCE I have observed a pattern of nurses being hesitant and even resistant to a very new approach to patient care in the ICU. This is usually rooted in justifiable fear. When nurses have the support to actually master the ABCDEF bundle with their patients they can finally see the impact and difference in action. They are charged with motivation and confidence as their experience and expertise builds. This is when they become captains of the ship. #nurses, what else do you need to optimize your role in creating #AwakeandWalkingICUs? #abcdefbundle

I met with two brilliant nurses today. They previously worked in a modern ICU that had a great ABCDEF Bundle culture. They both transitioned to a new hospital and were shocked to find that their new ICU team was deeply rooted in sedation and immobility. Delirium was the norm. Tracheostomies were anticipated for most intubated patients. Midazolam drips are still the primary sedative automatically started at high doses on all patients after intubation. The team responds with shock and horror when these nurses get their patients up. They have been pushing against the culture and even leadership for years now. They had horror stories including being written up for discontinuing a midazolam drip on a patient that didn't open their eyes for days after it was turned off. They shared their passion for fighting antiquated and lethal practices. They have been educating their colleagues for years. It broke my heart that the main barriers were the leaders that were supposed to be ensuring best evidence-based practices on the unit. They felt their proposals and revolution met resistance because they were "just nurses" to the physicians. The ABCDEF bundle requires each discipline of the ICU to be united with the same vision and understanding of best practices. Nurses should be educated and empowered to provide best practices, not micromanaged and restrained. They especially should NEVER be punished for failing to follow orders they know are harmful and even lethal for patients. Mastering the ABCDEF bundle requires leadership, support, autonomy, and true interdisciplinary collaboration. THIS is how we saves lives in the ICU. (Picture provided by Heidi Engel)

If you are attending #NTI2024, please join us for this session as we discuss fact vs. fiction of sedation in the ICU. (Link in comments) If you are interested in attending an ICU Revolutionists meetup at #NTI2024 with clinicians who are leading the transformation of sedation and mobility practices in the ICU, message me for more details!