Aleah Aaron BSN, RN’s Post

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

Surviving the ICU: Minimizing Delirium and Post Intensive Care Syndrome (PICS) Join us on Friday, August 30th, 2024, at 2:00 pm Central Time (UTC -6) for a vital and insightful webinar addressing one of the most challenging aspects of critical care: the prevention and management of delirium and Post Intensive Care Syndrome (PICS). This webinar features Dr. Wes Ely, a leading critical care pulmonologist and the author of the acclaimed book "Every Deep-Drawn Breath." Dr. Ely’s work is a powerful exploration of the human side of critical care, blending science, history, and deeply moving patient stories. His mission is clear: to prevent the unintentional harm that outdated sedation practices can cause to patients in the ICU. As Co-Director of The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center at Vanderbilt University, Dr. Ely has revolutionized how we approach ICU care. Also speaking will be Bill Cantrell, a seasoned Emergency and Critical Care Registered Nurse with a unique dual perspective as both a healthcare provider and an ICU survivor. His experiences offer a compelling narrative on the realities of ICU care from both sides of the bedrail. Joining them is Kali Dayton, Doctor of Nursing Practice, who specializes in guiding ICU teams in implementing evidence-based care bundles designed to prevent delirium and PICS, through mastering the ABCDEF Bundle to create Awake and Walking ICUs. This webinar is a must-attend for patients, families, and healthcare professionals dedicated to advancing ICU care and improving patient recovery. Don’t miss this opportunity to learn from leaders in the field who are reshaping the landscape of critical care. https://lnkd.in/gqTxHYv2

As healthcare transitions with digitisation and technology, nurses need to be prepared to embrace the changes and meet the challenges of the future. 

Alarm Fatigue can be a Silent Killer in the ICU. Sensory overload often occurs when nurses are exposed to multiple safety alarms. Welcome to the world of the ICU! The telemetry (heart rate) monitor has pre-set parameters for Low/high Blood pressure, heart rate, respirations, and Pulse oximetry (Oxygen level of the blood). These systems are also able to interpret heart rhythm changes. Some of these rhythm changes can be lethal if quick interventions are not applied, such as CPR and medication administration. Not so Fun Fact: Holding your breath, shaking, or tapping your fingers can also trigger the "Urgent" level alarms. Have you ever suffered a night through a bed alarm or had lunch with a chair alarm? Depending on the sensitivity of the alarm, every turn you make or shift of your bottom in that chair will alert not only the alarm box in your room, but also echo through the call bell system to be heard throughout the unit. ICU units with staff cell phones offer another section of alarms as each potentially dangerous alarm goes to every cell phone. And we cannot forget numerous device alarms ranging from Ventilators, Impellas, Balloon Pumps, CCRT machines (A much slower, gentler dialysis) , SCD (to prevent blood clots in the legs), and the IV machines! Include the call bells simultaneously going off and it's no surprise that Alarm Fatigue has become a dangerous issue hospitals are facing. To be honest; these alarms can be annoying and repetitive but, must never be ignored. They each serve their purpose in ensuring patient safety. Ignoring such alarms leads to delays or negligence in identifying, further preventing, and treating changes in a patient's medical status. Often alarms are silenced, turned off, or never turned on. This can lead to not calling code blues in a timely matter, patient falls, increased hospital stays, and even possibly a preventable death. __________________________________________________________________________________ Working on an ICU/CVICU case and want someone to sift through the medical records for you? DM me or book an appointment to get started: https://lnkd.in/eSAXqVyF #medmal #medicalmalpractice #LNC #Legalnurseconsultant #ICU #AlarmFatigue #PersonalInjury #PI

Season 1 Episode 9: A Day in the Life of Nurse Lerato in a Fully Digitalised Hospital 💔 Handling a Cardiac Arrest as an RRT Member In today's episode, we delve into the urgent scenario of handling a cardiac arrest outside of an ICU. Nurse Lerato, a member of the Rapid Response Team (RRT), showcases the critical role of technology & teamwork in saving lives. 💔 Cardiac Arrest in a General Ward Cardiac resuscitation (CPR) is vital for restoring circulation & oxygen in patients experiencing cardiac arrest. This high-stakes procedure requires a well-coordinated team approach, with each member playing a crucial role. 💔 Roles in Cardiac Resuscitation: Team Leader: Directs the resuscitation process. Compressor: Delivers chest compressions. Ventilator: Manages the airway & provides breaths. Medication Administrator: Prepares & administers medications. Runner: Fetches equipment & communicates with other providers. Defibrillator Operator: Prepares & delivers shocks. Recorder: Documents the resuscitation process in the EHR. ❣️EWS & EHR Systems The hospital's paperless system includes an Early Warning Scoring (EWS) system integrated into the EHR. This system continuously monitors patient data & generates alerts when vital signs indicate deterioration. The RRT is alerted immediately when a patient's EWS reaches a critical threshold. 💔 Today's Scenario: An adult male patient, Mr. Alberts, in Ward B, had his EWS flagged. The primary nurse confirmed the alert, and the RRT was notified. Nurse Lerato received the notification & rushed to Ward B, where the team assembled within a minute. ❣️Immediate Action: Upon arrival, Nurse Lerato, assigned to cardiac massage, noticed ventricular fibrillation on the monitor after placing defib pads on the patient. The team leader coordinated efforts, assigning roles & directing the resuscitation process. ❣️Coordination & Teamwork: Compressor: Began high-quality chest compressions. Ventilator: Managed the airway, ensuring effective ventilation. Medication Administrator: Administered medications like epinephrine & amiodarone. Defibrillator Operator: Delivered shocks as indicated. Runner: Retrieved additional equipment. Recorder: Documented all actions in the EHR. ❣️Role of EHR and EWS: EHR systems support healthcare professionals by providing real-time data & alerts for timely interventions. The integration of EWS into the EHR allows for early detection & rapid response, improving patient outcomes. 😍 Conclusion: Mr. Alberts survived the arrest & will be transferred to an ICU. Advanced EHR systems and coordinated RRT efforts are vital for managing cardiac arrests, demonstrating how technology can save lives by ensuring timely & precise medical interventions. 📕Reference: Health Information Systems in Nursing, Chapter 3, discusses the integration of Clinical Decision Support (CDS) in EHRs. Book published by Juta and Company (Pty) Ltd & available 👉 at https://bit.ly/3Igqf0K #NurseLerato #EHR #CardiacArrest #RRT #ProtoCare

Improving quality in healthcare requires a multifaceted approach that prioritizes patient safety, outcomes, and satisfaction. Here are some proven strategies that are already fully integrated or in deployment at Henry Ford Wyandotte Hospital. ❤️ 1. Develop a Culture of Safety: Fostering a culture where every team member feels empowered to speak up about safety concerns without fear of reprisal is paramount to success and is a consistent goal. Encouraging open communication, active listening, and collaborative problem-solving to identify and address potential risks are the hallmark of a safe culture. We’ve recently implemented Safety Stop where every team member has an opportunity to stop the line to ensure safety issues are immediately addressed. Does that exist in your organization? 2. Standardization and Protocols: Implementing standardized protocols and best practices across departments to ensure consistency in care delivery. Examples of this include our use of Nurse driven protocols around foley catheter usage which have resulted in 3 consecutive years of ZERO catheter acquired urinary track infections! Very few hospitals can say the same. You have to love the power of Nursing!! ❤️ 3. Patient Engagement: Involving patients and their families as partners in care by providing clear communication, education, and involvement in decision-making. Encouraging patients to ask questions, voice concerns, and actively participate in their own care to promote safety and improve outcomes. Implementation of Bedside Shift report and a hardwired process around leader rounding demonstrates our extensive commitment to improving the patient experience. Hardwiring these practices are top priorities for the Department of Nursing because we know they are important to our patients. 4. Data-driven Decision Making: Utilizing data analytics and performance metrics to identify trends, monitor outcomes, and drive quality improvement initiatives. Regular review of safety data, including adverse events, near misses, and patient feedback, to proactively identify areas for improvement and measure progress over time. Our incredible Quality department with their extensive knowledge, structure, transparent and collaborative approach in ensuring we are constantly learning and improving further demonstrates our commitment to our patients. Call me, text me, email me…..and I’ll tell you all about our best practice in quickly identifying high risk situations with evaluation and risk mitigation within 48 hours of a safety incident. Hard to do but we’re committed! By embracing these strategies and making safety a top priority, we know we will enhance patient outcomes, build trust within our community, and achieve sustainable long-term success and even further improve Nursing excellence. When you’re choosing a place to practice the art and science of Nursing consider Henry Ford Wyandotte Hospital. Come join my team where Nursing matters ❤️

The Silent Threat: Tension Pneumothorax in the Emergency Department As an Emergency Department (ED) nurse, I’ve encountered my fair share of urgent cases, but few are as silently threatening as tension pneumothorax. It’s a condition that demands swift recognition and immediate intervention to prevent catastrophic consequences. I aim to shed light on this critical condition and the role nurses play in its management. Tension pneumothorax occurs when air accumulates in the pleural space, exerting pressure on the affected lung and shifting the mediastinum, compromising cardiovascular function. The hallmark signs—absent breath sounds, distended neck veins, and tracheal deviation—are not always present initially, making it a diagnostic challenge. Picture this: a patient arrives at the ED complaining of chest pain and difficulty breathing. Initial assessment reveals tachycardia, tachypnea, and decreased oxygen saturation. While these symptoms could signify various conditions, a vigilant nurse considers tension pneumothorax, especially in trauma patients or those with underlying lung disease. Rapid assessment is key. Auscultation may reveal absent breath sounds on the affected side, but in critically ill patients, relying solely on this can be risky. Instead, observing for signs of respiratory distress—such as paradoxical chest wall movement—and assessing for tracheal deviation or jugular venous distension can provide crucial clues. Time is of the essence. In suspected tension pneumothorax, prompt action is non-negotiable. Initiating high-flow oxygen and establishing IV access are vital first steps. However, definitive treatment lies in needle decompression or chest tube insertion. As a nurse, being proficient in these procedures is essential for delivering timely care. Effective communication is paramount. In the chaos of the ED, clear and concise handoffs between healthcare providers can make all the difference. Communicating findings, interventions, and response to treatment ensures continuity of care and prevents delays in management. Education is empowerment. Tension pneumothorax doesn’t discriminate—it can occur in any patient, at any time. Therefore, patient education on recognizing symptoms, especially in those at risk, is crucial for early intervention and prevention of complications. A tension pneumothorax is a life-threatening emergency that demands a rapid and coordinated response. As ED nurses, we are frontline advocates for our patients, equipped with the knowledge and skills to recognize and manage this silent threat effectively. By staying vigilant, communicating efficiently, and empowering both patients and colleagues through education, we can save lives and make a significant impact in the fight against tension pneumothorax.

WHY IS ICU SO IMPORTANT Intensive care units (ICUs) are specialized hospital units that provide around-the-clock care to critically ill patients. These units are equipped with advanced medical technology and staffed by highly trained medical professionals who work tirelessly to monitor, diagnose, and treat patients who require intensive medical attention. While ICUs are often associated with emergency care, they are also used for planned procedures or in the management of long-term chronic conditions. ICUs are essential to modern medicine for several reasons. In this blog post, we will explore some of the key reasons why ICUs are so important. 1.    Life-Saving Treatment One of the primary reasons why ICUs are so important is that they provide life-saving treatment to critically ill patients. Patients who are admitted to the ICU may be experiencing a severe medical emergency such as a heart attack, stroke, or severe trauma. In the ICU, they can receive advanced medical care, including mechanical ventilation, dialysis, and drug therapies that can help stabilize their condition and save their life. 2.    Close Monitoring and Care ICUs provide close monitoring and care to patients who require constant attention due to their medical condition. Patients in the ICU are typically connected to a variety of medical devices that track their vital signs, including their heart rate, blood pressure, and oxygen saturation. Nurses and other medical professionals in the ICU constantly monitor these readings and intervene immediately if there is a significant change, such as a drop in oxygen levels or an irregular heartbeat. 3.    Multidisciplinary Care ICUs are staffed by a multidisciplinary team of medical professionals who work together to provide comprehensive care to patients. In addition to physicians and nurses, ICU teams may include respiratory therapists, physical therapists, social workers, and other healthcare professionals. This team-based approach ensures that patients receive the highest quality of care possible and that their medical needs are addressed from a variety of perspectives. 4.    Management of Chronic Conditions ICUs are not just for emergency situations. They are also used to manage chronic medical conditions that require intensive medical attention. Patients with severe respiratory conditions, heart failure, or chronic kidney disease may require ongoing care in the ICU to manage their symptoms and prevent complications. This ongoing care can improve their quality of life and reduce the risk of hospital readmission. In conclusion, intensive care units are essential to modern medicine. They provide life-saving treatment to critically ill patients, close monitoring and care, multidisciplinary care, and management of chronic conditions. The dedicated healthcare professionals who staff ICUs work tirelessly to provide the best possible care to their patients, and their work is critical to improving patient outcomes and saving lives.

WHY IS ICU SO IMPORTANT Intensive care units (ICUs) are specialized hospital units that provide around-the-clock care to critically ill patients. These units are equipped with advanced medical technology and staffed by highly trained medical professionals who work tirelessly to monitor, diagnose, and treat patients who require intensive medical attention. While ICUs are often associated with emergency care, they are also used for planned procedures or in the management of long-term chronic conditions. ICUs are essential to modern medicine for several reasons. In this blog post, we will explore some of the key reasons why ICUs are so important. 1.    Life-Saving Treatment One of the primary reasons why ICUs are so important is that they provide life-saving treatment to critically ill patients. Patients who are admitted to the ICU may be experiencing a severe medical emergency such as a heart attack, stroke, or severe trauma. In the ICU, they can receive advanced medical care, including mechanical ventilation, dialysis, and drug therapies that can help stabilize their condition and save their life. 2.    Close Monitoring and Care ICUs provide close monitoring and care to patients who require constant attention due to their medical condition. Patients in the ICU are typically connected to a variety of medical devices that track their vital signs, including their heart rate, blood pressure, and oxygen saturation. Nurses and other medical professionals in the ICU constantly monitor these readings and intervene immediately if there is a significant change, such as a drop in oxygen levels or an irregular heartbeat. 3.    Multidisciplinary Care ICUs are staffed by a multidisciplinary team of medical professionals who work together to provide comprehensive care to patients. In addition to physicians and nurses, ICU teams may include respiratory therapists, physical therapists, social workers, and other healthcare professionals. This team-based approach ensures that patients receive the highest quality of care possible and that their medical needs are addressed from a variety of perspectives. 4.    Management of Chronic Conditions ICUs are not just for emergency situations. They are also used to manage chronic medical conditions that require intensive medical attention. Patients with severe respiratory conditions, heart failure, or chronic kidney disease may require ongoing care in the ICU to manage their symptoms and prevent complications. This ongoing care can improve their quality of life and reduce the risk of hospital readmission. In conclusion, intensive care units are essential to modern medicine. They provide life-saving treatment to critically ill patients, close monitoring and care, multidisciplinary care, and management of chronic conditions. The dedicated healthcare professionals who staff ICUs work tirelessly to provide the best possible care to their patients, and their work is critical to improving patient outcomes and saving lives.