Aleah Aaron BSN, RN’s Post

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Clinical Nurse Manager - Critical Care Unit

Physician buy in, support and accountability is key to success with the A-F bundle.

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Transformative ICU Consultant | Leading Expert in Awake and Walking ICU Models | Acute Care Nurse Practitioner | "Walking Home From the ICU" Podcast

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

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