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Care Practice Change in the ICU

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Katharina Asterová

on 8 September 2015

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Transcript of Care Practice Change in the ICU

Care Practice Change in the ICU
It makes a difference
What matters most
what our customer says...
Quality of care
Caregiver safety
Financial Pressures
Improved outcomes

Prevent Readmission

Quality of care
Caregiver safety
Injury Reduction

Injury Avoidance

Staff Retention

Financial Pressures
Aquisition Cost

Total Cost of Ownership

Work Related Injuries

Do More With Less!

Nursing Time

Transport Time

Room Turnover

Equipment Down Time

Why is mobility important?
Benefits of mobility
Improved muscle strength
Reduced oxidative stress and inflammation
Improved gas exchange
Reduce VAP rates
Reduce mechanical ventilation time
Improved circulation
Improved skin care
Less fatigue
Positive mood changes (It feels good! It looks good!)
Greater ability to resume activities of daily living
We are about the customer
YOUR focus is OUR focus:
Nurse and patient safety
Patient mobilization
Effective infection control
Pressure ulcer prevention
Efficiency of healthcare procedures
Smart bed technology & EMR integration
Reducing costs of care
Muscle groups that lose the most strength are involved in maintaining posture, transferring activities and ambulation1
Skeletal muscle strength may decline 1%-1.5% per day of bed rest1,2-4
Major long term complication: diminished quality of life after discharge due to physical deconditioning that takes place during ICU stay5-8
Study showed survivors of ARDS (acute respiratory distress syndrome) had significant functional limitations 1 year after discharge because of muscle wasting and fatigue5
What are the steps in mobilizing a patient?
STEP Program
1. Turn and reposition
2. Head of bed raised to 30 degrees
3. Reverse Trend for orthostatic training

4. Chair position
5. Dangle at side of bed
6. Ambulation
...in the right direction with
in the right direction with
and weight bearing on footboard
If repositioning every 2 hours is the standard of care, why is the standard not being met?
Impact on the Patient

Large-sample, multi-site research project sponsored by AACN
Examined pain perceptions of critically ill patients to selected procedures
Wound care, wound drain removal, tracheal suctioning, turning, femoral sheath removal, central line placement
Turning was found to be one of the most painful!

Lateral Tilt Can Help
Lateral Tilt +/- 15 degrees
Vastly improves the task of repositioning a patient
Less stress to caregiver & patient with a controlled, gentle rotation
Lessons force exerted on patient to achieve optimal positioning
Insures Q2 turn schedules by reducing the number of caregivers required to turn a patient
Obstacles to mobility
Hemodynamic instability
Lack of resources/staff
Patient population (bariatric)
Equipment (lack there of)
Thunder Project II11
Turning hurts!
ABCs of Turn and Repositioning
Turn using the lateral tilt

Do skin assessment from head to toe

Reposition patient with support



Getting Out of Bed Can Hurt Too!
Mobi-Lift® significantly reduces pain during transition from sitting to standing at bedside.

Allows the patient to have an active role in pain management by controlling the speed at which egress takes place

Ideal for surgical patients, orthopedic patients to include knee and hip surgery for early and active mobilization
How do you mobilize safely?
Risk Tasks of Patient Handling
Top ICU Handling RISKS impacting the nurse
Pushing occupied beds/stretcher
Lateral Patient transfer bed/stretcher
Moving Patient to the head of bed
Repositioning side to side
Making occupied beds
Bed to chair transfer
Nurses have one of the
highest incidences of work-related back injuries
of all occupations
Back injuries may not be the most frequent injury, but do
result in the most lost workdays
Back injuries and other musculoskeletal disorders related to patient handling are the
leading and most costly
occupational health problem for nurses
40,000 annual back injuries among nurses
(often related to transferring and repositioning)
(750,000 lost days annually)
Average worker’s compensation cost for back pain = $10,698 per case

Nursing workforce is aging faster than the general workforce
(avg. age = 47 years)
Nursing shortage will likely result in
longer and more demanding work hours
As many as
20% of nurses leave direct patient care
due to risks associated with their work
Minimizing the risk
1. Work practices (proper body mechanics)
2. Administrative controls (safety policies, training)
3. Engineering controls (specialized at bedside equipment)

Minimal effectiveness

Minimal effectiveness

Shows the most promise to impact patient and caregiver

At LINET, we believe
too many nurses work in pain.
Our products include innovations that care for the caregiver.
Minimal back strain during turning

Minimal boosting & pulling patients up in bed

Minimal lifting during ambulation

Minimal effort during transport
The VALUE of Multicare
with Lateral Tilt
with Ergoframe®
with Mobi-Lift®
with light weight frame, i-Drive®, & i-Drive® Power
What do customers say about Lateral Tilt?
My patients are so much more comfortable when we turn them this way, instead of tugging and pulling on them.
The Lateral Tilt is like a Virtual Nurse
This product will allow me to stay at the bedside for 10 more years!

The foot pedal controls allow me to position the patient with both hands.
The Linet bed reduces the number of nurses required to turn patients.

The gentle tilting motion allows patients more dignity especially when the patient is larger than me and difficult for me to move.
I don’t need to wait for help to bathe, give a bed pan or change linen.
Patient Turning Forces
NIOSH, (National Institute of Occupational Safety and Health) a division of the CDC, sets standards for safe lifting practices.
Safe Patient Handling is
Less Painful
More Cost Effective
Take a turn for the better!
Safe patient handling just got
and more
cost effective.
How Multicare can impact YOU
Benefits to the Patients:

Benefits to the Nurses:

Benefits to the Organization:

Improved mobilization
Less VAP

Reduced risk for on the job injury
Increased job satisfaction
More efficiency with patient care assignment

Lower cost of care
Improved patient outcomes
Improved HCAHPS
Increased reimbursement

Improved Patient Outcomes
Positive Impact on HCAHPS
Other Cost Savings
Less HAPU + Less VAP + Less Falls + Less Complications = Cost Avoidance + Increased Reimbursement $$

Better Scores = Increased Reimbursement $$

Less Injuries = Less Turnover = Less Overtime + Less Float Pool + Less Nurse Recruitment = Lower Insurance Claims = $$ Saved!

Topp R, Ditmyer M, King K, et al. The effect of bedrest and potential prehabilitation on patients in the intensive care unit. AACN Clinical Issues. 2002;13(2):263-276.
De Jonghe B, Sharshar T, Lefaucheur JP, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859-2867.
De Jonghe B, Bastuji-Garin S, Durand MC, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Critical Care Medicine. 2007;39:2007-2015.
Siebens H, Aronow H, Edwards D, et al. A randomized controlled trial of exercise to improve outcomes of acute hospitalization of older adults. Journal of the American Geriatric Society. 2000;48(12):1545-1552.
Herridge MS, Cheung AM, Tansey CM, et al. One year outcomes in survivors of the acute respiratory distress syndrome. New England Journal of Medicine. 2003;348(8):683-693.
Hopkins RO, Weaver LK, Collingridge D, et al. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. American Journal of Respiratory Critical Care Medicine. 2005;171(4):340-347.
Dowdy DW, Eid MP, Sedrakyan A, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Medicine. 2005;31(5):611-620.
Dowdy DW, Eid MP, Dennison CR, et al. Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Medicine. 2006;32(8):1115-1124.
Krishnagopalan S, Johnson W, Low LL, Kaufman LJ. Body position of intensive care patients: clinical practice versus standards. Critical Care Medicine. 2002;30:2588-2592.
Goldhill DR, Badacsonyi A, Goldhill AA, Waldmann C. A prospective observational study of ICU patient population and frequency of turning. Anaesthesia. 2008;63:509-515.
Thunder Project II. Patterns and use of pharmacological interventions to manage procedural pain, and behavioral responses to procedural pain. Accessed 2001.
Occupational Safety & Health Administration Safe Patient Handling. www.osha.gov. Accessed September 26, 2013.
Department of Health and Human Services. Back Injuries in Nursing. www.hhs.gov. 2009.
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