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Dayton Walking From ICU Episode 22 Interdisciplinary Teamwork

Walking Home from The ICU Episode 22: Interdisciplinary Teamwork

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Patients cannot walk out of the ICU without the efforts and expertise of each discipline. Kali discusses the role each discipline plays in returning patients to their lives.

Episode Transcription

Kali Dayton  

I saw a profound statement on Twitter that said, “No one person can overcome delirium.” 

That is so true. It is as Polly said last episode, “An awake and walking culture requires buy in from everyone. delirium cannot be prevented, and patients will not be kept strong during critical illness without a multidisciplinary approach.” Nurses can keep their patients awake, but if respiratory therapists are not there to help walk the patients, there is no way we can keep them walking. 

Physical therapists can have a goal of walking patients. But if they are sedated, then physical therapists cannot do their job, we can have all the equipment up and ready to walk. But without the expertise of physical therapy every day, optimal mobility won’t happen. Nurses can want to achieve this goal. Though our nurse practitioners and doctors that have the same vision, they may face an uphill battle without the support of pharmacy. We may be inclined to jump to narcotics right away, or give unnecessary medications at three in the morning. Everyone collaborate- they create a game plan at the beginning of the shift and have a rough idea of who is traveling, what’s going on with the other patients. who was going to walk first, and they anticipate helping each other. 

Their goal is to help everyone succeed and make the burden lighter for everyone else. They are excited to see physical therapy enter the unit. Usually because their patients are already writing notes, asking to go for walks. I have seen a meme that reflected better sentiments. Nurses feel when physical therapists leave patients in the chair. That didn’t make sense to me. I see nurses walk into the room in the morning and get their patients up in the chair to wait for their walk with physical therapy. 

You see- mobility, delirium prevention, and preservation of function is not just isolated to PT, OT or any one discipline. As Polly said, “We do not work in silos. We work together.”  

The next series of episodes, each discipline of an ICU with an awake and walking culture will share with us their roles in getting patients back to their lives. We will see how this culture penetrates each specialty in the ICU, and the power that comes with collaboration. 

Every day, we have a multidisciplinary rounds meeting with a member of each team of the ICU and the loved ones of the patients. We discuss each case and plan. A big part of the discussion are the risk factors for delirium, obstacles to mobility, and where the patient is in their course to be functional in their lives. 

Again, these discussions are brief, succinct, but powerful. Everyone is in it together. Everyone has the same vision for their patients and knows the part that they play. They have the vision of them walking out of the ICU because they know it can be done and they have done it. The only people who truly qualified to teach this process are the ones that literally walk the talk so I present to you the masters of the awake and walking ICU.

 

Transcribed by https://otter.ai

 

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About the Author, Kali Dayton

Kali Dayton, DNP, AGACNP, is a critical care nurse practitioner, host of the Walking Home From The ICU and Walking You Through The ICU podcasts, and critical care outcomes consultant. She is dedicated to creating Awake and Walking ICUs by ensuring ICU sedation and mobility practices are aligned with current research. She works with ICU teams internationally to transform patient outcomes through early mobility and management of delirium in the ICU.

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I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU in Salt Lake City.

Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.

After discovering the no sedation, early mobility practice at the Awake and Walking ICU, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Implementation has been challenged by pushback at the bedside, but knowing how most patients can be off sedation and comfortable allowed me to advocate for the patients. So far, four patients were successfully kept off of sedation after getting intubated, and two of them immediately smiled at me as they woke up from induction meds. Kali and the members of the Awake and Walking ICU have decades of experience in this approach.

Mikita Fuchita, MD

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