Checking the Boxes but Missing the Mark: ICU Rounds
After working in 11 ICUs and training 14 others, I have seen multidisciplinary rounds conducted in many different ways. And I’ve also witnessed how easy it is to check the boxes but still miss the mark. Even in teams that are more progressive with the ABCDEF Bundle who “check the boxes” during ICU rounds, the
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Mobility vs. Positioning in the ICU: Are We Dangerously Confused?
We cannot fix what we cannot confront. So, bear with me as I delve into some hard realities within the ICU community. I am often told, “We do early mobility in our ICU!” However, when I probe deeper into the “mobility” provided, I find that the most common interventions that are considered mobility include: Chair
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Daily Doses of Gravity in the ICU
Throughout my journey in this ICU revolution, I have come to learn that the simplest concepts can be the most profound and the most important. This is going to sound too basic to be significant but hear me out. Gravity needs to be considered a standard “medication” in the ICU. Gravity is the grounding force
Lessons Learned From the TEAM Study
“See? From this we see that mobility does nothing!” This is the common rebuttal that I have received from at least a few physicians in every single ICU I have trained since the TEAM Study was published in The New England Journal of Medicine in 2022. There is often a sparkle of mischief in their
Raging Tigers and Merciful Angels: The Fight to Humanize Critical Care
Medicine is a field of evolution with a continuous trajectory of exploration, discovery, change, and progress. And this perpetual pattern has been just as reliable as the predictable resistance that comes with change. Past Revolutionists Who Fought to Humanize Critical Care This was demonstrated in the journey of Ignaz Semmelweis (pictured above), a Hungarian
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Why ICU Teams Need Expert ABCDEF Bundle Consulting
In my experience, teaching ICU clinicians about the ABCDEF Bundle can sometimes feel like trying to explain water to a fish. Just as a fish has no context to understand the water it’s swimming in, ICU teams may not always clearly see the preventable harm surrounding them. When clinicians are immersed in the daily realities
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Why Gradual ABCDEF Bundle Implementation Often Results in a Failure to Launch
“Let’s introduce the bundle gradually. We don’t want to overwhelm anyone. Let’s see what the team is willing to do. We can start with awakening and breathing trials, then tackle the rest once we have those down.” This kind of conversation has echoed through medical organizations and clinical leadership teams for years. It’s a logical
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What Clinicians Need to Know About Awakening Trials
I have to admit, I wasn’t a fan of awakening trials at first. During my first two years in an Awake and Walking ICU, we rarely initiated sedation, so the need to turn it off wasn’t a struggle for us. When sedation was necessary, we simply turned it off when we deemed it unnecessary. It
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Reviving Core Nursing Values in Critical Care Through the ABCDEF Bundle
Critical care is an extraordinary and complex specialty that’s continually evolving, with a growing capacity to save and extend life in the face of the most extreme perils. Research, knowledge, and technological developments have transformed nursing skills and our ability to care for patients who are critically ill. Unfortunately, the nursing values and ethics, which
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How Failing to Practice the ABCDEF Bundle Creates Legal Liabilities in the ICU
As a nurse and a nurse advocate, I am passionate about protecting nurses and all ICU clinicians from falling victim to legal liabilities in the ICU. The alarming reality is that when hospitals fail to train and support their teams in keeping patients as awake and mobile as possible, everyone from hospital administrators to bedside
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Dayton ICU Consulting team came to our unit for 4 days, and they did in-person training for over 100 staff members, and spoke with many on our Leadership team. The transformation of the staff after the consulting team was remarkable.
The consulting team pushed us to look outside of our comfort zone in a way that someone from within our team could not achieve. They have firsthand knowledge of what to do, and how to do it and they walked side by side with us while they showing us how to do it. Many of the staff who were very ambivalent prior to the in-person training are now the biggest advocate of implementing the change.
Kali and her team have the knowledge and the skills to help make change happen.
Roni Kelsey, BSN, ICU Liberation Leader, PeaceHealth
Bellingham, WA
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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