Episode 189: The ICU Revolution at Mercy San Juan Medical Center- Part 8 with Dr. Parimal Bharucha
What is the ethical and moral responsibility of a medical director to personally practice, lead, and support their ICU to keep patients as awake and mobile as possible? Dr. Parimal Bharucha shares with us the incredible revolution that has happened in his ICU. Episode Transcription Kali Dayton: [00:00:00] This is the walking home from the
Episode 188: The ICU Revolution at Mercy San Juan Medical Center – Part 7 with Dr. Jodi Coates
When the harm of “normal practices” shifts the perspective of an ICU revolutionist and medical director, what is the next course of action? Dr. Jodi Coates shares how her personal convictions inspired her to lead her trauma ICU to radically transform their sedation and mobility practices. Episode Transcription [00:00:00] This is the walking home from
Episode 187: The ICU Revolution at Mercy San Juan Medical Center – Part 6 with Ginger Manss
What is the role of the critical care director in leading ICU teams to become Awake and Walking ICUs? How can directors use the evidence to win executive leadership support for their teams to have what they need to succeed? Ginger Manss, DNP shares with us her key role as senior director of critical care
Episode 185: The ICU Revolution at Mercy San Juan Medical Center- Part 4 with the Trauma ICU RNs
How did education, training, leadership support, and deep compassion empower these experience trauma nurses to transform their ICU culture and practices? What successes have they had and how has keeping patients awake and mobile impacted their career fulfillment and team dynamics? Jessica Williams, BSN, RN, Adrienne Craig, BSN, RN, and Amber Brandt, BSN, RN share
Episode 184: The ICU Revolution at Mercy San Juan Medical Center- Part 3 with Luke Stratigates
Safe patient handling(SPH) is a fairly new and rapidly growing field. Mercy San Juan Medical Center is fortunate to have a strong SPH department and leadership. Luke Strategates, DPT shares with us the key role he plays in the ICU Revolution as the safe patient handling leader. Episode Transcription Kali Dayton 0:00 This is the
Episode 183: The ICU Revolution at Mercy San Juan Medical Center- Part 2 with Dr. Lawrence Bistrong
What happens when a medical director really sees the reality of “normal practices” and becomes a revolutionist? Dr. Bistrong shares his personal conversion and the key role he has playing in his team’s transformation. Episode Transcription Kali Dayton 0:00 This is the walking home from the ICU Podcast. I’m Kali Dayton, a nurse practitioner and
Episode 182: The ICU Revolution at Mercy San Juan Medical Center- Part 1 with Jeana Flakes
Standardized sedation and immobility are rooted in a gap in education. What is the power of a nurse educator in transforming knowledge, culture, and practice in the ICU? Jeana Flakes, MSN, RN shares how she helped lead the ICU Revolution as a nurse educator at Mercy San Juan Medical Center. Episode Transcription Kali Dayton 0:00
Episode 181: Physician Insights at CHEST
What do physicians understand of the ABCDEF bundle? What are their perceptions of early mobility? How are their teams practicing the ABCDEF bundle in their own units? What do physicians need to be able to lead an Awake and Walking ICU approach in their units? I interviewed physicians while attending the CHEST conference to find
Episode 180: Leading the ABCDEF Bundle in Bangledash
What happens when a visionary physician in a low-resource hospital in Bangledash leads his team to practice the ABCDEF bundle? How did this passionate team of ICU clinicians transform their care from automatic sedation and immobility to standardized mobility three times a day? How did they come to treat mobility as important and optional as
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Walking Home From The ICU Episode 179: The Legal Liability of Failing to Practice the ABCDEF Bundle
Fear of “liabilities” is often a barrier to keeping patients awake and mobile in the ICU. Yet, we know that the ABCDEF is evidence-based best practices. So what are the legal liabilities to a hospital, leadership, and bedside clinicians of current cultural practices? Maggie Ortiz, MSN, RN joins us now to share her expert perspective.
Over the last few years I have become aware of the PICS (post-intensive care syndrome) condition and the very serious negative impact that it has on our ICU survivors. I have become much more aware of the potential negative impact of anxiety, depression, PTSD and cognitive dysfunction. Many patients whom we consider saves in the sense they leave the ICU alive have many issues that most people would consider far from a successful experience. Their lives are often dramatically changed in a very negative fashion.
I am a professor of medicine and have been an ICU director for over forty years. What I find very disturbing in my own experience and that of many other intensivists is that this outcome is generally considered acceptable; the patient survived and will get better with time. We have little access to these patients and almost zero information about their condition unless they are unfortunate enough to return to our ICUs. Very few of us have a PICS clinic where we would have a chance to better understand the challenges that some of our patients encounter, and there are very few systems in place to provide feedback to us as ICU clinicians. Therefore, we are blissfully ignorant of the many challenges that a substantial number of our survivors encounter. This is a major problem. The vast majority of ICU survivors and their families will experience cognitive, emotional and physical symptoms which often have devastating impacts on their lives. At this time, with PICS clinics being a rarity, there is no reasonable mechanism for intensivists to have a solid perspective on the frequency and severity of this condition.
How patients and their families are treated in the ICU often has a major impact on how the patient and families survive post discharge. It is generally agreed that most sedation infusions, particularly benzodiazepines, frequently have higher incidences of delirium and post-discharge dysfunction. There are a few hospitals in this country where sedative infusions are rarely used and the incidence of the complications described above are dramatically decreased. I have visited one of these hospitals and was amazed to see how effectively patients on maximum ventilator support can be managed, even walking without sedative infusions. In an effort to explore this treatment option in greater detail I have identified Kali Dayton. She is a nurse practitioner who has practiced in this Awake and Walking ICU for many years and is an amazing source of information on this topic. After extensive discussion with many colleagues, administration and many others, and reviewing the major potential benefits of the program for our patients, we have decided to introduce this program into our hospital.
Peter J. Murphy, MD, FCCP, MRCPI, BSc
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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