SUBSCRIBE TO THE PODCAST

After 100 episodes of compelling stories, research, and testimonials, we know what can and should be for intensive care medicine. What is the next step? How do we lead our ICU teams into the future and standardize “Awake and Walking ICUs”? What resources are available to educate and support our teams in this transition?

Episode Transcription

Kali Dayton 0:00
Welcome to Episode 100. I wanted to take this opportunity to thank you for your support, inspiration and guidance since the beginning. The last two years of this podcast and throughout critical care has been unlike anything I could have anticipated when I started this podcast. This episode I want to briefly share with you how this started and where it is headed. As you’d likely know, I started my career as a new nurse in and awake and walking ICU. I thought it was normal to have most patients awake and walking throughout critical illness until I became a travel nurse.

Initially, I was shocked to the vast contrast in tone, human connection, routine and patient outcomes. But unfortunately, I had not learned why my first ICU avoided sedation and aggressively mobilized patients. I didn’t know why we did that, let alone the real risks and harm of sedation and immobility. So I missed the opportunity to advocate and teach and ended up going with the practices and culture I was surrounded by.

Years later, I returned to Salt Lake to study for my doctorate in acute care nursing practice. I worked in the ICU float pool and jumped around about five hospitals and nine ICUs including the awake and walking ICU. I definitely saw a big difference in culture and treatment even within the same hospital system. Then I had a huge awakening, not in my doctorate program.

] But by survivors that crossed my path. People told me the haunting truth about their experiences during and after their medical induced comas. They were the ones that led me to look into the research and the realization that we have been failing to act on research for decades and have been unnecessarily persisting in harmful practices. My first job as a new MP was back in the awaken walking ICU. It was there that I was under the mentorship of the legendary pioneers, Polly Bailey and Louise Bezdjian.

Being immersed again in that ICU, I kept thinking, “wow, the teams down the road and the same hospital system don’t know what we do here as possible. Families don’t realize how different their treatments and outcomes could be with only a few miles difference between the hospitals. Why isn’t anyone talking about this? Why does the ICU community even know?”

]My silence made me feel complicit in the problem. Then I started having more reality checks. I was in a meeting with the head of critical care, the rehabilitation department and clinicians from the awake and walking ICU. The purpose of the meeting was to discuss how to better track outcomes of ICU survivors throughout the system, and how to better unify our practices to improve outcomes.

I presented case studies from our ICU with astounding outcomes as well as statistics such as 98% of survivors from the awakened walking ICU discharge home and in another hospital in the same system with the same patients and same Apache scores. Only 46% discharged home.

Now the purpose had never been to create a competition, but a discussion. Yet the head of critical care became very defensive, slammed his hands on the table and yelled at me. The meeting was derailed. The discussion was shut down and the objectives were not met. That was when I started to define my answers as to why these practices had not been standardized, even in the same hospital system.

I kept thinking about the wonderful people in that system that I had worked with as a float nurse. I had experienced their compassion, passion and the skills and was filled with the conviction that despite the explosive leadership, they would deeply care and be excited about the prospect of having patients walk out of the ICU doors. I just didn’t know how I as one lone and new nurse practitioner could reach and teach them.

Later I was meeting in a different hospital system with a group of ICU a APPs. I mentioned that I’d come from an ICU in which most patients were awake and walking. And the immediate response was “no, you can’t do that.” I was dumbfounded.

This was long before the podcast and I was not prepared to explain the why and how. Also, after a few years of working and the awakened walk in ICU again, I had quickly forgotten how foreign that concept is to the outside world. My jaw dropped and all I could say was, “Well, I’ve done it for seven years, and I would be happy to help your team do so as well.”

It was just another drop in the bucket. The disbelief, the lack of understanding, the closed doors –I just knew could be gone if I could just explain it to them. I continue to presevere in the conviction that if all ICU clinicians from every discipline, knew the reality of sedation and immobility, and had the education, tools and support to prevent delirium and atrophy, then there would be no looking back.

I dream of a future in which we shatter at the normal culture we face now. We dread starting sedation when it is necessary. And we diligently collaborate and reassess together to make sure we discontinue sedation and rehabilitate as soon as possible. So I am optimistic that is our future. I felt a heavy sense of responsibility to make this information known. I wasn’t sure if anyone would listen to a nobody NP.

In December of 2019, I had the penetratingly clear spiritual revelation to quote, start a podcast.I had no idea how, but I couldn’t sleep or rest until I complied. This unshakable awakening came with the distinct understanding that I had to do over 30 specific episodes, by the beginning of March.

The urgency and timing make no sense to me. Yet, I would wake up in the morning and have to grab a pen and paper and write down the direct instructions that came to mind on what topics to address and in what order. And I had to get them out by the beginning of March. I started recording the end of January. And the survivors, researchers, clinicians that you hear at the beginning of the podcast, miraculously came available to me, it was nonetheless, so scary for me to launch the podcast.

I had accepted that it would be “career suicide” to expose these gaps in our system and to propose a process of care that most had never imagined could or would be done. Nonetheless, I released 32 episodes on March 10, of 2020. And then COVID hit.

Initially, I thought those six weeks of flurry had been a total waste. No one was going to care about my podcast when the focus focus was all about COVID. Now, then that same divine communication took me by the shoulders and said, “You still don’t get it. Millions of people will be suffering on mechanical ventilation. This podcast is for COVID.”

That was one of the first moments that I really realized that this was definitely not my podcast or my project, that this was going to be an international movement to unify in a struggle that change ICU culture and practices to ease the burden on our systems, clinicians, patients and families.

Certainly COVID created incredible barriers for the transition and practices. But it has also created an absolute necessity. We have been immersed in the repercussions of sedation and immobility. And the desperation is now leading to ongoing discussions and a new willingness to explore more information and different approaches.

Despite its unique and lowly message, the podcast has been growing, what I feared would be a frustration to exhausted and burnt out clinicians has actually been an inspiration and motivator to stay and keep trying.

I am so grateful for your example to me of absolute preserverance, humility, and innovation. I would not be on episode 100 If not for the impactful interactions I’ve had with people from all over the world that are working so hard to bring this change. When you tell me if your moments of victory and the ongoing battles you were facing, it moves me.

I have so much hope and optimism for our field, even and especially after this pandemic. I’ve had the honor of meeting with many of your teams for webinars and presentations and have been thrilled by the reception and excitement of your teams. It has reaffirmed my suspicions that where we are in our community is not because of a lack of willingness to do the right thing. But a lack of education and support. I knew the ICU is full of the best and your willingness to take leadership and try something new to save lives confirms all of my hopes. I just presented that my first in person conference for a trauma conference in Colorado.

Though I was honestly nervous and unsure how the reception would be, it’s not easy to tell a group of exhausted providers that a pillar of their normal practice is not what they have long believed it to be. It felt far more vulnerable to do so in person. I can even tell that those that had invited me and had deep convictions for this message. Were also nervous about how these 200 attendees would receive this message.

It was an incredibly spiritual experience to look into their maskless spaces, and see such sincerity and compassion as I shared with them a few testimonials from survivors explain what they actually experienced when clinicians thought they were sleeping. I saw the shock and discomfort as they relate the risk as I explained the research and painted the picture of the reality and risks of sedation. And then I saw the amazement and excitement when I share case studies with pictures and videos of intubated patients walking, playing volleyball on the guitar and all around the world.

Instead of being demoralized by the reality check, they were excited at the prospect of easier and more humane care in connection with greater success.

I left that meeting deeply humbled by the magnitude of greatness in our field. I understand the impatience and frustration, but please recognize that you are making a difference. Go back and listen to episode 21. To hear Polly Bailey’s journey to establishing an awake and walking ICU almost 30 years ago. This is a process. But now in 2022, we have far more evidence, collaboration and tools available to make this happen.

I want to do anything I can to support you and your teams and updating your practices to be able to experience the joy of an awake and walking ICU. This is why I started Dayton ICU consulting. I know how hard it can be to try to change mentalities and deeply rooted culture. It isn’t feasible or productive to have only a few people pushing for those changes and trying to teach during a normal shift.

There needs to be in depth and formal education with a complete picture for every member of the ICU team. When everyone understands why we need to truly practice the ABCDE F bundle, then we can work together to find our how, for far too long hospital systems have only superficially implemented RAS can fit SPT into the charting system out of obligation, but productive education and support has not been provided.

Mandating poorly conducted awakening and breathing trials is not supporting an ABCDEF bundle culture and practice in the ICU. Our culture is rooted in our education, we must first address the why we deeply stay all patients, why we must avoid it, and then how to implement evidence based practices to avoid sedation and optimize early mobility. The “why” must precede the how I have been conducting learning sessions via webinars with all members of ICU teams with exciting success.

My goal is to provide a succinct and comprehensive information that allows everyone an understanding and application of the research and patient and survivor perspective. Through dozens of discussions and interviews with individuals and teams. I have identified knowledge gaps and delirium, mobility and the ABCDEF bundle mission and tools that have created significant barriers to changing practices.

I recognize how daunting it can be for exhausted team members and leadership to approach the change in sedation and mobility practices, especially when they themselves do not have experience or expertise with it. I want to take the burden off of leadership and provide a process of education that streamlines this education and has the highest impact and fills teams with excitement, not exhaustion, I can provide a foundation of knowledge and perspective that will allow for productive collaboration between all the disciplines of the ICU.

Then I am ready to help your team build on that foundation. I can bring expert PT RT, RN and NP or MD on site to provide hands on training and support for your team. Scene can be believing we can help your team build that experience confidence to help them be able to continue applying that knowledge and those tools independently moving forward. Our ICU teams have been through enough the past few years. We cannot expect them to continue the incredible burdensome work that sedation and immobility require with a high rates of moral injury, lack of career fulfillment, and constant poor patient outcomes. Let me support and guide your team.

If you struggle with buy in from financial stakeholders, let me present the financial picture that makes a powerful argument that investing in proper care has a clear return on investment. This should be one of our most powerful cards to pull to ensure safe staffing ratios. I would love to pitch it to them.

If your main leadership can’t imagine patients being awake and walking on ventilators bring me in, I would love to catch them up. If you’re doubtful that your staff would be willing to change, stop that, give them a chance to learn and understand and then provide the support. I deeply believe that there are very few bad apples among us. I am determined that the jokes means dangerous practices and so forth, are rooted in a lack of education. We can fix that we can rekindle our faith in each other and in our specialty.

Thank you for listening to and supporting the podcast. Thank you for sticking with critical care medicine. Thank you for advocating for evidence based medicine. I know many of you have already worked so hard and given so much of yourself to bring these changes to your team and practice. Let me support you however you need. You are not alone.

Please join the Facebook discussion group called Walking home from the ICU discussion group. Add me on Twitter, Instagram and Facebook. The YouTube channel is an ongoing project but there are survivor testimonials and podcast episodes found there. Stay tuned on social media and my website. I will be having live webinar sessions for continuing education credits, as well as group discussions in the next few months. Check out my website www.DaytonICUconsulting.com.

I am new to all of this. So it’s an ongoing process. Yet I want to provide as many resources as possible to support your advocacy. There is a free ebook at the bottom of the homepage that gives a succinct outline dispelling six myths about medically induced comas with almost 60 citations. This can be printed out and used as an educational tool for your teams.

You will find case studies that you can share with your teams newsletters and a blog with the transcripts of each podcast episode, including citations for research use and each episode. There’s also a page with the history of an awakened walking, ICU sharing Polly Bailey and Louise Best Friends journeys and missions. There is also a page for testimonials from teams that have participated in the webinars, as well as information about the webinar content. Also by way of announcements, there is a new podcast dedicated to loved ones of ICU patients.

The objective of the new podcast is to help families and loved ones be productive members of the ICU team and be prepared to help the ICU team and their loved ones. Through the journey of critical illness. It provides an introduction to the ICU, the equipment team members and the flow of the ICU. There is a thorough explanation of the challenges that the critical care community is facing, and ways to be helpful and appropriate in all interactions with ICU clinicians. The role of the loved one and tools for advocacy are discussed. Then, of course, we catch them up on ICU delirium, and their role in helping prevent and treat it and how to help the ICU team implement the ABCDEF bundle and their loved ones care.

The new podcast is called walking you through the ICU. I hope that by referring families to this podcast, it can save you valuable time and facilitate successful interactions between families and the ICU team in order to to provide the best patient outcomes. If there’s anything I can do further topics you want to be addressed in the podcast any kind of support I can provide. Please let me know. The website provides direct contact to me as well as scheduling for consultation, nurses, if you’re going to the ACN NTI conference in Houston, this May of 22 Please tune in to my Instagram account.

Come to our presentation on delirium and let’s get together. I’ll be arranging a meet up for ICU revolutionists, come ready to party and share your experiences good or bad and any tips you have that will help other nurses that are on the same mission for change. I am so excited to meet you. If you’re going to the chest conference in October or the ACN conference in Minneapolis. I’ll be there presenting and let me know I would be honored to meet you there. I promise you are not alone in this. There are 1000s of clinicians around the world fighting for this same changes. Thank you for bringing forth a brighter future for Critical Care Medicine. I look forward to learning more from you. We have exciting podcast episodes coming up. After 100 episodes. This mission is really just starting

Transcribed by https://otter.ai

 

 

SUBSCRIBE TO THE PODCAST