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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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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

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