Louise Rose RN, BN, ICU Cert, Adult Ed Cert, MN, PhD
|
|
|
- Cordelia Clarke
- 5 years ago
- Views:
Transcription
1 Louise Rose RN, BN, ICU Cert, Adult Ed Cert, MN, PhD TD Nursing Professor in Critical Care Research, Sunnybrook Health Sciences Centre Associate Professor, LSBFON, University of Toronto CIHR New Investigator Director of Research, Provincial Centre of Weaning Excellence, Michael Garron Hospital Adjunct Scientist, Institute for Clinical Evaluative Sciences; West Park Healthcare Centre
2
3 Definition: any physical or mechanical device attached or adjacent to a patient s body that he/she cannot easily remove, which restricts freedom of movement or normal access to one s body
4
5 Physical restraint can be applied to prevent serious bodily harm Hospitals must have a policy The policy must encourage alternative methods Staff should receive training on alternative methods Only a physician or person specified by regulation can order Standing orders are prohibited
6 Recommendations: Level of Evidence C least restrictive but safest environment maintain dignity and comfort only in clinically appropriate situations: NOT as routine component risk of untoward treatment interference MUST outweigh all risk assess if treatment of existing problem obviates need alternatives should be considered least invasive restraining option rationale must be documented orders limited to 24-hr period potential to discontinue/reduce considered at least every 8 hrs monitor for complications at least every 4 hrs analgesics, sedatives, neuroleptics NOT overused as chemical restraint
7
8 France (De Jonghe et al. 2013) 82% of 130 ICUs: PR used at least once during MV 62% of ICUs: PR when applied used for >50% of MV duration 29% of ICUs: PR used in >50% of awake, calm and cooperative patients US vs Norway (Martin et al 2005) Norway: 0% though higher acuity, more sedated higher N:P ratio (1:1 for ventilated patients) US: 39% - Unplanned device removal: 7 US vs 0 Norway Prospective point prevalence survey 34 ICUs, 9 countries, 669 patients PR prevalence in individual ICUs: 0 to 100% Overall 33% patients restrained More likely to be MV, sedated, larger ICUs, lower daytime N:P ratio
9 I-CAN-SLEAP 51 ICUs across Canada - observational study 374/711 (53%) patients restrained The SLEAP trial 16 tertiary ICUs 14 Canada/ 2 US protocolized sedation plus daily sedation interruption vs protocolized sedation alone 328/430 (76%) patients had restraints applied at least once during ICU admission Luk et al. Crit Care 2014 Mehta et al. JAMA 2012
10
11 I-CAN-SLEAP: 51 ICUs:711 patients 53% restrained mean 4.1 days (SD 4.0), range 1-26 days Restraint use daily opioid dose Treatment Antipsychotic use characteristics SAS > More days of PR benzo dose, daily sedation interruption, antipsychotic drugs, accidental device removal Patient characteristics NOT associated with PR use age, gender, APACHE II, admission diagnosis, substance use, psychiatric diagnosis OR 95% CI daily benzodiazepine dose Both continuous & bolus sedatives University-affiliated ICUs
12 Secondary analysis of SLEAP trial 328 (76%) patients restrained
13
14 141 patients in 2 ICUs Prospective observational study Average duration of PR 1.8 (1.0) days Most common reason for PR Agitation 43% Precautionary 17% Restlessness 17% Altered mentation 7% Alternative measures used Reorientation 27% Sedation 21% Causes 20% Analgesia 18% Family/friends 10% Antipsychotics 2% Behaviours indicative of agitation Pulling at lines 34% Pulling at ETT 32% Climbing over bedrails 12% Thrashing 11% Striking staff 10% Reasons for discontinuation Calm & cooperative 75% Family/friend at bedside 7% Unrousable/sedated 7%
15 2 ICUs in Northwest England: 75 nurse participants Postal questionnaire AGREE DISAGREE By using PR, sedation can be more safely 58% 15% Preferable to use PR than to sedatives 52% 16% Use of PR allows for other duties to be completed 36% 51% Getting a colleague to hold pt s hand is preferable to PR 47% 23% Families do not appear to mind PR as know for pt safety 77% 0% I do not believe in the use of PR in the ICU 0% 89%
16
17
18 Identified 50 studies 1950 to 2011 Unplanned extubation rates 0.5 to 35.8/100 ventilated patients 0.1 to 4.2/100 intubated days Identified 17 studies reporting on PR % restrained at time of unplanned extubation 25% to 87% median 67% IQR 42% to 74%
19 3,256 nursing shifts 120 patients 3 ICUs PR applied on 1371 (43%) nursing shifts Significant restraint (Posey vest) on 521 (16%) shifts Only 5 patients never restrained # of events Unrestrained Restrained Total 59 (69%) 27 (31%) Self extubation 10 2 CVP removal AEs occurred when patients had SAS of 1-4 NG removal Peripheral/arterial line removal 7 6 Drain AEs occurred during PR and 60 when PR not applied (P<0.02) Concluded PR had a protective effect against any AE (OR=0.27; CI ) AND major AE (OR=0.04; CI )
20
21 Single centre: 98 patients Measured anxiety, depression and PTS symptoms in outpatient clinic after hospital discharge 24% of participants had memory of physical restraint PR memory was associated with PTS symptoms: OR % CI 2.23 to 16.23
22 SLEAP Investigators Severity of illness Hx smoking Antipsychotic before delirium
23
24 Environmental Therapy Communication Alter environmental stimuli Manage pain, hypoxemia, evaluate ventilator settings Maximize communication Keep objects necessary for daily living close at hand Decrease bed rail use if pt climbing over them Use more frequent or constant supervision Increase caregiver supervision ratio Maximize activities of daily living Eliminate bothersome treatments Remove catheters Review medications for contributors to delirium or anxiety Provide communication aids Provide reality links & reorientation cues Involve pt in care planning Use anxiety reduction techniques Use one-to one supervision Encourage physical exertion, exercise, mobility Involve family & others
25 Secondary analysis of RCT to evaluate the effect of a CDSS on referral to a geriatrician and reducing exposure to: inappropriate anticholinergics physical restraint urinary catheters All patients transferred to ICU (n = 60)
26 22 bed TICU 56/77 (73%) of nurses consented Intervention Power-point of non-pharmacological interventions and alternatives Therapeutic alternative device instruction protocol Handheld devices can twist & squeeze Activity lap belts Soft dolls/stuffed animals Visual & hearing aids Frequent communication Familiar objects Consistent nursing staff TV with news/music Day/night routine Sleep quiet times Frequent ambulation Pre: mean (SD) 314 (35) restraint occurrences/1000 patient days Post: mean (SD) 237 (56) P = 0.008
27 Before/after study 32 nurses (100%) Education and RDW Incidence of PR 37% (before) vs 18% (after) P=0.02
28 Physical restraint common in critically ill patients Most common rationale for use is safety and prevention of device removal Though frequently ineffective Use of physical restraint lacks a scientific evidence basis Physical restraint may cause harm Restraint minimization is possible
29
SOLUTION TITLE: Can Critical Care Become A Restraint Free Environment?
ORGANIZATION: ST AGNES MEDICAL CENTER SOLUTION TITLE: Can Critical Care Become A Restraint Free Environment? PROGRAM/PROJECT DESCRIPTION INCLUDING GOALS: The critical care environment is perhaps the last
The policy applies to all SHS employees involved in direct patient care and medical staff.
Restraints Use of Violent - System Introduction Restraints, Use of Violent System Introduction SCOPE The policy applies to all SHS employees involved in direct patient care and medical staff. Implementation
NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE RESTRAINT AS A LAST RESORT - CRITICAL CARE SCOPE Provincial: Critical Care APPROVAL AUTHORITY Clinical Operations Executive Committee SPONSOR Senior Operating Officer, Glenrose Rehabilitation Hospital
RESIDENT CARE AND SERVICES MANUAL SECTION: RESIDENT SAFETY INDEX I.D.: E-25. APPROVED BY: REVISED DATE: April 30, 2010
SUBJECT: RESTRAINTS PAGE: 1 OF 6 STANDARD: 1. The decision to use restraints is based on the principle that least restraint can only be considered after the interdisciplinary team had tried alternatives
Position Statement. Position Statement on the Use of Restraints in Client Care Settings
Position Statement Position Statement on the Use of Restraints in Client Care Settings June 1 Approved by the College and Association of Registered Nurses of Alberta () Provincial Council, June. Permission
Appendix E: Minimizing Restraining Staff Training Presentation. Least Restraint, Last Resort
Appendix E: Minimizing Restraining Staff Training Presentation Least Restraint, Last Resort Audience: Registered Staff Release Date: December 3, 2010 Adapted from educational materials provided by Belmont
Unplanned Extubation In Intensive Care Units (ICU) CMC Experience. Presented by: Fadwa Jabboury, RN, MSN
Unplanned Extubation In Intensive Care Units (ICU) CMC Experience Presented by: Fadwa Jabboury, RN, MSN Introduction Basic Definitions: 1. Endotracheal intubation: A life saving procedure for critically
Collaboration and Coordination in the MRICU: An Interprofessional Approach to Implementation of a Daily Review of Sedation Strategy, Liberation
Collaboration and Coordination in the MRICU: An Interprofessional Approach to Implementation of a Daily Review of Sedation Strategy, Liberation Potential and Mobility Plan Amy Dean, MS, RN, CCRN Kristin
Restraint Update 2016
Restraint Update 2016 For questions contact: Weddy Balmaceda, MSN, RN-BC, CCRN, CCDS Professional Development Ext. 5241 Source: RBMC policy and procedures Objectives Review types of restraints Review RBMC
ICU Restraint Reduction: Development of Evidence Based Tools to Guide Interventions
ICU Restraint Reduction: Development of Evidence Based Tools to Guide Interventions January 2012 Sandy Maag, BSN, RN Manager of Nursing Quality Malissa Mulkey, MSN, APRN, CCRN, CCNS Neuroscience ICU &
Restraint Education Program JHS Annual Mandatory Clinical Education
Restraint Education Program 2017 JHS Annual Mandatory Clinical Education Program Goals Prevent, reduce and eliminate use of restraints Initiate restraint only when other less restrictive measures have
Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre
Barriers to Early Rehabilitation in Critically Ill Patients Shannon Goddard, MD Sunnybrook Health Sciences Centre Disclosures/Funding No financial disclosures or conflicts of interest Work is funding by
9/17/2015. Bed Rail Safety A Clinical Process Guideline. Background. Federal Nursing Home Reform Act
Bed Rail Safety A Clinical Process Guideline Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy Background Safety hazards related to bed rail use have been realized since 1990. Michigan s initial
Bed Rail Safety A Clinical Process Guideline. Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy
Bed Rail Safety A Clinical Process Guideline Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy Background Safety hazards related to bed rail use have been realized since 1990. Michigan s initial
VAE PROJECT MASTER ACTION PLAN. Note: Please be aware that these areas overlap to reduce duplication and optimize the synergies
VAE PROJECT MASTER ACTION PLAN Note: Please be aware that these areas overlap to reduce duplication and optimize the synergies Practice NHSN Surveillance Data Collection Is VAE NHSN Surveillance data collection
Restraint Reduction. Moving Towards Restraint Free Care
Restraint Reduction Moving Towards Restraint Free Care Revised: BW/January 2016 RESTRAINTS: Defined Any manual method, physical or mechanical device, material or equipment, that immobilizes or reduces
SECTION P: RESTRAINTS
SECTION P: RESTRAINTS Intent: The intent of this section is to record the frequency over the 7-day look-back period that the resident was restrained by any of the listed devices at any time during the
Restraint Reduction. Moving Towards Restraint Free Care
Restraint Reduction Moving Towards Restraint Free Care Revised: BW/September 2010 RESTRAINTS: Defined Any manual method, physical or mechanical device, material or equipment, that immobilizes or reduces
BED RAIL SAFETY 9/15/2015. A Clinical Process Guideline. Background. Federal Nursing Home Reform Act
BED RAIL SAFETY A Clinical Process Guideline Laura Funsch, RN, BSN, MS Director of Regulatory Strategy, LeadingAge Michigan Background Safety hazards related to bed rail use have been realized since 1990.
PATIENT RESTRAINT-MINIMISATION POLICY Page 1 of 7 Reviewed: June 2017
Page 1 of 7 Policy Applies to All Mercy Hospital clinical staff. Compliance will be facilitated for Credentialed Specialists and Allied Health personnel involved in patient care. Exclusions: This policy
New OSU Hospital Policy on the Use of Restraints and Seclusion
University Hospitals Office of the Medical Director 130 Doan Hall 410 West 10 th Avenue Columbus, OH 43210-1228 Phone: (614) 293-8158 FAX: (614) 293-4989 MEMORANDUM DATE: February 7, 2000 TO: FROM: RE:
Physical Restraints. Purpose Policy Statement. Applicability
Approved by: Physical Restraints Senior Vice President, Medicine Vice President, Covenant Health Rural Health Services & Executive Lead for Professional Practice and Research Corporate Policy & Procedures
Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre
Barriers to Early Rehabilitation in Critically Ill Patients Shannon Goddard, MD Sunnybrook Health Sciences Centre Disclosures/Funding No financial disclosures or conflicts of interest Work is funding by
Pharmacy Services. Division of Nursing Homes
Pharmacy Services Division of Nursing Homes 1 483.45 Pharmacy Services Overview The Pharmacy Services section of Appendix PP contains all Pharmacy Services requirements and interpretive guidelines (IG)
Improving family experiences in ICU. Pamela Scott Senior Charge Nurse Forth Valley Royal Hospital ICU
Improving family experiences in ICU Pamela Scott Senior Charge Nurse Forth Valley Royal Hospital ICU Family Burden in icu:- Incidence of anxiety symptoms range from 21% to 60.4% (median 40%) from ICU admission
Restrictive Practices
Restrictive Practices Clinical Intervention or Management Failure May 2013 Chris Gork Governance and guiding principles Decision Making Tool: Supporting a Restraint Free Environment in Residential Aged
NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE RESTRAINT AS A LAST RESORT - ACUTE CARE INPATIENT - PEDIATRIC SCOPE Provincial: Acute Care Inpatient Pediatric APPROVAL AUTHORITY Clinical Operations Executive Committee SPONSOR Senior Operating
Patients Being Weaned From the Ventilator: Positive Effects of Guided Imagery. Authors McVay, Frank; Spiva, Elizabeth; Hart, Patricia L.
The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based
We use many of them. The devices are part of our restraint policy. See below
Do you utilize body pillow, beveled mattresses, moxi mattresses, rolled blankets, swim noodles for positioning or bed demarcation? Do you have a comprehensive device assessment? If so, would you please
Restraints and Seclusion Use Training
Restraints and Seclusion Use Training Table of Content TOPIC PAGE NUMBER OBJECTIVES 2 WHAT ARE RESTRAINTS? 3 INTRODUCTION 4 WHAT IS A RESTRAINT? 6 A RESTRAINT FREE ENVIRONMENT 8 THE MOST COMMON REASONS
Implementing a Restraint Free Policy. Esther Vance NSW Falls Injury Prevention Network Prince of Wales Medical Research Institute March 2008
Implementing a Restraint Free Policy Esther Vance NSW Falls Injury Prevention Network Prince of Wales Medical Research Institute March 2008 Restraint Definition anything that limits an individual s voluntary
STATE OF CONNECTICUT DEPARTMENT OF DEVELOPMENTAL SERVICES
STATE OF CONNECTICUT DEPARTMENT OF DEVELOPMENTAL SERVICES Procedure No. I.E.PR.003 Issue Date: October 28, 2003 Subject: Behavior Modifying Medications Effective Date: Upon Release Section: Health and
Contents. Introduction 3. Required knowledge and skills 4. Section One: Knowledge and skills for all nurses and care staff 6
Decision-making frameworks in advanced dementia: Links to improved care project. Page 2 of 17 Contents Introduction 3 Required knowledge and skills 4 Section One: Knowledge and skills for all nurses and
PRACTICE STANDARD. Restraints. Table of Contents. Introduction 3. What are Restraints? 3. Assumptions 4. Policy Direction: Least Restraint 4
PRACTICE STANDARD Restraints Table of Contents Introduction 3 What are Restraints? 3 Assumptions 4 Policy Direction: Least Restraint 4 Quality Practice Settings 4 Nursing Responsibilities 5 Case Studies
Raise your game: The UP Campaign. Bruce Spurlock, M.D. Cynosure Health
Raise your game: The UP Campaign Bruce Spurlock, M.D. Cynosure Health 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Can we streamline & simplify making it easier for front-line staff and still improve safety? 16
POLICY AND PROCEDURE RESTRAINT/SECLUSION, MEDICAL CENTER PATIENT CARE Effective Date: March 2010
Number: MS 08:03:05 Submitted by: BEHAVIORAL HEALTH CLINICAL PRACTICE TEAM Issuing Department: PATIENT CARE SERVICES Approved By: Reviewed by: Date: Patient Care Practice & 12/09 Outcomes David W. Cress,
Running Head: PHYSICAL RESTRAINT USE 1
Running Head: PHYSICAL RESTRAINT USE 1 Physical Restraint Use in Adult Intensive Care Units (ICUs): A Systematic Review Anastasia S. Philabaum The Ohio State University PHYSICAL RESTRAINT USE 2 Abstract
Pain: Facility Assessment Checklists
Pain: Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to pain management in the facility, in order to identify areas
WRHA Constant Care Guidelines for Acute Care 2018
WRHA Constant Care Guidelines for Acute Care 8. PURPOSE To establish standardized guidelines and support appropriate use of constant care in acute care settings. Separate guidelines apply to residents
Responding to Patients and Families that Want Everything Done
Responding to Patients and Families that Want Everything Done Steven Pantilat, MD Professor of Clinical Medicine Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care Director, Palliative
Pain: Facility Assessment Checklists
Pain: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a critical
Team collabora+on: an impera+ve for early mobiliza+on Dr Louise Rose BN, ICU Cert, MN, PhD, FAAN TD Nursing Professor in Cri+cal Care Research
Team collabora+on: an impera+ve for early mobiliza+on Dr Louise Rose BN, ICU Cert, MN, PhD, FAAN TD Nursing Professor in Cri+cal Care Research Sunnybrook Health Sciences Centre; Associate Professor, University
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
Use for a resident who has potentially unnecessary medications, is prescribed psychotropic medications or has the potential for an adverse outcome to determine whether facility practices are in place to
Symptoms and stress in family caregivers of ICU patients. Hanne Birgit Alfheim RN, CCN, PhD student Photo:
Symptoms and stress in family caregivers of ICU patients Hanne Birgit Alfheim RN, CCN, PhD student Photo: oystein.horgmo@medisin.uio.no Why are the family caregivers so important for the patients? Family
Institutional Handbook of Operating Procedures Policy Responsible Vice President: Executive Vice President and CEO, Health System
Section: Clinical Subject: General Policies Institutional Handbook of Operating Procedures Policy 09.13.06 Responsible Vice President: Executive Vice President and CEO, Health System Responsible Entity:
Barriers to Early Mobilization in Critically Ill Patients
Barriers to Early Mobilization in Critically Ill Patients Shannon Goddard, MD Department of Critical Care Medicine, Sunnybrook Health Sciences Centre PhD Student, Institute of Health Policy, Management
POLICY. Use of Antipsychotic Medications in Nursing Facility Residents. Preamble. Background
Preamble POLICY Use of Antipsychotic Medications in Nursing Facility Residents The Office of Inspector General of the U. S. Department of Health and Human Services issued a report in May 2011 finding that
Daily Interruptions of Sedation: A Clinical Approach to Improve Outcomes in Critically Ill Patients
Feature Daily Interruptions of Sedation: A Clinical Approach to Improve Outcomes in Critically Ill Patients Elizabeth Berry, MSN, ACNP-BC Heather Zecca, MSN, ACNP-BC The continuous infusion of sedative
Choosing Wisely Canada 5 things NOT to do in the ICU
Choosing Wisely Canada 5 things NOT to do in the ICU Andre Amaral, MD on behalf of the CWC Critical Care Task Force Assistant Professor Interdepartmental Division of Critical Care Medicine University of
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret
Central Maine Healthcare
General Administrative Policy No. HC-PA-2041 (R4) Patient Administrative SUBJECT: Restraint and Seclusion Policy POLICY: The purpose of this policy is to provide guidelines for the use of restraint and
Centralized Intake and Referral Application to Specialty Hospitals
Centralized Intake and Referral Application to Specialty Hospitals CLIENT INFORMATION **** upon completion of referral please fax to 416-506-0439 **** Client Name: Gender: Male Female Other Client Preferred
Organization: Solution Title: Program/Project Description, including Goals: What is this project? Why is this project important?
Organization: Hebrew Home of Greater Washington (The Charles E. Smith Life Communities) The Hebrew Home provides post-acute services and long-term care to a daily average census of 500 residents. The Home
Pay-for-Performance: Approaches of Professional Societies
Pay-for-Performance: Approaches of Professional Societies CCCF 2011 Damon Scales MD PhD University of Toronto Disclosures 1.I currently hold a New Investigator Award from the Canadian Institutes for Health
PATIENT RIGHTS, PRIVACY, AND PROTECTION
REGIONAL POLICY Subject/Title: ADVANCE CARE PLANNING: GOALS OF CARE DESIGNATION (ADULT) Approving Authority: EXECUTIVE MANAGEMENT Classification: Category: CLINICAL PATIENT RIGHTS, PRIVACY, AND PROTECTION
RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Recommendation Comparison Chart
RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care Recommendation Comparison Chart RECOMMENDATIONS FROM SCREENING FOR DELIRIUM, DEMENTIA AND DEPRESSION IN THE OLDER ADULT (2010)
SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1006 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: PEDIATRIC FALL PREVENTION EFFECTIVE DATE: REVISED DATE: POLICY TYPE: Job Title of Reviewer: Director, Women & Children s Department (pediatrics)
Running head: IMPROVING QUALITY OF LIFE 1
Running head: IMPROVING QUALITY OF LIFE 1 Music Therapy: Improving Quality of Life for Dementia Residents in Nursing Homes Keltie P. Keir, B.N., R.N University of New Brunswick IMPROVING QUALITY OF LIFE
Patient-Centered Case Management Assessment & Patient Interview Techniques
Patient-Centered Case Management Assessment & Patient Interview Techniques Rose M. Turner, RN, BSN, ACM Thursday, January 8 th, 2015 The information provided in AHC Media Webinars does not, and is not
Exemplary Professional Practice: Patient Care Delivery Model(s)
Exemplary Professional Practice: Patient Care Delivery Model(s) EP7EO Nurses systematically evaluate professional organizations standards of practice, incorporating them into the organization s professional
Beth Israel Deaconess Medical Center Perioperative Services Manual. Guidelines for Perioperative Handoffs from OR to receiving units.
Beth Israel Deaconess Medical Center Perioperative Services Manual Title: Guidelines for Perioperative Handoffs from OR to receiving units. Policy #: PSM 100-102A Purpose: This guideline provides a standard
Moral Conversations with ICU Patients and Families
Moral Conversations with ICU Patients and Families Barb Supanich,RSM, MD,FAAHPM Medical Director, Palliative Care and Senior Services Holy Cross Hospital March 11, 2010 Learner Objectives Describe three
INTEGRATED CARE PATHWAY FOR THE DYING PATIENT PATIENT S NAME.. UNIT NUMBER. DATE.. DATE OF BIRTH.. DATE OF IN PATIENT ADMISSION DIAGNOSIS: PRIMARY.
PATIENT S NAME.. UNIT NUMBER. DATE.. DATE OF BIRTH.. DATE OF IN PATIENT ADMISSION DIAGNOSIS: PRIMARY. SECONDARY.. A Care Pathway is intended as a guide to treatment and an aid to documenting patient progress.
The impact of nighttime intensivists on medical intensive care unit infection-related indicators
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2016 The impact of nighttime intensivists on medical intensive care unit infection-related indicators Abhaya Trivedi
SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1006 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: PEDIATRIC FALL PREVENTION EFFECTIVE DATE: REVISED DATE: POLICY TYPE: Job Title of Reviewer: Director, Women & Children s Department (pediatrics)
ROTATION DESCRIPTION
ROTATION TITLE Psychiatry Pediatrics (PGY2) ROTATION DESCRIPTION PURPOSE The psychiatry rotation is designed to allow the resident to further refine skills in therapeutics, pharmacokinetics, drug information,
A Review of Current EMTALA and Florida Law
A Review of Current EMTALA and Florida Law South Carolina Hospital Fined $1.28 Million for EMTALA violations Doctor fined $40,000 for not showing up at Emergency Room Chicago Hospital and Docs settle EMTALA
CLINICAL PREDICTORS OF DURATION OF MECHANICAL VENTILATION IN THE ICU. Jessica Spence, BMR(OT), BSc(Med), MD PGY2 Anesthesia
CLINICAL PREDICTORS OF DURATION OF MECHANICAL VENTILATION IN THE ICU Jessica Spence, BMR(OT), BSc(Med), MD PGY2 Anesthesia OBJECTIVES To discuss some of the factors that may predict duration of invasive
DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO. PANEL: Tammy Hedge, RPN Chairperson Ashley Friest, RPN Member Susannah McGeachy, RN Member
DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Tammy Hedge, RPN Chairperson Ashley Friest, RPN Member Susannah McGeachy, RN Member Abdul Patel Public Member Devinder Walia Public Member
Site: Lovelace Health System Title: PATIENT CARE - Restraints Approved Date: 08/28/2015 Effective Date: TBD
Approved Date: 08/28/2015 Effective Date: TBD 08/01/2018 Document Number P-NS-1063.6 Document Type: Policy Page 1 of 11 1. Policy: All patients have the right to be free from physical or mental abuse,
Mentoring Undergraduate Nursing Students for Evidence- Based Practice to Improve Quality and Safety in Long- Term Care Settings
The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based
End of Life Care in the ICU
End of Life Care in the ICU C.M. Stafford, MD, FCCP Medical Director, Intensive Care Unit Chairman, Healthcare Ethics Committee Naval Medical Center San Diego The views expressed in this presentation are
Communication with Surrogate Decision Makers. Shannon S. Carson, MD Associate Professor University of North Carolina
Communication with Surrogate Decision Makers Shannon S. Carson, MD Associate Professor University of North Carolina Role of Communication with Families in the ICU Sharing information about illness and
Challenges and Innovations in Community Health Nursing
Challenges and Innovations in Community Health Nursing Diana Lee Chair Professor of Nursing and Director The Nethersole School of Nursing The Chinese University of Hong Kong An outline The changing context
The Newcastle upon Tyne Hospitals NHS Foundation Trust. Safe and Effective Use of Bedrails
The Newcastle upon Tyne Hospitals NHS Foundation Trust Safe and Effective Use of Bedrails Version No.: 2.0 Effective From: 31 October 2017 Expiry Date: 31 October 2020 Date Ratified: 24 July 2017 Ratified
Emergency Use of Manual Restraints Policy
Emergency Use of Manual Restraints Policy It is the policy of this DHS licensed provider, Companion Linc, to promote the rights of persons served by this program and to protect their health and safety
Bed Rail Entrapment Risk Notification Guide
Bed Rail Entrapment Risk Notification Guide EN NOTICE TO EQUIPMENT PROVIDER: These instructions, in their entirety, must be provided to the patient, the patient s family and/or the patient s primary day-to-day
Trauma: An Interim Analysis of Trial Efficacy in a Pilot Study Investigating the Effects of Music Therapy in Ventilated ICU Patients
Trauma: An Interim Analysis of Trial Efficacy in a Pilot Study Investigating the Effects of Music Therapy in Ventilated ICU Patients Affiliations: ¹Muhlenberg College ²Dickinson College Katherine Kapelshon¹,
Your Results for: "NCLEX Review"
Your Results for: "NCLEX Review" Site Title: Medical-Surgical Nursing Book Title: Medical-Surgical Nursing Location on Site: PART 1: MEDICAL-SURGICAL NURSING PRACTICE > Chapter 5: Nursing Care of Clients
Notes from CMS Final Rule Document Pertinent to Culture Change and Person-directed Care
Notes from CMS Final Rule Document Pertinent to Culture Change and Person-directed Care Page 594 Prepared by Cathy Lieblich, Director of Network Relations, Pioneer Network G. Benefits of Final Rule: This
DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO. PANEL: Denise Dietrich, RPN Chairperson Anne McKenzie, RPN Member Susan Silver, RN
DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Denise Dietrich, RPN Chairperson Anne McKenzie, RPN Member Susan Silver, RN Member Joan King Public Member Faira Bari Public Member BETWEEN:
Solution Title: Multidisciplinary Approach to Reduce Delirium in the ICU
Solution Title: Multidisciplinary Approach to Reduce Delirium in the ICU Program/Project Description, including Goals What was the problem to be solved? How was it identified? Delirium leads to a three-fold
Disclosure Statement. Background. Challenges 23/06/2015. Marihuana for Medical Purposes Standards of Practice
Disclosure Statement Marihuana for Medical Purposes Standards of Practice Dr. Susan Ulan MMP Symposium June 18, 2015 Faculty: Dr. Susan Ulan Relationships with commercial interests: No financial disclosures
A REVIEW OF THE USE OF ANTIPSYCHOTIC DRUGS IN BRITISH COLUMBIA RESIDENTIAL CARE FACILITIES. Ministry of Health
A REVIEW OF THE USE OF ANTIPSYCHOTIC DRUGS IN BRITISH COLUMBIA RESIDENTIAL CARE FACILITIES Ministry of Health December 2011 An adult person in care has the right to the protection and promotion of his
Cochrane Review of Alternative versus Conventional Institutional Settings for Birth. E Hodnett, S Downe, D Walsh, 2012
Cochrane Review of Alternative versus Conventional Institutional Settings for Birth E Hodnett, S Downe, D Walsh, 2012 Why Study Types of Clinical Birth Settings? Concerns about the technological focus
Specialty Behavioral Health and Integrated Services
Introduction Behavioral health services that are provided within primary care clinics are important to meeting our members needs. Health Share of Oregon supports the integration of behavioral health and
MDS 3.0: What Leadership Needs to Know
MDS 3.0: What Leadership Needs to Know especially prepared for CANPFA Ann Spenard RN, MSN History of the MDS and RAI Process The Resident Assessment Instrument (RAI) was part of a set of reforms enacted
Resident/Fellow Training Orientation Policies
Resident/Fellow Training Orientation Policies Restraint or Seclusion: Violent Behavior Prevention and Reporting of Patient Abuse Blood Component Indications & Critical Tests HIPAA Privacy and Security
Disclaimer. Objectives: !"#$"%&' ! The learner will be able to:
Best Practices: How Enclosure Beds Can Be An Effective Intervention In The Clinical Setting. Presented by Sue Pugh, RN, MSN, CRRN, CNRN, CNS-BC, CBIS, FAHA Clinical Nurse Specialist Sinai Hospital of Baltimore
Patient Centered Care Planning and Behaviors. Presented by: Pam Paulsen, RN/BC,RAC-CT Angela Johnson, PharmD, BCGP
Patient Centered Care Planning and Behaviors Presented by: Pam Paulsen, RN/BC,RAC-CT Angela Johnson, PharmD, BCGP Objectives 1 2 3 Identify 3 ways to promote patient centered care throughout communication
Resident Rights in Nursing Facilities
Your Guide to Resident Rights in Nursing Facilities 1-800-499-0229 1 Table of Contents The Ombudsman Advocate...3 You Take Your Rights with You...4 Federal Regulations Protect You...5 Medical Assessment
Withdrawal of active treatment in intensive care: what is stopped comparison between belief and practice
Withdrawal of active treatment in intensive care: what is stopped comparison between belief and practice Alex J Psirides and Shawn Sturland Most deaths in intensive care units in the Western world are
1. Introduction. 1 CMS section
1. Introduction Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management
Tip Sheet Reducing Off Label Use of Antipsychotic Medications by Engaging Staff in Individualizing Care to Alleviate Resident Distress
Tip Sheet Reducing Off Label Use of Antipsychotic Medications by Engaging Staff in Individualizing Care to Alleviate Resident Distress WHAT IT IS Off label use of antipsychotic medications means uses the
NEW STANDARD OF PRACTICE PRESCRIBING
NEW STANDARD OF PRACTICE PRESCRIBING Notice to College Members June 21, 2018 Following consultation with College Members, on June 16, 2018 Council of the College approved a new Standard of Practice on
Conflict of Interest Disclosure 9/25/ An Interprofessional Approach to Manage Pain and Anxiety in Pediatric Burn Patients. Conflict of Interest
An Interprofessional Approach to Manage Pain and Anxiety in Pediatric Burn Patients Paul Plowman, RN-BC, and Caitlin Dougherty, CCLS 9/25/2013 1 Conflict of Interest 9/25/2013 2 Conflict of Interest Disclosure
Procedure. Applies To: UNM Hospitals Responsible Department: Quality Revised: 03/2014
Procedure Patient Age Group: ( ) N/A ( ) All Ages ( ) Newborns (X) Pediatric (x ) Adult DESCRIPTION/OVERVIEW UNM Hospitals (UNMH) is recognized as a large academic health care system providing services
FALLS RISK REDUCTION & MANAGEMENT OF INPATIENT FALLS - STANDARDS
STANDARDS TO BE MET 1. Safe Mobilisation and Falls Prevention Assessment 1.1 The multidisciplinary team will: a) Conduct the Safe Mobilisation and Fall Prevention Assessment; b) Initiate appropriate interventions
Preparing for Thoracic Surgery and Recovery
Division of Thoracic Surgery Preparing for Thoracic Surgery and Recovery A Guide for Patients and Families Brigham And Women s/faulkner Hospitals Important Phone Numbers Important Phone Numbers BWH NUMBERS
Mobilisation of Vulnerable Elders in Ontario: MOVE ON. Sharon E. Straus MD MSc FRCPC Tier 1 Canada Research Chair
Mobilisation of Vulnerable Elders in Ontario: MOVE ON Sharon E. Straus MD MSc FRCPC Tier 1 Canada Research Chair Competing interests I have no relevant financial COI to declare I have intellectual/academic