I. Call to Order Meeting was called to order at 1:30 p.m. Attendance: Feather Bacher, Cindy Tomazich, Brian Lohr, Dr. Tom Rice, Ryan Rich, Linda Bryner, Lisa Manni, Nancy Patterson, Melanie Westfall, Jill Kelley, Angela Rudisill, Kate Schramm Excused: Constance Pearson, Jennifer Linn, Kristen Trzeciakowski & Mike Welsh II. Mobility Implementation Go-live was June 2, 2014 Multidisciplinary mobility rounds being completed M-F @ 0800 through all ICU pods Rapid Rounding Form/Levels of Mobility MOTOmed Portable O2 holders Rapid Rounding Form has already been revised to better meet the needs of the unit. New form was shared with the group MOTOmed has been used on several patients. Still new to group and thus time consuming, however 2 patients have really liked the device. Possible additional use for re-directing patients in ETOH withdrawal as diversion. Linda Bryner shared with the group that she has the ordering information and shared the information with Feather. As determined by group, 2-3 holders per unit would serve the project well. In addition, portable O2 holders are already attached to portable ventilators and the heated high flow O2 devices. III. Education RN education has been completed by critical care nurse educator and clinicians. Included information specific to early mobility in the ICU and ICU delirium reduction. PT/OT education has centered on Ryan and Kate, who are assigned to the unit. Additional information will need to be shared for those that are covering for them on scheduled days off. In addition, request has been made for 1 additional PT and 1 additional OT to attend mobility conference at Johns Hopkins University Hospital Education will be on-going, especially as various barriers are identified and worked through
IV. Barriers Shift-to-shift communication of current mobility level and mobility plan Concerns over weekend coverage to maintain mobility levels of patients Possible inclusion of the night shift in participating with ICU mobility Re-enforcement with staff in regards to importance of passing this information between shifts. Also questioning staff in daily mobility rounds about mobility plan from prior shift. Per Cindy Tomazich, no current budget for adding PT/OTs on the weekends. Lisa Manni reinforced the importance of tracking data r/t LOS, vent days, etc to support the possible hiring of additional PT/OTs in the future Feather communicated dry erase board that is currently utilized by MICU at PUH to communicate mobility levels over the weekend. Revisions to current boards proposed and will be implemented in each ICU pod. This will be the eventual plan and has been discussed amongst unit leadership. Would like to fully ingratiate mobility on the daylight shift before moving to incorporate the night shift. Eventual implementation will include the night shift beginning to mobilize patients OOB around 0600 with daylight remobilizing patients between noon and 1700. Concern over noise at night and the impact on ICU delirium Noise at night is continued focus in ICU Peer-to-peer accountability is encouraged Continued coverage of subject in staff meetings and safety huddles Possible implementation of formal Quiet Time at night V. Order Sets MICU Mobility Order Set Feather currently meeting with DCOI to determine System Mobility group progress. New mobility order set and documentation coming soon but as yet undetermined whether revisions being
Sedation Algorithm made to ICU mobility order set. More to come. DCOI has PDF file to determine if original order set can be modified specifically for Passavant to include Brian Lohr s sedation algorithm. Fentanyl drip order sets Per Brian s report, the order set is up for approval during the week of 6/23. More to come VI. ICDSC Respiratory Pathways Education for use of the Intensive Care Delirium Care screening checklist (ICDSC) Concern raised from Dr. Rice that some staff are substituting the GCS for the ICDSC Per Linda Bryner, the existing respiratory pathways are being reviewed to ensure they are rooted in current literature. Updates being made. Once these updates are completed, the pathways are slated for Critical Care Committee approval in July, MEC in August. ICU clinicians and nurse educator have continued to teach the ICDSC on a daily basis either during or after mobility rounds. As this is new for ICU staff, they are reinforcing this process for compliance. As above, re-education and reinforcement is being completed daily VII. Data Collection Discussion over which data points will be most beneficial in determining success of ICU Mobility project At this time, it is thought that data specific to ICU LOS, hospital LOS, ventilator days, re-admission rates and disposition upon d/c from hospital could be most beneficial Feather has contacted ICU director at UPMC Magee to determine their recent data points and method of data extraction. They recently had poster at Nursing Now conference and data could be similar. Cindy to contact Craig Moreland, Director
of CRS at PUH b/c he is presenting at national conference on ICU Mobility. Will inquire about data specific to PT/OT VIII. Road Trip to PUH Revelations When unit is full, not possible to have new PT/OT consults on each patient and have them be seen Need to triage patients to determine best outcomes (attention paid to exclusion criteria). Ex. CMO would not be seen. Ex. Fresh pulmonary emboli will be deferred until therapeutic PTT established. MOTOmed not being used as much in PUH MICU. As staff have gotten comfortable with mobilizing patients, actual OOB plans being established more frequently New patients OK to establish formal plan of care and have formal PT/OT evaluations before determining mobility plan. Weekly afternoon rounds with rehab MD and pulmonary MD were very beneficial in promoting mobility and ensuring that therapies being utilized are appropriate to prepare patient for care outside of ICU/hospital IX. Open Comments Dr. Rice volunteered to participate in weekly rounds. Will make himself available to PT/OT/nursing to participate. Will also solicit participation of Passavant PM & R MD. Possible lunch rounds being debated. Dr. Rice will also ensure that one of his partners will participate in his scheduled absences from unit. X. Next Meeting Minutes Passed By, Plan for 1 month, conferred with Dr. Rice on timing meetings around his office schedule Cindy to pick out mutually agreeable date for the group Feather Bacher MSN RN CNRN Unit Director, Medical/Surgical ICU UPMC Passavant
LEVELl Pa!B~ ~af M;itlan PesltlilllllrC Daas;nat,._,,,... ACTIO Nyb l[' I' 4 Sa'el!lllllfWI! at llmlon Timi.. pllllantq:l haum lnltlltap TFslrMIU.al llmlon I :MJt:IPllOil._.nMtJtG:ne.4 tlawar EldRlmltlM "'2D at lq RPM1 1tr...,,._. EldRlmltlM... 111:10 RPM1 1tr D... sll*twdmlr w llt Ullllaht d~ I I ChlldcorttosllllJc'IS lfpmlltvanbin pllllllfltkl Iba& l :At pasttfdn-.dnotlff MDfur. Fell af>mmmmi In Sii' ar <*-lt.llndbpllltm'3... NO CU MOBILITY PROlOCOL LEVEL3 LEVEL2 lctlr ~af... NiMlb Follaw.s-.,6! mmlhll'itj... ACTION... IOI? Alllltpt... D/'-t 2 s 10 min sessions af Lf on MOM 1:3Slitsti10 n~ 115 td&11l&l by pt 'D,/w, Prvi»... Lnll 3 D........... te Ill ED8? YB... llll tl p:a1dw11... AllDMWMllelUNplM l&l a.aad.,.., Dependent.aw i;h11lr c:a-lc t*'v ~ und11r ~111 1 llilstrudlons ca.le orthamtk vs I If pmidw mwtu pmtient tit rsumbent PilSltbil..t notify,., Canlull "1flr Cllllult Im~ ---... LWll.,,.,.~.. &lpaf Bad m Outs aid Follows slm,.11 rep.. ~s ACTION 11111... Mt I mt...... wttyf 'VIS... ptllt... D/..,... Zllallr... "'...... Wwkwllh "' '.......,.. w... LWll4... 0,,...._..a OISlmobtlltyprotoml... ~I lnllrudtms 01i14 Of'lhacbltkVS lfpacltmi ralurapltlllll:id reaimbentpdlk+l1nd llloufymd LEVEL4 J\c& Aidlon FollCMMS slm,.11.,,...,... ACTION......,,........... 1 'VIS Wwkwllh n... ta a pl Aaa11ptllt..._... D/..,,.._.,.... hl > w... TPll... wtth......... Mal.,... _. tl... w t rat.i
Example of MS ICU Mobility Project Whiteboard (Note ML score refers to mobility level from AM-PAC assessment) Shared at staff meeting June 2014