Message from the President
Celebrating the Team
Judith Jacobi, PharmD, BCPS, FCCM
Critical Care Pharmacist, Dept. of Pharmacy
Methodist Hospital/Clarian Health Partners
Indianapolis, Indiana, USA
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We recently had the opportunity to learn, interact and have fun with a variety of Society of Critical Care Medicine (SCCM) members and guests at the 39th Critical Care Congress in Miami Beach, Florida, USA. This highly successful educational opportunity was the result of an incredible team of volunteers and SCCM staff who initiated plans for this year’s meeting two years ago and saw it through to completion. During Congress, I was inducted as your president and am truly humbled by this recognition. I am the first pharmacist to serve in this role and only the second non-physician. It is clear to me that I represent all of the critical care pharmacists who have contributed their knowledge, enthusiasm and heart to optimize the care of intensive care patients. Those who have not worked extensively with clinical pharmacists might find that we can be opinionated; we are not shy, and it takes convincing new evidence to change our minds. It is no wonder we fit in with critical care professionals so well!
Clinical pharmacists have completed extensive training in pharmacotherapy, pathophysiology and pharmacokinetics. Many current practitioners completed at least two years of postgraduate residency training. However, as members of the critical care team, we are prepared to learn something new every day – again, something that is no different from the other members of the critical care team. So today, I am celebrating the dedication, passion and flexibility of all the team members.
Miami was the site of both Congress and Super Bowl XLIV, a coincidence that aptly illustrates that teams with consistent performance throughout the season are in the best position to reach their lofty goals. When a player is injured, others must step in to contribute and achieve success. Teams that do not exercise effective trust and communication do not realize the highest level of success. Our Super Bowl happens every day; the successes we achieve in patient care are important rewards, but measuring them often can be difficult. Measurable goals are essential to assessing and improving our performance.
Can you elucidate the goals of your team? Have you assessed the team’s functionality? What is the trust level on your team? Stephen M.R. Covey, author of The Speed of Trust, stated that trust is the one thing that changes everything (2006, Free Press, New York). When we demonstrate consistent delivery of the care we have promised, we create trust and set the foundation for a high-functioning team. Our success will depend on collaboration and execution supported by open communication. The perception of how well we perform may vary, as marked differences have been observed among professional groups. We have the opportunity to measure the quality of collaboration and communication, and SCCM has the tools to help – such as the ICU REPORT (ICU Resource, Evaluation, and Patient Outcomes Reporting Tool). Knowing if there are different perspectives about team performance and communication is the first step to improvement.
Does your team have all the necessary players? We do not have a football draft, but the team members that you need to attain a high level of success may be waiting on the sidelines for your invitation. Contact the director of pharmacy to see if a pharmacist is available to join rounds for at least a few hours daily; this can lower the rate of medication errors and save money. But don’t stop there. Ask physical therapists to develop a mobility program for those patients receiving longterm mechanical ventilation. Or, include hospice or palliative care practitioners in rounds to help with end-of-life discussions. The opportunities are legion. Unfortunately, the resources are limited. You may have to start with a very focused program and build upon that success. Remember, practitioners who are new to critical care may need some coaching, and SCCM can provide assistance with the Paragon Critical Care Quality Implementation Program™, which provides multiprofessional expertise to help develop individuals and teams so that all understand their roles and team objectives.
Patient-focused goals are preeminent. Do all team members understand the goals for each patient every day? Daily goal sheets and multiprofessional rounds have been used with success in hospitals of all sizes, whether or not they are teaching institutions. The key is to develop a plan and implement consistent communication of those goals for every patient, every day. When the communication process becomes consistent, variability in other processes can be minimized. Consistent utilization of a daily goals sheet has resulted in improved understanding of the aims of care and has favorably impacted length of stay in multiple reports.
Care bundles have been applied to improve the performance and consistency of various processes. Data from the Surviving Sepsis Campaign (SSC), published in the February issues of Critical Care Medicine and Intensive Care Medicine, strengthen our understanding of the impact of bundles. Data were collected by practitioners in 166 hospitals just like yours – hospitals that weren’t perfect. The primary goal was to improve utilization of the sepsis bundles. This was achieved through a three-fold increase in utilization of the six-hour resuscitation bundle, sustained over a median of 14 months, as well as improvements in the 24-hour management bundle. This was associated with a significant and sustained reduction in hospital mortality; the likelihood of death decreased the longer a site participated in the SSC. Keys to the apparent success involved the development of a sepsis team, utilization of educational materials provided by the SSC, attendance at meetings, availability of a uniform database and ongoing team support through a listserv and the encouragement of members of the SSC network. Although these tools were focused around sepsis (many still are available through the SSC), similar resources focused on a variety of issues are available through SCCM. If these hospitals can do it, so can you and your team.
Improvement opportunities abound in the care of complex intensive care unit (ICU) patients; consideration of the long list of possibilities is overwhelming. My advice is to identify an opportunity or need, and tackle one project as a performance improvement initiative. Find a champion among your team members and gather the necessary resources. When the team at my institution, Methodist Hospital, established a goal for improved glycemic management, I led the initiative but used the skills of other colleagues and the resources of endocrinology and quality services departments. Together, we developed a system for safe and effective glycemic management. Similarly, other members of our critical care team have championed initiatives for the prevention of pneumonia or catheter-related bloodstream infections. However, sometimes everyone just has to work together. For example, there was a time that accomplishing routine hand hygiene seemed impossible, but with the persistence and participation of many different practitioners, it has become a reality in my ICU. If someone forgets, he or she is reminded quickly. These programs have contributed to a dramatic reduction in our rate of nosocomial infection, and this success is shared among all members of the team. We regularly put a spotlight on team accomplishments to maintain interest and enthusiasm, recognizing that it is difficult to sustain a project.
Obviously, the ultimate goal of a well-functioning team is optimal patient outcome, but there are other benefits along the way. When our teams prosper, individual members also prosper. The leadership style within the team can influence staff satisfaction. A leader practicing open communication and trust, who seeks and values the contributions of each team member, potentially can reduce employee dissatisfaction and turnover. We all may have the opportunity to provide leadership within our team. We have a responsibility to develop and demonstrate our integrity, show our intent to work with the team, and maximize and share our capabilities. These actions will help create the desired results.
As you embark on a similar journey, remember that SCCM has educational tools and resources available at www.LearnICU.org. In Critical Care Forums, accessed through MySCCM.org, you can find and share protocols, seek the opinions or assistance of other practitioners, and offer your ideas.
As I begin this exciting and challenging year, I will ask the assistance of my SCCM teammates. I will call upon the very dedicated members of the Executive Committee and Council and the outstanding professional staff to meet your needs. We will strive to improve our communication so that you understand our goals and your opportunities. We have made great strides to strengthen the fiscal position of SCCM; this has served us well during the challenging economy, and we will exercise a conservative approach in the near future. At the same time, we are regularly expanding the scope and depth of programs, striving to meet the varied educational needs of our members through the use of innovative technology, Webcasts and podcasts. Our goal is your success and the best outcomes for your patients. Share your success stories in Critical Care Forums, so we can join in and celebrate your team.
