Adult Surviving Sepis Campaign Guidelines (Hour-1 Bundle)
Children's Surviving Sepsis Campaign Guidelines
Adult ICU Liberation Guidelines and Bundle (A-F)
Management of Adults with COVID-19
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Implement the A-F elements of the ICU Liberation Bundle to improve outcomes while transforming culture.
The A Element of the ICU Liberation Bundle (A-F) refers to assessing, preventing and managing pain.
Pain is an unpleasant sensory and emotional experience. It is best reported by the person who is experiencing it, although self-reporting can be a challenge in the ICU. However, the inability to communicate verbally does not negate the possibility that a patient is experiencing pain.
Nonpharmacologic strategies play an important role in managing pain and agitation. IV opioids should be considered first-line analgesics for the treatment of non-neuropathic pain. Nonopioid analgesics should be considered to decrease the amount of opioids administered and thereby to decrease opioid-induced adverse effects.
Optimize opioid regimens by assessing the following considerations:
When treating agitation, it is important to titrate sedative medications to maintain lighter levels of sedation; deep sedation or coma should be avoided.
The PAD Guidelines suggest that, in adult ICU patients with delirium unrelated to alcohol or benzodiazepine withdrawal, continuous IV infusions of dexmedetomidine (rather than benzodiazepine infusions) be administered for sedation to reduce the duration of delirium. Also, atypical antipsychotics may reduce the duration of delirium in adult ICU patients. Treatment with rivastigmine or haloperidol does not reduce the duration of delirium.
Tools for Delirium Assessment
The Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most valid and reliable delirium monitoring tools for adult ICU patients.
The key question to ask during rounds is: Did the patient achieve maximum mobility or exercise today? If early mobilization is falling short, it is important to determine the reasons. Some factors to consider are:
Also take into account the following aspects before mobilizing a patient in the ICU:
Within the ICU Liberation Bundle (A-F), the F element refers to Family Engagement and Empowerment. The F Element focuses on examining the concept of family presence in the ICU and identifying strategies to create family engagement and empowerment.
Patient-centered care is defined as providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. Empowering family members with shared decision-making, safety and future care expectations engages them in the patient’s care.
Family and patient-centered care focuses on the following characteristics:
Social isolation separates patients from their families. Flexible visitation, including an open ICU, daily meetings with the family, and redesign efforts that target family comfort can all positively impact family presence.
Patient benefits of family presence and flexible visitation (Bell L. American Association of Critical-Care Nurses Practice Alert) include:
The Minimum Data Set Toolkit is provided for multiprofessional critical care teams to measure their practice for performance improvement. The toolkit includes data and compliance definitions, a spreadsheet for data collection, and input and compliance reports. It explains how to understand and use the data for continuous process improvement. The ICU Liberation Implementation Framework Binder Booklet, which provides guidance on implementing the A-F elements of the ICU Liberation Bundle, is now included with the toolkit. SCCM also provides additional ICU Liberation resources to get familiar with the PADIS Guidelines and the ICU Liberation Bundle, including links to the guidelines, success stories, and teaching slides.
The SCCM Licensing Team can provide details about bringing training to your institution.