Implementation of the Family HELP Protocol: A Feasibility Project for a West Texas ICU.

Rebecca Mcclay

doi:10.3390/healthcare9020146

Abstract

The purpose of this project was to determine if bedside intensive care unit (ICU) nurse buy-in to the Family Hospital Elder Life Program (HELP) protocol was sufficient to make implementation feasible at one county hospital in West Texas. Surveys were anonymous with ballot box collection being available to the bedside ICU nurses for one week each. Questions were based on literature findings of expected outcomes, identified barriers and facilitators, Calgary Family Intervention Method framework domains, and the Centers for Disease Control and Prevention Framework for program evaluation. Outcome measures were taken from the stated aims of the project and evaluated from paired baseline and summative survey questions. Survey participation was approximately half of nurses employed in the studied ICU. Analysis of the surveys showed a positive perception of family presence decreasing patient delirium symptoms, and a positive perception of the Family HELP protocol. The results described a high perception of family members as partners in care and high intention to implement the Family HELP protocol, indicating strong support of a full implementation of the protocol. The high level of bedside nurse buy-in present in this study has large implications for successful implementation of the Family HELP protocol in the near future, with sustainability and continued use supported by potential inclusion of the task in the electronic health record charting.

Highlights

Decreasing delirium occurrence and severity in the intensive care unit (ICU) is a significant concern and high priority for the Society of Critical Care Medicine (SCCM), an international interdisciplinary group that sets ICU clinical practice guidelines, and the American Geriatrics Society (AGS) [1,2]
Half of nurses employed in the studied ICU participated in the surveys, and analysis of responses demonstrated a positive perception of family presence at the bedside and the Family Hospital Elder Life Program (HELP) protocol use
Caring for patients with delirium (Figure 2)—Two questions from baseline survey, “Do you feel that patients experiencing ICU delirium take more of your time to care for and keep safe?”89% (4.45 out of 5) and “Does caring for a patient with delirium make your job as a nurse harder than caring for a patient that is not experiencing delirium?” 85% (4.27 out of 5), and summative survey question, “Do you feel directed family interventions, such as those outlined on Family HELP posters, would lessen your workload for patients

Summary

Introduction

Decreasing delirium occurrence and severity in the intensive care unit (ICU) is a significant concern and high priority for the Society of Critical Care Medicine (SCCM), an international interdisciplinary group that sets ICU clinical practice guidelines, and the American Geriatrics Society (AGS) [1,2]. The Hospital Elder Life Program (HELP) is a set of comprehensive patient centered guidelines providing optimal care for hospitalized older persons that has recently been folded into the AGS CoCare portfolio [2]. HELP is one such protocol, which has demonstrated reduced delirium in older adults through inclusion of family members into the healthcare team [4]. The AGS and the SCCM promote including family engagement as a means of reducing. ICU delirium, but there is little published about bedside nurse acceptance of implementing protocols that support bedside family education

Results

Discussion

Conclusion