Practice In Intensive Care Unit Research Articles

Physical restraints practice in adult intensive care units: a review

OBJECTIVE: To describe the available evidence on indications, complications, care and alternative strategies in the use of physical restraint in adult patients in Intensive Care Units. MATERIALS AND METHODS: An integrative review conducted in the Cochrane, PubMed, Scopus, LILACS, Nursing Database and the eLibrary portal. The search was performed on the queries: “physical restriction”, “fixation devices in intensive care”, “patient safety”, “fixation of the patient”. RESULTS: The final selection was of 93 articles, from which the indications, complications, care and alternative strategies were extracted. CONCLUSIONS: The most common practices regarding physical restraints in Russia and foreign countries were described, and the need for the elaboration and implementation of protocols on intervention to support decision — making was observed.

Neonatal pain management practice in the neonatal intensive care unit of public hospitals: a survey of healthcare providers in eastern Ethiopia.

Newborns experience multiple painful and stressful procedures during their hospitalization in neonatal intensive care units (NICUs). Repeated or untreated pain can have negative consequences for the health and development of newborns. Despite the growing knowledge of pain assessment and intervention, several studies have shown that the practice of neonatal pain management among healthcare providers is poor. Therefore, data regarding neonatal pain management practice and affecting factors are essential for taking appropriate actions. This study assessed neonatal pain management practice and associated factors among healthcare providers working in the NICUs of public hospitals in eastern Ethiopia from 1 January to 28 February 2022. An institution-based cross-sectional study design was used among 372 randomly selected healthcare providers working in the NICUs of public hospitals in eastern Ethiopia. Data were collected using a pre-tested structured self-administered questionnaire and an observation checklist. The collected data were reviewed, coded and entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. Bivariate and multivariable logistic regression were used to identify the associations between outcome and predictor variables at a 95% confidence level and P-values <0.05 were considered statistically significant. The study found that 185 (53.9%; 95% confidence interval [CI] 48.4 to 59.2) of the 343 respondents had good neonatal pain management practice with a mean of 11.38 (standard deviation 3.64). Receipt of in-service training in neonatal pain management (adjusted odds ratio [AOR] 2.12 [95% CI 1.15 to 3.91]), availability of protocols and guidelines in the NICUs (AOR 2.94 [95% CI 1.74 to 4.91]) and accessibility of analgesics in the NICUs (AOR 4.302 [95% CI 2.46 to 7.53]) were significantly associated with good neonatal pain management practice. The overall practice of healthcare providers in neonatal pain management in public hospitals in eastern Ethiopia is relatively high compared with previous studies conducted in Ethiopia. Improving the availability of analgesics as well as neonatal pain management protocols and guidelines in NICUs will aid in the promotion of good neonatal pain management practices. In addition, providing ongoing in-service training on neonatal pain management will allow healthcare providers to better care for newborns in pain.

Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study

Background/AimNutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. MethodsThis multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. ResultsA total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24hours of admission. On the study day, the median energy intake of the patients during the last 24hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU. ConclusionNutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.

Evaluation of a blended training solution for critical care nurses’ work environment: Lessons learned from focus groups in four European countries

AimThe aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs). BackgroundDespite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country. DesignAfter the pilot testing, a qualitative approach, with focus group discussions was used. MethodsAll the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out. FindingsThree themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues. ConclusionThe proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years

PurposeReligious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions.MethodsTwenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999–2000) and Ethicus-2 studies (years 2015–2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions.ResultsIn total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased.ConclusionsChanges in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.

Accuracy of intra-arterial line transducer levelling practice in a general intensive care unit

BackgroundThe intra-arterial line is a common device intervention used in the intensive care environment to provide continuous blood pressure measurement. The transducer line is levelled to the patient's phlebostatic axis to provide accurate measurements. AimThe aim of this study was to investigate registered nurses' accuracy at levelling the transducer to the correct anatomical position using visual judgement, compared to one done using a laser level. MethodsPatient transducers were levelled by visual judgement and then by using a laser level. Time and mean arterial pressure (MAP) were recorded with each measurement along with any difference in transducer level between the two methods and subsequent changes in inotrope administration. ResultsA total of 577 MAP measurements were recorded from 178 patients; 70% of observations had a difference in transducer level, 30% of the time the inotrope rate was increased and 18% of the time the inotrope rate was reduced. The prevalence of clinically significant observations with an absolute difference of 50 mm or more in transducer placement was 25%. The mean difference in MAP measurements when a cut-off of 64 mmHg or more for laser was applied to the data was 0.22 (95% confidence interval: −0.14, 0.58, n = 513, p = 0.23), and for a cut-off of less than 64 for laser, a larger mean difference of 4.36 (95% confidence interval: 3.75, 5.28], n = 64, p < 0.001) was observed. ConclusionsTransducers were unable to be accurately levelled for haemodynamic monitoring using visual means alone. Over the range of patient MAP values examined, 25% of all observations had a clinically significant absolute difference of 50 mm or more in the transducer level position between the two methods. The visual method became increasingly inaccurate and unreliable at low MAP levels requiring medical intervention.

Introducing the BlendedICU dataset, the first harmonized, international intensive care dataset

Objective:This study introduces the BlendedICU dataset, a massive dataset of international intensive care data. This dataset aims to facilitate generalizability studies of machine learning models, as well as statistical studies of clinical practices in the intensive care units. Methods:Four publicly available and patient-level intensive care databases were used as source databases. A unique and customizable preprocessing pipeline extracted clinically relevant patient-related variables from each source database. The variables were then harmonized and standardized to the Observational Medical Outcomes Partnership (OMOP) Common Data Format. Finally, a brief comparison was carried out to explore differences in the source databases. Results:The BlendedICU dataset features 41 timeseries variables as well as the exposure times to 113 active ingredients extracted from the AmsterdamUMCdb, eICU, HiRID, and MIMIC-IV databases. This resulted in a database of more than 309000 intensive care admissions, spanning over 13 years and three countries. We found that data collection, drug exposure, and patient outcomes varied strongly between source databases. Conclusion:The variability in data collection, drug exposure, and patient outcomes between the source databases indicated some dissimilarity in patient phenotypes and clinical practices between different intensive care units. This demonstrated the need for generalizability studies of machine learning models. This study provides the clinical data research community with essential data to build efficient and generalizable machine learning models, as well as to explore clinical practices in intensive care units around the world.

Use of Personal Protective Equipment and Hand Hygiene Practices of a State Hospital Workers in the COVID-19 Pandemic: Observational Study

Objective: This study aimed to observe the use of personal protective equipment and hand hygiene practices of healthcare personnel working in pandemic clinics.&#x0D; Methods: It is a descriptive and observational study. The research was conducted in the clinics of a pandemic hospital between 01.10.2020 and 31.12.2020. Personal Protective Equipment Usage and Hand Hygiene Compliance Data Collection Form was used. Data were collected by researchers who were infection control nurses, and 171 healthcare workers were observed. Percentage calculation and chi-square test were used in the analysis of the data.&#x0D; Results: In the patient care area, it was determined that personal protective equipment, excluding glasses/face protectors, was fully worn. 6.4% of employees did not remove goggles/face protectors, and 5.3% did not remove surgical masks/N95 masks when leaving the patient area. Practices in the pandemic intensive care unit (wearing the equipment correctly: 88.5%, correct removal: 85.2%) were more in line with guidelines than clinics (correct wearing: 64.5%, correct removal: 65.1%) (p=.001, p=.005). Compliance with hand hygiene is 69% before contact with the patient; 52.6% before aseptic procedure; 61.4% after contact with body fluid; 77.7% after contact with the patient; 73.1% after contact with the environment. Hand hygiene compliance was found to be moderate in pandemic units.&#x0D; Conclusions: In our study, it was determined that personal protective equipment was available in the clinics, the use of goggles/face protection was inadequate, all personal protective equipment was not removed when leaving the patient area, and personal protective equipment was used more appropriately in intensive care units and hand hygiene practices were generally moderate level. In the pandemic process, institutions should conduct more frequent training and make more observations on the use of personal protective equipment and hand hygiene.

Evaluation of intermittent antimicrobial infusion documentation practices in intensive care units: A cross-sectional study

ObjectiveTo observe nurse administration of carbapenem antibiotics, in the context of medication safety measures, in intensive care units. Research Methodology/DesignA quantitative study was conducted using observation principles. SettingThree adult private and public Intensive Care Units in the health district of a capital city in KwaZulu-Natal, South Africa. Main Outcome MeasuresNurse practices were observed for double-checking of the medication order, medication vial, and method of preparation and administration. Infusion bags were inspected for nurse labelling of medication and patient details. Patient medication treatment charts were inspected for nurse signature. ResultsCarbapenem infusion administrations (n = 223) to twenty patients were observed. Adherence to the scheduled time occurred in 34.9% administrations, 5.4% doses were not given, and an incorrect dose given on 1.4% administrations. One hundred and forty-four (64.6%) infusion bags were inspected during the administrations: there was no medication label affixed to 21.5% bags, and only 8.3% of bags were labelled with essential details; the patient’s name, drug, dose, date, time, signature of the nurse mixing and administering the dose, and signature of the secondary nurse. ConclusionThere was a lack of compliance with accepted medication risk mitigation measures. Sub-optimal double-checking resulted in the incorrect dose given, missed dose, and non-adherence to scheduled administration time. This has implications for the optimal administration of antimicrobial medications, raising concerns about the efficacy of treatment for critically ill patients. Implications for Clinical PracticeParenteral administration errors pose a challenge in acute care areas. Risk mitigation measures include double-checking of medications. If antimicrobial treatment is not administered at the prescribed dosing intervals, this may have implications for the efficacy of time-dependent broad-spectrum antibiotics such as carbapenems. Medication administration errors involving antimicrobial medications should therefore be considered as high-risk errors, with the potential to contribute towards antimicrobial resistance.

International Survey of Cardiopulmonary Physical Therapy Management of Adult Intensive Care Unit Patients and the Impact of COVID-19

Objectives: The aim of this study was to report on the cardiorespiratory assessments, interventions, and outcome measures used by physical therapists with critically ill patients and the impact of COVID-19. Design: An anonymous international online survey of practice (through Google Forms) of physical therapists was conducted. Setting: The study was conducted in adult intensive care units. Participants: A total of 309 physical therapists participated in the study. Interventions: A survey was used to determine current cardiopulmonary physical therapy practices in ICU. Results: Predominantly participants were female (74%), aged 31 to 40 years (40%), having worked in intensive care unit (ICU) for either 0 to 5 years (38%) or 11 to 20 years (28%), and worked full time (72%). Most participants worked in the United Kingdom (36%), Europe (21%), or Australia/Oceania (18%). The 3 most frequently reported assessment indicators for cardiopulmonary physical therapy interventions were lobar collapse/atelectasis, audible secretions, and decreased/added lung auscultation sounds. The 3 most commonly used outcome measures included lung auscultation, arterial blood gas analysis, and transcutaneous arterial saturation. The 3 most commonly used physical therapy interventions (“very often” in a descending order) included patient mobilization, repositioning to optimize gas exchange, and endotracheal suctioning. For the COVID-19 cohort, participants reported similar use of patient repositioning to optimize gas exchange and postural drainage, and lower use of patient mobilization and endotracheal suctioning, deep breathing exercises, active cycle of breathing technique, and oropharyngeal suctioning. Conclusion: This survey reports on the characteristics of physical therapists who work in ICU, and their cardiopulmonary physical therapy assessments, interventions, and outcome measures most commonly used, inclusive of patients with COVID-19. There were some differences in interventions provided to the COVID-19 cohort compared with the non–COVID-19 cohort.

In-service education in trauma care for intensive care unit nurses: An exploratory multiple case study

AimThis study explores the perceptions of intensive care units (ICUs) nurses with different educational backgrounds regarding their abilities in trauma care and the in-service education they receive to support it. BackgroundThe advanced care of patients with traumatic injuries in ICU environments requires skilled and knowledgeable nurses, who need continuing and in-service education to provide the best care. Therefore, it is essential to understand the competencies and educational support these nurses may need in the ICUs to ensure safe and effective care delivery. DesignAn exploratory multiple case study design was used, comprising three hospitals located in two different regions of Saudi Arabia. MethodsThe study was conducted between October 2021 and March 2022. A total of forty ICU clinical staff, twelve managers, nine leaders and seven clinical educators participated in semi-structured interviews, which were complemented by a review of available documents on the trauma care in-service education syllabi, competencies and protocols. Interview data were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis. FindingsThe data analysis revealed two interrelated categories relevant to trauma care: (i) care practice and (ii) education practice. The trauma care practice category highlighted the limited competencies and education in trauma care, as well as the perceived challenges and educational needs of nurses. The education practice category described the staff learning behaviours, supervision practices and in-service education systems in the participants’ settings. ConclusionsThe study concludes that there is a lack of trauma care education at the examined sites. It suggests the need for further research to develop a theoretical foundation for trauma care education that can meet ICU nurses’ educational needs while this being feasible to implement in the specific ICU context and practice.

Knowledge, attitude and practice regarding hypoactive delirium among ICU nurses: A nationwide cross-sectional study

Aims and objectivesThis study aimed to assess the knowledge, attitude and practice (KAP) of intensive care unit (ICU) nurses in patients with hypoactive delirium in China. BackgroundThe presentation of hypoactive delirium is not obvious and tends to be ignored. However, it has a high incidence and can cause critical impairment. Although nurses are the primary caregivers of patients, the evidence of the current status of KAP of hypoactive delirium among ICU nurses is insufficient in China. DesignThe study participants were 2835 ICU nurses from 201 hospitals in 69 cities from 31 provinces in China. MethodsThe current status of KAP of hypoactive delirium among ICU nurses was determined using a self-reported structured questionnaire, including 52 questions covering general personal information; three dimensions of KAP; and relevant issues. Descriptive analyses of the sample distribution were reported as percentages and medians. The factors were detected using univariate and multivariate analyses. To guide the reporting of the research, a STROBE checklist of cross-sectional studies was used. ResultsOf the 3101 returned questionnaires, 2835 were analyzed. Approximately 64. 94 % and 53. 30 % of them were identified with a positive attitude and appropriate practice, respectively, whereas only 1. 48 % showed a good level of knowledge. The regression analysis showed that age, years of working in the ICU, educational background, professional title, caring for patients with delirium, attending training on hypoactive delirium and hospital grading were significantly associated with their KAP status(P＜005). ConclusionsHypoactive delirium is an ignored entity by nursing professionals, with no definite nursing procedure. This study shows that receiving relevant training is a factor affecting KAP status, indicating that training should be strengthened. Additionally, appropriate screening and nursing procedures should be developed to standardize the behavior of ICU nurses and improve the quality of care. Relevance to clinical practiceICU nurses have poor knowledge of hypoactive delirium and related training should be strengthened, especially for middle-aged nurses. Screening and nursing procedures should be set up, which is critical to promote nursing practice. No patient or public contributionNone.

Intensive care as a specialty of choice for registered nurses: A descriptive phenomenological study.

Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care. To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit. This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two). Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment. This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit. The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.

Family Engagement in the Adult Cardiac Intensive Care Unit: A Survey of Family Engagement Practices in the Cardiac Critical Care Trials Network.

Cardiovascular and critical care professional societies recommend incorporating family engagement practices into routine clinical care. However, little is known about current family engagement practices in contemporary cardiac intensive care units (CICUs). We implemented a validated 12-item family engagement practice survey among site investigators participating in the Critical Care Cardiology Trials Network, a collaborative network of CICUs in North America. The survey includes 9 items assessing specific engagement practices, 1 item about other family-centered care practices, and 2 open-ended questions on strategies and barriers concerning family engagement practice. We developed an engagement practice score by assigning 1 point for each family engagement practice partially or fully adopted at each site (max score 9). We assessed for relationships between the engagement practice score and CICU demographics. All sites (N=39; 100%) completed the survey. The most common family engagement practices were open visitation (95%), information and support to families (85%), structured care conferences (n=82%), and family participation in rounds (77%). The median engagement practice score was 5 (interquartile range, 4). There were no differences in engagement practice scores by geographic region or CICU type. The most commonly used strategies to promote family engagement were family presence during rounds (41%), communication (28%), and family meetings (28%). The most common barriers to family engagement were COVID-related visitation policies (38%) and resource limitations (13%). Family engagement practices are routinely performed in many CICUs; however, considerable variability exists. There is a need for strategies to address the variability of family engagement practices in CICUs.

Intrahospital Transport Practice in Pediatric Intensive Care Units

Intrahospital Transport Practice in Pediatric Intensive Care Units

A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit

BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results. METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results. RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.

Perspectives of Intensive Care patients and family members on competencies for Advanced Intensive Care nurses in Europe

Background&#x0D; One output from the International Nursing Advanced Competency-based Training for Intensive Care (INACTIC) collaboration is a set of core competencies for advanced practice Intensive Care Unit (ICU) nurses across Europe. Some European countries, such as the UK, have identified such competencies, however, these advanced practice roles are rarely practiced across the rest of Europe. The INACTIC competencies were developed with an expert panel of 184 ICU nurses from 20 countries. It is also important to examine what patients and relatives with experience of intensive care felt about these competencies. &#x0D; Aim&#x0D; To examine the views of recovered ICU patients and relatives regarding the INACTIC competencies.&#x0D; Methods&#x0D; Three patient and relative focus groups were conducted in England (n=5), Scotland (n=4) and Greece (n=4) to discuss a lay version of the INACTIC competencies. Discussions were open ended, followed a topic guide, recorded and transcribed verbatim. Analysis followed a conventional thematic approach, with the findings discussed iteratively among the authors.&#x0D; Results&#x0D; The feedback from across the focus groups resulted in three themes: 1) the importance of nurses being empowered to advocate for the patient; 2) the centrality of communication; and, 3) the impact of variability in ICU practices. There was a notable difference with the Greek focus group; because of restricted family visiting policies, relatives did not feel encouraged to participate in patient care.&#x0D; Conclusions&#x0D; The perspectives of patients and relatives largely aligned with the consensus of the INACTIC expert panel. Local differences in ICU experience highlight the changes that some ICUs would need to make for the INACTIC competencies to be embedded.

Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic

BackgroundSupport for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences.MethodsWe performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support.ResultsA total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support.ConclusionsAlthough, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.

Use of Facebook in a quality improvement campaign to increase adherence to guidelines in intensive care: A qualitative study of nurses’ and physicians’ experiences

ObjectivesThis study aimed to explore intensive care unit nurses' and physicians' experiences with professional content provided through closed Facebook groups, as part of a quality improvement campaign to improve guideline adherence. Research methodologyThis study used an exploratory qualitative design. In June 2018, data were collected through focus groups of intensive care nurses and physicians who also were members of closed Facebook groups. Data were analysed using reflexive thematic analysis, and the study was reported according to the consolidated criteria for reporting qualitative research. SettingThe study’s setting was four intensive care units at Oslo University Hospital, Norway. Professional content on Facebook comprised audit and feedback on quality indicators on intensive care topics with related pictures, videos, and weblinks. FindingsTwo focus groups of 12 participants were included in this study. Two main themes were identified: 'One size does not fit all ' described that quality improvement and implementation are influenced by several factors related to current recommendations and personal preferences. Various strategies are required to serve different purposes and meet individual needs. 'Matter out of place' described conflicting experiences of being offered or exposed to professional content on Facebook. ConclusionAlthough the audit and feedback on quality indicators presented on Facebook motivated improvements, professional content on Facebook was perceived as inappropriate. Hospital platforms with applicable features of social media, such as reach, availability, convenience, ease, and possibility for commenting, were suggested to secure professional communication about recommended practices in intensive care units. Implications for clinical practiceSocial media platforms may be useful for professional communication among ICU personnel, but appropriate hospital applications with available and applicable social media features are recommended and needed. The use of several platforms may still be needed to reach all.

Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey

Background: Continuous and deep sedation until death is a much highly debated end-of-life practice. France is unique in having a regulatory framework for it. However, there are no data on its practice in intensive care units (ICUs). Aim: The aim is to describe continuous and deep sedation in relation to the framework in the specific context of withdrawal of life-sustaining therapies in ICUs, that is, its decision-making process and its practice compared to other end-of-life practices in this setting. Design and setting: French multicenter observational study. Consecutive ICU patients who died after a decision to withdraw life-sustaining therapies. Results: A total of 343 patients in 57 ICUs, 208 (60%) with continuous and deep sedation. A formalized procedure for continuous and deep sedation was available in 32% of the ICUs. Continuous and deep sedation was not the result of a collegial decision-making process in 17% of cases, and did not involve consultation with an external physician in 29% of cases. The most commonly used sedative medicines were midazolam (10 [5–18] mg h−1) and propofol (200 [120–250] mg h −1). The Richmond Agitation Sedation Scale (RASS) was −5 in 60% of cases. Analgesia was associated with sedation in 94% of cases. Compared with other end-of-life sedative practices (n = 98), medicines doses were higher with no difference in the depth of sedation. Conclusions: This study shows a poor compliance with the framework for continuous and deep sedation. It highlights the need to formalize it to improve the decision-making process and the match between the intent, the practice and the actual effect.