Progressing and discharging patients from the intensive care

Prevention of complications Post intensive care care: Prevention of complications Rehabilitation Return to normal living

When do you discharge patients from ICU Decreased risk of life threatening event Decreased need for invasive monitoring Increased stability Increased ability to participate in their care When does the discharge planning start? Can you predict a discharge? Long term vs short term patients - Elective surgical pts stay less than 24 hours just for post-op optimisation, therefore their DX process requires less preparation, their are identified early in the morning as potentials for DX What process is involved? How can you help? What is your role in discharge planning? – you don’t have to wait for the bed availability to commence DX process

Make the transition easier Anticipate Inform and discuss it with the patient and the family Reduce the frequency of attending to the patient Thorough handover Support Prepare documentation (at night before DX), discharge summary, remove unnecessary lines, give medication to reduce ward nurses burden, change dressings if appropriate, prepare nursing handover, identify any particular equipment that would be required (air mattress, feeding pump or infusion pump for TPN for example) (prepare them for the change, especially the long term patients as it will be a shock for them when they depend on the equipment and constant access to the nurse) Give the patient a call bell and encourage self care and independence. Inform the patient why it is done so. To ensure that no information is missed. To highlight the condition the patient was in and how fragile/unsure they feel.

GICU liaison role Look at identified discharges with nurse and medical team to highlight any issues Communicate with bed managers Communicate with nurse I/C and bedside nurse Communicate with patient and relatives Negotiate discharge/bed availability with destination ward Complex issues e.g. vulnerable adults etc

Prevent complication EWS SBAR ICU follow-up: liaison nurse Physiotherapy OT Dietician SLT What are the potential complications? How to avoid them? Clear communication, clear handover (give them a story), continuity of care,

Rehabilitation PT, OT, dietetic department, SLT, liaison nursing LD, diabetic, psychiatry, alcohol and substance misuse, etc. Specialist T&O, neuro rehab, cardiac rehab, heart failure etc. What are rehab needs of ICU patients?

Return to normal living Specialist follow-up: surgical team, medical team, GP ICU follow-up clinics healthtalk.org icusteps.org What do you think do patients expect when they go home? And what do you think is the reality? What support is there for those patients?

Post intensive care syndrome How can you minimise it? Good pain control Early extubation Early mobilisation – but not passive joint movement – resistance exercise non-pharmacological management: re-orientation, communication, nutrition, sensory stimulation, Family involvement

References Nates et al 2016, ICU admission, discharge, and tiage guidelines. A framework to enhance clinical operations, development of institutional policies, and further research, Critical care medicine 44 (8) National Institute of Health and Care Excellence. NICE 50 Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital. NICE 2007. National Institute for Health and Care Excellence (NICE). Clinical Guideline 83. Rehabilitation after Critical Illness. London, NICE 2009. Needham et al 2012, Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Critical Care Medicine 40 (2)