We are pleased to announce that LIVENGOOD will be highlighted in an article being published in the June 2015 issue of JONA (The Journal of Nursing Administration). The article titled “Use of an Ambulation Platform Apparatus” addresses our joint study done with Medical Center of the Rockies discussing how The PACE reduced LOS and the number of Care Givers needed in each mobility event. We are very excited to be part of the solution for mobilizing patients.
The hardest part about losing weight isn’t always losing it, it can often be maintaining the loss. The same is true with most big changes, especially when the change involves multiple people.
Many ICU departments are starting early mobility programs because it has proven to be ” best practice” for their patients. Starting a mobility program is tough and takes a lot of planning, discipline and enthusiasm from the staff. The trend I see is that programs start out strong and then often fizzle out.
Maintaining a strong early mobility program takes continuous effort and I would like to offer some suggestions on how to be successful. It is important to have champions both when a program starts and while it is maintained. Champions should be available on each shift and should serve as a point of education and guidance. ICU rounds should always have a line item for mobility and even if a patient isn’t being mobilized yet, there should be a discussion about mobility and when it might be appropriate. Mobility should be on a pre-printed order sheet which will act as a stimulus for doctors when writing and checking off orders. Equipment which makes mobility more efficient should be readily available and easy to use. P.T. should have a daily presence in the ICU. Programs should have a clear exclusion criteria and if a patient isn’t mobilizing the only excuse should be that they meet these criteria. The programs I see succeed are those with a constant driving force from management. Mobility becomes an expectation for patients and not a choice made by staff.
80% of the sickest patients in the ICU will suffer from delirium. They have multiple risk factors that include immobility, medications for pain and sedation, and interrupted circadian rhythms, just to name a few. Delirium in the ICU will complicate the patients stay and can lead to many adverse outcomes. Patients who suffer from delirium will often be combative, pull out catheters, be unable to participate in therapy, and they may even self-extubate. These adverse outcomes can be hard on patients, families and ICU staff. Education about delirium should be provided to family members when applicable. ICU delirium will also increase the total cost of a patient’s stay.
ICU staff should have a system in place for assessing delirium such as the CAM-ICU. Their CAM-ICU score should be reported regularly in the EHR and during rounds. If staff is consistently reporting on delirium they can aim their interventions towards minimizing any adverse outcomes. Interventions will range from reducing certain medications, increasing mobility during the day , reducing stimulation at night, and to introducing cognitive therapy with an Occupation Therapist.
Delirium in the ICU is prevalent and also somewhat preventable. By tracking and addressing the following six risk factors our patients will have less complications: sleep deprivation, immobility, visual impairment, hearing impairment, cognitive impairment and dehydration.
We’ve all woken up early in the morning really needing to pee, but are so tired that we try to just lie there a little longer. We all know that the second we finally commit to getting out of bed we can rush to the bathroom. I bet you’ve never thought of that as a luxury. For millions of people who are in the hospital every day, it’s just that. Continue reading
On a recent trip to trial the LIVENGOOD PACE at Tulane Medical Center I had the pleasure of meeting Sarah. Sarah was a patient in the neurological ICU who had been on a ventilator for 3 weeks. During the placement of cervical traction she experienced heart failure. After being resuscitated she had to be intubated. The staff had good intentions of getting Sarah out of bed but equipment management was difficult. Consequently, she stayed in bed most days and occasionally, at best, made it to a chair. Continue reading
Please take a moment and read this article by InnovatioNews. Read Article
FORT COLLINS – Most people don’t want to stay in a hospital any longer than they absolutely have to. And while that’s primarily based on a person’s desire simply to be well again and get back home, there are other factors that weigh in favor of getting out of that hospital bed as soon as possible. Read Article