ICU Liberation eCommunity

The ICU Liberation eCommunity connects you with colleagues and thought leaders seeking to share resources and information.  Pose a question, share valuable resources or offer insight into topics related to pain, agitation, delirium and early mobility.

The ICU Liberation eCommunity is part of the SCCM eCommunity. Users may be prompted to log in or create a user profile before gaining access. You are leaving the ICU Liberation site when you enter the SCCM eCommunity. 

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Latest ICU Liberation eCommunity Posts

During rounding,  nurses were asking questions regarding the RASS.  One scenario was the nurse enters the room and calls patient name. The opens eyes and make eye contacts.  He is conversing with them appropriatley, but he is restless.  Some nurses are gi

Discovery Spring Clinical Investigators Meeting call for proposals
[cid:image001.jpg@01D2AFA9.D6AA8940]Discovery, the Critical Care Research Network, is encouraging members to submit proposals for review and discussion at the Discovery Spring Clinical Investigators Meeting. The Discovery Spring Clinical Investigators Mee

CPOT and comfort care?
Do y'all use CPOT for your non-verbal comfort care patients?

claiming CE Credit for the 4/3 ICU Liberation meeting
Is anyone having any issues claiming credit for the 4/3 meeting?I followed the directions to register for the event, but the mtg is not in MySCCM tab?Any suggestions?From: Michael Chapman via icul []Sent: Friday, April 7, 2017 5:

I had an interesting interaction checking the CAM-ICU on a young man in our ICU recovering from severe ARDS from pneumococcal pneumonia (he had been prone and receiving NMBA for a week). He had been delirious the prior day and on my testing that day made

My I.C.U. Patient Lived. Is That Enough?
NEW YORK TIMES - OPINIONMy I.C.U. Patient Lived. Is That Enough?By DANIELA J. LAMAS APRIL 1, 2017He is breathing better and the doctors say his lungs will recover, but he can’t remember his appointments or where he put his keys.It has been months since th

Visitor Policy in ICU
What is everyone's visitor's policy?  Do you have a locked unit? Open unit?  How do you inforce a visitor policy with an open unit?  Do visitors check in?  PPMC is looking to re-vamp  the visitor policy in our Critical Care Unit and we would love some fee

ICU Liberation Changing Practice Culture beyond ICU -RUHS
Dear Colleagues, We often wondered and asked the question:  What would happen to our ICU patients after they leave our ICU, will our hand-off be good enough to encourage others to continue with our efforts?  I just want to share an email I received from o

NIDUS pilot grant announcement
ICU Liberations Team,Exciting news- See attachment. NIDUS is an NIH sponsored grant (Sharon Inouye, PI) that many of us are a part of to help grow the Delirium Community of researchers to advance the science and medical improvements for our patients and

Visitation Guidelines/Policies
Would anyone be willing to share their critical care visitation guidelines or policies?Are you open, have protected times, restricted....?Thanks,SarahSarah Pandullo MSN, ARNP, CCRN, CCNS-BCCritical Care Clinical Nurse Specialist, Clinical Professional Dev

Team-based Training, Leadership
Dear Collaborative Members, As we expand the reach of our A-F bundle across our healthcare system, the variability in team dynamics, team performance, and leadership have provided great insight (and in truth exposed some real weaknesses) in how we behave

Good evening,   Does anyone have a protocol on Ketamine that they would be willing to share?   Thank you,   Felicia Cape Fear Valley Medical Center

World Delirium Day
Teams – This info is from the International Federation of Delirium Societies (I-Delirium) which includes American Delirium Society. See links below.They have a lot of resources on the website. My top 2 favorite things:1. The two attachments2.

Pediatric PT/OT Outcome Measurements
My colleagues in our Burn ICU would like to ask the following information: What functional outcome measures are PT/OT using for the 3 year old and under patient population.  We have new evaluation codes that require an outcome measure, but currently have

We are almost there
The finish line is in sight, so keep up the strong work with that data collection! Thank you to all the members of the ICU Liberation Collaborative Teams for all of your hard work on implementing this important initiative! You are truly affecting pati

ICU Liberation Data Collection Completion Information
ICU Liberation Collaborative Team Members: REMINDERAggregate and Site Level Data Entry Deadlines, Analysis and ReportsThe final week of data collection is quickly approaching.ALL data collection/Survey Completion end Saturday, March 18, 2017 7AMfor the fo

Family Centered Care Guidelines and ICU Patient Care Outcomes Presentation Links
Dear ICU Liberation Team Members:The webcast presented by Judy Davidson DNP, RN, FCCM, FAAN and Carrie Sona CCRN, CNS, MSN, RN February 28, 2017 was excellent. Please find the links for the webcast, slides and comfort care guidelines posted in the e-comm

Happy Mardi Gras
Happy Mardi Gras! Think Happy everyone...Wes

Spiritual Board at Columbia in NY to this ICU team! This is an article in WSJ about the article I sent out a few months ago (link to that is in this piece), learn, do...

Schweitzer - all should know
Teams,All of us should know about the life and person of Albert Schweitzer, who won the Nobel Peace Prize in the 1950s. I first read about him as a medical student at Tulane walking through the hallowed halls of Charity Hospital with our 20 bed open ward

F implementation From Parkland
Natalie, Stacey, Brian, and Crew - I snapped these pictures while on your ICUs (as you know) to share with others. I have a feeling that we at Vanderbilt and others will want to mimic to help w family rounds and our F implementation in units across the U

NPR Dallas on ICU Lib and Parkland Story
Teams,The Parkland team is in the news...AGAIN...bringing the story of ICU Liberation to the masses.Stacey, Natalie, Katie, Brian and the rest are ALL OVER THIS...and the following link is a good one to the audio/text of the latest media coverage. Ignore

Question regarding EPIC users- sedation documentation
We have been working on improving our sedation practices, specifically with the administration of fentanyl.  We have designed, submitted, and approved at a hospital level the use of a bolus first strategy with continuous fentanyl infusions.  However, we h

Volunteers in the ICU
I'm very excited! Starting this week, we finally have volunteers in our ICU's that can provide some distraction for our ICU patients. Historically volunteers were only given office or supply stocking duties if they came to ICU.  When we worked on "C" and

ICU provider response time
Team-does anyone have a guideline on how soon after admission to intensive care the provider is required to see the patient? Some sources say 24 hrs but I've heard discussion of 8-12 hrs. Thank you

ICU Liberation Collaborative Update - Feb. 14, 2017
ICU Liberation ABCDEF Bundle Implementation Collaborative Update 02/14/2017Call for Pet Visitation ExperiencesHighlights Form 46th SCCM CongressFinal ICU Liberation Collaborative Meeting April 2017Data Collection/Analysis UpdateCo-Learning CallsCall for P

Reminder to register for the February 28 Co-Learning Call
Title/Register: Family-Centered Guidelines & IC Patient-Centered Outcomes
Pet Visitation
Could those of you who are working on pet visitation contact me directly?I am dreaming of tearing down the signs on each of our buildings broadcasting "No Dogs Allowed"Timing is everything, and the policy is up for revision...... those involved cared to a

Reporting Outcome Data for Bundle Process Measures
What outcome measures are being reviewed monthly at your critical care meetings - from the process measures of the bundle?Currently we have only reported on the B element and LOS.Are you using a systematic approach to present each bundle element and then

the original Kermit
ICU Liberation Teams,I just told this story to a friend in the office and she seemed to like it, so I thought I'd share. The "original Kermit in full costume" came to my office today. Sat in my chair. After my recent talk on ICU Liberation in Hawaii, a ma

trauma from immobilization
ICU Liberation Teams,Attached is an elbow Xray from a patient I cared for last week in Haiti. Look at the calcification around the medial epicondyle (and some on the other side). This is the "freezing up" of a joint that has been left immobilized. This

F resource
Dear Colleagues,So many rich resources came to light in Hawaii at the 46th SCCM Congress regarding the F in our bundle family engagement and empowerment. It feels like a bit of groundswell and we thank you all so very much for the important role each of y

[PCOR-ICU Collaborative] - ICU Bereavement programs
Hi ICU Liberation teamsI wanted to share the postings from the PCOR-ICU e-community that were received after sending out the request for ICU bereavement program examples that originated with your e-community listserve. Several are from members of our pat

Recent CCM Publications
Dear Colleagues,There are several articles worth noting that were published in the current issue of Critical Care Medicine - see below. You may need to log in to your SCCM account to access the articles. Thank you, Christina* Bringing the ABCDEF B

ICU Liberation Collaborative Update - Jan. 31, 2017
ICU Liberation ABCDEF Bundle Implementation Collaborative Update - 01/31/2017Final ICU Liberation Collaborative Meeting April 2017Data Collection/Analysis UpdateCo-Learning CallsFinal ICU Liberation Collaborative Meetings April 2017* Midwest/East

Download New Family-Centered ICU Guidelines & Tools and Register for Feb 28 web conference
Dear Colleagues, the new SCCM Guidelines for Family-Centered Care in the Neonatal, Pediatric and Adult Intensive Care Unit were recently released at Congress on January 24, 2016. The objective for developing the new guidelines is “To provide clinicians wi

Spirituality, Palliative Care elements?
Greetings, not sure if others found this recent article by Swinton et al from one of the ATS journals of interest.  Sure gave me a lot to think about in this space.  I attached the article and accompanying editiorial for any interested.  But the idea of a

Call for 2018 Congress Session Proposals now open through March 1, 2017
ICU Liberation Collaborative Participating Sites:The call for 2018 session proposals is now open: deadline is March 1, 2017.Thank you,ChristinaChristina

SCCM Congress
Just wanted to thank the whole ABCDEF Bundle Team for the multiple great lectures promoting the bundle and providing additional tips, advice and support. Special Mahaho to Wes for the increbible Grenvik Lecture which he did without ppt!!! Thanks again. Em

ICU Bereavement programs
Hello,I would like to learn what other ICU have in place for an ICU Bereavement Process.We would like to improve our process and would welcome your input and sharing of best practices for end of life care, family follow up, staff support etc.Thanks in adv

Milestones Chart
The Family Bundle Champions in Parkland's SICU created a Milestones chart for families and patients to see the progress they have made throughout their ICU stay.  The milestone chart will stay with the patient in their room and will be a keepsake for them

ICU Liberation Collaborative Update - Jan. 17, 2017
ICU Liberation ABCDEF Bundle Implementation Collaborative Update – 01/17/2017Final ICU Liberation Collaborative Meeting April 2017
POSS vs RASS for post opiod admin monitoring
Our organization uses POSS outside of the ICU to monitor for sedation post opiod adminstration. While looking at making this a mandatory charting field, it brings the question of having it used in the ICU. Currently we use RASS to assess for sedation and

Team Strengthening Approaches - needed
Teams – Happy New Year! I am preparing a short lecture for SCCM conference in a couple week that explains the teamwork focus of this collaborative. While I have several examples from the co-learning calls and the in-person meetings, I wanted to reach out

Start Time Correction: Feb 28 Web Conference on Family-Centered Guidelines & ICU Patient-Centere
Dear Colleagues, the start times for the conference were listed incorrectly in the original message, see the changed below, my apologies for the confusion, KathyHi, below is information and the registration link for the February 28 PCOR-ICU web conference

Register for Feb 28 Web Conference on Family-Centered Guidelines & ICU Patient-Centered Outcomes
Hi, below is information and the registration link for the February 28 PCOR-ICU web conference that Ruth mentioned. The ICU Liberation members are very welcome to participate in the event and there is no charge to attend. Kathy VermochTitle/Register: Fami

Patient and Family Guidelines
Group, I read with interest this recent article in Critical Care Medicine regarding the variety of interventions for the F portion of the bundle potentially.  I must say, there are so many recommendations (many of which we do, but many of which we do not)

biking in bed
Colleagues,Interesting story - not an equipment endorsement just FYI A. Harmon, RRT, MBADirector, QualitySociety of Critical Care Medic

ICU Liberation January Co-Learning Call Link
ICU Liberation Collaborative Team Members:See below the link to the January Co-Learning Call Webcast.ICU Liberation - January 2017 Co-Learning CallBack to A: Preventing, Assessing and Managing Procedural Pain

ICU Liberation Collaborative Update - Jan. 3, 2017
ICU Liberation ABCDEF Bundle Implementation Collaborative Update - 01/03/2017Final ICU Liberation Collaborative Meeting April 2017Data Collection/Analysis UpdateCo-Learning CallsICU Liberation Sessions/Meetings at CongressFinal ICU Liberation Collaborativ

delirium and sleep
Hi Mara,No one really knows a number of hours except that more sleep is needed than is received by nearly any ICU patient (real sleep, not drug induced unconsciousness). And the best, of course, if to wear a patient out through mobility and do all we can

Christmas Suit
ICU Liberation Teams -OK, Crew....I was reticent to do this, but my wife Kim insisted that it would bring some smiles and laughs to my otherwise beaten down ICU patients, I wore the Christmas suit today. The patients who could, had belly laugh

ICU Liberation Collaborative Family Resources
ICU Liberation Collaborative:Two printable pocket cards have been posted in the e-community. These cards were developed by the Institute for Patient and Family Centered Care. The link to the cards is below and the documents are attached.Better Together

ICU Liberation Collaborative Update December 8 2016
ICU LiberationABCDEFBundle Implementation Collaborative Update – 12/08/2016Co-Learning CallsICU Liberation Sessions/Meetings at CongressData Collection/Analysis UpdateICU Liberation Collaborative MeetingFinal ICU Liberation Collaborative Meeting April 201

Parkland ICU Liberation Team Featured on
Natalie, Stacey and Katie keep the machine running at Parkland!

ICU Liberation Collaborative Co-Learning Call Webcast and Powerpoint File Links
ICU Liberation Collaborative teams:See below links to November and December Co-Learning Call Webcast and Powerpoint for both session 1 and 2 have been posted in the e-communityBuilding Reliability and Sustainability - Session 1 and 2 - ICU Liberation Coll

ICU Liberation American Association Respiratory Care Congress
ICU Liberation Collaborative Teams:See below a link for an interview at American Association of Respiratory Care Congress with Neil MacIntyre, MD, FCCP, FAARC, Clinical Chief Pulmonary/Critical Care and Professor of Medicine Duke University, being intervi

ICU Liberation Collaborative Update - Co-Learning Calls, Data Collection/Analysis, November Meeting,
ICU LiberationABCDEFBundle Implementation Collaborative Update - 11/30/2016Co-Learning CallsICU Liberation Sessions/Meetings at CongressData Collection/Analysis UpdateICU Liberation Collaborative MeetingFinal ICU Liberation Collaborative Meeting April 201

Register for upcoming ICU Liberation Collaborative December Co-Learning Call
REMINDER: Register for upcoming ICU Liberation Collaborative Co-Learning CallDecember Co-Learning CallTopic: Building Reliability and Sustainability Session 2Registration Link: Dec 1 Call Registration Link
ICU Liberation Collaborative: January Co-Learning Call Information/Registration
REMINDER to registerRegister for upcoming ICU Liberation Collaborative Co-Learning CallJanuary Co-Learning CallRegistration Link: Jan 4 Call Registration LinkWednesday, January 4, 2017 2P

new important A-F bundle QI paper just published - must read for everyone involved in ICU liberation
Congratulations to Mary Ann Barnes Daly and Wes Ely, MD! Mary Ann is on the ICU Liberation Collaborative Steering Committee and serves as West Regional faculty. Dr. Ely serves as the ICU Liberation Collaborative PI.Her study supports all the efforts of

Parkland SICU Featured for ICU Liberation
The Parkland Foundation, which is the philanthropic organization supporting the the mission of our health system, did a nice write-up on ICU Liberation. Mainly focused on the "E" Bundle and acknowledging the role of SCCM in the collaborative. Link below.

Palliative Sedation Protocol
Any hospital in the collaborative currently have a palliative sedation protocol they can share?ThanksKarenKaren Reynolds, DNP, CNS-BC, FGNLAGeriatric Nursing Leadership Academy FellowAdvanced Practice Nurse - GeriatricsEducation, Professional Development

Register for December Co-Learning call
REMINDER: Register for upcoming ICU Liberation Collaborative Co-Learning CallDecember Co-Learning CallTopic: Building Reliability and Sustainability Session 1Registration Link: Dec 1 Call Registration Link
ICU Liberation November Co-Learning Call link/Powerpoint
Dear ICU Liberation Teams:See below the link for the ICU Liberation Collaborative November Co-Learning Call - Building Reliability and Sustainability with Dr. Roger Resar Senior Fellow with IHI.The webcast audio portion had feedback that required multiple

Staffing Update SCCM
Dear Colleagues,   I write to share the good news that Vishakha Kumar has moved into a new role at SCCM as Senior Research Manager. Please join me in celebrating her promotion. As many of you know, we are very fortunate to have welcomed Christina Hielsber

PRADA - the queen's delirium contribution might enjoy...From: Ely, WesSent: Friday, November 04, 2016 12:29 PMTo: Ely, Kim; Alessandro Morandi []; Amanda Westhelle []; McNeil, Joel B; Brummel, Nathan Edward; Chandrasekhar, Rameela; Marra, An

ABCDEs - history
Teams, I just found this and had totally forgotten that 5 years ago the ABCDEs had been written up in the Wall Street Journal. Very cool. Lots of progress since this time...[cid:image003.jpg@01D235F6.B4C03CD0]

The Week - Stat
Hey Team, the Stat article about our ICU Liberation work made it into The Week!

Need Input: Recognizing and Managing Delirium in PICU
Dear ICU Liberation Colleagues:Request from: RUHS Medical CenterAs we are now beginning to see the overall benefits of the A to F Bundle in our Adult ICU patients, at RUHS we have extended the value of what we learned to our Pediatric ICU Colleagues

CAM-ICU has reached Netflix!
See post below fro John Devlin, PharmD FCCMFrom: Devlin, JohnSent: Tuesday, November 01, 2016 9:53 AMTo: icul@lists.sccm.orgSubject: CAM-ICU has reached Netflix!Not sure if any of you watch the Irish crime show, "the Fall" on N

National Healthcare Quality Week at Parkland Hospital
Parkland's ICU Liberation Program Manarger, Natalie Provenzale, organized an excellent week of informative presentations for National Healthcare Quality Week. The highlight for me was the mini-nursing summit on Tuesday dominated by SICU nurses who had eig

Field Hockey - teaches us...
Teams,Here at ANZICS in Perth, I am lucky to have met Ric Charlesworth, the most famous Australian field hockey coach of all time. ( He is also a physician and was once the world's greatest player. He took

ICU Liberation October Co-Learning Call Link
ICU Liberation Collaborative Team Members:On the October Co-Learning Call today, Jane Taylor EdD and Brenda Pun RN, DNP assisted team members to review and interpret their site level data. If you were unable to attend today's call please access the link

ICU Lib October 2016 site level data report
Dear Colleagues,This morning your institution's ICU Liberation team lead and redcap data administrator have received the statistician run October 2016 ICU Lib site level data report. This report includes data for retrospective and prospective months based

Sharing posting from SCCM PCOR-ICU Collaborative
Hi ICU Liberation Teams,We currently have 63 national ICU teams participating in an SCCM 10 month collaborative that is supported by PCORI funding (PCOR-ICU) which is focused on promoting patient and family engagement in the ICU - the "F" of the bundle.I

ICU Liberation Collaborative - September 29 Co-Learning Call Link
ICU Collaborative Teams:See below the link to the September 29 Co-Learning Call. If you or your team members missed the call, you are encouraged to watch the webcast for important information on how three collaborative teams shared their data, a review

Does anyone have any F policies they could share with me
I would really like to review some F (Family) related policies and procedures. If possible, could you please send directly to my email? Balas.17@osu.eduThanks so muchMicheleMichele C. Balas PhD, RN, APRN-NP, CCRNAssociate Professo

REDCap User Expiration
ICU Collaborative Teams and REDCap users:The REDCap data base requires the REDCap users renew REDCap user status yearly.If you or your REDCap users receive an email stating their REDCap access will expire in 14 days. Please do not send an email to Brenda

for the F - living room instead of waiting room is the natural (R)evolution of the waiting ICU rooms. And the beggining of the schools for ICU families.I am sure yo

Early Mobility RCT in Lancet
Teams,See attached. Bill S sent this from Lancet!Wes_______________________________E. Wesley Ely, MD, MPHVanderbilt UniversityAssoc Director of Aging Research, VA-GRECCPulmonary and Critical Care Medicine615-936-3395www.icudelirium.orghttp:

ICU Liberation Collaborative: October November December Co-Learning Call Information/Registration
Register for upcoming ICU Liberation Collaborative Co-Learning CallsOctober Co-Learning CallRegistration Link: Oct 19 Registration LinkWednesday, October 19, 2016 12PM-1PM CTTopic: Review

Parkland Mobility Boards at ICU Bedside
Teams,Re: see picture of Parkland Mobility Boards at each bedsideWhat a privilege it has been to meet with our Parkland ICU Liberation Team leader here today at Vanderbilt, where he is giving one of our esteemed Flexner Lectures. While going around our I

Reminder to Register for the September Co-Learning call
Reminder to Register for the September Co-Learning CallICU Liberation Collaborative Team Members register for the September Co-Learning CallSeptember Co-Learning Call Registration Link: SeptCoLearnRegistration
Psychologist in ICU?
Dear Colleagues,There was a question posted on the ongoing SCCM PCOR collaborative listserv.Please see below and respond by clicking "reply" or please send responses to: you.Vishakha KumarHi, I was wondering

F Bundle Element resources
ICU Liberation Collaborative Teams:Two items of interest in latest American Association of Critical Care Nurses CriticalCare eNewsline September 22, 2106The National Academies of Sciences Engineering Medicine news releaseFindings of a study regarding fami

Extubation to mobility protocols
Hi,I ran into a first today - I got the ok to see a patient and when I arrived, the team was there preparing to extubate. I asked the pulmonary/critical care physician if there was a protocol on length of time to wait between extubation and therapy and sh

Respiratory therapy extubation decision
Dear ICU Collaborative,Does anyone have an extubation protocol that allows the respiratory therapist to extubate a patient who meets extubation criteria that does not require a physician visualization of the patient?Our team is considering placing a few p

Rounding Scripts-wooster community hospital
Hello,Our rounding script is somewhat more lengthy, but we have found it helps to communicate the type of information that can be discussed during daily rounds. We tweaked the A & F components, so that it helps us include lines & nutrition. SO you will se

Rounding Scripts
I apologize if this has already been covered.  Does anyone have some samples of rounding scripts that you are using in your implementation?  PPMC is going to streamline report/rounding and would love some input about scripts.  I saw the few that were post

Extremis - our EOL portion of ICU Liberation
Dear Friends,Something has been on my mind about these remaining months of ICU Liberation: having explicit discussion with you about how ICU Liberation factors into good end-of-life (EOL) practices for our dying ICU patients. Then when this movie was rec

Decreasing Foley Utilization in ICU
This question was posted on the listserv a couple of weeks ago by Felicia McGarry from Cape Fear Valley.In efforts to decrease foley utilization we are going to use scales to weigh our chucks for output. Is anyone currently doing this? Do you have a proto

Webcast Interprofessional Coaching in the ICU Results
Remember to register for the follow up Interprofessional Team Coaching in the ICU: Results session September 21, 2016Webcasts: Interprofessional Team Coaching in ICU[]Registration is now open for the upcoming tw

Interprofessional Team Test of Change Experiment DUE Today
ICU Liberation Collaborative Teams:During the August 31 Interprofessional Team Coaching call, the presenters, Dorothy Lingren and Mary Ann Barnes Daly, asked teams to conduct a test of change.The test of change forms are due TODAY. Please send completed

Interprofessional Coaching call
Our team missed the initial interprofessional coaching call.  Is there a way to view that?  We would like to view the intitial coaching call prior to the next interprofessional coaching call.  Is there a link or somewhere we can view this?     Thank you,

OT Services Reduce Hospital Readmissions
This is a great article which will hopefully give added substance to the importance of OT in the acute care setting! Enjoy!CherylCHERYL L. ESBROOK, OTR/L, BCPRProgram Coordinator of Occupational Therapy Professional DevelopmentThe University of Chicago M

ICU Liberation: September Co-Learning Call Registration
ICU Liberation Collaborative Team Members register for the September Co-Learning CallSeptember Co-Learning CallTopic: Using your ICU Liberation Collaboration Data to Improve Practice and Patient Outcomes1. Identify strategies to use data to improve pract

Changes to Compliance Definition for E
Dear ICU Liberation Colleagues,At the June 30th, 2016 ICU Liberation Faculty Meeting, the faculty had the opportunity to view initial data collection by the Collaborative sites and discuss next steps to continue improving our process of adoption of the el

Zero foley ICU
In efforts to decrease foley utilization we are going to use scales to weigh our chucks for output. Is anyone currently doing this? Do you have a protocol you would like to share?   Thank you,   Felicia McGarry, MSN, RN Cape Fear Valley Medical Center Adu

the bottom line

Medicating Patients using CPOT
We have been working to switch from our current non-verbal pain scale to the CPOT which is evidenced based, but we have a question for hospitals currently using CPOT.  With our current scale the physicians write pain medicaton orders for 2 different level

nexus between sedation, delirium, sleep
ICU Liberation Teams -Sometimes we know something but it just needs to be studied and proven to help us face the reality of "need for change"...check out the message of this paper just out from Hopkins. Luckily, our ABCDEF Bundle is "just what the ICU Te

[Pediatric ICU Liberation Collaborative] - Sustaining QI Initiatives
Adult Collaborative Teams:Please see great article posted on the (P)ICU Liberation e-community by Dr. Jerry Zimmerman, related to designing maintenance/sustenance into QI interventions.Diane Byrum RN MSN CCNS CCRN FCCM | Manager, Quality Implementation Pr

August Co-Learning (PICS) Call Link
ICU Collaborative Teams:The ICU Liberation August Co-Learning Call video link (below) has been posted in the e-community. If you were unable to attend the August Co-Learning call yesterday, I encourage you to watch the webcast with your team.http://sccmm

[External] early mobility win
Super amazing awesome. Strong work MMCSent from my Android phone using Symantec TouchDown ( Message-----From: Lori Harmon via icul []Received: Wednesday, 17 Aug 2016, 4:03PMTo: [icul@lis

early mobility win
I just wanted to relay a patient story on early mobility success.We have a 30 year old, morbidly obese, man who required mechanical ventilation during septic shock. We had difficulty oxygenating him and had him on reverse I:E, PCV with FiO2 70 and peep of

Gait Belts Yes or No?
Interested in the value of a gait belt? Is everyone using a gait belt for patient mobility/ambulation? Thanks

Protocol for patient ambulation with PA catheter
Wanting to know if anyone has a protocol/safety screen etc., for walking patients with PA catheters they are willing to share? Thanks

Team Spirit in Spectrum Health - Michigan
ICU Liberation Teams,Someone sent me this picture from the ICU in Michigan of Spectrum Health of the SIGNED "yes I will" statement about ICU Liberation today. I thought I'd pass it on and say, "Keep it going, All, for our patients. Onwards and Upwards."

ICU Liberation Collaborative August Co-Learning Call Information and Registration link
Reminder to Register for the August Co-Learning CallAugust Co-Learning Call Information and Registration(One call for all regions)Topic: Post Intensive Care Syndrome: Real Patient Stories Influence ChangeOrange Regional Medical Center will present inform

Webcasts: Interprofessional Team Coaching in ICU
Webcasts: Interprofessional Team Coaching in ICU[]Registration is now open for the upcoming two-part webcast, "Interprofessional Team Coaching in the ICU
Level 0
This question came up within our group.  Is there any reason a patient would not be a Level 1?  For example, an unstable patient who was not ready for ROM, not passed any screening, medically lrestricted, etc.  If this is the case, are others still classi

ACTION Requested: August ICU Liberation Co-Learning Call Registration Information
August Co-Learning Call Information and Registration(One call for all regions)Topic: Post Intensive Care Syndrome: Real Patient Stories Influence ChangeOrange Regional Medical Center will present information on how a 'real' patient's story of their ICU s

Incentivizing physicians and other stakeholders to comply with ABCDEF Bundle elements.
Dear ICU Liberation Collaborative Team Members: During the ICU Liberation Collaborative Webcast in May on the role of ICU and Hospital Administrators, one of the participants (an ICU Medical Director) posted the following question: "How do we go about inc

ICU Liberation July Co-Learning Call Webcast Link
ICU Liberation Collaborative Team Members: TITLE: Implementation Strategies for Interpersonal Rounds and Early Mobilization: Community Hospital Perspective This co-learning call features the ICU Collaborative teams from Wooster Community Hospital and Co

power of the E
Teams,Here is an example of why the Early Mobility concept is so important. We must END the "keep them in the bed when on the vent" mentality. I won't say where his terrible pressure ulcer occurred, though I will say it didn't happen at any hospital inv

Welcome Dr. Jane Taylor
[cid:image001.jpg@01D1E984.AA3EEAE0]The SCCM ICU Liberation Faculty and Staff would like to welcome Jane Taylor, Ed.D. as a Performance Improvement Advisor to the ICU Liberation Collaborative.Jane Taylor, Ed.D. is an Improvement Advisor and Learning Desig

Congress Abstract Submission Closes Wednesday, August 3
Dear Colleagues,The due date for Congress abstract submission is fast approaching. Take this opportunity to share your ongoing work (in the formats given below) at the SCCM Congress 2017 in Hawaii.Thank you.VishakhaVishakha K Kumar, MD, MBA| Manager, Qual

A-F bundle in new nurse orientation
Has anyone incorporated the ABCDEF Bundle into their new nurse orientation? If you have, would you be willing to share some of your materials? Does anyone know of any online courses or eLearning materials for the bundle? Thanks!Miriam C. Dowling, MS, AGNP

PTSD in our patients
ICU teams,This topic of PTSD has been escalating in concern. I have attached our 2014 Jackson and the very latest 2016 Patel PTSD study. This new one is very unique in that we finally were able to report on a cohort study we did that included BOTH VA an

Interprofessional Team Development - Save the Dates August 31 and September 21
SAVE-THE-DATES: The ICU Liberation Collaborative will host two webcast sessions focused on Interprofessional Team Development ICU Liberation Collaborative :  Interprofessional Team Development The ICU Liberation Collabortive Interprofessional Team shoul

ICU Liberation Co-Learning Call - July 20 2pm CT Registration Link
ICU Liberation Collaborative July Co-Learning Call  Title:  Implementation Strategies for Interpersonal Rounds and Early Mobilization: Community Hospital Perspective  This co-learning call will feature the ICU Collaborative teams from Wooster Community Ho

question related to RASS
Hello Liberation Team,the following question(s) came up recently: * How should RASS assessment be handled for a patient we want to have an opportunity for uninterrupted sleep at night? Our RN standard ask for q2h assessment which conflicts with the per

ICU Liberation Collaborative Discipline Specific Discussion Recordings
The ICU Liberation discipline specific June audio events were a great success.  If you or one of your colleagues was unable to join us, please find the link to the discussion located below.  These links are posted in the e-community  Subsequent calls will

Patient Inclusion / Exclusion for Data Collection
Hi! I want to confirm/clarify whether a patient should be included in the data collection --  Scenario is that patient was admitted during previous month, but did NOT get included in data collection (was not one of first 15 admitted to unit).  The patient

CAM-ICU Positive or UTA?
We made some CAM-ICU training videos for staff education.  This is one of the scenarios that we shot to show CAM-ICU Positive in a patient that is following simple commands but not participating in S-A-V-E-A-H-A-A-R-T.  After watching it, I'm starting to

Family participation in formulating the plan of care
Hello ICU Liberation Collaborative Members! I was asked by SCCM faculty members how our facility captures family participation in formulating the plan of care.  Prior to joining this collaborative we did not document this in any reliable manner.  We added

patient orientation channel?
One of our speech therapists had the idea to utilize our patient education channels and create a patient orientation channel that says the time, date, geographic location, etc. Has anyone else done this or have any feedback on creating this type of progra

Teams,Here is one more for you...very "on topic" regarding what we are doing. What do you think of this eCASH? There are parts of this message related to SATs that I don't agree with simply because turning OFF drugs is the most sure-fire way to avoid the

Two relevant articles from ICM
Hey all....Here are two relevant articles, one for the adult teams and one for the pediatric teams. We'd be interested in your thoughts.Wes

CPOT and delirium
Dear All,Katie Walker and I had some correspondence about use of the CPOT with delerious patients. We thought that this information might be helpful for others. Please see below, starting with Katie's question at the bottom.Sincerely,KathleenKathleen Pu

ICU Liberation Collaborative June Co-Learning Calls - Discipline Specific Information
Join your ICU Liberation Colleagues on the June Co-Learning Calls to discuss successes and barriers/solutions in the implementation of the ABCDEF Bundle  Schedule and call in information: Nursing - Monday, June 27 12:30-1:30 PM CT  Pharmacists- Monday,

Articles related to F Bundle element - CCM June 2016
Hello,Attached are 2 articles related to the F Bundle element that were published in CCM June 2016 issue.1. Liput et al. A Review of the Perceptions of Healthcare Providers and Family Members Toward Family Involvement in Active Adult Patient Care in

Family loss and grief in delirium
ICU Liberation Teams,I want to share something special with you. This video link below was presented at the ADS meeting in May in Nashville. I was blown away by the clarity and truthfulness of this Professor’s “one take” comments on Family Loss and Grie

mobility scores for all!
Hello ICU liberation community,How are you capturing the mobility level your patient achieved today?How are you able to comprehend if they are making progress in their recovery as reflected in functional mobility gains?Did your patient achieve their optim

assessing pain when patient is sleeping
Dear All,I am curious to know your protocol for assessing pain when patients are sleeping; e.g., during the night. While pain behavioral scales should not be used in self-reporting patients, I hear that some night nurses just observe patient behaviors( i

MICU Quality, early mobilization, and falls
Hi everyone,Great to bring the topic of falls into the conversation about early mobility. There are no direct studies to definitively answer this question: I was wondering if your group has any articles linking early mobilization and falls prevention?We

Swimming pool
‘A Swimming Pool in the ICU?’ no mistake...our ICU Liberation collaborative is why this story unfolded as it did in the service of our awake and non-delirious patient.Kelly, Margaret, Se

CPOT and Med orders
We are using CPOT and building into Cerner. With our recent JACHO experience we are having the pain med order challenge and want to ensure we have orders that staff can follow safely and meet JACHO recommendations. How have you written pain med administra

Information about THRIVE Funding - For patients & families
Dear Colleagues,In support of the THRIVE initiative, the Society of Critical Care Medicine (SCCM) is proud to fund the second round of seed grants to foster an interna

Neat article concept
See attached - new article and see the images in this PDF. They have them in English and translations.Wes

Physician Burnout
Hi Wes,Just reading the On Being A Doctor section in Annals while eating dinner tonight Was struck by several statements by this physician who tried to commit suicide and what he had to say about a long ordeal he had as a patient in the ICU with septi

Teams,Someone wrote back to me asking what True Dat meant. ☺From the Deep South and Nawlins’, we have lots of lagniappe expressions. They include this “yatty” expression that means, “yes, that is true” or “true that” boiled down to “true dat.” It comes

Lucky us...Heidi here today
ICU teams,We had a huge bonus today: Heidi Engel came to Vanderbilt and our VA and we had such a powerful session!Wes_______________________________E. Wesley Ely, MD, MPHVanderbilt UniversityAssoc Director of Aging Research, VA-GRECCPulmonary and Critical

[EXTERNAL] Patient Speaks About His Experience With Delirium
This is awesome. If you are able to get additional patients who are willing to share their story see if they would allow for videotaping and sharing of their stories. I find that the humanity and story is what moves the needle the fastest. Michael Chapma

Patient Speaks About His Experience With Delirium
Yesterday, Orange Regional Medical Center was fortunate enough to have a former patient come and speak to the ICU nursing staff about his experience with delirium as an inpatient. This individual was a young man and hospitalized for over four weeks, with

Ketamine for acute pain in opioid-tolerant patients
At our institution, we are adding ketamine infusions for the management of acute pain in opioid tolerant patients.Should concomitant benzodiazepines be added and when? Are there any absolute contraindications for use?Does anyone have a protocol to share?

Early mobility while SBT
________________________________________Hello ICU Colleagues,There have been a couple of questions recently regarding how to coordinate SBT and mobility as a way to optimize patient capability for extubation.Here are my thoughts:There is only one article

staffing PT in the ICU
HI Melinda,We at UCSF have had, and continue to have the same issues, you mention here, as do hospitals everywhere.It is the challenge for our entire profession to determine how we want to handle this patient prioritization issue, define our role in the h

Question for the group
Would it be beneficial for patients records to be flagged when they have an episode of delirium affirmed. My feeling is that if on subsequent admissions, if we were made aware of the prior history of delirium we may make different decisions related to pre

A-F Bundle Communication Boards
As we are continuing with the implementation of integrating the A-F Bundle into our daily ICU routine, we have now updated our communication boards in all 30 rooms. The staff loves it. It's straight forward, reflective of the care that is being given, a

mobility scores
At UCSF we have our own simple mobility score that is utilized in our EMR hospital wide. It is one number assigned by the PT or OT per patient to represent the highest level of activity the patient achieved while participating in PT and OT. This tells you

early mobility CRRT
Attached is the CRRT presentation. Next year the ATS Conference is in Washington DC, Dale will again hold his ICU Mobility pre-ATS Meeting free to all on the Saturday before the conference. It is well worth attending. Some people have suggested pushing t

Early Mobility
We currently have an early mobility program here at Kettering Medical Center that we have had in place for the past two years.  When it was first implemented there was some initial resistance and our initial approach was conservative.  As our program has

ICU Liberation Steering Committee Regional faculty Meeting May 25 minutes and other documents
Dear Steering Committee Regional faculty:Please find attached minutes from the May 25, 2016 Steering Committee Regional faculty Meeting. In addition, documents referenced in the minutes are attached for your review.Thank you. Let me know if you have any

History of A to F Bundle
Hello all. During our recent sight visit by Dr. Barr, I put together the "history" of our "A to F" Bundle Implementaiton at Pali Momi Medical Center. In creating this, I found myself asking "what is the history of A to F?" Can some one comment on when and

Nurse-Led Rounds
A couple of questions for those in the group that practice nurse-led rounds at teaching hospitals- 1) How did you gain buy-in from faculty to allow nurses rather than residents to present patients? 2) What is the role of the residents in rounds? 3) What t

South County Health
Hi all,   The ICU team at South County Health is excited to notify the collaborative about our recent success in ambulating our ventilated patients. It felt great to challenge traditional practice and to bring the team together to particiapte in making th

AnnalsATS Blog
Heidi and Chris - read the "How I roll" blog below about the A-F bundle in the E section I hope :)Others share at will. This is real world application... Ely, MD, MPH - sent from iPad so please excuse typos <>

Delirium Thriller
An oldie but goodie :)

Lighter Note
Tonight at dinner here in Nashville, following our ICU QI Conference held by IHI, Kim and I were telling Heidi Engel and the others about Dolly and others people who live here. Then…I get a strong poke on my shoulder and spent the next hour watching peop

Rehab services following reintubation
Hello,I am wondering what are people's thoughts regarding mobility following reintubation.We have a patient who has been intubated/extubated/reintubated several times now due to increased work of breathing (massive GI/esophageal surgery due to esophageal

ICU liberation- pharmacists west coast
Hi Jill: Great question. I would refer you to the American Geriatric Society's recent clinical practice guidelines for post-operative delirium in older adults. As outlined below (and in the attached), there is insufficient evidence to recommend that antip

Annals of ATS - new blog
Teams,Here is a relevant piece on weaning that was just “put up” on the new Annals of ATS blog spot. Laurent, Andres, and I answered our approach to “weaning” (which you and I call “liberation!”):

SAT experience stories
Good morning liberators-We are planning on going live with our last element of the bundle within the next month- the SAT! I know that this will be hard for some of our nurses to get used to this big practice change, so we are looking for stories or vignet

ICU Liberation May Co-Learning Call - Register
Dear Collaborative Team Members:This is a reminder to register for the ICU Liberation May Co-Learning Call.ICU Liberation ABCDEF: "A" double duty for administration.Registration Link.May 25, 2

Anoxic brain injury and RASS scoring
A physician came up to me and asked:"If a patient comes in with anoxic brain injury with a RASS of -4 (but he is not on sedation), and our goal is Target RASS 0 to -1 what should we document? According to our target, we want our patient to be at 0 to -1,

[EXTERNAL] Measuring family engagement : Any ideas?
The idea of the team calling the elected family member/surrogate after bedside rounds is a great idea. I think having the same team that was present during rounds to update the family member and discuss the plan would be beneficial to our better understa

Measuring family engagement : Any ideas?
Good afternoon:I have several questions....can anyone share an example of what this looks like to their staff:Family participated in rounds* Would you say "yes" if the family was present but did not speak....they only listenedFamily participated i

A review of perceptions of healthcare providers and familty members towards family invovlement in th
Here is a great review article for your files about the letter "F".Objective: The objective of this article is to provide a summary of the perceptions of healthcare providers and family members toward their role in active patient care in the ICU and compa

Was hoping someone could share two policies. -care of the ventilator patient-restraintThank you

Back to Work for Survivors?
Wes and Team,  Nice article in the Published Ahead of Print about employment outcomes after critical illness (attached).  I enjoyed reading it and am trying to understand what we can do to help in this arena. Anecdotally, I saw a young woman just yesterda

ICU Liberation ABCDEF Bundle Implementation Collaborative Update
Dear Collaborative Colleagues,The ICU Liberation faculty and SCCM staff extend congratulations to your ICU for all of the amazing work put forward implementing the ABCDEF bundle over these past six months. The efforts of many hospital teams has been incr

Last Day - important teaching points
Teams,This story taught me a lot about post-ICU trajectory (PTSD, depression) and about HCP burnout.Wes

veil of blackness
Re: RIP ROARING PTSDI'm just sending this clinical anecdote to you because it puts a "face" on this problem of PTSD that we are trying to tackle along with depression in our ICU survivors. Remember that most data now support a PTSD and Depression occur a

May Co-Learning Call Registration Link
Please register for ICU Liberation ABCDEF: "A" double duty for administration on May 25, 2016 2:00 PM CDT at:  This webcast will feature an interview with Michael Gropper MD, PhD, Chair of the

NTI New Orleans??
Are any ICU Liberation Collaborative members going to be in New Orleans next week for NTI??  If so, anyone interested in trying to meet for dinner on one of the evenings?

AACN Advanced Critical Care PICS Issue
The April-June Issue of AACN Advanced Critical Care contains a symposium on PICS (5 different articles) written by many of the members of SCCM's THRIVE. I have attached this for you.Joanna Stollings, PharmD, FCCM, BCPSMICU Clinical Pharmacy SpecialistIC

Inter-professional Resources
Greetings, Not sure the following are helpful but a couple of thoughts: 1) We have some videos of the various disciplines for interprofessional rounding in case others wish to refer to these (helps us explain/define the roles of team members).  Speech the

Spirit of ;IGY6
Teams,Re: ;IGY6 image attachedThis image of the ;IGY6 tatoo makes SUCH a statement...and the more I think about it, the more WE as the ICU Liberation Collaborative must embrace the spirit of this message. This is on the arm of a soldier who is part of th

Teams - this is a pretty great cover of the Lancet. Makes me think about our collaborative and how we might be undoing some of the calamities and serving as a "fortuitous external intervention" :)Onward with this drama of improving lives! Stay tightly ad

A-F Cookies!
We are taking this seriously!

Question on Delirium Assessments
Would like to know how often are most of you assessing for delirium? Once a shift, twice a shift, every 4 hours?Lorna Coloma, RN, MSN, MBAIntensive Care UnitClinical Service Line ManagerDirect Line: 808-485-4679Fax:<

[External] Taking patient's outside of the ICU setting as a diversion strategy
Hi all,So we took our patient outside again today which was wonderful but here's my question. I'm running into difficulty initiating therapy activities during the outdoor excursions - like there are too many cooks in the kitchen. For example, I had to ins

Sent from Snipping Tool
Hi,To further clarify, we use the "Alaris" pump to bolus from the fentanyl drip. The added safety feature are the guardrails around the dosing.[cid:image001.png@01D1A11F.0C4D84C0]http://mysutter/shssr/smcs/Pages/default.aspx-----Original Message-----From:

CAM-ICU Competency
Has anyone developed a competency evaluation for correct use of the CAM-ICU?  If so, can you share?

Holding tube feeds for SBT
I have had question from one of my Sutter Health ICU Liberation teams wondering if there is literature to support holding tube feeds during the SBT in anticipation of extubation.We were unable to find any literature to support practice either way. I under

May be most important contribution to collaborative!!!!!!!!!!!!!!!!!!
Alexandra,You beautifully articulated some of the challenges RNs face when trying to manage pain with prn dosing. THANK YOU SO MUCH. First, we need to have the orders written in a way that we can administer the necessary dose based on individual patient

Some of our Respiratory Therapist have expressed an opinion that Vapotherm is nearly like putting the patient on BIPAP because the flow rate is so high that it creates Positive pressure. Is this treatment alternative something that you want recorded or

ICU Liberation Rap
Collaborative team members: The ICU Liberation Rap seen at the April meetings has been posted to youtube.  The link to the video is also copied below.   Diane Byrum  

Analgosedation protocols
Like everyone, we are reviewing our ICU sedation protocols with an eye towards analgosedation. We currently sedate most ventilated patients with propofol, using Dilaudid prn for pain. As we look at the narcotic first approach (fentanyl prn, fentanyl dri

Hospital quality depends on nurses per Penn study
Interesting article from Penn on the benefits of empowering nurses. C. Balas PhD, RN, APRN-NP, CCRNAssociate ProfessorCen