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

Transplant Centers mobility program/protocol
Hell All!I hope this email goes through and if it indeed does I hope it finds you all well. My name is Jill and I am a Level II OT at a large based trauma 1 center in the south Chicago land. Our institution has a highly recognized Cardiovascular Institute

CPOT outside of the critical care environment
Hello all, I am wondering if any of you are using the CPOT outside of the critical care area. While I understand that the tool is only validated in critical care patients, we are looking at adopting CPOT across the hospital. We currently use a tool that i

Pain medication orders using CPOT values
Hello,We are looking for some guidance for developing analgesia orders using CPOT . Has anyone developed pain medication orders with CPOT parameters? If so,Would you be able to share them with usThanks in advance for your helpJoann PannoJoann M. Panno, MS

ICU culture...need to overcome
[cid:d2418bb3-abdf-4394-b1ec-b6c912beb4f0]Gabi Heraswww.humanizingintensivecare.com http://www.humanizingintensivecare.com Twitter: @HUMANIZALAUCI https://twitter.com/HUMANIZALAUCI [1488365027270_logo]

Critical Connections
Colleagues,Happy summer everyone. Your team here at SCCM extends our regards to you and your families as you enjoy the remaining shining days ahead of this important season.Today I am sharing a posting from my colleague here at SCCM Kathy Vermoch. Kathy i

ICU Liberation Committee - July call agenda and feedback reqeusted
Hi Matt,I recorded the call for Christina so she can send out the highlights. I think the main point was for the minimal dataset, we would like to finalize it and then send it to a designer for layout. Brenda suggested to have a right call out for zooming

call for abstracts
Colleagues,Don't miss the opportunity to let your work shine. Abstracts are open for the SCCM Congress through August 2nd : http://www.sccm.org/Education-Center/Annual-Congress/Abstracts/Pages/default.aspxLoriLori A. Harmon, RRT, MBADirector, QualitySocie

Impact of "F" on "D"
Hi TeamsI shared this with the PCOR-ICU collaborative teams and wanted to be sure that you saw this article published in the June 30 issue of Critical Care Medicine from a study in Brazil on the impact of extended visitation, which was associated with red

Pet Program Success
F: FamilySo, the Pet policy revisions went out to my organization last week.One neuro stepdown nurse has started writing a protocol to explore nurse, patient, family experience with patient-pet visits.Another stepdown unit that had been sneaking in pets h

CEUs
Hello Team,I was never able to get my CEUs for our final meeting. Can someone assist me with that pleaseThank youKareem Dally, MSN, RNSICU ManagerSharp Grossmont HospitalOffice (619) 740.5856Cell (858) 761-3637Fax (619) 740.3926[cid:image001

F: Family Patient Pet Visit Policy
F: FamilyA couple of months ago I asked you all for help with finding evidence to support patient's own pet visits.I want to thank those of you that sent me pictures and video links and encouragement.Today we finalized the approval of our system-wide poli

Mobility with femoral Swan Ganz?
All,Is there a team who has mobilized a patient with a femoral Swan Ganz catheter? If yes, what did your clinical reasoning and mobility process look like?Historically have not at USC as they were temporary and for concerns about length of line, mobile jo

Another article of interest: sleep associated delirium
All,Please find attached an article released in CCM June 2017 on sound levels and sleep disruption in the ICU sponsored by The George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevale

Economic and clinical impact of sustained progressive mobility CCM
All,Check out this study by Hester, Guin, et. al. Estimated $12M in cost reduction with progressive mobility program in neurocritical care population. Interesting reading.LoriLori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care Medic

ABCDE bundle from HOUSTON
From Dale Needham…paying it forward by sending us this paper….essentially an ABCDE (not family piece) bundleObjective To evaluate the effectiveness of a deliriumprevention bundle in decreasing delirium incidence in2 medical-surgical intensive care units i

Learning from P4P and thinking about ICU Liberation - next steps
Teams,Exploring P4P to see how we can accomplish implementation and do things better is a great idea. See the attached paper now in press at AJRCCM. I have a few added comments that I want to share with you as you keep thinking about all of our next step

CVICUs
I was wondering if any of the CVSICUs in the collaborative would be willing to share some challenges and successes overcoming them with me?  We are trying to move the bundle into other ICUs in the hospital and I want to be well armed with info for the car

Frail visitors
Thank you to Judy Davidson (jdavidson@ucsd.edu) from UCSD for sharing the excellent information below.From: Davidson, Judy [mailto:jdavidson@ucsd.edu]Sent: Wednesday, June 07, 2017 11:05 AMTo: adharmad@lifebridgehealth.org
Questions about vulnerable visitors and white boards
The questions below come from Dr. Ashwin Dharmadhikari at Sinai Hospital of Baltimore, Lifebridge Health, and have also been posted on the PCOR-ICU Collaborative listserv; please send responses to adharmad@lifebridgehealth.org
RASS scoring
One of our nurses asked me this question. I present a situation where a patient has a neurological disease, or has severe brain damage and has their eyes open but does not seem to see anything or track with their eyes, or they open their eyes briefly to s

Comfort Care Extubation Order Sets/Protocols
Not sure if this is still an active list serve - seems like all my questions are coming up after the collaborative.Is anyone willing to share. The "perfect" (i.e. most comfortable) withdrawal of care: What does it look like? Who does what? What d

delirium
HI everyone, We are in the process of updating all of our policies here.  A few years back we implemented asssesing  for delirium in the ICU with the use of the RASS and CAM-ICU.  We don't have a formal policy that explains how to do the assessments.  I a

Submit your abstract for the
Submit an abstract for the 2018 47th Annual SCCM Congress in San Antonio, TX sharing the excellent work that your team accomplished during participation in the ICU Liberation Moore Foundation collaborative. If accepted please let the community know! (See

Listen to iCritical Care Podcast 341
Teams,#341 at this SCCM Link below is Brenda getting interviewed about ICU Liberation…check it out!Have a great day.WesFrom: Samantha Geib >Date: Thursday, May 18, 2017 at 10:41 AMTo: Brenda Pun
WFSICCM PATIENT and FAMILY CENTERED CARE Research Project
F for Family:Ruth Kleinpell asked me to distribute this link to all of my contacts and of course I thought of all of you!Please consider participating in this WFSICCM research project.You will need this data to complete the demographic portion of the surv

POCD and Delirium
I was talking to a retired anesthesiologist a few days ago regarding POCD and DeliriumWe had a lengthy discussion regarding how after surgery we attribute anesthesia to affect cognitive changes - acute.I asked him how many patients had he had pre - op dis

NPR Marketplace Coverage of ICU liberation
On behalf of SCCM, we are very proud of all of the work of the sites in the ICU Liberation Collaborative! The following story from Parkland can help serve as a template for our collaborative as we think about ways to disseminate this important work.NPR M

Rehab therapist clinical competencies for ICU
Hello,I was wondering if anyone has established competencies for PT's and OT's working in the ICU and if they would be willing to share as part of this collaborative? In our push for promoting early mobility I know that staff would feel more comfortable i

EPIC Reports
We are currently working with our system EPIC team to try and generate some type of compliance reports to track our progress going forward with the ABCDEF Bundle. So far, the reports they have built for us have generated an overwhelming amount of informat

CAPA vs. 0-10 Pain Scale
There is a team at UCSD starting a dialogue of whether or not to replace the 0-10 pain scale with the CAPA pain assessment ‘dialogue’ (across the board, not just in the ICU).Do any of you have exposure to this method, or comments?Validation has not been p

In Appreciation and One more question :-)
Thank you everyone for your support and responses regarding the SAT/SBT - assessments and the goal of weaning/stopping the meds.I think one of the greatest accomplishments of this ICU Collaborative is the many other projects- implementations that are ste

list serv
Colleagues,I fear I created confusion with my post. When I said "carry on" I meant continue to use the SCCM ICU Liberation list serv. We will notify everyone when the new site is available probably closer to the fall of 2017, until then continue to use th

Can I ask one last question :-) before the list serve goes on pause - SATs
My niece is in grad school - DNP and was suggested her project focus on the BundleShe has posed the following question and I would love to share expert/EBP information with herShe works in a cardiothoracic ICU in NebraskaThank youKarenMy question is can y

will miss these conversations
SCCM,I think all of us in the Collaborative are going to miss this collegial and wholesome clinical forum for clinical conversations.So how long does this list serve stay active? Do tell…Wes_______________________________E. Wesley Ely, MD, MPHPulmonary a

lots to learn here
Teams,I'm sharing an email stream with all our sites because much of our success (and failure) in ICU Liberation has to do with our ability to communicate well both as a team and with our patients. To that end, see messages below and use this as you see

[**External**] Cardiac Chairs
If you studied the 3 experiences for both patients and staff you would get answers we don't have today.Of course, if they can get out of bed they should.From: Barnes-Daly, Mary Ann, MS, RN, CCRN, DC [mailto:BarnesM4@sutterhealth.org]Sent: Thursday, April

Cardiac Chairs
I am wondering if anyone has knowledge of reaserch regarding usage/benefits of passive transfer of patients to a bedside cardiac chair versus using the cardiac chair mode in the bed for patients that absolutely cannot actively participate in the transfer

RASS
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 [mailto:icul@lists.sccm.org]Sent: Friday, April 7, 2017 5:

CAM-ICU
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

Ketamine
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
https://www.wsj.com/articles/a-spiritual-board-brings-comfort-to-the-critically-ill-1487695567Bravo 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)...read, 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: https://www.aievolution.com/sccm18/index.cfm?Submission 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 http://www.cbc.ca/news/canada/hamilton/biking-in-bed-is-good-for-icu-patients-says-new-mcmaster-study-1.3915472LoriLori 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 Painhttp://sccmmedia.sccm.org/video/webcast/ICULibe

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 today...so, 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 Nurse.com
Natalie, Stacey and Katie keep the machine running at Parkland! https://www.nurse.com/blog/2016/11/16/icu-process-improvement-measures/

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