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Brentwood, TN, United States

Pun B.,Vanderbilt University | Balas M.,University of Nebraska Medical Center | Davidson J.,Integration Management
Seminars in Respiratory and Critical Care Medicine

It has been 10 years since the last publication of the clinical practice guidelines for pain, agitation/sedation, and delirium (PAD). The results of new studies have directed significant changes in critical care practice. Using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, the guidelines were revised, resulting in 32 recommendations and 22 summary statements. This article provides guidance toward guideline implementation strategies and outlines 10 key points to consider. Compared with its predecessor, the 2013 PAD guidelines are less prescriptive in that they recommend approaches to patient care rather than giving specific medication recommendations. This will help focus care teams on the process and structure of patient management and result in more flexibility when choosing specific medications. This article outlines approaches to guideline implementation that take into account the changes in philosophy surrounding medication selection. The manuscript focuses on the areas anticipated to generate the most change such as lighter sedation targets, avoidance of benzodiazepines, and early mobility. A gap analysis grid is provided. The release of any guideline should prompt reevaluation of current institutional practice standards. This manuscript uses the PAD guidelines as an example of how to approach the interprofessional work of guideline implementation. © 2013 by Thieme Medical Publishers, Inc. Source

Davidson J.,Integration Management | Tung A.,University of Chicago | Kishman C.,University of Cincinnati | Barr J.,Stanford University
Seminars in Respiratory and Critical Care Medicine

This article evaluates the methodology used to develop the updated American College of Critical Care Medicine/Society of Critical Care Medicine Pain Agitation and Delirium (PAD) Guidelines in terms of (1) evaluating the role of a medical librarian in the guidelines development process; (2) summarizing the impressions of the guideline task force members on the use of Grades of Recommendation, Assessment, Development, and Evaluation and anonymous voting to develop guideline questions, statements, and recommendations; and (3) analyzing the impact of this approach to developing clinical practice guidelines on interrater reliability in evaluating evidence, statements, and recommendations. © 2013 by Thieme Medical Publishers, Inc. Source

Davidson J.E.,Integration Management | Jones C.,Nurse Consultant Critical Care Rehabilitation | Bienvenu O.J.,Johns Hopkins University
Critical Care Medicine

Background: The family response to critical illness includes development of adverse psychological outcomes such as anxiety, acute stress disorder, posttraumatic stress, depression, and complicated grief. This cluster of complications from exposure to critical care is now entitled postintensive care syndrome-family. Adverse psychological outcomes occur in parents of neonatal and pediatric patients and in family members of adult patients, and may be present for >4 yrs after intensive care unit discharge. Psychological repercussions of critical illness affect the family member's ability to fully engage in necessary care-giving functions after hospitalization. Prevention: It has been suggested that the manner in which healthcare workers communicate with family members and the way in which families are included in care and decision-making, may affect long-term outcomes. Preventive strategies for optimal communication and inclusion in care are reviewed. Assessment: Many tools are available to assess the risk for and to diagnose postintensive care syndrome-family conditions during hospitalization and at intervals after discharge. Treatment: Visits after discharge, support groups, and clinics have been proposed for assessing the need for professional referrals as well as for treating family members when psychological illness persists. Studies evaluating these measures are reviewed. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source

Solomon R.,Integration Management | Damba C.,Senior planner epidemiologist in performance measurement and information management at the TC LHIN | Bryant S.,Senior planner in performance measurement and information management at the TC LHIN
Healthcare quarterly (Toronto, Ont.)

Quality is being measured and reported across healthcare organizations and sectors, but efforts are rarely made to connect the activity in one organization to quality experienced by patients and clients in another part of the healthcare system. This article describes one regional health organization's journey to measuring health quality at a system level. The authors describe a highly consultative and iterative process used to measure quality across the continuum of care, and the challenges experienced in approaching this type of measurement, and they highlight some of the early findings. Copyright © 2013 Longwoods Publishing. Source

Davidson J.E.,Integration Management | Buenavista R.,Scripps Mercy Hospital and Memorial Hospital | Hobbs K.,Scripps Mercy Hospital and Memorial Hospital | Kracht K.,Scripps Mercy Hospital and Memorial Hospital
Advanced Emergency Nursing Journal

The purpose of this qualitative study was to explore inhibitors and enhancing factors surrounding the practice of allowing family presence in the emergency room. Staff and physician interviews were transcribed and decoded for themes. A visual model was built to depict the results. Inhibitors and enhancing factors included the following drivers: staff emotions, personalizing the patient, seeing/ hearing everything, closure, emotional support of the family, and "if it were me." The following staff needs were also identified as important issues that needed to be addressed before practice could change further: staff education, optimize environment for privacy, and implementation of a family liaison. The use of qualitative researchmethods was effective in identifying organizational barriers to transition of evidence into practice. Copyright © 2011 LippincottWilliams & Wilkins. Source

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