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多专业团队查房以促进 ICU 患者脱离呼吸机(ABCDEF)方案实施的最佳实践。

Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle.

机构信息

Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.

Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN.

出版信息

Crit Care Med. 2020 Apr;48(4):562-570. doi: 10.1097/CCM.0000000000004197.

Abstract

OBJECTIVES

Daily ICU interprofessional team rounds, which incorporate the ICU Liberation ("A" for Assessment, Prevention, and Manage Pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; "F" for Family Engagement and Empowerment [ABCDEF]) Bundle, support both the care coordination and regular provider communication necessary for Bundle execution. This article describes evidence-based practices for conducting effective interprofessional team rounds in the ICU to improve Bundle performance.

DESIGN

Best practice synthesis.

METHODS

The authors, each extensively involved in the Society of Critical Care Medicine's ICU Liberation Campaign, reviewed the pertinent literature to identify how ICU interprofessional team rounds can be optimized to increase ICU Liberation adherence.

RESULTS

Daily ICU interprofessional team rounds that foster ICU Liberation Bundle use support both care coordination and regular provider communication within and between teams. Evidence-based best practices for conducting effective interprofessional team rounds in the ICU include the optimal structure for ICU interprofessional team rounds; the importance of conducting rounds at patients' bedside; essential participants in rounds; the inclusion of ICU patients and their families in rounds-based discussions; and incorporation of the Bundle into the Electronic Health Record. Interprofessional team rounds in the ICU ideally employ communication strategies to foster inclusive and supportive behaviors consistent with interprofessional collaboration in the ICU. Patient care discussions during interprofessional team rounds benefit from being patient-centered and goal-oriented. Documentation of ICU Liberation Bundle elements in the Electronic Health Record may help facilitate team communication and decision-making.

CONCLUSIONS

Conducting high-quality interprofessional team rounds in the ICU is a key strategy to support ICU Liberation Bundle use.

摘要

目的

每日 ICU 跨专业团队查房,整合 ICU 患者脱机方案(A 代表评估、预防和管理疼痛;B 代表自主唤醒试验和自主呼吸试验;C 代表选择镇痛和镇静药物;D 代表评估、预防和管理谵妄;E 代表早期活动和运动;F 代表家属参与和赋能[ABCDEF]),以支持执行该方案所必需的护理协调和常规医护人员沟通。本文介绍了在 ICU 中进行有效的跨专业团队查房的循证实践,以提高方案的执行率。

设计

最佳实践综述。

方法

作者均广泛参与了重症监护医学学会的 ICU 患者脱机方案推广活动,回顾了相关文献,以确定如何优化 ICU 跨专业团队查房,以提高 ICU 患者脱机方案的依从性。

结果

促进 ICU 患者脱机方案使用的每日 ICU 跨专业团队查房,支持了团队内部和团队之间的护理协调和常规医护人员沟通。在 ICU 中进行有效的跨专业团队查房的循证最佳实践包括:ICU 跨专业团队查房的最佳结构;在患者床边进行查房的重要性;查房的基本参与者;将 ICU 患者及其家属纳入查房讨论;以及将方案纳入电子健康记录。理想情况下,在 ICU 中进行跨专业团队查房时,应采用沟通策略,以促进符合 ICU 跨专业协作的包容性和支持性行为。跨专业团队查房期间的患者护理讨论应注重以患者为中心和目标导向。在电子健康记录中记录 ICU 患者脱机方案的要素,可能有助于促进团队沟通和决策。

结论

在 ICU 中进行高质量的跨专业团队查房是支持 ICU 患者脱机方案使用的关键策略。

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