Adapting guidelines to support Intensive Care Unit survivorship : a pilot study

Background: As ICU mortality decreases, it has been reported that over half of ICU survivors inadvertently experience post-intensive care syndrome (PICS). Comprehensive and consistent strategies to prevent, recognize and treat the physical, cognitive and psychological symptoms of PICS are in development in a large number of clinical settings nationally and internationally. There exists little research focusing on the implementation of PICS care pathways at the individual institutional level. Purpose: This was a pilot study and the first step in a quality improvement initiative. The purpose of this study was to examine whether the United Kingdom, National Institute for health and Clinical Excellence (NICE) 2009 guideline on rehabilitation after critical illness could be helpful to audit clinical practice in a Canadian hospital. Method: This was a pilot study that incorporated a retrospective chart audit. Data was collected from patient charts utilizing the NICE 2009 rehabilitation after critical illness audit support tool. Results: Not all of the proposed recommendations in the NICE 2009 guideline were applicable to the Canadian context. While the selected Canadian clinical setting in the study does not have an implemented PICS pathway, nine out of fifteen proposed audited recommendations were a part of usual care or based on health care professional expertise in the Canadian hospital. Conclusion: Collecting data on post-ICU recovery in the Canadian clinical setting utilizing the NICE 2009 rehabilitation after critical illness audit support tool is feasible. Clarification of the roles of multidisciplinary team members in the rehabilitation pathway and the auditing strategies to prevent, manage, and treat PICS throughout the ICU trajectory could potentially improve the usability and relevance of the NICE chart abstraction tool to the Canadian context. Implications: A PICS care pathway has the potential to optimize health outcomes of ICU survivors. To be effective, a multidisciplinary team approach is recommended in caring for the critically ill patient throughout the ICU trajectory. Nurse leaders, in collaboration with the multidisciplinary team, should review each proposed recommendation on rehabilitation after critical illness published by NICE to determine the applicability to local clinical settings in efforts to optimize ICU survivorship.Applied Science, Faculty ofNursing, School ofGraduat