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Key Point #3: Focus on the Interprofessional Nature of the Guidelines
Effective management of each of the syndromes of PAD is clearly beyond the scope of any single profession. The recommendations contained in these guidelines (e.g., light sedation, early mobility) demand that the bedside treatment team work together in identifying and aligning patient goals and coordinating care. The successful integration of the new PAD guidelines into everyday practice will therefore likely require intense, sustained, and effective interprofessional collaboration and communication. Although some may find the concept "interprofessional" to be rather intuitive, others may be less familiar with its definition and application in the critical care setting.
The unique characteristics of interprofessional collaborative practice have recently been defined and include the ability to (1) work with individuals of other professions to maintain a climate of mutual respect and shared values; (2) use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of the patients and populations served; (3) communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease; and (4) apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable. The development of the PAD guidelines is a beautiful example of a truly successful, interprofessional collaborative effort. Successfully implementing these guidelines in everyday practice will require a similar interprofessional approach.
The importance of performing daily interprofessional ICU rounds cannot be overemphasized. Daily "rounding" allows the ICU team the time to collectively use their clinical expertise, coordinate patient care, determine care priorities, establish daily goals, and plan for potential transfer or discharge. Endorsed by several quality and safety organizations including the Institute for Healthcare Improvement, use of this patient-centered model of care has been associated with reduced patient days, improved satisfaction with care, improvement in overall quality of care, and better communication and collaboration among the ICU team. The shared time of rounding is also a perfect opportunity for all the ICU team members to discuss how the patient is responding to the interventions recommended within the PAD guidelines. In addition to rounding, the use of daily goals sheets/checklists have also been shown to be instrumental in improving interprofessional communication, enhancing coordination of care, and improving patient outcomes. This process may be facilitated by the use of a standardized script that addresses many of these guideline components (example provided in Table 3). Additionally, the Brain Road Map script could be modified to include pain to form the PAD Road Map script (see the article "Delirium Monitoring in the ICU: Strategies for Initiating and Sustaining Screening Efforts" in this issue of Seminars in Respiratory and Critical Care Medicine) Using a script allows for the team to review patient goals, current assessment levels, and current medications and leads the team to a discussion point regarding treatment. Lastly the utilization of bundled care approaches such as the ABCDE bundle, which incorporates many of the recommendations from the PAD guidelines, is another way to align personnel and coordinate care. The components of the ABCDE bundle are awakening and breathing trial coordination, delirium monitoring and management, and early mobility. The American Association of Critical Care Nurses (AACN) has created an online education and implementation resource site for the ABCDE bundle (http://www.aacn.org/pearl-abcde) that includes specific information on each component as well as general information regarding change readiness, implementation roadmaps, and gap analysis guides. Daily interprofessional rounding as well as the utilization of goals checklists, report scripts, and the ABCDE bundle can facilitate clear communication among the interprofessional team.
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