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Tips From the Experts Deborah Cook. The Consent Encounter. Smith et al, for the PROTECT RCs, Intensive Crit Care Nursing 2013. Strategies & Suggestions.
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Tips From the Experts Deborah Cook
Smith et al, for the PROTECT RCs, Intensive Crit Care Nursing 2013
Strategies & Suggestions • Ask the MD about predicted duration of ventilation, asking if the patient is likely to be extubated tomorrow….if not likely, approach for consent encounter • Prioritize Monday morning screening to consider patients admitted on the weekend • Capitalize on telephone consent when needed • Call forth the vitality culture & health literacy in your community
10 Reasons Why PROSPECT Consent is Easy 1) Public is familiar with probiotics 2) Probiotics are a natural health food product 3) Probiotics appear to be safe 4) Probiotics may regulate the bowels 5) Probiotics may introduce `good bacteria` 6) Probiotics may prevent infection 7) Care is otherwise `as usual` 8) PROSPECT occurs only in the ICU 9) Canadian $$ are funding PROSPECT 10) CCCTG is committed to this trial
Strategies & Suggestions • All of you worked closely with your pharmacy & bedside nurses • Reminders for staggered dosing with some oral antibiotics • PROSPECT orders:electronic medical record • A collaboration of research team and IT • Alerts for staggered timing re: some oral antibiotics • Easier • for RNs to administer per protocol • for pharmacy to track doses
Clinical Outcomes VAP All nosocomial infections Diarrhea (total, antibiotic-associated, C. difficile) Antimicrobial use (DDD, DOT, antibiotic-free days) Adverse events: Lactobacillus spp. infection Duration of Mechanical ventilation, ICU & hospital stay Mortality ICU & hospital
Post-It note reminders on Research Coordinator’s computer
Checklist on the front of every patient’s research file folder
Reminders to bedside nurses about documenting each bowel movement, if not reliably recorded
SOP: aseptic techniquehand hygiene before & after preparation +wear gloves, +prepare >4 feet from the patient
and Resources such as: Duotang of info at each bedside Binder of info at nursing station
Teach Others • Attend rounds when you can • especially the first few days on protocol • when intensivists or residents change • Give verbal summaries of the trial • Indicate ‘what it means for each ICU staff’ • business as usual • “I will be asking you about infections when you prescribe antibiotics”
It Takes a Village • “Include & invite anyone and everyone whom you might think will be exposed to the study to be part of the process – particularly the nursing team.” • “You might find your best ally for the study in the most unexpected places.”
With Input From • Families • Nurses • Nurse Educators • Pharmacists • Study Pharmacists • IT staff • Residents • Intensivists
Lori Hand Tina Millen Eileen Campbell Andrea Matte Irene Watpool Brigette Gomes Orla Smith Josie Campisi Marie-Claude Tremblay Erik Tamberg Virginie Williams Marie-Hélène Masse Victoria Alcuaz Barbara Kosky Nicole Marten France Clarke Lisa Julien With Thanks To