Abstract

Introduction: Extensive communication occurs during daily ICU rounds including a bedside review of a patient’s problems, progress and plans. To facilitate accurate, comprehensive and patient focused management, Daily Goals Checklists (DGC) have been developed. The objective of this study was to examine the attitudes and perspectives of multidisciplinary health care providers about a newly implemented DGC in a tertiary care, academic ICU. Hypothesis: We hypothesized that variable views would be held by different members of the multidisciplinary team on both the importance and utility of the DGC. Methods: In this qualitative study, we conducted individual semi-structured interviews and focus groups of 42 ICU clinicians (20 nurses, 5 respiratory therapists, 3 physiotherapists, 2 pharmacists, 1 dietician, 5 fellows and 6 intensivists). Inductive analysis of the transcribed interviews was used by the multidisciplinary investigative team to identify emerging themes. Results: Clinicians endorsed the DGC as a tool to enhance a structured, comprehensive approach to the innumerable interventions made on critically ill patients. The utility of the DGC was perceived to be greatest for nurses, pharmacists and physicians who attended to most aspects of the form. For some clinician groups, there were dominant foci - for respiratory therapists: weaning, sedation and fluid plans; for physiotherapists: sedation and central line plans; and for the dietitian: optimizing nutrition. All clinicians suggested more detail for rehabilitation and mobility targets on the DGC. Patient rounds were endorsed as multidisciplinary but the utilization of the DGC was considered primarily an inter-professional communication tool between nurses and physicians. Nurses were wary that the DGC should always enhance rather than replace verbal communication. Conclusions: Prominent users of the DGC (nurses, physicians and pharmacists) endorsed its ability to enrich communication about systematic, comprehensive plans of care. Less engaged users reported utility of the DGC in selected domains. All clinicians were interested in adapting the DGC and further enhancing its integration into practice

Authors

Hoad N; Centofanti J; Duan E; Perri D; Waugh L; Cook D

Journal

Critical Care Medicine, Vol. 40, No. 12, pp. 1–328

Publisher

Wolters Kluwer

Publication Date

December 1, 2012

DOI

10.1097/01.ccm.0000425029.69526.78

ISSN

0090-3493

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