Personalizing Care for Critically Ill Patients: The Footprints Project
CCCF ePoster library. Hoad N. 10/31/16; 150918; 39
Ms. Neala Hoad
Ms. Neala Hoad
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Topic: Quality Assurance & Improvement

Personalizing Care for Critically Ill Patients: The Footprints Project

Hoad N,1 French T,1 Shears M,1 Toledo F2, Clarke F1, Swinton M3,  Duan E1, Waugh L1, Soth M1, Cook D1,3
1 Department of Critical Care, St Josephs Healthcare Hamilton, Canada
2 Department of Spiritual Care, St. Joseph's Healthcare Hamilton, Canada
3 Department of Clinical Epidemiology and Biostatistics,  McMaster University,  Hamilton,  Canada


Background:  The intensive care unit (ICU) may be so austere and impersonal that clinicians are at risk of forgetting the 'lives lived' of critically ill patients before hospitalization.

Objectives: To a) facilitate patient-centered care, b) inform clinical encounters, and c) create deeper connections among patients, families and clinicians.

Methods: Mixed-methods project. Phase 1: We conducted 20 semi-structured interviews with ICU staff to generate key information about patients' lives and experiences to populate the Footprints Form and to seek input on operationalizing the Footprints Project. Phase 2: Whiteboards were installed in patient rooms to capture essential information from the Footprints Form, and the Footprints Form was pilot tested with the families of 16 patients. Phase 3: We enrolled 26 additional patients, and elicited feedback from family members (verbal and written) and clinicians (verbal).  Phase 4: Clinicians implemented the Footprints Form for 5 months. Phase 5: A group of 16 interdisciplinary colleagues participated in a positive deviance group brainstorming exercise to encourage completion of the Footprints Forms and whiteboards, and to generate additional implementation suggestions.

Results: Phase 1: We interviewed 8 nurses, 2 physicians, 5 respiratory therapists, 2 physiotherapists, 1 chaplain, 1 medical student and 1 research coordinator. The favoured approach was completing a paper-based Footprints Form, alerting the ICU team to placing the completed form on the front of the medical chart, and selecting items to be written on the whiteboard in the patient's room along with a photo. Phase 2: 16 patients aged 48-89 (mean 67.1 years) with medical (11) or surgical (5) diagnoses were enrolled; 15 families (93.8%) completed the Footprints Form (7 interviewer-administered, 8 self-administered). Whiteboard data included: the date, the patient’s preferred name, names of clinicians providing medical care family spokesperson, aids used at home, life milestones, important issues to share and a message centre for families, friends and clinicians. Phase 3: 21 families and 30 clinicians (response rates 80.4%, 100%, respectively) considered Footprints to foster holistic, personalized care and promote humanism in practice. Phase 4: Bedside RNs provided Footprints Forms to families of patients admitted to the ICU and updated the whiteboards with selected information provided. Phase 5: By addressing barriers generated during the facilitated brainstorming exercise, we formulated strategies to increase completion (e.g., better accessibility of forms for families, unit communication clerks and clinicians, and RN documentation on the transfer of accountability checklist within 48 hours of patient admission).

Conclusions: The Footprints Project helps to share important information about patients before and beyond their critical illness among members of the interprofessional team. Future implementation success will benefit from addressing barriers to completion and engaging a more diverse group of clinician champions


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