Acutely Ill Special Needs Management

Acutely Ill Special Needs Management

By Dr. Carol Thompson

In the hospital setting today those that currently providing care to patients are familiar with Core Measure Sets Prophylaxis: Pneumonia (head elevation etc), PE/DVT (heparin or compression boots), URI (foley care and length of use), Gastric Ulcer (PPI or variant) etc. Also standards about timing (stroke time to intervention), MI time to  stent,) and specific treatments (thrombolytic for MI).

Skin care standards are a big issue in bedridden patients so besides turning and specialty beds there is staging of bed ulcers and specialized care providers. As we learn more about muscle atrophy with acute illness, mobility as intervention has become more of an expectation. Fall risk assessment and management is more common. Palliative care in the hospital now may have special locations and teams to manage this stage of care. Increasingly pharmacists and physical therapists are being added to the patient team.

Team communications has also turned into a special focus. Fast Huddles are instituted: where the team meets for about 10 minutes and highlights special needs of the day like who is going to surgery or who is most unstable. Communication technology for intubated patients such as use of iPads, and family communication with the team through technology such as iphone messaging and special time routinely planned for meeting with the NP/MD. Nurses carrying pagers for notifications of their assigned patient’s needs. Handoff effectiveness as quality improvement recognized as highly important. Journaling of ICU activities so patients and primary care providers can interpret post ICU syndrome issues.

Continuity of care with transitions is covered elsewhere but highlights special needs as well far beyond drug reconcile.  Rehabilitation post ICU/hospitalization is increasingly a part of discharge/transfer planning.