Developing user centred critical care discharge information

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Developing user Developing user centred critical care centred critical care discharge information discharge information Suzanne Bench Florence Nightingale School of Nursing & Midwifery

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Transcript of Developing user centred critical care discharge information

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Developing user centred Developing user centred critical care discharge critical care discharge

informationinformation

Suzanne Bench

Florence Nightingale School of Nursing & Midwifery

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Background• Critical care discharge is a difficult time for patients and

relatives, requiring effective support strategies to optimize further recovery and rehabilitation (NICE, 2009)

Acutely ill patients• “ should be offered information about their condition and

encouraged to actively participate in decisions related to their recovery…tailored to individual circumstances”. (NICE, 2007: 16; recommendation 1.2.2.16).

Patient focused interventions should be developed that • “recognise the role of participants in the process of

securing appropriate, effective, safe and responsive healthcare” (Coulter and Ellis, 2006:7)

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The Medical Research Council framework (MRC 2008) for the

development and evaluation of complex interventions was used as information

meets the criteria of a complex intervention (Campbell et al, 2007)

Florence Nightingale School of Nursing & Midwifery

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This phase enabled review of current literature in order to identify:

• Meta-synthesis of the physical and psycho-social problems faced by patients and families at discharge from critical care to a general ward (Bench and Day 2010) • The scope and effectiveness of discharge information strategies currently utilised within critical care and other areas of acute care.• The potential for use of self-assessment and active participation strategies as part of rehabilitation to improve patient safety.

Pre-Clinical Work

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Phase IFocus group study

Aim

• To gain user insight into the most effective information strategies, to support the adult patient and their family at the point of discharge from critical care (ICU/HDU) to the ward

Objectives

To elicit the views of patients, families, and health care professionals with regard to:

• The most effective methods of information delivery

• The required information content of any proposed strategies

• The benefits and limitations of any existing strategies

• Any potential resource implications

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Focus Group

Number of participants

Type of participant Data collection site

1 4 Patients=2Relatives=2

London

2 3 Patients=2Relatives=1

London

3 8 Patients=4Relatives=4

Coventry

4 4 Patients=2Relatives=2

Coventry

5 3 Critical care nurses London

6 8 Critical care and ward nurses London

7 3 Physiotherapists=2Occupational therapist=1

London

8 9 Medical staff=8Pharmacist=1

London

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Considerations related to effective information provision

Enormity of the experience

Relationships Information blockers

The goals of critical care discharge information

Understanding of experience

Supported independence

The Five Rights: Right time, right place, right content, right person,

right amount

Resources

Current information provision

Information tools

Themes and Categories

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Data extrapolated from the literature was combined with results of the focus group

study in order to develop a new information strategy focusing on user

participation.

Florence Nightingale School of Nursing & Midwifery

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User Centred Critical care Discharge Information Pack (UCCDIP)

• A ‘lay’ patient discharge summary• Separate sections for core patient and relative information• Prompts for patients/families to identify individual needs and related

questions • Provision of a diary• Support resources• Input from critical care and ward staff trained in information delivery

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Phase IIRandomised Controlled Trial

Phase II centres around a single centre RCT (n=200) comparing the new information strategy with usual care

Title• User centred active information strategies, for adult

critical care patients and their families, at the point of discharge from critical care to the ward; an exploration of effectiveness and feasibility.

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A user centred critical care discharge information pack (UCCDIP) developed with service users, for adult critical care patients and their families, in comparison to usual care, will:

1. Improve the psychological and physical well-being of patients leaving critical care

2. Improve the psychological well-being of relatives when their loved one leaves critical care

3. Improve the critical care discharge experience for patients and relatives

4. Be considered feasible from the perspective of patients, relatives and critical care and ward nurses

Hypothesis

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Data collection

Cluster randomisation by day of discharge:• Group 1: Usual care (Informal ad-hoc verbal

information)• Group 2: Intervention (UCCDIP)• Group 3: Attention Control (Discharge booklet)

Outcome measures at one week and one month post critical care discharge

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User involvement

• Meta-synthesis of the user perspective of critical care discharge (Bench and Day 2010)

• Patients, relatives and health care professionals’ perspective obtained from focus group study

• ‘Expert user group’ convened to inform final development of UCCDIP

• Ex-patients and relatives via ICUsteps and ican-uk websites and a follow up clinic in London involved in RCT

• Ex-ICU patient on investigating team for RCT

Review of all documentation prior to use Assistance with study design and data

analysisContribution to dissemination of results

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Conclusions and further work• Integration of the user perspective is key to the development

of any effective intervention (Coulter and Ellis, 2006). This project aims to produce critical care discharge information based on specific research into what patients want

Findings from this study will be used to:• Refine the UCCDIP prior to further evaluation using a larger

multi-site phase III trial• Provide data, to inform the power calculation and sample

size for a phase III trial.

This should ensure that a complex intervention is developed that is both clinically and cost effective

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Publications

Bench S, Day T (2010) The user experience of critical care discharge; a meta-synthesis of qualitative research. International Journal of Nursing Studies 47: 487-499

• Bench S, Day T, Griffiths P, (2010) Involving users in the development of effective critical care discharge information: a focus group study with patients, relatives and health care staff. Currently undergoing review by American Journal of Critical care

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Acknowledgements

• The focus group study was part funded by the British Association of Critical Care Nurses (BACCN) southern region and the Florence Nightingale School of Nursing and Midwifery, King’s College, London.

• Thanks are extended to both NHS hospitals and all patients, relatives and health care staff who took part in the focus group study, and who provided assistance with recruitment of participants and organisation of focus group meetings.

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Thank you for listening

[email protected]

Florence Nightingale School of Nursing & Midwifery