Authors (including presenting author) :
Stephen WW Chan(1), Henry CH Pak(2), Karen KY Leung(3), MY Chan(1), PL Wong(1),
WW Hui(1), J Lam(1), YB HO(1), NC Chan(1), KL Hon(3)
Affiliation :
(1)Allied Health (Physiotherapy), Hong Kong Children’s Hospital, Hong Kong
(2)Registered Physiotherapist, Hong Kong
(3)Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
Introduction :
Despite improved survival rates in critically ill children, admission to a Paediatric Intensive Care Unit (PICU) can be physically and emotionally stressful for children. As such, the Society of Critical Care Medicine launched the PICU liberation bundle campaign, which aims to free patients from the harmful effects of pain, sedation, delirium, immobility, and sleep disruption in PICU. However, there is no consensus on the elements of rehabilitation to promote patient recovery.
Objectives :
Identifying rehabilitation elements in the PICU liberation bundle and assessing clinician consensus
Methodology :
A three-step modified Delphi method was used to establish consensus. In step 1, the elements of rehabilitation were identified via literature search including Pain management (P), Respiratory optimization (R), early Exercises and mobilization (E), Family engagement (F), Empowerment of patients (E) and Realization of rehabilitation goals among clinical team, patients and family (R), which were referred to as ‘PREFER’. In step 2, clinicians were asked to complete an online survey to rank their level of agreement (LOA) (1-9; 1= totally disagree, 9= totally agree) and level of importance (LOI) (1-9; 1= least important, 9= most important) on including these rehabilitation elements as the role of Physiotherapists in the PICU. In step 3, the findings were summarized and discussed among the panel members.
Result & Outcome :
Forty-five clinicians completed the survey (44.4% Physiotherapists, 22.2% Medical officers & 33.3% Nurses; Years of PICU experience: majority 3-9 years: 62.5%). The following were the results (mean / SD): Pain management: (LOA: 8.0.9±1.1 /LOI: 7.6±1.4), Respiratory optimization (LOA: 8.8±1.1/LOI: 7.9±1.0), early Exercises and mobilization (LOA: 8.9±0.6 /LOI: 8.9±0.5), Family engagement (LOA: 8.4±1.2/LOI: 8.0±1.3), Empowerment of patients (LOA: 8.3±1.2/LOI: 8.1±1.3) and Realization of rehabilitation goals among clinical team, patients and families (LOA: 8.2±1.1/LOI:8.2 ±1.2). The panel members reached an agreement on the important rehabilitation elements of the PICU liberation bundle.
Conclusions
This abstract describes the development of a new rehabilitation PICU liberation bundle - PREFER through the use of a consensus approach. The implementation strategies and clinical care pathways could be developed based on these identified elements in the future.
