Peer support to improve recovery following critical care discharge: a case-based discussion

McPeake, Joanne; Iwashyna, Theodore J.; Devine, Helen; MacTavish, Pamela; Quasim, Tara

doi:10.1136/thoraxjnl-2016-209661

Cited by 39 publications

(27 citation statements)

References 7 publications

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“…They also state that health care systems should ensure that any adult who has had a critical care stay can be reassessed if they selfrefer at any time. A model integrating early, time-limited post-ICU follow-up (including nurses, physicians, physical therapists, pharmacists, social workers, and peer support) is also being disseminated across Scotland [179]. In the United States, there is growing interest in both post-ICU clinics and post-ICU peer support models [180].…”

Section: Are There Potential Post-discharge Interventions That Can Immentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Are There Potential Post-discharge Interventions That Can Immentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…(2) developing and disseminating educational materials to clinicians working in postacute care facilities and the outpatient setting, such as this recent perspective on sepsis survivorship geared towards physical therapists 53 ; and (3) incorporating education on sepsis sequelae into medical school curriculum, professional society conferences, and continuing medical education opportunities. 67 ; and (4) co-design of critical illness follow-up clinics by patients and clinicians 68,69 .…”

Section: Shorter-term Priority 2: Developing and Disseminating Educatmentioning

confidence: 99%

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Prescott

Iwashyna

Blackwood

et al. 2019

Am J Respir Crit Care Med

111

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An estimated 14.1 million patients survive sepsis hospitalization each year. Many survivors experience poor long-term outcomes, including new or exacerbated neuropsychological impairment, functional disability, and heightened vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, current guidelines and interventional trials have focused on shorter-term survival, so there is little data on how to best promote longer-term recovery. To address this unmet need, a Colloquium on "Understanding and Enhancing Sepsis Survivorship" was held in February 2018, sponsored by the International Sepsis Forum. The goals of the Colloquium were to identify (1) gaps and limitations of current research, (2) shorter-term research priorities, and (3) longer-term research priorities for understanding and enhancing sepsis survivorship, informed by review of the literature and expert opinion. A total of 26 experts from 8 countries participated. The top three short-term priorities were to better leverage existing databases for research, to develop and disseminate educational resources on post-sepsis morbidity, and to build deep connections with sepsis survivors to define and achieve research priorities. The top longer-term priorities were to link mechanisms to long-term outcomes through large cohort studies with deep phenotyping, build a harmonized global sepsis registry from which patients could be enrolled into cohort studies or interventional trials, and to complete detailed longitudinal follow-up to characterize the heterogeneity of recovery experiences across sepsis survivors. This Perspective reports on the Colloquium discussions, the rationale for the research priorities, and current initiatives addressing these priorities.

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“…The InS:PIRE programme involved individual sessions for patients and their caregivers with a pharmacist and physiotherapist along with interventions from medical, nursing, psychology and community services. A full description of the InS:PIRE intervention and the outcomes of this complex intervention pilot have been published previously 22 23…”

Section: Methodsmentioning

confidence: 99%

Impact of a pharmacist intervention at an intensive care rehabilitation clinic

et al. 2019

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ObjectiveWhile disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge.DesignConsecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation.SettingTertiary care regional centre in Scotland (UK).Participants47 patients reviewed after critical care discharge at an ICU follow-up programme.InterventionsPharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence.MeasurementsMedication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix.Main results69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03).ConclusionsMedication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.

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Peer support to improve recovery following critical care discharge: a case-based discussion

Cited by 39 publications

References 7 publications

Surviving sepsis campaign: research priorities for sepsis and septic shock

Surviving sepsis campaign: research priorities for sepsis and septic shock

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Impact of a pharmacist intervention at an intensive care rehabilitation clinic

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