7th EfCCNa CONGRESS 2017 'Working together - Achieving more' 15-18 February 2017 | Belfast | Northern Ireland BOOK OF ABSTRACTS www.efccna.org © Copyright EfCCNa www.EfCCNa.org Disclaimer EfCCNa, Global Conference Support, its Board members, officers, agents and employees (hereafter referred to as: the organisers) accept no liability for personal injuries or loss, of any nature whatsoever, or for loss or damage to property either during or as a result of the 7th EfCCNa Congress. Delegates have been advised to arrange adequate travel, health, and other insurance before they leave their home country. Participation is completely at the participant’s own risk. The organisers will not be liable and will not compensate for any damage incurred to participants during the meeting. The organisers are hereby released from all claims. 2 TABLE OF CONTENTS PLENARY PRESENTATIONS 4 Keynote Lecture by Paul Fulbrook 4 Keynote Lecture by Stijn Blot 5 Keynote Lecture by Leanne Aitken 5 Orion Industrial Partner Presentation SYMPOSIA 6 SYM1 - Nursing Activities Score (NAS) and the state of art: past, present 6 and future SYM2 - ESPNIC – Psychological care of the child and family /siblings 10 in the ICU SYM3 - Sex and stress in the ICU 11 WORKSHOPS 15 WS1 - SCREAM: Standardised Critical Care Resuscitation and Emergency 15 Airway Management WS2 - see WS1 15 WS3 - ESPNIC – Caring for the child in an adult ICU 16 WS4 - Manual Hyperinflation 16 WS5 - Haemodynamic Monitoring 15 WS6 - See W1 MASTER CLASSES 17 MC1 - Patient safety – To err is human 17 MC2 - Research Methods 17 ORAL PRESENTATIONS 19 OP1 - Managing Pain/Sleep 19 OP2 - Family-centred care 22 OP3 - Pain, agitation & Delirium 25 OP4 - Palliation and end of life 28 OP5 - Organisation 32 OP6 - Breathing 35 OP7 - Critical Care Education 38 PAR8 - Respiratory management of critically ill patients 42 OP9 - ICU Complex Care 42 OP10 - ICU Nursing Workload 45 OP11 - Infection Control 48 OP12 - Perioperative Care 51 OP13 - Mobilisation & Restraint 55 OP14 - Psychological Care 58 OP15 - Humanistic Care 62 POSTER PRESENTATIONS 64 Please note – only the changes in the scientific programme received before 31 January have been processed in this abstract book. 3 PLENARY PRESENTATIONS (PLE) PLE-1 KEYNOTE LECTURE WHAT'S HAPPENING IN THE WORLD OF CRITICAL CARE NURSING? Paul Fulbrook RN, PhD, MSc, PG Dip Educ, BSc (Hons) Professor of Nursing, School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Australia Nursing Director Research & Practice Development, The Prince Charles Hospital, Metro North Health Service District, Brisbane, Australia Adjunct Professor, School of Health Sciences, University of Tasmania, Australia President, World Federation of Critical Care Nurses Honorary Fellow, European federation of Critical Care Nursing associations President, Australian College of Critical Care Nurses (Queensland) This presentation will focus on what is happening in the world, from the perspective of Paul’s role as President of the World Federation of Critical Care Nurses (WFCCN). The history of the WFCCN will be described briefly, including its origins and association with the European federation of Critical Care Nursing associations (EfCCNa) before presenting an overview of the current role and objectives of the Federation, and its current activities. What’s happening in critical care nursing will then be explored via a contemporary stroll through the online world. PLE-2 KEYNOTE LECTURE LONG TERM PSYCHOLOGICAL AND COGNITIVE RECOVERY AFTER CRITICAL ILLNESS Leanne M Aitken, BHSc(Nurs), PhD, FACCN, FACN, FAAN School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB [email protected] Aims: To summarise the incidence, type and severity of psychological and cognitive dysfunction following critical illness and to examine the evidence underpinning interventions to improve recovery within these domains. Introduction / Outline: Psychological dysfunction, incorporating either anxiety, depression or post-traumatic stress disorder in isolation or combination, is experienced by 30 – 40% of critical illness survivors. Cognitive dysfunction may also be experienced by many patients after critical illness, although there is less consensus on the extent of this problem, with rates of reported compromise varying from 10% to 70%; this variation may be dependent on the time after ICU discharge and the method of assessment used. Known risk factors for dysfunction include demographic and socioeconomic factors such as older age, chronic illness, past psychological history, lower education and less social support; and clinical factors such as hypoxia, hypotension, anaemia, sleep deprivation, early deep sedation, agitation and mood in ICU. Interventions to improve psychological and cognitive recovery after ICU have focused on three goals including to: (1) adapt ICU to limit the detrimental effects; (ii) introduce programs of care within ICU to improve long term recovery; and (iii) provide interventions for patients after they leave ICU. Where resources are limited, patients at greatest risk of compromise and/or greatest potential for improvement should be targeted. Relevance / Conclusions: There is widespread agreement that psychological and cognitive dysfunction is a significant issue for patients recovering from critical illness. Of less agreement are the strategies that are effective in reducing this dysfunction, with limited and inconsistent evidence regarding the effectiveness of interventions. Early and multi- dimensional improvement strategies are likely to provide optimal benefit to patients. 4 PLE-3 KEYNOTE LECTURE ANTIBIOTIC THERAPY IN THE ICU: WHAT NURSES SHOULD KNOW Stijn Blot, full professor, Dept. of Internal Medicine, Ghent University, [email protected] Critically ill patients are at high risk for developing life-threatening infection such as bloodstream infection or pneumonia. These infections might lead to sepsis and multiple organ failure. Adequate antimicrobial therapy is essential to optimize the chances of survival. Three key issues in this regard are (i) a first antimicrobial dose administered as soon as possible after onset of the septic episode, (ii) an empiric antimicrobial spectrum covering the causative pathogens, and (iii) adequate dosing. However, efficient dosing is problematic because pathophysiological changes associated with critical illness effects the pharmacokinetics of mainly hydrophilic antimicrobials. Concentrations of hydrophilic antimicrobials may be too high because of decreased renal clearance due to acute kidney injury. On the other hand, antimicrobial concentrations may be decreased because of increased volume of distribution and augmented renal clearance triggered by systemic inflammatory response syndrome, capillary leak, alterations in protein binding and administration of intravenous fluids and inotropes leading to a hyper-hemodynamic status. Multiple conditions that may influence pharmacokinetics can be present simultaneously thereby excessively complicating the prediction of adequate concentrations. Generally, conditions leading to underdosing are predominant. Yet, since prediction of serum concentrations remains difficult, therapeutic drug monitoring for individual fine-tuning of antimicrobial therapy seems the way forward. The alterations in pharmacokinetics also have consequences for the administration of antimicrobials and as such for nursing practice. Nursing points of attention include (i) checking the necessity of prompt administration of a new antibiotic agent in case of a switch in therapy, (ii) control of the duration of the infusion of antimicrobial agents, (iii) respecting the dosing schedule, and (iv) the simultaneous administration of the loading dose and the continuous infusion when time-dependent antimicrobials are administered by continuous infusion. ORION INDUSTRIAL PARTNER PRESENTATION EVIDENCE BASED CRITICAL CARE FOR PAIN AGITATION AND DELIRIUM (PAD) Daniel Conway1, Natalie Mason, Donna Cummings 1 Consultant in Critical Care, Manchester Royal Infirmary, Manchester Academic Health Science Centre Aims: The critical care community has made great improvements in understating and treating Pain, Agitation and Delirium (PAD) amongst our patients. This knowledge has led to the development of PAD Guidelines in the USA and Europe. The purpose of this presentation is to review the evidence-based approach to implementing these guidelines. Outline: Pain and discomfort should be routinely monitored with validated self-assessment tools eg Visual Analogue Scale or observational assessments eg Behavioural Pain Score. Pain management should incorporate non- pharmacological methods and multi-modal analgesic techniques. Sedation and agitation is monitored using scales such as RASS. Deep sedation is associated with adverse outcomes and oversedation, defined as a measured sedation score deeper than the prescribed or target score for a stable patient, is not desirable. Using dexmedetomidine has been shown to facilitate light sedation. Delirium is a common challenge in ICU affecting 50% patients and associated with worse mortality, length of stay and long-term quality of life. The guidelines recommend monitoring delirium with validated tools eg CAM-ICU or ICDSC at least twice daily. Non-pharmacological techniques such as re-assurance, orientation, positioning, personal effects and discontinuation of deliriogenic drugs may prevent or manage hypoactive delirium. For agitation or hyperactive delirium, the recent DahLIA