Name: Denise Penney, Gayle Woodhouse and Wayne Robson
Job Title: Nurse Consultant Critical Care
Organisation: Chesterfield and North Derbyshire Royal Hospital NHS Trust
Email: wayne.robson@chesterfieldroyal.nhs.uk
Telephone: 01246 277 271 Ext 3687 Bleep 198
Key team: Denise Penney - Senior Sister ICU - Chesterfield Royal Hospital, Gayle Woodhouse - Sister ICU - Chesterfield Royal Hospital
Abstract:
Patients who have been intensive care often remember little of their stay. This is mainly because patients are usually sedated whilst receiving mechanical ventilation in the earlier stages of their admission. Sometimes what patients do remember can be delusional memories. A study carried out in Sweden showed that keeping a diary for patients that included photographs helped them understand what had happened to them, and helped them make sense of their ICU stay.
By introducing the diaries we hoped that patients would have a better understanding of the time they had spent on ICU, and that by reading the diary and seeing themselves attached to equipment, such as the ventilator they would realise how poorly they had been. Patients are often frustrated by their slow progress after ICU, as they cannot really appreciate just how ill they were.
We expected the patient and their relatives to benefit. Patients could fill in the gaps in the time they had lost whist ill on ICU. We expected that the diaries would help relatives whilst on ICU as it would give them a focus, somewhere they could express their feelings, and where they could feel they were doing something for the patient.
We introduced the diaries by firstly making articles available for the nursing and medical staff to read. A group of nurses and one of the Medical Consultants went to visit Whiston Hospital in Merseyside who were already using the diaries. They kindly let us adapt their guideline. We then wrote a local guideline for Chesterfield. After advice from the Patient Safety Team we introduced the diaries in Oct 03.
The following staff contributed:-
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A Consultant Anaesthetist
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Two Sisters and two staff nurses from ICU
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Nurse Consultant for Critical Care
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Patient Safety Team
We knew we had achieved our first aims when the diary guideline was approved by Clinical Governance Committee, and was then introduced in OCT 03.
Some staff expressed concerns about the following:-
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Taking photographs of patients
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Having enough time to fill in diary entries
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What sort of things to write
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Uncertainty of whos property the diary was
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What would happen if we started a diary and the patient died, could it be given to the relatives
We overcame the barriers by discussion, explaining the potential benefits, listening to staff's concerns and being supportive.
It is still early days to see if there are any unexpected benefits, but to date we have handed over 6 diaries to patients and all have been well received with positive feedback.
Our next steps for the future are to carry out a research project, interviewing patients who have received a diary. This will probably take place towards the end of this year.
We are speaking at a critical care modernisation agency conference in Birmingham in March about our experiences introducing the diaries.
Two of the intensive care units in our network have expressed interest in also introducing the diaries.
