Duke Raleigh Hospital

By Kristin Merritt, MSN, MBA/HCM, RN, NE-BC, CCRN

Mashed potatoes probably don’t seem like they have much to do with the Intensive Care Unit (ICU). But some patients in the ICU have a simple wish – they just want to eat mashed potatoes. No matter how simple (or big) the request, we try our best to honor it.

We ask patients during the admission process: “What is important to you during your stay?” We’re so serious about making sure patients get what they need that we write the question – and the patient’s answer – on what we call a “care board” in their room. Each day, the patient, his or her family, physicians and staff look at the request and try to ensure they’re taking care of it.

The answer to the question, “What’s important to you?” is very personal. Some people tell us, “I just want to go home,” and we think of that request each time we’re in their room. One patient asked simply, “Please let me know what you are doing to me and why.”

Consider it done.

Our focus in the ICU is on making sick patients well enough to go home. But we never forget their humanity and that they have wants and needs beyond the medical ones. We ask – and listen.

We also understand that a person is at his or her most vulnerable when being cared for in the ICU. He or she needs loved ones around. So we have an open visitation policy. That’s different from some other ICUs and certainly an improvement over where ICUs were even a few years ago.

It used to be that family members could visit in 15-minute increments four times a day. In some cases, people had traveled a great distance to be near their loved one, and seeing their son or daughter, mother, father or friend in 15-minute spurts just wasn’t acceptable. There were lots of limitations back in the old days, and we’ve done our best to lift those, while still keeping a patient’s physical well being top of mind. Just recently, we had a seven-month-old baby among an ICU patient’s visitors.

We’re proud to offer care that’s focused on the patient and his family and friends.

Hospitals also used to have a narrow definition of “family.” Only immediate family could visit an ICU patient. We understand, though, that patients may have a different definition of what constitutes family. We refer to visitors as “loved ones” or “patient support,” because they may not be related by blood or marriage. They may be friends or neighbors. But their presence is just as valid – and just as needed – as any sibling or parent.

Honors and awards

Our team has been honored for our accomplishments several times over the past couple of years. June 2012 marked two-and-a-half years without having a patient develop a central line associated bloodstream infection (CLABSI).  About half of all ICU patients need a central line during their hospital stay. Usually, it’s because the patient needs multiple antibiotics – more than we can administer through an ordinary IV.

A central line catheter infection happens when a patient develops an infection in the bloodstream that is unrelated to an infection at another site. The infection may be accompanied by fever, chills or decreased blood pressure. Until 2010, the medical community thought central line infections were an unfortunate, but frequent, risk. Now, we know they are avoidable. And, we’re doing all we can to prevent them. Our enhanced process, called Central Line Insertion Bundle Compliance, is a strict protocol that involves proper dressing, line maintenance and scrubbing the hub of IV line access ports with isopropyl alcohol (70 percent) for 15 seconds prior to each use.

Most recently, we won the N.C. Nurses Association Best Practice Award for preventing CLABSI. Maki Gallano-Massey, RN; Robin Fichuk, RN; Kim Bagley, RN; and Brittain Wood, RN accepted the award at the Oct. 2013 conference.

In October 2012, we were awarded a $10,000 grant from the American Association of Critical Care Nurses (AACN) to participate in the Clinical Scene Investigator (CSI) Academy. Our project is focused on ambulating ICU patients, including ventilated patients.

We’ve also assisted Community Health Systems Hospital in Franklin, Tenn. In July 2013, the hospital’s director of infection prevention contacted our team to learn more about our challenges and how the team overcame them.  Maki Gallano-Massey, RN; Robin Fichuk, RN, Kim Bagley, RN and Brittain Wood, RN led the way in sharing our knowledge and best practices with the ICU staff in Franklin.

In September, we presented at UNC/Rex Research Symposium on how to reduce visitor anxiety in the ICU. The ICU nurses involved in that presentation were Robin Fichuk, BSN, RN, CCRN; Susan Smith, MSN, RN; and IJ Anen, MSN, ACNP, CCRN.

We love getting industry recognition for our efforts to make our ICU care among the best in the region and the country. But not as much as we love being able to serve a patient mashed potatoes once he or she is able to eat them. That’s what really makes us proud.

Kristin Merritt is Nurse Manager, Operations in Duke Raleigh Hospital’s Intensive Care Unit and Neuroscience Step Down.