Cardiac Critical Care Family Initiatives fund's first focus, Communication in CCCU and PICU

Labatt Family Heart Centre has setup a new fund for Cardiac Critical Care Family Initiatives which has already received $45,000 in donations. The first strategic initiative is communication, which we are so happy to hear on this blog. Since orientation of senior staff in April, the unit is preparing rollout of 'Crucial Confrontations' training to a first group of interprofessional staff in both the CCCU and the PICU. According to the company website, this training "teaches a straightforward step-by-step process for identifying and resolving performance gaps, strengthening accountability, eliminating inconsistency and reducing resentment." The skill tools they list to achieve this accountability and evolve execution are:

• Hold anyone accountable—no matter the person's power, position, or temperament.
• Master performance discussions—get positive results and maintain good relations along the way. Stay focused on the real issues and avoid getting distracted.
• Motivate without using power—clearly and concisely explain specific, natural consequences and permanently resolve problems.
• Enable without taking over—creatively help others avoid excuses, stay on track, and resolve performance barriers. Learn to avoid roadblocks to performance.
• Move to action—agree on a plan, follow up and engage in good reporting practices, and manage new expectations.

These would appear to be necessary interpersonal skills to achieve 'smooth' team dynamics. Perhaps we just expect nurses, doctors and all professionals to have just mastered them by the time they are on the floor yet so far the time devoted to team and family communication training in medical training is too little or too late. Such skills are learned (or not) on the job, hence my excitement to see how this particular training pans out for staff and families. It would also be great to see this staff training on teamwork find ways to appropriately include parents; the parent's point of view from first hand experience differs from that of staff in interesting and useful ways.  

Dr Steven Schwartz of SickKids CCCU appointed new cardiovascular chair

Congratulations to Dr Steven Schwartz on his appointment as inaugural holder of The Norine Rose Chair in Cardiovascular Sciences. Dr Schwartz started at SickKids while Sasha was in CCCU and I first met him as he visited all the bedsides and introduced himself to families on the unit. Though he was not on Sasha's care team I have talked with Dr Schwartz several times about communication between staff and families in the ICU. So it was very encouraging to see him champion a new communication training module focused on resolving staff-family confrontation and the Sasha Bella Fund supported the launch of the program. I hope this new role offers Dr Schwartz more resources to continue evolving patient and family supports and particularly to strike an interprofessional group that can work with parent volunteers who experienced care delivery in the cardiac and paediatric intensive care units. I think the Labatt Family Heart Centre will benefit greatly from an advisory and clearing-house for patient and family-centred concerns encompassing both the ICU and Floor 4.

CCCU adopts Vital Smarts communication training

SickKids CCCU have started a new communication program based on Vital Smarts (Health Care) training for Crucial Conversations and Crucial Confrontations, started from a study aiming to "create cultures of safety" in partnership with the American Association of Critical Care Nurses and leading to their their joint publication, "Silence Kills: The Seven Crucial Conversations for Heathcare".

- 84% of doctors have seen co-workers taking shortcuts that could be dangerous to patients

- 88% of doctors work with co-workers who show poor clinical judgement

-fewer than 10% of physicians, nurses and other clinical staff directly confront their colleagues about their concerns

By providing your info you can download an occupational questionaire that identifies key team and communication barriers.

Exciting CCCU family centred initiatives

Here are some initiatives, pilots and family related news from The Cardiac Critical Care Unit, the ICU for the Labatt Family Heart Centre.

Renovation of Room 53 for long stay patients

Arguably the biggest structural change to the CCCU in years will be the complete renovation of the large room 53 facing out onto the Atrium as a long stay location. Improvements include all new decorations to make the room more attractive, more privacy for individual patients and families, new lighting that can be dimmed for each bedside and the turning of the storage room into a play and therapy room. This renovation has been in the planning for almost two years and apparently the work is now imminent.

'My Child's Day' program piloted

Alison Hassall, a Physiotherapy Academic and Clinicial Specialist, and her PT colleagues have been working diligently on 'My Childs Day', a binder that will give parents instructions, diagrams and care plans from all services helping the family. Alison has spent over a year developing the program, consulting with all services in the CCCU and stakeholders concerned that care data was stored outside the computer system, and then piloting the project. This Rehab championed family centred pilot sprang from a staff sense that patient care was becoming increasingly represented by data separated by discipline into separate spreadsheets and that this data was neither accessible nor particularly comprehensible to parents. Nor can the SIMs computer system import other file types like Word documents, pictures etc. Families also want both cutting edge medical support and continuing and expanded relationships with PTs, OTs, dieticians, respiratory therapists and other allied professionals. We are very excited about this family centred initiative and plan to hold a design contest to create an extremely functional 'binder' that could be used by other teams in the hospital. We will be able to share more over the coming months.

New APN in the CCCU assists families and staff

If there is one missing patient support that sums up the difference between a ward and an ICU it is the lack of Nurse Practitioners. These highly trained nurses really get to know your child and feed this textured patient and family information to medical staff. Nursing staff are very excited that Linda Fazari has been rotated from 4 into the ICU as a new Adanced Practise Nurse role in the CCCU to float where needed; staff joke that Linda is now "taking patients" as she regularly follows several patients and families. The experience, knowledge of 4, non-rotating presence and ability to assist both families and other staff was hailed by fellow nurses who shared this exciting initiative.

Parent coffee group extends from 4D to CCCU

I was very happy to hear the 4D parent coffee group, started by social worker Ruta Niedra and colleagues in 2006 will now be extended to the CCCU. Yeah!! Currently about 5-8 parents participate each Friday afternoon and a social worker organizing the groups described the parent ability to air concerns and share information as nipping problems in the bud. Parents are given a feedback sheet to fill out before they leave. It is fantastic news that CCCU parents can talk with other parents in a staff supported environment.


Other Initiatives:

* CCCU is exploring having a nurse who initially meets the family continue to checkin on the patient and family to offer communication and contact consistency. This Contact Nurse will be of particular help to long stay patients and patients facing great uncertainty and their families assimilating lots of new information and getting comfortable with a new team.

* the CCCU welcome binder is to be updated and staff are updating cardiac articles at AboutKidsHealth.

* the Labatt Family Heart Centre "Family Day" will be held in September

* a Transition Day event to support patients approaching adult care will be held in May