ABSTRACT
BACKGROUND AND AIM: Widely-implemented restricted family presence (RFP) policies/practices during the COVID-19 pandemic were counter to family centered values embraced by many PICUs. This study explored the impact of implementing and enforcing these policies on Canadian PICU clinicians. METHOD(S): Cross-sectional survey of Canadian PICU clinicians. We developed an online, self-administered, survey to assess 1. Family presence policy and practice changes;2. Experience and opinions;3. Moral distress (Moral Distress Thermometer);and 4. Impact (Impact of Event Scale [IES] and attributable stress [5-point Likert scale]). Analysis included descriptive statistics, t-tests, one-way ANOVA;biand multi-variable stepwise regression assessed correlations. RESULT(S): Of 388 respondents representing 17/19 PICUs, 368 (94.1%) indicated that they experienced RFP policies and were predominantly female (n=333, 90.7%), English speaking (n=338, 91.8%), and RN (n=240, 65.2%). Incongruence between RFP policies/practices and PICU values was perceived by 66% (n=217). Most (n=235, 71%) felt their opinions were not valued when implementing policies. Though restrictions were perceived as beneficial to clinicians (n=252, 76%) and families (n=236, 75%), and 52% (n=171) felt RFP made their work easier, 57% (n=188) disagreed that their RFP experience was mainly positive. The median (IQR) reported moral distress was 5 (2-6) (n=307, scale 0-10);the strongest predictor was perception of differential impact of RFP on families. The mean (SD) total IES score (n=290, 78.8%) was 29.7 (10.5), suggesting moderate traumatic stress. For 56% (n=176) there was increased/significantly increased attributable stress. CONCLUSION(S): PICU-based RFP rules, designed and implemented without clinician input, caused increased emotional burden.
ABSTRACT
BACKGROUND AND AIM: Due to the COVID-19 pandemic, restricted family presence (RFP) policies were rapidly developed and implemented. PICU leadership was instrumental in dissemination, clarification, and policy enforcement. However, the experience of PICU leaders has not been explored. This study examines the lived experience of physician leads and operational/clinical managers with RFP policies and practices in the PICU. METHOD(S): Qualitative descriptive study. We invited physician leads and managers from all Canadian PICUs to participate in telephone or virtual, audio-recorded, semi-structured interviews, which were transcribed. We performed inductive content analysis: three researchers generated a codebook, two independent coders met regularly to compare codes and refine the codebook, and three researchers organized the data into themes. RESULT(S): We interviewed 9 managers and 15 physician leads from 13 Canadian PICUs. We identified 6 main themes. (1) Operationalizing the policies required enhancement and adaptation of usual leadership roles while (2) working in the middle of organizational hierarchy. (3) The RFP policies made explicit the need to balance stakeholder safety with compassion in caring for the sickest children. (4) Most PICU leaders perceived unintended effects of the RFP policies as having a negative impact on families, healthcare providers, and family centered care. (5) Implementing, communicating, and enforcing restrictions took personal tolls on many of the leaders. (6) Leaders recognized multiple opportunities for policy improvements. CONCLUSION(S): RFP policies had significant professional and personal impacts on PICU leaders, who identified both unintended consequences of and future opportunities for restricted presence policies.
ABSTRACT
BACKGROUND AND AIM: In response to the COVID-19 pandemic, multiple Canadian PICUs restricted presence to one caregiver. Though patients could receive support, sources of caregiver support were limited. We sought to examine caregiver support during PICU admission under restricted family presence policies. METHOD(S): We conducted a cross-sectional survey of caregiver experience with restriction policies in Canadian PICUs. Support, or lack thereof, emerged as a dominant theme. Hence, in this sub-study, open-ended questions were analyzed using inductive content analysis, focusing on the concept of support. Likert-scale questions related to being alone at a PICU bedside were summarized using descriptive statistics. RESULT(S): 250 respondents experienced restriction policies (Mean [SD] age 38.8[8.4] years;226[91%] primarily Englishspeaking;230[92%] post-secondary education;208[83%] in a maternal role). Of 187 responses referring to the most difficult aspects of RFP policies, 84 (45%) addressed lack of support. Respondents felt alone in facing the admission and its associated experiences (n=32). RFP resulted in unmet needs for: emotional/moral support (n=42);a specific person's presence (n=28);and respite (n=10). Lack of support impaired medical care, communication, and decisionmaking (n=23). Weighted for strength of agreement, the top situation in which respondents were alone and both wished for a support person (n=9, 81.8%) and felt it was traumatic being alone (n=6, 85.7%) was when their child died. Nonweighted, the highest agreement was when the child's condition worsened (n=99 [89.2%] "wanted support" and n=94 [87.8%] "it was traumatic"). CONCLUSION(S): Restricted family presence policies in PICUs limited caregivers' access to social support systems, resulting in unmet needs and traumatic experiences.
ABSTRACT
Background: During the first wave of the COVID-19 pandemic, an increased need for critical care pharmacist (CCP) coverage in the two medical/surgical intensive care units (ICUs) at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia was identified. Description: CCP coverage was expanded in two medical/surgical ICUs from 8 hours per day, 5 days per week excluding holidays to 8 hours per day, 7 days per week including holidays. Action: Workflow within the pharmacy department was rearranged so that two CCPs, on a rotating schedule, provided dedicated clinical coverage to each ICU seven days a week. CCPs were not responsible for dispensary coverage during this time period. Evaluation: A 22 question survey was developed by the research team and distributed to all health care providers (HCP) who work in the medical/surgical ICUs. Survey questions solicited HCP perceptions and opinions on the impact of expanded CCP coverage;importance of 25 evidenceinformed CCP activities was assessed via 5-point Likert scale. Clinical pharmacist output, reported as the number of drug-therapy problems (DTPs) addressed over a 6-week period, was retrospectively evaluated. The majority of respondents agreed/strongly agreed with the following: CCP are integral members of the multidisciplinary healthcare team, CCP play an important role in improving patient outcomes, CCP presence in the unit and on patient care rounds allows HCP to concentrate on their own professional responsibilities, and that the expanded CCP coverage improved patient care. The majority of respondents categorized 23 of the 25 CCP activities as very important. During the 6-week time period, four CCPs addressed 798 DTPs for 140 discreet patients: an average of 5.7 DTPs per patient. Implications: HCPs felt that expanded CCP coverage improved patient care and that evidence-informed CCP activities were very important. Given the perceived impact of CCP in the ICU, novel staffing models are being explored to optimize CCP coverage.