Complex and challenging cases encountered by intensive care unit (ICU) healthcare professionals

QUESTION

• Describe a clinical  experience of a patient who was admitted  in the ICU who was intubated, has uncontrolled hypertension, diabetes, EGFR 15% and on dialysis from this week that left an impression on you.
• What was learned from the experience? How did this experience make you re-think your practice, attitude, or values?  What can you take forward to implement in future practice?
•  Relate this experience to a QSEN competency of Informatics—Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

ANSWER

Introduction

In the intensive care unit (ICU), healthcare professionals often encounter complex and challenging cases that leave a lasting impression. One such experience that had a profound impact on my practice occurred when caring for a patient who was admitted to the ICU with uncontrolled hypertension, diabetes, end-stage renal disease (ESRD) with an estimated glomerular filtration rate (eGFR) of 15%, and required dialysis. The patient’s condition necessitated intubation and mechanical ventilation. This essay will reflect upon the lessons learned from this experience, how it prompted a reevaluation of my practice, attitude, and values, and how the principles of informatics, specifically the QSEN competency of Informatics, played a crucial role.

Description of the Clinical Experience

The patient’s admission to the ICU presented numerous challenges. Their uncontrolled hypertension posed a risk for complications such as stroke or myocardial infarction. The management of their diabetes was complicated by their critical condition, making glucose control a priority. With a significantly reduced eGFR, the patient’s renal function was severely compromised, necessitating dialysis for fluid and electrolyte balance. The patient’s intubation and mechanical ventilation added another layer of complexity to their care, requiring constant monitoring and adjustment to optimize respiratory support.

Lessons Learned and Impact on Practice, Attitude, and Values

This experience taught me the importance of a holistic and multidisciplinary approach to patient care. The interconnectedness of the patient’s comorbidities highlighted the need for collaborative decision-making among healthcare professionals from various specialties. It emphasized the significance of effective communication, coordination, and information sharing to ensure optimal patient outcomes. Witnessing the complexity and fragility of this patient’s condition made me realize the critical role of teamwork, both within the ICU and in collaboration with other healthcare providers involved in the patient’s care.

This experience also challenged my ability to adapt to rapidly changing situations and make informed decisions. The constant monitoring and interpretation of patient data, including vital signs, laboratory results, and ventilator settings, became crucial for recognizing trends and promptly addressing any deteriorations. It reinforced the importance of staying current with evidence-based practices and utilizing technology and information systems effectively to support clinical decision-making.

Relating the Experience to the QSEN Competency of Informatics

The QSEN competency of Informatics is integral in the ICU setting, as it encompasses the use of information and technology to communicate, manage knowledge, mitigate error, and support decision-making. In this experience, informatics played a vital role in facilitating communication among the interdisciplinary team. Electronic health records allowed for real-time access to the patient’s medical history, laboratory results, and medication records, ensuring accurate and up-to-date information was available for informed decision-making.

Furthermore, informatics supported the management of complex patient data. Integration of data from various monitoring devices and systems enabled comprehensive and real-time assessment of the patient’s condition. Trend analysis and visualization tools helped identify patterns and changes that guided treatment interventions. Additionally, informatics played a critical role in mitigating errors by providing decision support systems, medication alerts, and reminders for interventions such as timely administration of medications and documentation.

Conclusion

Caring for a critically ill patient with multiple comorbidities in the ICU provided invaluable insights and learnings. It underscored the importance of a collaborative approach, effective communication, and the use of informatics to support decision-making and optimize patient outcomes. This experience prompted a reevaluation of my practice, attitude, and values, emphasizing the significance of teamwork, adaptability, and staying informed about advancements in technology and evidence-based practices. By integrating the principles of informatics into future practice, I aim to enhance patient care, promote interdisciplinary collaboration, and mitigate errors, ultimately improving patient outcomes in the ICU setting.