Background and Aims

There is an increasing number of chronic critically ill (CCI) patients in pediatric intensive care unit (PICU). Due to the complexity of care, efficient interprofessional collaboration is paramount but to date the evidence is scare.

The aim of this study is to describe the extend of interprofessional collaboration amongst PICU teams when working with CII patients and their families and to identify the predictors of good interprofessional collaboration.

Methods

This observational study took place in eight Swiss PICUs. All healthcare professionals working in PICU for at least three months and caring for CCI children were invited to participate in an online survey. It included sociodemographic and professional characteristics as well as the multidimensional Assessment of Interprofessional Team Collaboration Scale II. Items of the domains of partnership, cooperation, and coordination were rated on a Likert scale from 1 (the lowest) to 5 (the highest). Descriptive and regression analyses were performed.

Results

458 questionnaires were completed from 8 PICUs (45% Response rate). The majority of the participants were nurses (60%) and physicians (20%), female (88%), specialized in PICU (73%) and working fulltime (54%). The mean total collaboration score was 3.60 ±0.51, for partnership 3.75 ±0.57, for cooperation 3.74 ±0.50, and for coordination 3.28 ±0.65. Regression analyses shows the medical profession was the only predictor of better interprofessional collaboration (Coef. 0.28 (SE.08) p=0.001).

Conclusions

Overall there is room for interprofessional collaboration improvement, especially in the coordination domain. The whole team would benefit from clarification about what it really means working together. Interprofessional critical care education is warranted.

Background and Aims

Background and aims: Inappropriate interprofessional collaboration (IPC) may contribute to sub-optimal pediatric pain management, but evidence is scarce in this context. To evaluate healthcare professionals’ perceptions of IPC in their pain practice and to assess relations between sociodemographic data and perceived IPC.

Methods

Methods: This observational study included a convenience sample of healthcare professionals from medical, nursing, and allied health, working for at least three months in a university hospital in Switzerland, and caring for children aged between 1 and 18 years. Participants responded to the Assessment of Interprofessional Team Collaboration Scale II, which includes three dimensions: partnership, cooperation, and coordination rated on a Likert scale (from 1 (the lowest) to 5 (the highest)). Descriptive and correlational analyses were performed. Four open-ended questions were added at the end of the questionnaire to allow participants to share additional reflections on IPC and pediatric pain management.

Results

Results: A total of 140 participants from five professions were included (response rate 45%). The mean AITCS-II score was 3.77 (SD 0.61). The mean score for partnership was 3.83 (SD 0.69), for cooperation 4.05 (SD 0.50), for coordination 3.43 (SD 0.82). Physicians perceived a higher degree of IPC when compared to nurses (4.08 (SD 0.49) and 3.59(SD 0.61), p = 0.006, respectively). Thirteen themes emerged from content analysis, revealing a need in IPC training and new measures for assessing child pain.

Conclusions

Conclusions: Our results show that IPC overall is suboptimal, especially in the partnership and the coordination domains. IPC should be improved to avoid unnecessary children’s suffering.

Background and Aims

ESPNIC recommends using validated tools to assess pain, sedation, delirium, and withdrawal in PICUs. However, international surveys revealed worldwide variation in their application. A strategy to improve uptake is to incorporate measurement instruments into algorithms (flow charts) to support decision-making. This review synthesized the evidence on the development, implementation and outcomes of algorithms for assessing either pain, sedation, delirium and/or withdrawal in pediatric critical care.

Methods

We followed the five-step Whittemore and Knafl integrative review methodology. CINAHL, PubMed, Embase, Cochrane library, and grey literature were used to identify studies in English or French and published since 2005, that implemented algorithms in PICUs. Two independent reviewers selected studies using predetermined criteria. Quality for development and implementation was assessed using selected items from the AGREE II instrument. These quality scores ranged from 0% (lowest quality) to 100% (highest quality).

Results

Twenty-nine algorithms (33 articles) from 3087 citations were included. Algorithms related to pain (9%), sedation (21%), delirium (6%), withdrawal (18%), or combinations (46%). Preliminary results indicate that 58% of included studies had positive impact on patient outcomes and another 58% improved adherence to elements of the algorithm (e.g. assessment). The content used for algorithm development was primarily not referenced, with 53% including a statement “based on the literature”, 30% derived their algorithm from another, while 17% used clinical practice guidelines. The average quality score for both development and implementation was 20%.

Conclusions

This review shows the lack of methodological rigour in algorithm development. There is insufficient evidence for their implementation in PICUs.

Background and Aims

Background and aims: Inappropriate interprofessional collaboration (IPC) may contribute to sub-optimal pediatric pain management, but evidence is scarce in this context. To evaluate healthcare professionals’ perceptions of IPC in their pain practice and to assess relations between sociodemographic data and perceived IPC.

Methods

Methods: This observational study included a convenience sample of healthcare professionals from medical, nursing, and allied health, working for at least three months in a university hospital in Switzerland, and caring for children aged between 1 and 18 years. Participants responded to the Assessment of Interprofessional Team Collaboration Scale II, which includes three dimensions: partnership, cooperation, and coordination rated on a Likert scale (from 1 (the lowest) to 5 (the highest)). Descriptive and correlational analyses were performed. Four open-ended questions were added at the end of the questionnaire to allow participants to share additional reflections on IPC and pediatric pain management.

Results

Results: A total of 140 participants from five professions were included (response rate 45%). The mean AITCS-II score was 3.77 (SD 0.61). The mean score for partnership was 3.83 (SD 0.69), for cooperation 4.05 (SD 0.50), for coordination 3.43 (SD 0.82). Physicians perceived a higher degree of IPC when compared to nurses (4.08 (SD 0.49) and 3.59(SD 0.61), p = 0.006, respectively). Thirteen themes emerged from content analysis, revealing a need in IPC training and new measures for assessing child pain.

Conclusions

Conclusions: Our results show that IPC overall is suboptimal, especially in the partnership and the coordination domains. IPC should be improved to avoid unnecessary children’s suffering.

Background and Aims

There is an increasing number of chronic critically ill (CCI) patients in pediatric intensive care unit (PICU). Due to the complexity of care, efficient interprofessional collaboration is paramount but to date the evidence is scare.

The aim of this study is to describe the extend of interprofessional collaboration amongst PICU teams when working with CII patients and their families and to identify the predictors of good interprofessional collaboration.

Methods

This observational study took place in eight Swiss PICUs. All healthcare professionals working in PICU for at least three months and caring for CCI children were invited to participate in an online survey. It included sociodemographic and professional characteristics as well as the multidimensional Assessment of Interprofessional Team Collaboration Scale II. Items of the domains of partnership, cooperation, and coordination were rated on a Likert scale from 1 (the lowest) to 5 (the highest). Descriptive and regression analyses were performed.

Results

458 questionnaires were completed from 8 PICUs (45% Response rate). The majority of the participants were nurses (60%) and physicians (20%), female (88%), specialized in PICU (73%) and working fulltime (54%). The mean total collaboration score was 3.60 ±0.51, for partnership 3.75 ±0.57, for cooperation 3.74 ±0.50, and for coordination 3.28 ±0.65. Regression analyses shows the medical profession was the only predictor of better interprofessional collaboration (Coef. 0.28 (SE.08) p=0.001).

Conclusions

Overall there is room for interprofessional collaboration improvement, especially in the coordination domain. The whole team would benefit from clarification about what it really means working together. Interprofessional critical care education is warranted.