Pre Admission Orientation Program for Elective Adult ICU Patients

By LAI Kam Wai, RN, BSN, MN, FHKAN (Cardiac) 
Hong Kong Sanatorium & Hospital

Purpose

The purpose of this evidence-based practice project was to evaluate the impact of an intensive care unit (ICU) orientation program for patients electively admitted to the adult ICU. The goal was to improve patient and family satisfaction scores upon discharge from the ICU. 

Background

Most patients electively admitted to Hong Kong Sanatorium & Hospital adult ICU and their relatives stated that there was insufficient information provided about the ICU environment and the patient’s immediate post-operative condition. It is common for patients and their families to worry about the critical care environment and access to support before admission. This rapid-cycle small test of change was launched with the premise that patient anxiety and depression could be allayed if they were provided more pre-operative information prior to ICU admission.

Methods

An ICU orientation program in PowerPoint format was developed for craniotomy and cardiothoracic surgery patients. The orientation program primarily introduced ICU admission and discharge policy, the ICU setting, medical equipment, routine and ward schedule. Secondly, the pain management program and specific nursing care for two different types of operation were explained. Lastly, psychological support and modes of communication for better understanding of patient’s condition were provided to patient families. After the orientation program was developed, patients and their families were interviewed, the purpose of the program was explained and the program was presented. The session was concluded with an opportunity to answer any questions. 

Results

Patient satisfaction was assessed via a survey. Prior to launch of the orientation program, five cases (5 patients and their families) completed the survey. The average satisfaction score was 3.3 (out of 5). The same satisfaction survey was completed by eight cases that completed the orientation program. Their average satisfaction score was 4.4 (out of 5). 

Discussion

Satisfaction score improved by 1.1 with implementation of the orientation program. Most of the cardiothoracic cases (patients and families) found the ICU orientation program to be helpful. Most of the relatives felt safer to leave the patient in the ICU with an understanding that their loved one would be closely monitored. Information provided by the doctor about immediate post-operative care and treatment plan was sufficient, but there was still opportunity for improvement after the orientation program. Many patient questions remained despite the successful implementation of the orientation program. Further questions about post-operative care and rehabilitation resulted in more time for explanation.

Implications/Conclusion

With consideration to develop a sustainable project, the orientation program was divided into two parts. The first part was ICU core general information and the second part was specific information for two different operations. The whole ICU orientation program was uploaded to the patient console for easy access before operation. It may also serve as a useful resource for general ward nurses. Additional program growth could include follow up visits to increase patient satisfaction and ensure effectiveness of post-operative care. This may be considered as the program personnel increase.