EXECUTIVE SUMMARY

New guidelines from the Society of Critical Care Medicine emphasize the benefits of family-centered care in the ICU. Some recommendations include:

• accommodations for loved ones to sleep;

• educational programs to teach family how to assist with care;

• encouraging family members to be part of the decision-making process.


New guidelines from the Society of Critical Care Medicine (SCCM) emphasize the benefits of family-centered care in the ICU.1

“We now know that providing family-centered care improves outcomes in families of critically ill patients long-term,” says Judy E. Davidson, DNP, RN, FCCM, EBP, lead author of the guidelines and nurse scientist at University of California, San Diego Health.

A multidisciplinary group of 29 healthcare experts developed recommendations for family-centered care based on an analysis of more than 450 studies. “ICUs may find some recommendations easier to implement than others,” Davidson acknowledges. Some recommendations include:

• educational programs to teach family how to assist with care;

• encouraging family members to be part of the decision-making process;

• accommodations for loved ones to sleep.

The design of older ICUs doesn’t allow a sleep space. “But at the very least, prior to remodeling or rebuilding, a sleep surface should be available for those who want to spend the night,” says Davidson.

“If we adhere to ‘do no harm,’ we cannot treat the family as if they are an add-on to care, or people you deal with only if you have time,” adds Davidson. Engaging families in care can decrease long-term anxiety, depression, and/or symptoms of post-traumatic stress.

“Therefore, we are duty-bound to ascribe to the principles of family-centered care,” says Davison. “These are best practices that can prevent harm.”

There are more than 11 million ICU patients each year in the United States alone. “One-third of their family members will develop mental health, physical, or social ramifications from their exposure to critical illness. We can make a big dent in that,” says Davidson.

By providing family-centered ICU care during times of crisis, says Davidson, “downstream, we can improve the health of our communities.”

Patients Want Family Involved

There is growing focus on the issue of family-centered ICU care, and more evidence-based interventions to improve it. “However, there is also compelling evidence that we often don’t provide high-quality, family-centered care,” says J. Randall Curtis, MD, MPH, professor of medicine and director of the Cambia Palliative Care Center of Excellence at University of Washington Medicine in Seattle.

The motivation for the SCCM guidelines was threefold: to summarize the existing evidence, make recommendations for best practices, and highlight areas in need of future research. “First and foremost, we know that most patients want their family members to be involved in care and supported through their critical illness,” says Curtis. In fact, many patients care as much or more about the care their family is receiving than about their own care.

Curtis cautions that family-centered care must be viewed as an adjunct to patient-centered care, not a replacement: “There are situations where what is in the best interests of the patient and the family are different. These situations need to be negotiated carefully.”

One of the recommendations of the SCCM guidelines is to use a palliative care or ethics consult team when challenging situations like this arise, to help sort out appropriate next steps. “Evidence shows that ethicists can improve care when value-ladened conflicts arise in the ICU,” notes Curtis.2 Palliative care consultants also can provide similar support.

“The most appropriate consultant will vary from hospital to hospital, depending on the resources available,” says Curtis. At UW Medicine, the team often uses palliative care consultants and ethics consultants for the same patient and family.

“We generally start with a palliative care consult to provide additional support for patients and family members, and then add an ethics consult if the conflict or distress remains unresolved,” says Curtis.

REFERENCES

1. Davidson JE, Askakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017; 45(1):103-128.

2. Schneiderman LJ, Gilmer T, Teetzel HD, et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 2003; 290(9):1166-1172.

SOURCES

• J. Randall Curtis, MD, MPH, Professor of Medicine/Director, Cambia Palliative Care Center of Excellence at UW Medicine, Seattle. Phone: (206) 744-3356. Email: jrc@u.washington.edu.

• Judy E. Davidson, DNP, RN, FCCM, Nurse Scientist, UC San Diego Health. Email: jdavidson@ucsd.edu.