Critical illness rehabilitation rehabilitation checklist by MikeJenny

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       Critical illness rehabilitation checklist for healthcare professional(s)* coordinating the patient’s
                                           rehabilitation care pathway

Patient’s name:                                                                                           ID number:
Healthcare professional(s):                                                                               Date of admission to critical care unit:
Patient pathway         Measure                                                                                         (Circle or highlight)       Date and                 Comments
                                                                                                                                                    signature
During the                        Short clinical assessment completed (see table 1 below)                              Yes          No
                             
                                                             1
critical care                      Patient given information                                                            Yes          No
stay                              Information given more than once during the patient’s critical                       Yes          No
                                   care stay
                                  Patient at risk                                                                      Yes          Low risk
If patient at risk
                                  Comprehensive clinical assessment completed                                          Yes          No
                                  Short-term and medium-term rehabilitation goals agreed                               Yes          No
                                  Rehabilitation started as early as clinically possible                               Yes          No
                        Rehabilitation included:
                             1. measures to prevent avoidable physical and non-physical                                 Yes          No
                                morbidity (including review of previous and current medication)
                             2. nutrition support                                                                       Yes          No
                             3. an individualised, structured rehabilitation programme with
                                frequent follow-up reviews.                                                             Yes          No

                                                       Review 1 completed                                              Yes          No
                                                       Review 2 completed                                              Yes          No
                                                       Review 3 completed (as required).                               Yes          No

1
  Information about: the patient’s critical illness, interventions and treatments; the equipment used during the patient’s critical care stay; and if applicable, any possible short-term and/or long-term
physical and non-physical problems which may require rehabilitation. All the above should be given to the patient more than once during their critical care stay and should also be given to their
family and/or carer, unless the patient disagrees.


                                                                         Rehabilitation after critical illness checklist 1
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Patient pathway         Measure                                                                                        (Circle or highlight)     Date and                 Comments
                                                                                                                                                 signature
Before                           Short clinical assessment completed if patient previously                            Yes         No
discharge from                    identified as low risk
                             
                                                            2
critical care                     Patient given information                                                            Yes         No
                                 Patient given the contact details of the healthcare                                  Yes         No
                                  professional(s)
                                 Patient at risk                                                                      Yes         Low risk
If patient at risk, or if started individualised rehabilitation programme in critical care
                             Comprehensive clinical reassessment completed                                            Yes         No
                             Rehabilitation goals agreed, reviewed and updated                                        Yes         No
                        Particular attention paid to:
                             1. physical, sensory and communication problems                                           Yes         No
                             2. underlying factors such as psychological or psychiatric distress                       Yes         No
                             3. symptoms that developed during critical care stay such as                              Yes         No
                                delusions, anxiety or nightmares
During ward-                     Short clinical assessment completed if patient previously                            Yes         No
based care                        identified as low risk
                                 Patient at risk                                                                      Yes         Low risk
If patient at risk
                                 Comprehensive clinical reassessment completed                                        Yes         No
                                 An individualised, structured rehabilitation programme offered                       Yes         No
                                 The individualised, structured rehabilitation programme                              Yes         No
                                  developed and delivered by members of a multidisciplinary
                                  team
                                 A structured and supported self-directed rehabilitation manual                       Yes         No
                                  offered, based on clinical judgement and the individual
                                  patient's rehabilitation needs, if applicable



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  Information about: the rehabilitation care pathway; differences between critical care and ward-based care including the differences in the environment, and staffing and monitoring levels; and the
transfer of clinical responsibility to a different medical team (this includes the formal structured handover of care recommended in ‘Acutely ill patients in hospital’ (NICE clinical guideline 50). If
applicable: emphasise possible short-term and/or long-term physical and non-physical problems that may require rehabilitation; and give information about sleeping problems, nightmares and
hallucinations and the readjustment to ward-based care. The information should also be given to their family and/or carer, unless the patient disagrees.

                                                                        Rehabilitation after critical illness checklist 2
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Patient pathway         Measure                                                                                      (Circle or highlight)      Date and                Comments
                                                                                                                                                signature
Before                           Functional assessment completed if the patient was receiving                       Yes          No
discharge to                      an individualised rehabilitation programme. This includes
home or                           physical and non-physical dimensions (see table 2 below)
community                        Rehabilitation goals reviewed, updated and agreed with the                         Yes          No
                                  patient
                                 Patient given the contact details of the healthcare                                Yes          No
                                  professional(s)
                                 Information, including documentation such as this checklist,                       Yes          No
                                  communicated as appropriate to any other healthcare settings
                                                                 3
                                  and the patient or their carer
At 2–3 months                    The patient reviewed and a face-to-face functional assessment                      Yes          No
after critical                    completed, based on the first functional assessment
care discharge                   Patient referred to appropriate rehabilitation or specialist                       Yes          No
                                  services if recovering at a slower rate than anticipated or if the
                                  patient has developed unanticipated physical and/or non-
                                  physical morbidity that was not previously identified
                                 Information, including documentation such as this checklist,                       Yes          No
                                  communicated as appropriate to any other healthcare settings
                                  and the patient or their carer




* The healthcare professional(s) may be intensive care professional(s) or, depending on local arrangements, any appropriately trained
healthcare professional(s) from a service (including specialist rehabilitation medicine services) with access to referral pathways and medical
support (if not medically qualified).

This checklist can be used as part of a trust’s clinical audit process – see NICE audit support tool.


3
 Information about: their physical recovery, based on the goals set during ward-based care if applicable; diet and any other continuing treatments; how to manage activities of daily living including
self-care and re-engaging with everyday life; driving, returning to work, housing and benefits; local statutory and non-statutory support services, such as support groups. General guidance,
especially for the family and/or carer, on what to expect and how to support the patient at home. This should take into account both the patient’s needs and the family’s/carer’s needs. Give the
patient their own copy of the critical care discharge summary. The information should also be given to their family and/or carer, unless the patient disagrees.
                                                                       Rehabilitation after critical illness checklist 3
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Table 1: Examples from the short clinical assessment that may indicate the patient is at risk of developing physical and
non-physical morbidity

 Physical                       Unable to get out of bed independently.
                                Anticipated long duration of critical care stay.
                                Obvious significant physical or neurological injury.
                                Lack of cognitive functioning to continue exercise independently.
                                Unable to self ventilate on 35% of oxygen or less.
                                Presence of premorbid respiratory or mobility problems.
                                Unable to mobilise independently over short distances.

 Non-physical                   Recurrent nightmares, particularly where patients report trying to stay awake to avoid nightmares.
                                Intrusive memories of traumatic events which have occurred prior to admission (for example, road traffic accidents) or during
                                their critical care stay (for example, delusion experiences or flashbacks).
                                New and recurrent anxiety or panic attacks.
                                Expressing the wish not to talk about their illness or changing the subject quickly off the topic.
Note: This list is not exhaustive and healthcare professionals should use their clinical judgement.




                                                                Rehabilitation after critical illness checklist 4
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Table 2: Symptoms from the functional assessment that may indicate the presence of physical and non-physical
morbidity
 Physical dimensions
 Physical problems              Weakness, inability/partial ability to sit, rise to standing, or to walk, fatigue, pain, breathlessness, swallowing difficulties,
                                incontinence, inability/partial ability to self-care.
 Sensory problems               Changes in vision or hearing, pain, altered sensation.
 Communication                  Difficulties in speaking or using language to communicate, difficulties in writing.
 problems
 Social care or                 Mobility aids, transport, housing, benefits, employment and leisure needs.
 equipment needs
 Non-physical dimensions
 Anxiety, depression and        New or recurrent somatic symptoms including palpitations, irritability and sweating; symptoms of derealisation and
 PTS-related symptoms           depersonalisation; avoidance behaviour; depressive symptoms including tearfulness and withdrawal; nightmares, delusions,
                                hallucinations and flashbacks.
 Behavioural and                Loss of memory, attention deficits, sequencing problems, deficits in organisational skills, confusion, apathy, disinhibition,
 cognitive problems             compromised insight.
 Other psychological or         Low self-esteem, poor or low self-image and/or body image issues, relationship difficulties, including those with the family
 psychosocial problems          and/or carer.
Note: This list is not exhaustive and healthcare professionals should use their clinical judgement.



This checklist should be used in conjunction with the clinical guideline on rehabilitation after critical illness and the results of the assessments
should be recorded in the patient’s clinical records. For further information about the guideline please visit: http://www.nice.org.uk/CG83




                                                                Rehabilitation after critical illness checklist 5

								
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