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be implemented within the ICU setting by anymember of staff, regardless of nursing skill mix oravailability of medical staff. The weaning frame-work was structured according to best practice ofavailable research articles.

The literature on weaning from mechanical ven-tilation was reviewed from 1998 to 2010 by thedatabases Medline, Proquest and CINAHL. The key-words used were: mechanical ventilation, weaning,protocol and Dysfunctional Ventilatory WeaningResponse.

After thorough review of the literature, amethod was created approaching weaning ina holistic, multidisciplinary manner. This con-sisted of specific pre-weaning criteria, dailyspontaneous breathing trials and contingenciesfor patients requiring long-term ventilation andtracheostomies. Consultation and approval forimplementation of the framework was granted bythe Director, Assistant Director and Nurse Unit Man-ager of the Wesley ICU.

Ventilatory weaning is a multifaceted problemthat is very complex. Through a full literaturereview and revision of best practice, a frameworkwas created to meet these challenges. This enabledthe nursing staff and the ICU healthcare team toprovide a high standard of care and achieve the bestpossible outcomes and inspired the production of apaper.

doi:10.1016/j.aucc.2011.12.034

Use of respiratory pattern monitoring in longterm weaning: A comparison of Scottish andGreek nurses

K. Kydonaki

University of Edinburgh, United Kingdom

Observation and management of mechanicalventilation is a daily routine of critical care nursesand is particularly important for long-term venti-lated patients. Prompt and accurate identificationof the patient’s ability to sustain reduction of ven-tilatory support has the potential to increase thelikelihood of successful weaning. Nurses’ role inprocessing information during the ventilation wean-ing trajectory has not been well described. The aimof this paper is to describe how critical care nursesuse respiratory pattern monitoring to inform theirdecision-making process as they wean patients fromlong-term ventilatory support.

Eight Scottish and five Greek nurses, who cared

for long-term ventilated patients during the wean-ing process, were recruited from two tertiaryintensive care units. Reflective interviews that

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Papers and Poster Abstracts

ocused on respiratory assessment were conductedt the end of the shift. Concept attainment the-ry was used to guide the mapping of the contentnd processes used by nurses during their decision-aking. Ethics approval and informed consent were

btained.Scottish and Greek critical care nurses adopted

imilar decision-making strategies, despite differ-nces in their experience. They acquired a wideariety of data, which they clustered around eightoncepts descriptive of the patient’s ability toean. Gas exchange, work of breathing and levelf consciousness were the most common concepts.ocusing decision-making strategies were used toeduce the mental strain of the decision task.

Understanding how critical care nurses usessessment information to direct patient careill allow development of strategies designed to

mprove skills in making accurate and high-qualitylinical decisions in weaning management.

oi:10.1016/j.aucc.2011.12.035

nterventions to meet family needs of criticallyll patients in an adult intensive care unit: A sys-ematic review

. Kynoch 1,2,3,∗, A. Chang 1,2,3, F. Coyer 3

Nursing Research Centre, Mater Health Services,ustraliaQueensland Centre for Evidence Based Nursingnd Midwifery, AustraliaInstitute of Health and Biomedical Innovation,ueensland University of Technology, Australia

Introduction: Attending to the needs of familyembers of critically ill patients is an important

nd necessary step in providing appropriate careor both the patient and the family.

Objectives: The objective of this systematiceview was to establish best practice in address-ng the needs of family members with a relativedmitted to an adult critical care unit.

Methods: An extensive search of the majoratabases was conducted. The search includedublished and unpublished studies and papers innglish from 1980 to 2010. This review consid-red any quantitative comparative research studieshat evaluated the effectiveness of interventionsddressing family needs of critically ill patients indult intensive care units. Each included study wasssessed by two independent reviewers and dataas extracted using standardised critical appraisal

nd data extraction tools.

Results: Fourteen studies and one dissertationet the inclusion criteria and were included in the

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eview. Interventions including: the use of supportroups for family members of patients admitted ton intensive care unit, structured communicationnd/or education programs for family members,he use of leaflets or brochures to meet family infor-ation needs and open or more flexible visiting

ours were found to have some evidence to supportheir use.

Conclusion: This review makes several recom-endations for clinical practice to address family

eeds of patients admitted to critical care unitsnd identifies the need for further research. Futurentervention studies focusing on family needs couldnclude: the use of technology for informing fam-lies and interventions specifically designed tomprove family satisfaction.

oi:10.1016/j.aucc.2011.12.036

mplementing the modified early warning scoreMEWS), the need and effectiveness of trainingsers as part of the implementation process

. Ludikhuize 1,∗, D. Dongelmans 1, E. De Jonge 2

Academic Medical Center, The NetherlandsLeiden University Medical Center, Theetherlands

Introduction: This study is part of the multi-enter Cost and Outcome analysis of Medicalmergency Teams (COMET) trial, which analysesffectiveness and costs of Rapid Response SystemsRRS) in the Netherlands. As part of the train-ng prior to introduction of the RRS, a survey andritten exam were administered to nurses andhysicians of 14 hospitals.

Objectives: To analyse perceptions of normalhresholds for vital parameters and post-trainingxam results.

Methods: Nurses and physicians were instructedn the background of RRSs and especially in theodified Early Warning Score (MEWS) during a0 min training. Pre-training, participants filled outquestionnaire to investigate perceptions of nor-al thresholds for vital parameters. Post-training,written test which included four patient cases inhich the MEWS needed to be applied was admin-

stered.Results: 1755 pre-training questionnaires were

ollected. A median of 90% was scored for thebottom) threshold for haemoglobin saturation andpper and lower thresholds for respiratory rateere 22 and 10 per minute. Analysis of the post-

raining test indicated that 3% of respondentscored 100%. An additional 43% scored 3 out of 4uestions and 3% had no correct answers.

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Conclusion: Important differences werebserved between respondents in respect toerceptions regarding ‘‘normal values’’ for someasic, yet important, vital parameters. Togetherith results of the post-training test, it must beoncluded that the use of the MEWS instrumentven in the general ease of a classroom is trouble-ome. This could have important implications forhe effectiveness of RRSs as a whole.

oi:10.1016/j.aucc.2011.12.037

vidence of suboptimal recognition of deteriorat-ng patients on medical nursing wards is presentith contradicting perceptions of good quality ofare

. Ludikhuize 1,∗, S. de Rooij 1, S. Smorenburg 1, M.ans-Langelaar 1, E. de Jonge 2, D. Dongelmans 1

Academic Medical Center, Amsterdam, TheetherlandsLeiden University Medical Center, Leiden, Theetherlands

Introduction: Adverse events including car-iopulmonary arrests (CA) and unplanned ICUdmission are preceded by clear and detectableigns of deterioration. At this moment, no evidences present which factors interfere with care pro-ided in the hours prior an event.

Objectives: To identify perceptions of careroviders and possible presence of delay in theecognition of deteriorating patients compared ton expert panel.

Methods: Between April and July 2009, all CAsnd unplanned ICU admissions from six medicalursing wards were included. The care providersnurses and physicians) taking care for theseatients in the previous twelve hours were ques-ioned regarding the event circumstances. Expertsvaluated each case for the presence of delay inecognition.

Results: Forty-seven patients and 198 interviewsere analyzed. Forty care providers (20%) did notxperience any worries regarding the clinical con-ition of the patient. Care providers rated theirnowledge and skill level at 8 (IQR 7.5—8 and—8, respectively). Nurses appointed themselves asoordinator of care in 72% compared to residents in3% of cases. Communication and quality of coordi-ation were both rated at 8 (IQR 7—8). Presence ofelay in recognition was recognized in 21% of casesccording to the care providers compared to 60% by

xperts.

Conclusion: Care providers mostly rate theirare provided to patients in the hours preceding a