British Association of Critical Care Nurses Conference

Brighton September 17th - 19th


The conference hosted a number of workshops and presentations that shared innovation and good practice, with the end of the conference focusing on the patient experience and perspective on critical care.  MRSA Action UK were given an opportunity to share the personal experiences of how the contraction of a healthcare infection can leave a lifetime legacy, with a powerful presentation and panel discussion.  This precis of events focuses on links with the patient experience, with patient involvement and empowerment coming to the fore, examining the professionals' perception of the patient experience was of particular interest.  Some events described and researched demonstrated a close affinity with our own members' experiences, and we would like to thank the organisers for the opportunity to give the patient perspective at this event.


Barriers and levers to the promotion of excellence and the achievement of innovation,  Professor Julie Scholes


Professor Scholes' presentation sent a stark message on some of the barriers that promoted excellence and the achievement of innovation, which examined what constitutes innovation and excellence and examined why it was that the sustainability of implementing innovative projects was so problematic.


The lever the Critical Care profession had was a shared vision and a culture of really caring that promotes innovation and good practice.


Why was innovation relative and short-lived?


Constant restructuring and changing agendas, cuts in services often meant that the very people who were providing innovation and excellence were finding their jobs under threat.


Modernising agendas such as public involvement in NHS Governance, education and research and how the profession deal with the patient on discharge and through the patient journey.


There were fiscal challenges, and there needed to be a focus on the culture of the organisation as well as the systems that were constantly changing.


Some of the impediments could be summarised as:

  • Operational fire fighting
  • Too much of a focus on systems rather than people
  • Lack of empowerment
  • Budgetary
  • Cuts and service decommissioning
  • Shift to Primary Care setting
  • Governance with Trust and Strategic Health Authority reorganisation
  • Out of hours services - may not be medically driven


In lobbying there was a need to look at the impact on discharging patients

Examine the nurse patient interaction

Look at where savings can be made elsewhere (for example healthcare infections)

Engage in participative consultation


Professor Scholes' presentation and discussion gave a valuable opportunity to air some of the issues that affect staff on a daily basis, and the closing part of the presentation was very poignant highlighting the caring culture of the profession.


Patients' Perspective of Critical Care and After Care

Dr Cheryl Crocker


This patient study was completed in 2003/04 assessing 103 patients over a 4 year period, patients in the study had spent 4 days or more in a critical care setting.  Some of the findings which were of particular interest showed that 36% of patients "wished they knew more", 32% knew what was happening most of the time and 65% were aware that someone was near.  Asked what was the best aspect of their critical care, being looked after and feeling safe was important, the worst included having a dry mouth and always wanting cold water to drink.


Two months after discharge post-traumatic stress increased in six out of seven cases - only two patients were offered follow-up.


What does this mean to the patient, what should the critical care profession be doing?  The hospital has no access to a clinical psychologist.


Post critical care symptoms include weakness, fatigue, and lack of mobility, breathlessness, hallucinations, depression and anxiety.  The study showed there was little support to patients after discharge, and they have quite high expectations about how they are going to feel.


Where post-traumatic stress exhibits up to six months after critical care there is some correlation with the length of time it took patients to recover, for example if there were complications with infections.


The challenge was to develop an appropriate intervention to optimise recovery in critical care patients (ie the longer they take to recover versus the "better" experience the less likely post-traumatic stress occurs).


Further research including the keeping of diaries is under way.  Scotland and Reading are undertaking studies on interventions.


The study showed there was a need for a delirium screening tool (importance of nursing notes when patients were moved to the ward).  NICE were looking at rehabilitation guidelines.


End of Life Care Practice within ICU

Laura Clinton


This study came after the consultation paper "Building on the Best, Choice Responsiveness and Equity in the NHS" (DoH 2003),

setting out how the Government proposed to make NHS services more responsive to patients needs.


The 3 tools used in End of Life Care are:

  • Gold standard
  • Preferred Place of Care
  • Liverpool Care Pathway

The Liverpool Care Pathway was now being used widely across hospital trusts. 


19.5% of patients died in ICU in 2005 - Intensive Care National Audit & Research Centre (ICNARC)


Interventions examined in the study were difficult to clarify, as the data used in the research was taken from patient notes, therefore limitations on how much was recorded impact on the findings.


Communication with families was difficult to quantify, assessing 23 patients medical notes 96% of families were spoken to by the ICU doctors, only 4% of nurses were involved in the discussion.


Many of the interventions to make the patients end of life humane varied, invasive monitoring and record keeping varied so the statistics are not robust, however the research suggests that 20-30% of patients had no pain relief.  Should we be doing this more systematically the way the Americans regulate the end of life care pathway?




There was a need to improve and standardise the end of life process

And a need to communicate better between disciplines and with relatives


A Healthcare Infection

A life time legacy

Presentation by MRSA Action UK


The last session at the conference gave an overview of MRSA in the Critical Care setting exploring current trends and implications for practitioners.  Following the introduction by David Tucker (Deputy Director, Infection Prevention and Control) Derek Butler gave an account of the impact the death of his stepfather from MRSA has had on his family, and the effect of acquiring a healthcare infection has had on many of the people who have come to MRSA Action UK for support.  The powerful presentations show the impact on everyone affected by the legacy of some of the more serious infections that are occurring in the modern healthcare setting.


Whoever you are, namely patient, carer, dependant, or healthcare worker, the aftermath that healthcare infections leave behind can leave a lifetime legacy.


The presentation outlined the responsibility that Healthcare workers have to not only those they are treating in their care, but also the duty of care that they have to the family of those they are caring for.  It was powerful showing delegates how families have been changed beyond all recognition and how the legacy of these infections will last a lifetime.


As a Charity we believe that to do nothing would be to discharge our responsibility to society, and to accept what some think is inevitable in our hospitals would be a betrayal. The presentation outlined how important it is to involve the patient and their family in the care of someone who has acquired the increasingly prevalent infections such as MRSA and Clostridium Difficile, rather than shut the patient out and put up a wall of silence.  The powerful conclusion shows that a change in culture is needed, we should not rely on antibiotics to fight the infections that have harmed so many people, if we do we will leave a legacy of no reliable treatment for our future generations.

















Derek Butler

20th September 2007