NICE produces draft quality standard on rehabilitation following critical illness

Draft guidance says rehabilitation goals need setting out within four days of admission to critical care

Published on 3rd April 2017

Adults who require rehabilitation following critical illness should have their short-term rehabilitation goals agreed within four days of admission to hospital, new draft NICE guidance suggests.

A draft quality standard published by the National Institute for Health and Clinical Excellence states that adults in critical care who are at risk of physical and non-physical morbidity have short-and medium-term rehabilitation goals agreed within four days of being admitted to and before discharge from critical care.

Symptoms which may suggest someone is at risk of physical morbidity includes difficulty getting out of bed independently, an anticipated long duration of critical care stay, obvious significant physical or neurological injury, lack of cognitive functioning to continue exercise independently, difficulties in self-ventilating on 35% of oxygen or less, presence of premorbid respiratory or mobility problems and difficulties mobilising independently over short distances.

Examples that may indicate an adult is at risk of non-physical morbidity includes recurrent nightmares, particularly where patients report trying to stay awake to avoid nightmares, intrusive memories of traumatic events that have occurred before admission (for example, road traffic accidents) or during their critical care stay, new and recurrent anxiety or panic attacks or expressing the wish not to talk about their illness or changing the subject quickly to another topic.

“Setting rehabilitation goals early during the critical care stay, based on a comprehensive clinical assessment, means that rehabilitation can start as soon as possible,” said the draft standard. “Goals can then be regularly reviewed to see if they are being achieved.”

“Early rehabilitation may help to improve physical and non-physical functioning and can prevent future problems,” it adds.

The second quality statement within the draft quality standard states that adults transferring from critical care to a general ward have a formal handover of their individualised structured rehabilitation programme.

The transition between critical care and a general ward can be difficult because of the step down in the level of care. A formal handover of the individualised, structured rehabilitation programme ensures that the general ward team understands the person’s specific physical and non-physical rehabilitation needs and how best to support them. NICE states that adhering to this standards will improve the experience of transition for the person and staff.

The NICE draft quality standard adds that adults who have been in critical care and are discharged from hospital should be given information about what to expect after discharge. “Moving from hospital to a home environment can be a difficult change for adults who have been in critical care,” says the guidance.

“Giving advice and information on what the person is likely to experience after leaving hospital and how to manage activities of daily living can help people to prepare for recovering at home. It can also help carers to plan how they can support the adult at home,” it adds.

The following information should be given before discharge:

  • · Information about physical recovery, based on the goals set during ward-based care, if applicable.
  • · If applicable, information about diet and any other continuing treatments.
  • · Information about how to manage activities of daily living, including self-care and re-engaging with everyday life.
  • · If applicable, information about driving, returning to work, housing and benefits.
  • · Information about local statutory and non-statutory support services, such as support groups.
  • · General guidance, especially for the family or carers, 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 or carers’ needs.

The patient should be given their own copy of the critical care discharge summary.

The fourth quality statement relates to follow-up after critical care and states that adults with rehabilitation needs identified from a functional assessment have a review 2 to 3 months after their discharge from critical care.

Adults receiving individualised structured rehabilitation programme during ward-based care have a functional assessment before they are discharged home or to community care. This assessment allows identifying their ongoing rehabilitation needs. A follow up is needed because further needs may become apparent after the discharge and by reviewing the patients’ needs 2 to 3 months after discharge from critical care ensures that any new physical or non-physical problems are identified and further support is arranged as needed.

The draft quality standard is out for consultation from 27 March to 21 April 2017. The final quality standard is expected to publish in August 2017.

You can respond to the consultation here: Rehabilitation after critical illness



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