Table 4 Definitions of PICU Liberation program: Bundle Performance and Daily Goals (adapted from PUN et al.) [16]
Element | Days eligible | Performance in the last 24 h it was documented that the patient received | Performance in the last 24 h it was documented on the daily goal checklist |
|---|---|---|---|
A | All days | FLACC goal | |
B1 | Only days when patient received continuous or intermittent sedation | A spontaneous awakening trial (SAT) if receiving continuous or intermittent sedative infusions OR sedation target set as “light” in the daily goals | Suitability for SAT if receiving continuous or intermittent sedative infusions OR suitability for sedation goal set as “light” |
B2 | Only days when patient was on ventilatory support | A spontaneous breathing trial (SBT) if receiving invasive ventilation | Suitability for SBT if receiving invasive ventilation |
B3 | Only days when patient was on ventilatory support | An extubation assessments if receiving invasive ventilation | Suitability for extubation assessments if receiving invasive ventilation |
C | All days | ≥ 6 agitation-sedation assessments using the RASS (Richmond Agitation-Sedation Scale [29] | RASS goal |
D | All days | ≥ 1 delirium assessments using the CAP-D [31] | CAP-D requested |
E | Only days when patient was not classed as “lizard – for range of motion activities only” | ≥ 1 Mobility activity administered that was higher than range of motion | Mobility goal (Lizard – passive range of motion unless contraindicated; Koala – in bed activities including sitting; Wombat – out of bed activities including transfers; Kangaroo – activities away from bedspace including ambulatory) set |
F | Only days when family was present | Family member/carer educated on the PICU Liberation bundle and/or participated in at least one of the following: liberation goal setting, cares, neurodevelopmental or early mobility activity, rounds, plan of care. | Suitability of family inclusion in liberation goal setting, cares, neurodevelopmental or early mobility activity, rounds, plan of care. |
G | All days | Nutritional assessment tool used OR weight obtained | Nutritional goal set |
H | All days | Tool to help personalise the patient for the clinicians administered OR humanism activity administered | Humanism goal set |
Baby Liberation | Only infants | “flower” tool to adapt each bundle element to include developmentally appropriate components | Baby Liberation goals documented |