Build out the Cross-skilling screen

lukesleeman commented 4 years ago

From the main menu there is a button which takes you to the ICU Tips for junior staffers screen. That screen is currently really basic.

We need to build build out a detailed version of the ICU Tips for junior staffers screen

@greggmiller Can you please provide some information in this issue on what should be in this section? Once that is done assign the issue to Marc Edwards.

@marcedwards Once greg has provided info, can you provide some design guidance in this issue in on how it should look. Once this is done, can you label this issue as "Ready for Dev" so that one of the devs can pick it up.

greggmiller commented 4 years ago

This may be a work in progress as waiting for more information being compiled by ICU for this.

greggmiller commented 4 years ago

Hopefully in next couple of days, but otherwise put this on backburner.

greggmiller commented 4 years ago

We can always just add Page under construction for this one for time being. This will probably be the last one to fill as we are still waiting for the ICU to provide us with what they wish to do.

lukesleeman commented 4 years ago

Yeah, it currently just says "TODO" in that screen

greggmiller commented 4 years ago

I have been in touch with one of the ICU consultants (James Douglas)

He is going to draw up 1-page summaries for us for this to start with. Initial topics are:

Assessment of the ICU patient Daily protocols/investigations etc. Ventilation in ARDS/COVID19 Management of the deteriorating patient (Management and diagnosis of septic shock and ARF This may come later as will be a bit further down the track )

There is likely to be some overlap from the general ICU section which is probably alright.

@lukesleeman I probably won't have these documents until tomorrow at the earliest. @Western-Health-Covid19-Collaboration/designers We can consider how the "ICU tips for junior staffers" section opens up. This will likely to be a growing list of topics over time so instead of separate boxes it may to open into a list. This list might have subcategories. Daily routine Deteriorating patient Airway Breathing Circulation Disability/Sedation protocols Investigations

@galtaforce @benblackman thoughts?

benblackman commented 4 years ago

Sounds good. The first two on the list of topics may have a lot of crossover with #42 I think?

greggmiller commented 4 years ago

This section of app is now titled Cross-skilling as per discussions in #96 . After discussions with ICU today, content is unlikely to be ready until Monday, I will update then.

greggmiller commented 4 years ago

Still awaiting further content for this section from ICU.

We can begin to build this out though when @Western-Health-Covid19-Collaboration/designers get an opportunity.

The consensus is that this would be best to be a list with subheaders.

The subheaders would reflect the categories of #42.

Airway Breathing Circulation Disability/Neurological Exposure/Infection Fluids/Renal GIT Haem/blood

Under each subheader, we would eventually be building up a number of topics (this is likely to be over several versions)

Each item on the list would then open up to a PDF/Infographic/link, a quick reference card or other content.

In the first instance, we have a few items to put under subheaders on this list.

e.g. Breathing (subheader) Prone positioning (- links to video https://www.youtube.com/watch?v=YFrA1cCuDnY&feature=youtu.be) (This is from #88)

Please feel free to ask for clarification @Western-Health-Covid19-Collaboration/designers

I will discuss with @fabiendade about what content this section would best contain.

lukesleeman commented 4 years ago

Awesome - I've hidden a lot of chatter on this issue to make it clear to the designers what to look at. @Mattro or @marcedwards either of you want to pick it up?

cjmlgrto commented 4 years ago

Is something like this what you're after @greggmiller? I'll hold off on this until we get the first round of content in.

Tips

greggmiller commented 4 years ago

@cjmlgrto 🙌 💯 Yes that looks excellent. This will probably be the aspect that fills out most over time. At the moment there are only a few infographics/videos to put in this section, but this is likely to grow to total of 20-30. It shouldn't end up much more than this as we have other means for the more comprehensive stuff (we now have separate anaesthetic and ICU microsites). Mainly items that are referenced elsewhere in-app and ones that are useful for quick access. 😄 👍

lukesleeman commented 4 years ago

👋 Hey @greggmiller with this one, should I leave it with design, or remove the designers from it until you get more resources to add into this screen?

greggmiller commented 4 years ago

I think @fabiendade was going to start putting together some content for this. So he might come back to us in the next couple of days.

In the meantime if it was built out like above with each A,B.C... etc.. Saying something like content pending or blank underneath. This would give users the chance to see the intention for the app. From what @Mattro said on the call this should be ok?

fabiendade commented 4 years ago

I have been compiling a list of useful topics to include in this section and should have something back to you by Wednesday morning. Will Liase with Ben and some other Reg’s to make sure it is relevant.

lukesleeman commented 4 years ago

I think in this case, its probably best to just wait for @fabiendade info on wednesday, then move it back to design then

fabiendade commented 4 years ago

Under Breathing Section of the cross skilling instructions and a checklist for proning a patient is required - a complex process not often performed - and a checklist would be ideal

Format proposed is a button labelled “Proning” which opens into scrollable Tab format detailed below.

It would be useful if each bullet point (except those under indications and contraindications section) to be check boxes like intubation checklist

For each heading within a Tab it would be useful to split into boxes.

Proning

(Tab 1) – Indication

Indications • Severe ARDS with hypoxia • Posterior wounds / skin flaps

Contraindications • Lack of staff • Untrained staff • Out of hours • Open abdomen • C spine precautions • Haemodynamic instability

TAB 2 (Pre-Manoeuvre)

Pre-Manoevre

Team • ICU consultant aware • Specialised proning team on site? – contact ICU physio • Adequate staffing on unit? • Staff trained in proning procedure • 6 x Staff available for proning • Allocate roles – Airway x 1, Trunk and limbs x 4, Lines and equipment x 1 • Able to reintubate?

Equipment and Preparation • Crash trolley • ECG dots • Fresh sheet x 2 • Slide sheet x 2 • Foldable Pillows x 3 • Clear bed area

Patient

General consideration • Review indications and contraindications • Check ROM of neck – 90ᵒ • Explain procedure to patient / family

Airway • Check ETT position on CXR – document lip level • Check patient airway grade • Secure ETT • Sleek connections • Check for cuff leak • Suction mouth and nasal passages

Breathing • Pre-oxygenate • Confirm ventilator settings • Check capnography

Circulation • Check adequate vascular access + secure • Confirm haemodynamically stable • Confirm plan if patient becomes unstable • identify drug access point and metaraminol accessible

Disability • Sedated • Plan for further sedation discussed

Equipment and lines • Secure all tubes and lines • Consider disconnecting unnecessary infusions • Remove uneccessary indwelling devices • Consider disconnecting RRT • NGT – aspirate and spigot

Other • Assess for device potential for pressure injury • Apply padding to bony prominences • Mouth care • Dress anterior wounds

(TAB 3) Manoeuvre

Manoeuvre

Prepare • Position team – team leader at head of bed • Brief team on steps – turning direction • Position ETT on opposite side • Remove patient pillow and set air mattress to firm

Horizontal move • Move patient to edge of bed • Tuck original sheet + new slide sheet under patient • Tuck new sheet and slide sheet on side patient turning towards

Side lying position • Tuck lower arm under buttock with palm up • Turn patient into lateral position • Untangle lines and remove ECG leads from anterior thorax • Place ECG leads on posterior thorax • Remove old sheet • Pull new sheet + slide sheet through • Slide patient to end of bed – away from ventilator • Fold pillows by 1/3 and place under chest and pelvis

Complete Prone • Turn patient onto stomach • Pull pillows through position in swimmer position • Place pillow under lower legs

TAB 4 - Post manoeuvre

Post manoeuvre

Checks Position • One arm above head, other by side. Shoulder in neutral position • Reposition patient in centre of bed • Adjust position to ensure abdomen is hanging freely • Postion head to reduce pressure on eyes and enable access to airway • Readjust lines for comfort and NG on free drainage

Airway • Check ETT lip level and ventilator circuit for kinks • Suction if indicated • Cuff pressure

Breathing • Auscultate for bilateral breath sounds • Respiratory parameters • Check Peak inspiratory pressurs and Minute ventilation

Circulation • Check haemodynamics • ABG – 30 minute post proning

Pressure area care • Air mattress to usual setting – ensure functioning • Reposition head hourly – frequent eye toilets may be necessary • Ensure tongue in mouth • Document skin assessment • Lateral Tilt patient 2 hourly

Video – separate embedded section in Cross link section
Demonstration of proning technique https://www.youtube.com/watch?v=YFrA1cCuDnY&feature=youtu.be

Infographic – top right 2 power point slides

fabiendade commented 4 years ago

prone_checklist_september_2018.pptx

cjmlgrto commented 4 years ago

Alright, here are the designs for the "Proning" screens. I've decided to split the "Pre-Manoeuvre" screens into two separate ones ("Staff" and "Patient") because they were getting quite long.

Slice