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Session Agenda

Upon completion of this program, participants will be able to:
·         Identify methods to monitor for delirium, agitation, confusion, and sleep using validated assessment tools.
·         Apply new ways to reduce patient time in a delirious state and identify patients at high risk for acute brain injury.
·         Define new techniques to increase patient mobility earlier in the care process.
·         Identify proven practices for reducing sedative overuse.
·         Describe ways to reduce patient time on ventilators in the ICU.
·         Build policies that increase patient safety and engage the entire critical care team.
Day 1: November 5, 2013
7:00 AM-8:00 AM
Registration and Continental Breakfast
8:00 AM-8:15 AM
Welcome and Overview
Kelly McCutcheon Adams, LICSW
8:15 AM-8:30 AM
Critical Care: Where We’ve Come From, Where We Need to Go
Terry Clemmer, MD
This session will offer a discussion of how Critical Care Medicine evolved early on to be very technology oriented, and focus on a limited time frame. Basic caring was relegated to a lower priority and work processes became more focused on new technology and on a provider’s needs rather than a patient’s needs.
Now the focus is shifting from what we do, to how we do it. Basic care is having resurgence as being very important regarding outcomes. Longitudinal outcomes are beginning to relate back to how we practice in the ICU.
8:30 AM-9:00 AM
Reducing Patient Harm from Immobility, Sedation, and Delirium: Making the Connections and Making the Case
Vicki Spuhler, RN, MS and Wes Ely, MD, MPH
This session will provide a framework that will link immobility, sedation, and delirium as three of the most critical elements affecting ICU patients today and offer a pathway for making the case to engage in the work.
9:00 AM-9:45 AM
Short- and Long-term Complications of Immobility
Vicki Spuhler, RN, MS
This session will provide a review of the current literature about the consequences of immobility for ICU patients, the result of mobility on patient outcomes, and guidelines for the development of an early mobility protocol.
9:45 AM-10:15 AM
10:15 AM-11:15 AM
Short- and Long-term Complications of Over-sedation and Delirium
Wes Ely, MD, MPH
Delirium is an organ failure that can often predict length of stay and mortality. This session will discuss the changing culture of sedation and mechanical ventilation in modern ICU practice and review salient data about the risk of sedative overexposure for delirium in different clinical settings. This data-driven discussion will also cover the risks for long-term cognitive impairment in survivors. 
11:15 AM-12:15 PM
Taking Action to Reduce Cognitive Complications
Wes Ely, MD, MPH
This session will demonstrate data to show brain dysfunction as a public health problem in the ICU and in ICU survivors. Participants will learn the evidence for implementation of an “ABCDE” program to improve outcomes in ICU patients and when to use pharmacological and non-pharmacological interventions. Changing ICU culture to incorporate the inter-disciplinary approach to ABCDEs provides an opportunity to improve patient safety and comfort.
12:15 PM-1:00 PM
1:00 PM-1:45 PM
A New Perspective Regarding Sedation and Mobility
Terry Clemmer, MD

This session will make the case that sedation is harmful to patients and that being on a ventilator does not always mean being sedated. The first step to improvement is establishing measures and defining the specific problem to be treated with appropriate therapy rather than worsened with inappropriate therapy.
1:45 PM-2:30 PM
Getting into Action: Early Removal of Sedation
Terry Clemmer, MD

This session will use case studies to bring out the practical aspects of removing sedation safely and the process and tools used to do so emphasizing protocols, measuring tools, and cultural barriers.
2:30 PM-2:45 PM
2:45 PM-3:30 PM
Getting into Action: Mobility Skills – Assessment, Safety, and Progression
Heidi Engel, PT, DPT
This session will provide a framework for using mobility as a therapy for respiratory failure and strategies for developing a mobility protocol that can be adapted to any ICU environment. Participants will learn the use of appropriate resources and manpower for implementing early mobility.
3:30 PM-4:15 PM
Getting into Action: Using Sedation and Delirium Assessment Tools
Wes Ely, MD, MPH
This session will present valid and reliable tools for monitoring the brain in ICU patients. Participants will engage in a detailed discussion of implementation tips and the avoidance of pitfalls to ensure culture change and positive results.  This session will also feature demonstrations of the arousal and delirium tools in action, case studies to teach nuances, and the “top ten” tips for success.
4:15 PM-5:00 PM
Putting the Pieces Together
All Faculty
In this session, participants will discuss the interconnectedness of sedation, mobility, delirium and sleep and their impact on long term patient outcomes.  There will be open Q&A time with the faculty.
5:00 PM-6:00 PM
Day 2: November 6, 2013
7:00 AM-8:00 AM
Continental Breakfast
8:00 AM-8:15 AM
Opening of Day 2
Kelly McCutcheon Adams, LICSW
8:15 AM-9:00 AM
Seeing the Work in Action: Videos
All Faculty
During this session, participants will see videos from Intermountain Healthcare and Vanderbilt Medical Center demonstrating the strategies discussed on Day 1.
9:00 AM-10:00 AM
Building a Foundation with Reliability
Terry Clemmer, MD
In this session the participants will learn to identify unreliable practices in their environments and the importance of explicit protocols and their impact on improving reliability. Participants will also learn to identify and use tools to push reliability from “level 1 to level 2”, including rapid cycle testing to mobilize patients and build a culture of safety.
10:00 AM-10:30 AM
10:30 AM-11:00 AM
Tackling the Challenges of Culture Change
Vicki Spuhler, RN, MS
This session will define the elements necessary for culture change in an organization and emphasize the role of culture in changing the care environment. 
11:00 AM-12:00 PM
Learning Through Case Studies
All Faculty
This interactive session will allow participants to continue to learn about delirium screening, use of sedation protocols, and use of mobility protocols through case discussions and exercises.
12:00 PM-12:45 PM
12:45 PM-1:30 PM
Brass Tacks Q&A
All Faculty
This session will provide participants an opportunity to interact with faculty to delve deeply into the “how-to’s” of the tools and improvement strategies for managing sedation, immobility and delirium.
1:30 PM-2:30 PM
Traveling the Road Ahead in Critical Care; Leaving in Action
All Faculty
This session will review some advances in other arenas of critical care and will give participants time to make a plan to leave the seminar in action with ideas for testing at their own hospitals.
2:30 PM-3:00 PM
Wrap Up and Closing
Please note this agenda is tentative and subject to change.