Skip to main content

Family Role in Patient Safety in the Intensive Care Unit

  • Chapter
  • First Online:
Families in the Intensive Care Unit

Abstract

Family members feel a natural inclination to protect and serve their loved ones and can serve an important role in patient safety in the intensive care unit (ICU). However, family members have often been excluded from this role by policies that keep them away from the bedside and have not been included in safety process design. In order to include families in a way that can maximize patient safety, healthcare providers must encourage the following: (1) family members must be included as part of the team during rounds, procedures, and bedside care; (2) family members need to be empowered to speak up if something is not going well with their loved one or if they are concerned about a potential error; and (3) family members need to be given a role to play in development of hospital safety policy and plans that would encourage these actions, such as through Patient-Family Advisory Councils (PFACs).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Davidson JE. Family-centered care: meeting the needs of patients’ families and helping families adapt to critical illness. Crit Care Nurse. 2009;29(3):28–34; quiz 35.

    Article  PubMed  Google Scholar 

  2. Pizzo P, Walker D, Bomba P. Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: Institute of Medicine; 2015.

    Google Scholar 

  3. Lawton A, White J, Fromme EK. End-of-life and advance care planning considerations for lesbian, gay, bisexual, and transgender patients# 275. J Palliat Med. 2014;17(1):106–8.

    Article  PubMed  Google Scholar 

  4. DeMartino ES, Dudzinski DM, Doyle CK, et al. Who decides when a patient can’t? Statutes on alternate decision makers. N Engl J Med. 2017;376(15):1478–82.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Institute NPSFsLL. Safety is personal: partnering with patients and families for the safest care. Boston: Foundation NPS; 2014.

    Google Scholar 

  6. Sokol-Hessner L, Folcarelli PH, Sands KE. Emotional harm from disrespect: the neglected preventable harm. BMJ Qual Saf. 2015;24(9):550–3.

    Article  PubMed  Google Scholar 

  7. Masso Guijarro P, Aranaz Andres JM, Mira JJ, Perdiguero E, Aibar C. Adverse events in hospitals: the patient’s point of view. Qual Saf Health Care. 2010;19(2):144–7.

    Article  CAS  PubMed  Google Scholar 

  8. Johnstone MJ, Kanitsaki O. The neglect of racism as an ethical issue in health care. J Immigr Minor Health. 2010;12(4):489–95.

    Article  PubMed  Google Scholar 

  9. Haque OS, Waytz A. Dehumanization in medicine: causes, solutions, and functions. Perspect Psychol Sci J Assoc Psychol Sci. 2012;7(2):176–86.

    Article  Google Scholar 

  10. Brown SM, Rozenblum R, Aboumatar H, et al. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med. 2015;191(3):358–60.

    Article  PubMed  Google Scholar 

  11. Haines KJ, Kelly P, Fitzgerald P, Skinner EH, Iwashyna TJ. The untapped potential of patient and family engagement in the organization of critical care. Crit Care Med. 2017;45(5):899–906.

    Article  PubMed  Google Scholar 

  12. Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect Int J Public Particip Health Care Health Policy. Dec 2016;19(6):1183–202.

    Google Scholar 

  13. Spruce L. Back to basics: patient and family engagement. AORN J. 2015;102(1):34–7; quiz 38-39.

    Article  PubMed  Google Scholar 

  14. Liu V, Read JL, Scruth E, Cheng E. Visitation policies and practices in US ICUs. Crit Care. 2013;17(2):R71.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605–22.

    Article  PubMed  Google Scholar 

  16. American Association of Critical-Care Nurses. Practice alert: Family presence during resuscitation and invasive procedures (position statement). 2010. http://www.aacn.org/wd/practice/docs/practicealerts/familypresence-during-resuscitation-invasive-procedures.pdf. Accessed March 12, 2015.

  17. Fulbrooke P, Latour J, Albarran J, et al. The presence of family members during cardiopulmonary resuscitation: European federation of Critical Care Nursing associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Profressions Joint Position Statement. Connect World Crit Care Nurs. 2007;5(4):86–8.

    Article  Google Scholar 

  18. Jacob M, Horton C, Rance-Ashley S, et al. Needs of patients’ family members in an intensive care unit with continuous visitation. Am J Crit Care Off Publ Am Assoc Crit-Care Nurs. 2016;25(2):118–25.

    Google Scholar 

  19. Barratt F, Wallis DN. Relatives in the resuscitation room: their point of view. J Accid Emerg Med. 1998;15(2):109–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Brown SM. We still lack patient centered visitation in intensive care units. BMJ : Br Med J (Online). 2015;250:h792.

    Article  PubMed  Google Scholar 

  21. Carman KL, Dardess P, Maurer M, Workman T, Ganachari D, Pathak-Sen E. A roadmap for patient and family engagement in healthcare practice and research. Prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore Foundation, Dominick Frosch, Project Officer and Fellow; Susan Baade, Program Officer. 2014.

    Google Scholar 

  22. Chapman DK, Collingridge DS, Mitchell LA, et al. Satisfaction with elimination of all visitation restrictions in a mixed-profile intensive care unit. Am J Crit Care. 2016;25(1):46–50.

    Article  PubMed  Google Scholar 

  23. Chapman DK, Collingridge DS, Mitchell LA, et al. Satisfaction with elimination of all visitation restrictions in a mixed-profile intensive care unit. Am J Crit Care. 2016;25(1):46–50.

    Article  Google Scholar 

  24. Netzer G, Iwashyna TJ. Fair is fair: preventing the misuse of visiting hours to reduce inequities. Ann Am Thorac Soc. 2017;14(12):1744–6.

    Google Scholar 

  25. Simon SK, Phillips K, Badalamenti S, Ohlert J, Krumberger J. Current practices regarding visitation policies in critical care units. Am J Crit Care Off Publ Am Assoc Crit-Care Nurs. 1997;6(3):210–7.

    CAS  Google Scholar 

  26. Rosa RG, Tonietto TF, da Silva DB, et al. Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study. Crit Care Med. 2017;45(10):1660–7.

    Article  PubMed  Google Scholar 

  27. Stickney CA, Ziniel SI, Brett MS, Truog RD. Family participation during intensive care unit rounds: attitudes and experiences of parents and healthcare providers in a tertiary pediatric intensive care unit. J Pediatr. 2014;164(2):402–6. e401–404.

    Article  PubMed  Google Scholar 

  28. Jacobowski NL, Girard TD, Mulder JA, Ely EW. Communication in critical care: family rounds in the intensive care unit. Am J Crit Care Off Publ Am Assoc Crit-Care Nurs. 2010;19(5):421–30.

    Google Scholar 

  29. Davidson JE. Family presence on rounds in neonatal, pediatric, and adult intensive care units. Ann Am Thorac Soc. 2013;10(2):152–6.

    Article  PubMed  Google Scholar 

  30. Azoulay E, Pochard F, Chevret S, et al. Opinions about surrogate designation: a population survey in France. Crit Care Med. 2003;31(6):1711–4.

    Article  PubMed  Google Scholar 

  31. Wyskiel RM, Weeks K, Marsteller JA. Inviting families to participate in care: a family involvement menu. Jt Comm J Qual Patient Saf. 2015;41(1):43–6.

    Article  PubMed  Google Scholar 

  32. Van De Graaff M, Beesley SJ, Butler J, et al. Partners in healing: postsurgical outcomes after family involvement in nursing care. Chest. 2018;153(2):572–4.

    Article  PubMed  Google Scholar 

  33. Franck LS, Oulton K, Nderitu S, Lim M, Fang S, Kaiser A. Parent involvement in pain management for NICU infants: a randomized controlled trial. Pediatrics. 2011;128(3):510–8.

    PubMed  Google Scholar 

  34. Bastani F, Abadi TA, Haghani H. Effect of family-centered care on improving parental satisfaction and reducing readmission among premature infants: a randomized controlled trial. J Clin Diagn Res. 2015;9(1):SC04–8.

    PubMed  PubMed Central  Google Scholar 

  35. Mortelmans LJ, Cas WM, Van Hellemond PL, De Cauwer HG. Should relatives witness resuscitation in the emergency department? The point of view of the Belgian Emergency Department staff. Eur J Emerg Med Off J Eur Soc Emerg Med. 2009;16(2):87–91.

    Article  Google Scholar 

  36. McClenathan BM, Torrington KG, Uyehara CF. Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest. 2002;122(6):2204–11.

    Article  PubMed  Google Scholar 

  37. Haley KJ, Fessler DMT. Nobody’s watching: subtle cues affect generosity in an anonymous economic game. Evol Hum Behav. 2005;26(3):245–56.

    Article  Google Scholar 

  38. Sevransky JE, Nicholl B, Nicholl JB, Buchman TG. Patient- and family-centered care: first steps on a long journey. Crit Care Med. 2017;45(5):757–8.

    Article  PubMed  Google Scholar 

  39. Boyd R, White S. Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff? Eur J Emerg Med Off J Eur Soc Emerg Med. 2000;7(1):51–3.

    Article  CAS  Google Scholar 

  40. Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med. 2013;368(11):1008–18.

    Article  CAS  PubMed  Google Scholar 

  41. Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87(5):1115–45.

    Article  PubMed  Google Scholar 

  42. Mello MM, Studdert DM, Kachalia A. The medical liability climate and prospects for reform. JAMA. 2014;312(20):2146–55.

    Article  CAS  PubMed  Google Scholar 

  43. Boothman RC, Imhoff SJ, Campbell DA Jr. Nurturing a culture of patient safety and achieving lower malpractice risk through disclosure: lessons learned and future directions. Front Health Serv Manage. 2012;28(3):13–28.

    Article  PubMed  Google Scholar 

  44. Axelsen P. Correspondence: should family members be present during cardiopulmonary resuscitation. N Engl J Med. 2002;347:450–2.

    Article  PubMed  Google Scholar 

  45. Reuters. Hospital sued over deadly faint. The Boston Globe. July 8, 2005.

    Google Scholar 

  46. Committee on Quality of Health Care in America IoM. To err is human: building a safer health system. Washington, DC: National Academics Press; 2000.

    Google Scholar 

  47. Reason J. Human error: models and management. BMJ. 2000;320(7237):768–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Khan A, Coffey M, Litterer KP, et al. Families as partners in hospital error and adverse event surveillance. JAMA Pediatr. 2017;171(4):372–81.

    Article  PubMed  PubMed Central  Google Scholar 

  49. McGuckin M, Govednik J. Patient empowerment and hand hygiene, 1997-2012. J Hosp Infect. 2013;84(3):191–9.

    Article  CAS  PubMed  Google Scholar 

  50. McGuckin M, Waterman R, Porten L, et al. Patient education model for increasing handwashing compliance. Am J Infect Control. 1999;27(4):309–14.

    Article  CAS  PubMed  Google Scholar 

  51. Longtin Y, Sax H, Allegranzi B, Hugonnet S, Pittet D. Patients’ beliefs and perceptions of their participation to increase healthcare worker compliance with hand hygiene. Infect Control Hosp Epidemiol. 2009;30(9):830–9.

    Article  PubMed  Google Scholar 

  52. Gerdik C, Vallish RO, Miles K, Godwin SA, Wludyka PS, Panni MK. Successful implementation of a family and patient activated rapid response team in an adult level 1 trauma center. Resuscitation. 2010;81(12):1676–81.

    Article  PubMed  Google Scholar 

  53. Mazor KM, Roblin DW, Greene SM, et al. Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(15):1784–90.

    Article  Google Scholar 

  54. Delbanco T, Bell SK. Guilty, afraid, and alone – struggling with medical error. N Engl J Med. 2007;357(17):1682–3.

    Article  CAS  PubMed  Google Scholar 

  55. Fisher KA, Ahmad S, Jackson M, Mazor KM. Surrogate decision makers’ perspectives on preventable breakdowns in care among critically ill patients: a qualitative study. Patient Educ Couns. 2016;99(10):1685–93.

    Article  PubMed  Google Scholar 

  56. Etchegaray JM, Ottosen MJ, Burress L, et al. Structuring patient and family involvement in medical error event disclosure and analysis. Health Aff. 2014;33(1):46–52.

    Article  Google Scholar 

  57. Etchegaray JM, Ottosen MJ, Aigbe A, et al. Patients as partners in learning from unexpected events. Health Serv Res. 2016;51(Suppl 3):2600–14.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Niehaus K. Using a patient and family advisory council as a mechanism to hear the patient’s voice. J Oncol Pract. 2017;13(8):509–11.

    Article  PubMed  Google Scholar 

  59. Bazuin D, Cardon K. Creating healing intensive care unit environments: physical and psychological considerations in designing critical care areas. Crit Care Nurs Q. 2011;34(4):259–67.

    Article  PubMed  Google Scholar 

  60. Niehaus K. A patient and family advisory council for quality; making its voice heard at Memorial Sloan Kettering Cancer Center. NEJM Catalyst. Strategy 1: Working with patients and families as advisors. Content last reviewed. Rockville: Agency for Healthcare Research and Quality. 2017. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html. Accessed Sep 29, 2017.

  61. Strategy 1: working with patients and families as advisors. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html. Accessed 29 Sept 2017.

  62. Azoulay E, Pochard F, Chevret S, et al. Meeting the needs of intensive care unit patient families: a multicenter study. Am J Respir Crit Care Med. 2001;163(1):135–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We appreciate the insights and advice on this chapter from the following: Intermountain Medical Center, Patient-Family Advisory Council members, nursing staff of the Shock Trauma Intensive Care Unit at Intermountain Medical Center, and the Center for Humanizing Critical Care led by Samuel Brown, MD, and Elliotte Hirshberg, MD.

Financial Support and Conflicts of Interest

No disclosures

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah J. Beesley .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Doran Bostwick, A., Beesley, S.J. (2018). Family Role in Patient Safety in the Intensive Care Unit. In: Netzer, G. (eds) Families in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-94337-4_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-94337-4_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94336-7

  • Online ISBN: 978-3-319-94337-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics