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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

Davidson, Judy E. RN, FCCM; Powers, Karen MD; Hedayat, Kamyar M. MD; Tieszen, Mark MD, FCCM; Kon, Alexander A. MD, FCCM; Shepard, Eric MD, FCCM; Spuhler, Vicki RN, MS, CCRN; Todres, I David MD, FCCM; Levy, Mitchell MD, FCCM; Barr, Juliana MD, FCCM; Ghandi, Raj MD, FCCM; Hirsch, Gregory MD; Armstrong, Deborah PharmD, FCCM

doi: 10.1097/01.CCM.0000254067.14607.EB
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Objective: To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU.

Participants: A multidisciplinary task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units.

Evidence: The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion.

Consensus Process: The topic was divided into subheadings: decision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal.

Conclusions: More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.

These guidelines were developed by a task force assembled by the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM) and have been reviewed by the Society’s Council. These guidelines reflect the official opinion of the SCCM and should not be construed to reflect the views of the specialty boards or any other professional medical organization.

Ms. Davidson was the task force chairperson; Dr. Armstrong was the liaison with the American College of Critical Care Medicine.

The American College of Critical Care Medicine (ACCM), which honors individuals for their achievements and contributions to multiprofessional critical care medicine, is the consultative body of the Society of Critical Care Medicine (SCCM) that possesses recognized expertise in the practice of critical care. The College has developed administrative guidelines and clinical practice parameters for the critical care practitioner. New guidelines and practice parameters are continually developed, and current ones are systematically reviewed and revised.

Dr. Levy has received honoraria and research support from Eli Lilly and Edwards Lifesciences. He also received research support from Philips Medical Systems, Chiron, and Biosite. The remaining authors have not disclosed any potential conflicts of interest.

© 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins