PICS: Post Intensive Care Syndrome with Dr. Tara McMichael & Clinical Nurse Specialist, Stacy Jepsen

Ridgeview Podcast: CME Series

For this podcast, we don't just have one but two guests. Returning to the show is Dr. Tara McMichael, an Internal Medicine Physician with Lakeview Clinic and Internist for Ridgeview, and Stacy Jepsen, an advanced practice nurse/clinical nurse specialist with Ridgeview. During this podcast, Dr. McMichael and Stacy will be discussing Post Intensive Care Syndrome, also known as PICS. They will both bring unique perspectives from the initial critical illness and care in the ICU to the patient's outpatient visits and long term prognosis.

Enjoy the podcast.

Objectives:Upon completion of this podcast, participants should be able to:

• Define post intensive care syndrome (PICS) and post intensive care syndrome-family (PICS-F).
• Identify risk factors for devcelopment of PICS and PICS-F.
• Summarize prevention and treatment strategies for PICS and PICS-F
• Interpret the prevalence of PICS within the community.
• Utilize available resources to support patients/families with PICS symptoms.
• Describe how patients and their families can be supported who are struggling with PICS.

CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at [e-mail].

To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws.

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

Thank-you for listening to the podcast.

SHOW NOTES: *See the attachment for additional information. CLINICAL NURSE EDUCATOR- Advance practice RN who operates as an expert clinician, educator, researcher or consultant. - Masters or doctorate degree - Role had been around the US for over 60 years.

POST INTENSIVE CARE SYNDROME (PICS)- New or worsening cognitive, psychological, physical limitation, post survival of critical illness and stay in ICU. - Post intensive care syndrome - family (PICS): family memvers who have mental limiations from the experience of having a loved on eiwth a critical illness. - First defined by Society of Critical Crea Medicine in 2010. - Remains difficult to diagnose for coding and reimbursement. ICD-10 code does not exsist.

RISK FACTORS - critical illness with stay in ICU- Delirium- Sedataion during hostpital stay- Diagnosis of sepsis, ARDS, etc.

DIAGNOSIS - Cognitive: short term memory loss, slow cognition, mental disorganization - Physical: changes in balance and gait - Psychological: anxiety, depression, insomnia, PTSD

TESTING - no specific tests available for PICS - MoCa - Mini mental status - PHQ9 (in setting of depression) - GAD7 (in setting of anxiety) - two or more symptoms in any category - cognitive, physical and psychological 4-6 weeks post hspitalization.

PREVALENCE - Of 5.8 ICU admissions, 4.8 million survive - Of the 4.8 million survivors, 50-80% will beet diagnostic criteria - COVID has brought PICS to forefront.

PREVENTION- Prevention tips (multidisciplinary rounds, ABCDEF bundle, checklists for goals, support groups)- ABCDEF Bundle A - Assess, precent and manage pain B - Sedation reduction and vent weaning C - Choice of analgesic and sedation D - delirium prevention, recognition and treatment E - Early mobility F - Family

BARRIERS - Communication, not true barrier, but requires effort

PICS RESOURCES & TREATMENT - PICS clinics (pros & cons) - For primary care physician (it exists, dont; have to solve it one go; there are online resources available) - Addition PICS resources (listed in show notes).

Thanks for listening.Please check out the additonal show notes for additional resources.