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  1. Discuss the importance of an interprofessional plan of care for optimizing clinical outcomes.

  2. Describe interventions for prevention of common complications in critically ill patients:

    • Venous thromboembolism

    • Infection

    • Sleep pattern disturbances

    • Pressure injury

    • Delirium

  3. Discuss interventions to maintain psychosocial integrity and minimize anxiety for the critically ill patient and family members.

  4. Describe interventions to promote family-centered care and patient and family education.

  5. Identify necessary equipment and personnel required to safely transport the critically ill patient within the hospital.

  6. Describe transfer-related complications and preventive measures to be taken before and during patient transport.


The achievement of optimal clinical outcomes in the critically ill patient requires a coordinated approach to care delivery by interprofessional team members. Experts in nutrition, respiratory therapy, critical care nursing and medicine, psychiatry, and social work, as well as other disciplines, work collaboratively to effectively and efficiently provide optimal care.

An interprofessional plan of care is a useful approach to facilitate the coordination of a patient’s care by the team and optimize clinical outcomes. These plans of care are increasingly being used to replace individual, discipline-specific plans of care. Each clinical condition presented in this text discusses the management of patient needs or problems with an integrated, interprofessional approach.

The following section provides an overview of interprofessional plans of care and benefits. In addition, this chapter discusses patient management approaches to needs or problems during critical illnesses that are not diagnosis specific, but common to a majority of critically ill patients, such as sleep deprivation, pressure injury, and patient and family education. Additional discussion of these needs or problems is also presented in other chapters if related to specific disease management.


An interprofessional plan of care is a set of expectations for the major components of care a patient receives during the hospitalization to manage a specific medical or surgical problem. Other types of plans include clinical pathways, protocols, and care maps. The interprofessional plan of care expands the concept of a medical or nursing care plan and provides an interprofessional, comprehensive blueprint for patient care. The result is a diagnosis-specific plan of care that focuses the entire care team on expected patient outcomes.

The interprofessional plan of care outlines the tests, medications, care, and treatments needed to transition the patient to the next level of care in a timely manner with all patient outcomes met. These plans have a variety of benefits to both patients and the hospital system:

  • Improved patient outcomes (eg, survival rates)

  • Increased quality and continuity of care

  • Improved communication and collaboration

  • Identification of hospital system problems

  • Coordination of necessary services and reduced duplication

  • Prioritization of activities

Teams of individuals who closely interact with a specific patient population develop interprofessional plans of care. It is this process of multiple disciplines communicating and collaborating around ...

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