1. Creating lasting memories for bereaved families - the handprints project in the Intensive Care Unit
Bettina Korn, End-of-Life Care Coordinator &
Maire McAuliffe, Clinical Nurse Manager2
St. James’s Hospital, Dublin

2. Environment in the Intensive Care Unit

3. Background - organisation
Acute adult academic hospital
1000 beds
Tertiary referral centre
General Intensive Care Unit/High Dependency Unit
18 ICU beds, 4 HDU beds
838 admissions in 2015
Overall mortality of 14%
ICU End-of-Life Care committee
St. James’s Hospital
Deaths in SJH 2015
951
ICU
141 (15%)
Critical Care Areas
(ICU, HDU & CCU)
182 (19%)
“Our father seemed to have been at the centre of the care that he received. In other words, he was well looked after rather than just being another patient in the bed.” Relative’s feedback

4. Background - handprints
Hands - personal significance & individuality
Handprints can help to capture the unique nature of a person & provide a memento of their life and their death
Common practice in Organ Donation (performed by organ procurement coordinators in theatre)
Practiced in other organisations(e.g. Beaumont ICU, maternity & paediatric hospitals, internationally)
Literature: draws relatives in, creates physical connection with the dying & opens space for conversations about the patient, their relationship and role in their lives
PeaceHealth, Alaska, USA

5. Catalyst: Corridor conversations
ICU EOLC Committee
End-of-Life Care
Coordinator
Organ Donation
Nurse Manager
Project team
Hospital Foundation Manager

6. Engaged patients & families
Driver Diagram
Primary Drivers
Secondary Drivers
Elicit staff claims, concern, & ideas
Gain ‘buy in’ from staff
Committed staff
Identify education & training needs
Develop & provide training
Create education opportunities
Promote ‘Pioneers’ & support followers
Competent Staff
Engaged patients & families
Introduce idea appropriately to patients & relatives
Elicit their feedback & concerns
Utilise social media
By the end of August 2016 every dying patient & their relatives in ICU will be offered to have their handprint taken
Source Funding
Approach St. James’s Hospital Foundation
Costings
Self-funding opportunities
Develop Materials
Source hand prints materials
Trial material & evaluate
Design accompanying envelop
Communication
Strategy to keep stakeholders informed of the progress
Collect data
Collect baseline, process & outcome measures data

7. PDSA 1 ‘Hand prints pilot’
Plan/Predict
Introduce handprints on a trial basis
EOLC committee members to pilot at next
opportunity (pioneers)
Utilise samples from supplier
Prediction:
mixed reactions from relatives & staff Do
Pilot handprints as planned
Measure number of opportunities and
utilisation
Collect and assess data, problems and
unexpected observations
Act
Identify best technique
Photocopy handprint
Design, fund and print envelop
Staff education – practicalities & values/culture
Introduce handprints as part of the care plan –
timing & conversations
Study
Mixed reactions, relatives more open than staff
Identified:- issues with technique
- envelope required for the print
- possibly fading over time
- competence & confidence required
- ‘clashing values’
We used QI tools such as PDSA cycles, one example here

8. Photo: Anthony Edwards, Clinical Photographer

9. Hand prints - a few tips Low cost & easy to use Shiny surface
Hard surface
Double glove
Photocopy
Ask for assistance from the family
‘Save the moment’ UK company
€2.70 per handprint & envelop

10. Relatives perceptions
From a daughter who had just lost her mom, when asked ‘is this something new’, she began to cry and asked why we could not have done this for her dad 2 years ago when he had passed away in ICU. ‘I would have loved to have that from my dad’.
From the sister of a patient who had passed away: ‘this is not just nursing, this is much greater, all that you do’.
From a mother about her teenage son: ‘I don’t want that, he’s dead, what good is that.’ His sister asked for it and said she would keep it safe and give it to her mom one day.

11. Relatives perceptions cont.
To the other relatives ‘please leave all of you please leave, the nurse would like to take a hand print, please do it now.’
From a relative whose sister had just passed: ‘ I would love that, we would all love that, please take them.’
‘This is great. Is it new? Do all hospitals do this?’

12. Staff responses pre education
Why?
Hand prints are for children to be stuck on the fridge
More work
Possibly a good idea
Would an old photograph not do the job?
Surely memories are more important

13. Staff Reponses Post education
I’m coming around a bit
I don’t think I would like it myself but the families seem to like it
I think its nice for the families
It would be lovely to frame it
It’s a lovely idea along with the lock of hair
“The environment in ICU can be very high tech and intimidating at times. Taking the handprints brings everything back to a very human, deeply personal level.”
Staff Nurse in ICU
“The hand prints are very popular with families. I'm not sure popular is the word but most people really like the concept.“ Nurse Manager in ICU

14. Social Media Comments:
Lovely idea, I would have loved this for my dad who passed away in St. James in April.
Ah, that’s a wonderful idea.
Such a beautiful keepsake. A unit very close to my heart since I lost my dad in May 2014.
Aw what a fantastic idea. I wish that they had this 5 years ago.
Responses:
5,241 people reached
350 reactions, comments & shares
More than any other campaign!
Social Media

15. Sustainability
Part of larger EOLC quality improvement process in the ICU
Integral to the care at end of life
Part of the care process
Need to keep collecting data/feedback
“… about the hand prints in ICU, it is just the nicest thing I have ever heard at such a sad time. I am very interested in having a look at it and how they do it in ICU. I am wondering if this is something that could happen on the wards to?” Health Care Assistant & EOLC lead on another ward
Knock-on effect hospital wide
Source funding for potential expansion
Start engagement process with wider hospital community

16. Acknowledgments ICU End-of-Life Care Committee Rynagh Gilligan, CNM3
Claire Holdsworth, Hospital Foundation Manager
Deidre Coffey, Organ Donation Manager
Official launch of the handprints in ICU