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Post-ICU Presentation Screen (PICUPS) and Rehabilitation Prescription (RP)

Post-ICU Presentation Screen (PICUPS) and Rehabilitation Prescription (RP) in patients stepping down from intensive care and recovering

 

Background

The Post ICU Presentation Screen (PICUPS) is a simple 14-item clinical tool developed to support triage and handover of patients stepping down from ITU into the acute wards, and onwards into rehabilitation. The PICUPS Plus represents 10 additional items to identify potential higher-level items that may need to be addressed as the patient progresses during acute care.

Their purpose is:

  • To inform the immediate plan for care on the acute ward.

  • To identify problems likely to require furthermore detailed assessment / evaluation by members of the multi-disciplinary team and so trigger appropriate referrals.

Together, these help to inform development of a personalised Rehabilitation Prescription as the patient leaves the acute care setting. The RP sets out their needs for rehabilitation and helps to direct their on-going care after discharge from the acute ward. For most patients, this will be to home and community based services, but a small proportion may require a further period of inpatient rehabilitation before they are ready to leave hospital.

As well as guiding decision-making for individual patients, this information will help to identify where their needs are and are not being met. Used at population level, the information will enable us to quantify shortfalls in current service provision and to estimate the gap between capacity and demand for future planning. Developed in the context of the Covid-19 pandemic, the tools are also expected to be useful in future for any patient following prolonged treatment in intensive care.

UKROC has developed a simple software programme based on Microsoft Excel to assist with data collection and collation. This is free to use and can be obtained by emailing the UKROC team at LNWH-tr.ukroc-rp@nhs.net

 

Testing and development

The PICUPS was developed by a multi-professional group brought together through the National Post ICU Rehabilitation Collaborative.

  • It was designed as a simple tool to be completed by a junior doctor, a nurse and a member of the ICU therapy team, not requiring any particular specialist knowledge.

  • A national pilot across 26 ICUs and acute wards in July-August 2020 showed the PICUPS to be a psychometrically robust tool that is clinically useful to assist with decision-making and triggering referral to the various disciplines who should be involved.

The piloting and ongoing development is led by the Intensive Care Society and British Society of Rehabilitation Medicine on behalf of the National Post ICU Rehabilitation Collaborative. Data is being collected and collated by UKROC.

 

Ongoing piloting

An extended national pilot started in December 2020. The aim is to encourage all ICUs in the UK to be using the PICUPS and RP routinely for all patients (COVID-19 and non-COVID) and to submit data to UKROC.

For further details about the pilot study visit Intensive Care Society website or email ICS at ICSRehabCollaborative@ics.ac.uk

 

Dataset

The longer term aim is to establish the PICUPS and RP as part of the national data collection for patients who have ongoing needs for rehabilitation after leaving intensive care. A summary of the full dataset is available here:

Full dataset collection paper form for PICUPS and RP

For further information please contact UKROC team at LNWH-tr.ukroc-rp@nhs.net

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