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Turning a fasthug  into low flat hugs could improve compliance with daily care bundles on the general intensive care unit: a preliminary audit
Intensive Care Medicine Experimental volume 3, Article number: A145 (2015)
Over recent years, Intensive Care Medicine has recognised the benefit of implementing checklists to augment strategies for improving patient safety. One such care bundle checklist is the FASTHUG mnemonic (Feeding; Analgesia; Sedation; Thromboprophylaxis; Head up positioning; Ulcer Protection and Glucose levels). In our ICU a variation of the mnemonic has evolved, initially into 'FLATHUGS', and more recently into 'FLATHUGS VC', where additional care bundle components include L: invasive vascular L ines; C: C hlorhexidine mouth care; V: lung protective V entilation.
This clinical audit examines (i) compliance with a locally adapted version of the FASTHUG mnemonic, and (ii)suggests an updated version and template to improve its clinical utility.
A random convenience sample of medical notes from 92 separate patient day reviews over a 4 week period were analysed for documented versions of FLATHUGS VC. Data was collected from all patients with an ICU stay >24 hours, and any actions raised during the documentation of FLATHUGS were checked for completion within that same 24 hour period.
In our unit, a basic 'FLATHUGS' package was completed in 81.5% of cases. The two most recently introduced components in addition to FLATHUGS (lung protective ventilation; and Chlorhexidine mouth care) were documented in 38% and 3.3% of cases respectively (Table 1). In addition, we found there were inconsistencies in the detail of what was recorded under each heading. Common examples included: (i) recording either the type of sedation, or the level of sedation (RASS Score); (ii) date of IV line insertion or anticipated date of IV line replacement.
There is currently an inconsistent approach amongst our ICU physicians in their application of the ´FASTHUGS VC´ care bundle, and we feel it is conceivable that this situation may be partially attributable to degradation of the original mnemonic. Although FASTHUG is an excellent mnemonic for a basic care bundle, we suggest it could be further improved by amending it to 'LOW FLAT HUGS', which includes four additional elements to those described by Vincent in the original version (Lung protective ventilation; Oral hygiene of intubated patients; Weight change; Line change with date). To help embed these proposed changes and improve compliance a template sticker (Figure 1) may prove useful, and further evaluation after a period of implementation is recommended.
Vincent JL: Give your patient a fast hug (at least) once a Day. Crit Care Med. 2005, 33 (6): 1225-9. Jun
Conroy KM, et al: Validating a process-of-care checklist for intensive care units. Anaesth Intensive Care. 2013, 41 (3): 342-8. May
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Brooke, M., Murthy, B. Turning a fasthug  into low flat hugs could improve compliance with daily care bundles on the general intensive care unit: a preliminary audit. ICMx 3, A145 (2015). https://doi.org/10.1186/2197-425X-3-S1-A145
- Oral Hygiene
- Intensive Care Medicine
- Improve Patient Safety
- Clinical Audit
- General Intensive Care Unit