‘ Don't Break my Patient ’: Physiotherapists' Management of Instability and Adverse Events in Paediatric Intensive Care

BACKGROUND AND PURPOSE: Respiratory physiotherapy is a treatment option for children on paediatric intensive care units (PICUs), aiming to facilitate airway clearance and improve ventilation. Given the vulnerable nature of this patient group, safety and adverse events related to respiratory physiotherapy are important considerations. The aim of this qualitative study was to understand what physiotherapists perceive to be risk factors for instability and adverse events and how they manage these. METHOD: This study involved virtual semi-structured interviews and focus groups with PICU physiotherapists. Sixteen interviews and two focus groups (n = 7) were completed. These were audio-recorded and transcribed verbatim. Framework analysis was used. RESULTS: From the interview analysis, a framework Strategies for managing instability and adverse events was developed. Two frameworks were developed from the focus group analysis: Instability and adverse events and Managing instability and adverse events. Physiotherapists provided a comprehensive list of perceived risk factors for instability and adverse events, including clinical presentations and support required. Practical strategies were reported to promote efficiency, including readiness of equipment and two-person treatments. Physiotherapists described accepting short-term unwanted effects for longer-term improvement, discussed in terms of risk versus benefit. The patient's parents/family were involved in the sharing of responsibility for treatment decisions. Multidisciplinary team involvement included collaborative discussion with practical assistance as required. DISCUSSION: This study provides novel data about physiotherapists' management of instability and adverse events in PICUs. Preparation and planning, involving the multidisciplinary team, family inclusion, reacting and adapting, and accepting instability were important strategies. The findings from this study highlight several areas that require consideration from a workforce support and education perspective.