LifeMapp Registration Form

Foreword

LifeMapp.fr service listing questionnaire — One O One (101) Fund.

Welcome!

Thank you for your interest in LifeMapp. We are delighted to list your unit. LifeMapp is a web app designed to support and complement the welcome and guidance provided by healthcare professionals, by giving patients and their families information and advice to help them become familiar with the intensive care environment and prepare for the return to everyday life.

Who are we?

The One O One (101) Fund is a non-profit organization whose mission is to advance intensive care medicine by funding training programs for healthcare professionals, research projects, and initiatives to better support patients and their families during and after an ICU stay.

Why this questionnaire?

This questionnaire gathers the information needed to list your unit on LifeMapp. It will be used both to create a dedicated page for your unit on lifemapp.fr and to ensure effective communication between your unit and the 101 Fund. You can view an example unit page at: lifemapp.one-o-one.eu/template-page-service

Use of data

The 101 Fund is strongly committed to data protection. By completing this form, you consent to the use of your responses by the 101 Fund as part of the LifeMapp program and, where applicable, LifeMapp Diary. The data collected will not be disclosed outside the 101 Fund.

Page 1 — Unit contacts

The information below will be used strictly for communication between your intensive care unit and the 101 Fund. It will not appear on your unit's page.

101 Fund contacts

Primary contact for exchanges with the 101 Fund
Secondary contact for exchanges with the 101 Fund

Unit leadership team

Head of unit contact details
Nurse / paramedical manager contact details

Other contacts

Reception host contact details
What is the reception host's daily availability?
Unit psychologist contact details

E.g. Monday to Friday, 8am–6pm.

Does your unit have a working group dedicated to improving the ICU experience and/or supporting families?
Mieux Accompagner working group contact details

Communication

Hospital communications department contact details
Institutional website ↔ LifeMapp link
Page 2 — Listing your unit on LifeMapp

This information will be displayed on your unit's dedicated page on lifemapp.fr. The questions follow the order of the fields on the example unit page (lifemapp.one-o-one.eu/template-page-service). We recommend opening it in parallel so you can preview the final result.

General information

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Welcome message

E.g. Professor X, Head of Unit

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You can add several photos (team photos, photos of the team at work, etc.). They will appear in a carousel on your unit's page next to your welcome message.

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If you have a PDF staff directory for your team, we can add it to your LifeMapp page. Please note that your unit will be responsible for keeping it up to date by regularly sending the latest version to lifemapp@one-o-one.eu.

Other messages

If you wish, you can add other messages to your unit's page.

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Other message(s) you would like to add to the page (optional)
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Click “+ Add a message” for each additional message you would like to include.

Research groups

Does your unit participate in research groups?

E.g. GrrrOH, AtlanRéa, REVA…

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Visits

Visiting hours
Does your unit allow visits from children?
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Pets

Does your unit allow visits from pets?
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PDF or Word document. It may be displayed on your LifeMapp page.

Contact information to display on your LifeMapp page

Unit administrative office contact
Would you like the psychologist's contact details to be displayed on your LifeMapp page?
Would you like the reception host's contact details to be displayed on your LifeMapp page?
Are there any other contact details you would like to display on your unit's page? (optional)

Add as many rows as necessary (label, number, email).

Access

Hospital address
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Unit organization

Indicate the time slots that are most suitable for visits, phone calls and medical meetings. The sentence “These time slots are indicative and may vary depending on unit activity” will be displayed on your LifeMapp page together with the time slots you select below.

Best time slots for visits (optional)
Best time slots for phone calls (optional)
Best time slots for medical meetings (optional)

Photos

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Please upload 4 photos or more. They will appear on your LifeMapp page next to the visiting hours. Suggestions include: the waiting room, corridors, units, an empty patient room, etc.

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Please upload 2 to 4 photos. They will appear on your LifeMapp page after the access information.

Other documents and information

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E.g. patient/family information booklet PDF, patient charter…

Page 3 — Other information about your unit

The information below will not be displayed on your unit's LifeMapp page and will not be shared outside the 101 Fund.

Unit characteristics

Hospital type
Is your hospital a university hospital?
Type of intensive care unit

Clinical staff (FTE)

Number of staff by category (full-time equivalent)
Page 4 — Your unit's commitments to better support patients and families

This information will help the 101 Fund better understand the practices and resources in place in listed units. It is collected for analysis and to highlight existing initiatives, and will not be shared outside the 101 Fund without your explicit consent.

a) Preventing patient discomfort

How do you assess your patients' pain?
How do you assess your patients' thirst?
Does your unit have a policy to limit the use of restraints?
What non-verbal communication methods are available for patients who cannot communicate verbally?
What measures does your unit use to manage noise?
How do you assess your patients' sleep quality?
Do you provide earplugs and/or sleep masks to patients?

b) Improving the patient's ICU experience

Are the rooms in your unit single rooms?
Do patients have an outside view from their bed (window)?
Are the time and date visible from the patient's bed?
Can relatives personalize the patient's room (photos, objects, etc.)?
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May this photo be displayed on your LifeMapp page?
Does your unit have a wellbeing cart?
Are members of your team trained in therapeutic touch/massage or socio-aesthetic care?
Are members of your team trained in hypnosis?
Can relatives participate in the patient's care?
What entertainment options are available to patients?
Would you like these entertainment options to be displayed on your LifeMapp page?

c) Supporting relatives and families

Does your unit have a waiting room?

E.g. seating, power outlets, Wi-Fi, vending machine, information booklets…

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You can add one or more photos of the waiting room.

Does your unit have wayfinding signage for relatives?
Does your unit offer secure storage/lockers for relatives?
Do you have an overnight accommodation solution for relatives?
Does your unit have a family room or meeting room?
How does your unit organize communication with relatives?

d) Improving the post-ICU experience

Do you use ICU diaries in your unit?
Does your unit offer post-ICU consultations?
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If you would like to add one or more web links, please list them in a .doc document and upload it above.

Display on your LifeMapp page
Does your unit offer a discussion or support group for former patients and/or their relatives?

e) Sustainable intensive care

Is your unit engaged in a sustainable intensive care approach?