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Sample records for care units observational

  1. An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit.

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    Lillibridge, Nichole; Botti, Mari; Wood, Beverley; Redley, Bernice

    2017-12-01

    To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. Naturalistic, exploratory descriptive design using observation. Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. Patient outcomes sensitive to the quality of interprofessional handover on patient

  2. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef

    2012-01-01

    on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly....

  3. Does neonatal pain management in intensive care units differ between night and day? An observational study.

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    Guedj, Romain; Danan, Claude; Daoud, Patrick; Zupan, Véronique; Renolleau, Sylvain; Zana, Elodie; Aizenfisz, Sophie; Lapillonne, Alexandre; de Saint Blanquat, Laure; Granier, Michèle; Durand, Philippe; Castela, Florence; Coursol, Anne; Hubert, Philippe; Cimerman, Patricia; Anand, K J S; Khoshnood, Babak; Carbajal, Ricardo

    2014-02-20

    To determine whether analgesic use for painful procedures performed in neonates in the neonatal intensive care unit (NICU) differs during nights and days and during each of the 6 h period of the day. Conducted as part of the prospective observational Epidemiology of Painful Procedures in Neonates study which was designed to collect in real time and around-the-clock bedside data on all painful or stressful procedures. 13 NICUs and paediatric intensive care units in the Paris Region, France. All 430 neonates admitted to the participating units during a 6-week period between September 2005 and January 2006. During the first 14 days of admission, data were collected on all painful procedures and analgesic therapy. The five most frequent procedures representing 38 012 of all 42 413 (90%) painful procedures were analysed. Observational study. We compared the use of specific analgesic for procedures performed during each of the 6 h period of a day: morning (7:00 to 12:59), afternoon, early night and late night and during daytime (morning+afternoon) and night-time (early night+late night). 7724 of 38 012 (20.3%) painful procedures were carried out with a specific analgesic treatment. For morning, afternoon, early night and late night, respectively, the use of analgesic was 25.8%, 18.9%, 18.3% and 18%. The relative reduction of analgesia was 18.3%, pnight-time and 28.8%, pday. Parental presence, nurses on 8 h shifts and written protocols for analgesia were associated with a decrease in this difference. The substantial differences in the use of analgesics around-the-clock may be questioned on quality of care grounds.

  4. Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge.

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    De Meester, K; Das, T; Hellemans, K; Verbrugghe, W; Jorens, P G; Verpooten, G A; Van Bogaert, P

    2013-02-01

    Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol. To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart. Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention. For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%. The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

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    Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

    2018-01-01

    The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

  6. Predictors of stress among parents in pediatric intensive care unit: a prospective observational study.

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    Aamir, Mohd; Mittal, Kundan; Kaushik, Jaya Shankar; Kashyap, Haripal; Kaur, Gurpreet

    2014-11-01

    To determine the sociodemographic and clinical factors leading to stress among parents whose children are admitted in pediatric intensive care unit (PICU). A prospective observational study was conducted in PICU of a tertiary care hospital of north India. Parents of children admitted to PICU for at least 48 h duration were eligible for participation. At the end of 48 h, parental stress was assessed using parental stress scale (PSS:PICU) questionnaire which was administered to the parents. Baseline demographic and clinical parameters of children admitted to PICU were recorded. The parental stress was compared with demographic and clinical characteristics of children using appropriate statistical methods. A total of 49 parents were finally eligible for participation. Mean (SD) parental stress scores was highest in domains of procedures [1.52 (0.66)] and behavior and emotional [1.32 (0.42)] subscales. Mean (SD) total parental stress score among intubated children [1.31 (0.25)] was significantly more than among non intubated children [0.97 (0.26)] (p parental stress score were comparable in terms of gender (p = 0.15) and socioeconomic status (p = 0.32). On subscale analysis, it was found that professional communication is a significant stressor in age groups 0-12 mo [0.61(0.41)] (p = 0.02). It was observed that parents of intubated children were significantly stressed by the physical appearance of their children (p parental role (p = 0.002). Total parental stress score had a positive correlation with PRISM score (r = 0.308). Indian parents are stressed maximally with environment of PICU. Factor leading to parental stress was intubation status of the child and was not affected by gender or socio demographic profile of the parents.

  7. Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data

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    Giuseppina Caggiano

    2017-01-01

    Full Text Available We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions. Candida parapsilosis sensu stricto (58.5% and C. albicans (34.1% were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12. Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%. Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.; non-albicans species predominate in Asia (75%. Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment.

  8. Changes in dental plaque following hospitalisation in a critical care unit: an observational study.

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    Sachdev, Mishal; Ready, Derren; Brealey, David; Ryu, Jung; Bercades, Georgia; Nagle, Janette; Borja-Boluda, Susana; Agudo, Elisa; Petrie, Aviva; Suvan, Jean; Donos, Nikos; Singer, Mervyn; Needleman, Ian

    2013-09-04

    Previous research has suggested that deterioration in oral health can occur following hospitalisation. The impact of such deterioration could increase the risk of oral disease, reduce quality of life and increase the potential for healthcare-associated infections (HCAI) such as healthcare-associated pneumonia (HAP). However, the strength of the evidence is limited by, amongst other factors, the few observational studies published that assess oral health longitudinally. In view of the microbiological component of oral diseases and HCAIs, the objective of this study was to investigate the microbiological changes in dental plaque following hospitalisation in a Critical Care Unit (CCU): (1) total number of cultivable bacteria and (2) presence and changes in specific HAP pathogens. We conducted a prospective, longitudinal observational study in the CCU of University College Hospital, London. Study participants were recruited within 24 hours of admission. Dental plaque samples were collected from up to six sites per patient. The primary outcome was microbiological change from baseline to seven days with additional analysis for participants still present at day 14. 50 patients were recruited with 36 available for review at one week, with early discharge accounting for much of the loss to follow-up. The median total viable count of the plaque microbiota at baseline was 4.40 × 105 cfu/ml and increased at week one to 3.44 × 106 cfu/ml. The total viable microbe counts increased by a median of 2.26 × 106 cfu/ml from baseline to week one (95% CI: 3.19 × 106, 1.24 × 107) and this was statistically significant (P bacterial count of dental plaque increases during hospitalisation in CCU. This finding, together with the colonisation of dental plaque by HAP bacteria strengthens the evidence for a deterioration in oral health in CCU and a risk factor for negative health and quality of life outcomes.

  9. Asthma changes at a Pediatric Intensive Care Unit after 10 years: Observational study

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    Ayman A Al-Eyadhy

    2015-01-01

    Full Text Available Objectives: To describe the change in the management, and outcome of children with acute severe asthma (ASA admitted to Pediatric Intensive Care Unit (PICU at tertiary institute, as compared to previously published report in 2003. Methods : This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort. Results: In comparison to previous 2003 Cohort, current Cohort (2013 revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001, higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007, less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03, less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001. There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001, intravenous magnesium sulfate (68.2% vs. none, intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015, and noninvasive ventilation (NIV (35.8% vs. none while no patients were treated with theophylline (none vs. 62.5%. The median length of stay (LOS was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality. Conclusion: We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.

  10. Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study

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    Vignaud, Marie; Constantin, Jean-Michel; Ruivard, Marc; Villemeyre-Plane, Michele; Futier, Emmanuel; Bazin, Jean-Etienne; Annane, Djillali

    2010-01-01

    Introduction Data on the epidemiology and management of anorexia nervosa (AN) in the intensive care unit (ICU) are scarce. The aim of this study was to evaluate the prevalence and associated morbidity and mortality of AN in French ICUs. Methods We randomly selected 30 ICUs throughout France. Thereafter, we retrospectively analyzed all patients with AN admitted to any of these 30 ICUs between May 2006 and May 2008. We considered demographic data, diagnosis at admission and complications occurr...

  11. Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry.

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    Judge, Bryan S; Ouellette, Lindsey M; VandenBerg, Melissa; Riley, Brad D; Wax, Paul M

    2016-03-01

    Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify

  12. [Preliminary study on detox in outpatient care units with 18 alcoholic patients in Directly Observed Treatment].

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    Lloréns Martínez, Ramón; Calatayud Francés, María; Morales Gallús, Esperanza; Añó Cervera, Consol; Adriá Caballero, Librada

    2008-01-01

    Directly Observed Treatment (TOD-DOT) has been tested in different conditions. The objective of this work is to check whether a UCA-CAB (Centre for Addictive Behaviour) can achieve detox and reduce the risk of early relapse (up to 12 weeks) in alcoholic patients. All patients had an established organic addiction and serious withdrawal syndrome, and had undergone multiple previous treatments. Furthermore, they had not managed to abstain for a 3-month consecutive period over the previous 2 years. The aim of the Directly Observed Treatment was to attain detox and reduce relapse by following a multi-method approach: medical, psychological and personal care, based on a brief daily consultation and pharmacological supervision. The results were as follows: Of the 18 patients included in the study, after 12 weeks, 13 (72 %) were still abstinent and 4 (22 %) had relapsed. Thus, 17 (94 %) were still following the treatment, with just one drop-out. We analysed the profiles of the patients abstaining, of those who relapsed (4) and of the one who dropped out. The average CIWA-Ar was 27.05 (21-36). Any value over 20 is considered to indicate serious withdrawal syndrome, though there were no negative events leading to hospitalization. Level of adherence to the treatment (94 %) meant that the most seriously affected patients and those with fewest financial resources could benefit, not only from any auxiliary social schemes, but also from basic health services, permitting them to improve the quality of their everyday life.

  13. Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study.

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    Vignaud, Marie; Constantin, Jean-Michel; Ruivard, Marc; Villemeyre-Plane, Michele; Futier, Emmanuel; Bazin, Jean-Etienne; Annane, Djillali

    2010-01-01

    Data on the epidemiology and management of anorexia nervosa (AN) in the intensive care unit (ICU) are scarce. The aim of this study was to evaluate the prevalence and associated morbidity and mortality of AN in French ICUs. We randomly selected 30 ICUs throughout France. Thereafter, we retrospectively analyzed all patients with AN admitted to any of these 30 ICUs between May 2006 and May 2008. We considered demographic data, diagnosis at admission and complications occurring during the stay, focusing on refeeding syndrome and management of refeeding. Eleven of the 30 ICUs participated in the retrospective study, featuring 68 patients, including 62 women. Average body mass index at the admission was 12 ± 3 kg/m2. Twenty one were mechanically ventilated, mainly for neurological reasons. The reported average calorie intake was 22.3 ± 13 kcal/kg/24 h. Major diagnoses at admission were metabolic problems, refeeding survey and voluntary drug intoxication and infection. The most common complications were metabolic, hematological, hepatic, and infectious events, of which 10% occurred during refeeding. Seven patients developed refeeding syndrome. At day one, the average calorie intake was higher for patients who developed refeeding syndrome (23.2 ± 5 Kcal/kg/j; n = 7) versus patients without refeeding syndrome (14.1 ± 3 Kcal/kg/j; n = 61) P = 0.02. Seven patients died, two from acute respiratory distress syndrome and five from multiorgan-failure associated with major hydroelectrolytic problems. The frequency of AN in ICU patients is very low and the crude mortality in this group is about 10%. Prevention and early-detection of refeeding syndrome is the key point.

  14. Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: Use of continuous closed circle television versus overt observation.

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    Brotfain, Evgeni; Livshiz-Riven, Ilana; Gushansky, Alexander; Erblat, Alexander; Koyfman, Leonid; Ziv, Tomer; Saidel-Odes, Lisa; Klein, Moti; Borer, Abraham

    2017-08-01

    A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

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    Çiğdem Aliosmanoğlu

    2011-06-01

    Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.

  16. Medication Errors in an Internal Intensive Care Unit of a Large Teaching Hospital: A Direct Observation Study

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    Saadat Delfani

    2012-06-01

    Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

  17. Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

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    Jane Topolovec-Vranic

    2013-01-01

    Full Text Available BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.

  18. External Validation of Risk Prediction Scores for Invasive Candidiasis in a Medical/Surgical Intensive Care Unit: An Observational Study

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    Ahmed, Armin; Baronia, Arvind Kumar; Azim, Afzal; Marak, Rungmei S. K.; Yadav, Reema; Sharma, Preeti; Gurjar, Mohan; Poddar, Banani; Singh, Ratender Kumar

    2017-01-01

    Background: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis. Methods: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis. Results: Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%–47%, along with negative predictive values (NPVs) in the range of 84%–96% in the subgroup analysis. Conclusion: Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy. PMID:28904481

  19. Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan.

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    Morita, Tatsuya; Chinone, Yoshikazu; Ikenaga, Masayuki; Miyoshi, Makoto; Nakaho, Toshimichi; Nishitateno, Kenji; Sakonji, Mitsuaki; Shima, Yasuo; Suenaga, Kazuyuki; Takigawa, Chizuko; Kohara, Hiroyuki; Tani, Kazuhiko; Kawamura, Yasuo; Matsubara, Tatsuhiro; Watanabe, Akihiko; Yagi, Yasuo; Sasaki, Toru; Higuchi, Akiko; Kimura, Hideyuki; Abo, Hirofumi; Ozawa, Taketoshi; Kizawa, Yoshiyuki; Uchitomi, Yosuke

    2005-10-01

    Although palliative sedation therapy is often required in terminally ill cancer patients to achieve acceptable symptom relief, empirical data supporting the ethical validity of this approach are lacking. The primary aim of this study was to systematically investigate whether empirical evidence supports the ethical validity of sedation. This was a multicenter, prospective, observational study, which was conducted by 21 specialized palliative care units in Japan. One-hundred two consecutive adult cancer patients who received continuous deep sedation were enrolled. Continuous deep sedation was defined as the continuous use of sedative medications to relieve intolerable and refractory distress by achieving almost or complete unconsciousness until death. Prior to the study, we conceptualized the ethical validity of sedation from the viewpoints of physicians' intent, proportionality, and autonomy. Sedation was performed mainly with midazolam and phenobarbital. The initial doses of midazolam and phenobarbital were 1.5 mg/hour and 20 mg/hour, respectively. Main administration routes were continuous subcutaneous infusion and continuous intravenous infusion, and no rapid intravenous injection was reported. Of 59 patients who received artificial hydration or could intake adequate fluids/foods orally before sedation, 63% received artificial hydration therapy after sedation, and in the remaining patients, artificial hydration was withheld or withdrawn due to fluid retention symptoms and/or patient wishes. Of 66 patients who were able to verbally express themselves, 95% explicitly stated that symptoms were intolerable. The etiologies of the symptoms requiring sedation were primarily related to the progression of the underlying malignancy, such as cancer cachexia and organ failure, and standard palliative treatments had failed: steroids in 68% of patients with fatigue, opioids in 95% of patients with dyspnea, antisecretion medications in 75% of patients with bronchial secretion

  20. [Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit].

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    Álvarez Maldonado, Pablo; Cueto Robledo, Guillermo; Cicero Sabido, Raúl

    2015-04-01

    To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). A prospective, comparative, longitudinal and interventional study was carried out. The RICU of Hospital General de México (Mexico). All patients admitted to the RICU from March 2012 to March 2013. An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP). NPE, reintubation and VAP ratios. A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5). Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study.

    Science.gov (United States)

    Machado, Flavia R; Cavalcanti, Alexandre Biasi; Bozza, Fernando Augusto; Ferreira, Elaine M; Angotti Carrara, Fernanda Sousa; Sousa, Juliana Lubarino; Caixeta, Noemi; Salomao, Reinaldo; Angus, Derek C; Pontes Azevedo, Luciano Cesar

    2017-11-01

    The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models. On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4-31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8-44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2-59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02-2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37-0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital. The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the

  2. Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

    Directory of Open Access Journals (Sweden)

    Yugang Hu

    2017-11-01

    Full Text Available Background/Aims: Acute Kidney Injury (AKI is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6% patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842] outperformed β2-micro globulin (AUC=0.813 and the clinical model (AUC=0.777, and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2% patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR, 4.955; 95% confidence interval (95% CI, 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867, as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463. Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

  3. Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting.

    Science.gov (United States)

    Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne

    2014-12-01

    Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  4. Intensive Care Unit Delirium

    Directory of Open Access Journals (Sweden)

    Yongsuk Kim

    2015-05-01

    Full Text Available Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition’s high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

  5. Nutritional Care in Iranian Intensive Care Units

    Science.gov (United States)

    2018-01-01

    Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary. PMID:29713622

  6. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.

    Science.gov (United States)

    Galiczewski, Janet M; Shurpin, Kathleen M

    2017-06-01

    Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Information structure and organisation in change of shift reports: An observational study of nursing hand-offs in a Paediatric Intensive Care Unit.

    Science.gov (United States)

    Foster-Hunt, Tara; Parush, Avi; Ellis, Jacqueline; Thomas, Margot; Rashotte, Judy

    2015-06-01

    Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study.

    Science.gov (United States)

    van Deijck, Rogier H P D; Hasselaar, Jeroen G J; Verhagen, Stans C A H H V M; Vissers, Kris C P; Koopmans, Raymond T C M

    2016-05-01

    Knowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning. This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life. A prospective multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed. A total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Observations on kangaroo baby care.

    Science.gov (United States)

    Mukasa, G K

    1992-01-01

    The author's visit to "kangaroo care" programs in Guatemala and Colombia has led Uganda's University of Kampala to consider the introduction of this innovation in its neonatal special care unit. Such programs, which place premature infants in direct contact with their mother's skin during breastfeeding, represents a simple, inexpensive strategy for infant survival in developing countries and eliminates the need for mechanical incubators. Research conducted at the Hospital Universitario de Valle in Cali, Colombia, found that falls in the infant's body temperature. In the Latin American programs, premature infants are entered into the breastfeeding program immediately after delivery.

  10. What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study.

    Science.gov (United States)

    Sefton, G; McGrath, C; Tume, L; Lane, S; Lisboa, P J G; Carrol, E D

    2015-04-01

    The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital. The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (pemergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Incidence, Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units: A 10 Year Observation in a Provincial Hospital in Southern Poland

    Science.gov (United States)

    Kołpa, Małgorzata; Wałaszek, Marta; Gniadek, Agnieszka; Wolak, Zdzisław; Dobroś, Wiesław

    2018-01-01

    Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Aetiological factors of these infections can have an impact on treatment effects, treatment duration and mortality. The aim of the study was to determine the prevalence and microbiological profile of HAIs in patients hospitalized in an ICU over a span of 10 years. The active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a general ICU ward located in southern Poland between 2007 and 2016. The study was conducted in compliance with the methodology recommended by the Healthcare-associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC). During the 10 years of the study, 1849 patients hospitalized in an ICU for a total of 17,599 days acquired 510 with overall HAIs rates of 27.6% and 29.0% infections per 1000 ICU days. Intubation-associated pneumonia (IAP) posed the greatest risk (15.2 per 1000 ventilator days), followed by CLA-BSI (8.0 per 1000 catheter days) and CA-UTI (3.0 per 1000 catheter days). The most common isolated microorganism was Acinetobacter baumannii (25%) followed by Coagulaase-negativ staphylococci (15%), Escherichia coli (9%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (7%), Candida albicans (6%). Acinetobacter baumannii in 87% and were classified as extensive-drug resistant (XDR). In summary, in ICU patients pneumonia and bloodstream infections were the most frequently found. Acinetobacter baumannii strains were most often isolated from clinical materials taken from HAI patients and showed resistance to many groups of antibiotics. A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed. PMID:29324651

  12. Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study.

    Science.gov (United States)

    Widerström, Micael; Wiström, Johan; Edebro, Helén; Marklund, Elisabeth; Backman, Mattias; Lindqvist, Per; Monsen, Tor

    2016-12-09

    During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU). Over 12 months in 2006-2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates. We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes. Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting.

  13. New Modalities for the Administration of Inhaled Nitric Oxide in Intensive Care Units After Cardiac Surgery or for Neonatal Indications: A Prospective Observational Study.

    Science.gov (United States)

    Gaudard, Philippe; Barbanti, Claudio; Rozec, Bertrand; Mauriat, Philippe; M'rini, Mimoun; Cambonie, Gilles; Liet, Jean Michel; Girard, Claude; Leger, Pierre Louis; Assaf, Ziad; Damas, Pierre; Loron, Gauthier; Lecourt, Laurent; Amour, Julien; Pouard, Philippe

    2018-04-01

    Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed. Concomitant pulmonary vasodilator treatments, safety data, and outcome were also collected. Quantitative data are expressed as median (25th, 75th percentile). Over 1 year, 236 patients were included from 14 equipped and trained centers: 117 adults and 81 children with PH associated with cardiac surgery and 38 neonates with persistent PH of the newborn. Inhaled NO was initiated before intensive care unit (ICU) admission in 57%, 12.7%, and 38.9% with an initial dose of 10 (10, 15) ppm, 20 (18, 20) ppm, and 17 (11, 20) ppm, and a median duration of administration of 3.9 (1.9, 6.1) days, 3.8 (1.8, 6.8) days, and 3.1 (1.0, 5.7) days, respectively, for the adult population, pediatric cardiac group, and newborns. The treatment was performed using administration synchronized to the mechanical ventilation. The dose was gradually decreased before withdrawal in 86% of the cases according to the usual procedure of each center. Adverse events included rebound effect for 3.4% (95% confidence interval [CI], 0.9%-8.5%) of adults, 1.2% (95% CI, 0.0%-6.7%) of children, and 2.6% (95% CI, 0.1%-13.8%) of neonates and methemoglobinemia exceeded 2.5% for 5 of 62 monitored patients. Other pulmonary vasodilators were associated with NO in 23% of adults, 95% of children, and 23.7% of neonates. ICU stay was respectively 10 (6, 22) days, 7.5 (5.5, 15) days, and 9 (8, 15) days and ICU mortality was 22.2%, 6.2%, and 7.9% for adults, children, and neonates, respectively. This study confirms the safety

  14. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki

    2017-01-01

    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...... patients. We were not able to further reduce the already existing low noise levels in the ICU and did not find any association between the environmental intervention and the presence of normal sleep characteristics in the PSG....

  15. [Medication errors in Spanish intensive care units].

    Science.gov (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

    2013-01-01

    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  16. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira

    2015-12-01

    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  17. Care management in nursing within emergency care units.

    Science.gov (United States)

    Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma

    2015-12-01

    Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  18. Care management in nursing within emergency care units

    OpenAIRE

    Roberta Juliane Tono de Oliveira; Patrícia Madalena Vieira Hermida; Fernanda Hannah da Silva Copelli; José Luís Guedes dos Santos; Alacoque Lorenzini Erdmann; Selma Regina de Andrade

    2015-01-01

    Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency se...

  19. Delirium and coma evaluated in mechanically ventilated patients in the intensive care unit in Japan: a multi-institutional prospective observational study.

    Science.gov (United States)

    Tsuruta, Ryosuke; Oda, Yasutaka; Shintani, Ayumi; Nunomiya, Shin; Hashimoto, Satoru; Nakagawa, Takashi; Oida, Yasuhisa; Miyazaki, Dai; Yabe, Shigemi

    2014-06-01

    The object of this study is to evaluate the prevalence and effects of delirium on 28-day mortality in critically ill patients on mechanical ventilation in Japan. Prospective cohort study was conducted in medical and surgical intensive care units (ICUs) of 24 medical centers. Patients were followed up daily for delirium during ICU stay after enrollment. Coma was defined with the Richmond Agitation Sedation Scale score of -4 or -5. Delirium was diagnosed using the Confusion Assessment Method for the ICU. The Cox proportional hazards regression model was used to assess the effects of delirium and coma on 28-day mortality, time to extubation, and time to ICU discharge; delirium and coma were included as time-varying covariates after controlling for age, Acute Physiology and Chronic Health Evaluation II score, ventilator-associated pneumonia, and the reason for intubation with infection. Of 180 patients, 115 patients (64%) developed delirium. Moreover, 15 patients (8%) died within 28 days after ICU admission, including 7 patients who experienced coma and 8 patients who experienced both coma and delirium. There were no deaths among patients who did not experience coma. Delirium was associated with a shorter time to extubation (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.65-3.85; Pcoma, although statistical significance was not detected due to limited analytical power (HR, 0.62; 95% CI, 0.34-1.12; P=.114). Delirium during ICU stay was not associated with higher mortality. Further study is needed to investigate the discrepancy between these and previous data. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Spiritual Care in the Intensive Care Unit: A Narrative Review.

    Science.gov (United States)

    Ho, Jim Q; Nguyen, Christopher D; Lopes, Richard; Ezeji-Okoye, Stephen C; Kuschner, Ware G

    2018-05-01

    Spiritual care is an important component of high-quality health care, especially for critically ill patients and their families. Despite evidence of benefits from spiritual care, physicians and other health-care providers commonly fail to assess and address their patients' spiritual care needs in the intensive care unit (ICU). In addition, it is common that spiritual care resources that can improve both patient outcomes and family member experiences are underutilized. In this review, we provide an overview of spiritual care and its role in the ICU. We review evidence demonstrating the benefits of, and persistent unmet needs for, spiritual care services, as well as the current state of spiritual care delivery in the ICU setting. Furthermore, we outline tools and strategies intensivists and other critical care medicine health-care professionals can employ to support the spiritual well-being of patients and families, with a special focus on chaplaincy services.

  1. A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

    Science.gov (United States)

    Jakobsen, Louise M; Jorgensen, Anette F B; Thomsen, Birthe L; Greiner, Birgit A; Rugulies, Reiner

    2015-01-01

    Objectives Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. Methods Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. Results Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. Conclusions Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions. PMID:26560058

  2. Nurse management skills required at an emergency care unit

    OpenAIRE

    Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth

    2013-01-01

    Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...

  3. A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, Louise M.; Jorgensen, Anette F. B.; Thomsen, Birthe L.

    2015-01-01

    -observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. RESULTS: Higher levels of regulation requirements were associated with lower depressive symptoms at the individual......OBJECTIVES: Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare...... workers. METHODS: Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work...

  4. Methicillin-resistant Staphylococcus aureus: Prevalence, incidence, risk factors, and effects on survival of patients in a specialist palliative care unit: A prospective observational study.

    Science.gov (United States)

    Gleeson, Aoife; Larkin, Philip; Walsh, Cathal; O'Sullivan, Niamh

    2016-04-01

    Little is known about the impact of methicillin-resistant Staphylococcus aureus in palliative care settings. To date, the clinical impact of methicillin-resistant Staphylococcus aureus in palliative care is unknown. To determine prevalence and incidence of methicillin-resistant Staphylococcus aureus colonisation in a specialist palliative care setting, to identify risk factors for methicillin-resistant Staphylococcus aureus colonisation, to determine the eradication success rate and to determine the impact of methicillin-resistant Staphylococcus aureus on survival. Prospective cohort study. Data were collected for consecutive admissions to an inpatient palliative care service. Patients were screened for methicillin-resistant Staphylococcus aureus colonisation on admission and 1 week post admission. Methicillin-resistant Staphylococcus aureus eradication was attempted in methicillin-resistant Staphylococcus aureus positive patients. Data were collected from 609 admissions for 466 individual patients. Admission screening data were available in 95.5%. Prevalence of methicillin-resistant Staphylococcus aureus colonisation was 11.59% (54 patients). One week incidence of methicillin-resistant Staphylococcus aureus colonisation was 1.2%. Risk factors for methicillin-resistant Staphylococcus aureus colonisation were determined using Chi-Squared test and included high Waterlow score (p resistant Staphylococcus aureus status prior to admission (p resistant Staphylococcus aureus was eradicated in 8.1% of admissions, while 46 patients commenced on the protocol (62.2%) died before completing it. Methicillin-resistant Staphylococcus aureus did not significantly impact survival but was significantly associated with having infection episodes and longer length of stay. This study identified risk factors for methicillin-resistant Staphylococcus aureus colonisation in palliative care patients. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of patients. Hence

  5. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Yaqub, K.M.; Usman, J.; Zaidi, S.B.H.; Khalil, A.; Noor, N.; Gill, M.M.

    2013-01-01

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  6. Teamwork in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Barbosa, Vanessa Maziero

    2013-01-01

    Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of…

  7. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit

  8. Dementia Special Care Units in Residential Care Communities: United States, 2010

    Science.gov (United States)

    ... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care Utilization ... dementia special care units, or in a more traditional setting where these residents are integrated with residents ...

  9. Observation-status patients in children's hospitals with and without dedicated observation units in 2011.

    Science.gov (United States)

    Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S

    2015-06-01

    Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, P hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.

  10. Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

    Science.gov (United States)

    Dias, Douglas de Sá; Resende, Mariane Vanessa; Diniz, Gisele do Carmo Leite Machado

    2015-01-01

    Objective To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). Conclusion The perception of major stressors and the total stress score were similar between patients

  11. Antibiotic Policies in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nese Saltoglu

    2003-08-01

    Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

  12. Impact of harmful use of alcohol on the sedation of critical patients on mechanical ventilation: A multicentre prospective, observational study in 8 Spanish intensive care units.

    Science.gov (United States)

    Sandiumenge, A; Torrado, H; Muñoz, T; Alonso, M Á; Jiménez, M J; Alonso, J; Pardo, C; Chamorro, C

    2016-05-01

    To evaluate the impact of a history of harmful use of alcohol (HUA) on sedoanalgesia practices and outcomes in patients on mechanical ventilation (MV). A prospective, observational multicentre study was made of all adults consecutively admitted during 30 days to 8 Spanish ICUs. Patients on MV >24h were followed-up on until discharge from the ICU or death. Data on HUA, smoking, the use of illegal (IP) and medically prescribed psychotropics (MPP), sedoanalgesia practices and their related complications (sedative failure [SF] and sedative withdrawal [SW]), as well as outcome, were prospectively recorded. A total of 23.4% (119/509) of the admitted patients received MV >24h; 68.9% were males; age 57.0 (17.9) years; APACHE II score 18.8 (7.2); with a medical cause of admission in 53.9%. Half of them consumed at least one psychotropic agent (smoking 27.7%, HUA 25.2%; MPP 9.2%; and IP 7.6%). HUA patients more frequently required PS (86.7% vs. 64%; p2 sedatives (56.7% vs. 28.1%; p<0.02). HUA was associated to an eightfold (p<0.001) and fourfold (p<0.02) increase in SF and SW, respectively. In turn, the duration of MV and the stay in the ICU was increased by 151h (p<0.02) and 4.4 days (p<0.02), respectively, when compared with the non-HUA group. No differences were found in terms of mortality. HUA may be associated to a higher risk of SF and WS, and can prolong MV and the duration of stay in the ICU in critical patients. Early identification could allow the implementation of specific sedation strategies aimed at preventing these complications. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  13. Pharmacovigilance in Intensive Care Unit - An Overview

    Directory of Open Access Journals (Sweden)

    Bimla Sharma

    2008-01-01

    Full Text Available The drug related complications are on the rise warranting special attention towards patient safety in Intensive Care Unit (ICU setup. Pharmacovigilance is the science about the detection, assessment and prevention of drug related problems. This review is aimed to highlight significant problems arising from medication errors with emphasis on special drugs used in ICU (oxygen, antibiotics, sedatives, analgesics and neuromuscular blocking drugs and their risk reduction strategies in ICU utilizing practice of pharmacovigilance. Human error, lack of communication among various health providers, inadequate knowledge about drugs, failure to follow protocols or recommended guidelines are important causes of drug related problems in ICU. It is imperative that ICU administrators and medical directors of hospitals consider adverse drug events (ADEs as system failures. Pharmacovigilance, an observational science is the need of the hour for patients admitted in ICUs. We need to give more emphasis on prevention rather than treating the potentially fatal complications arising from ADEs. Eternal vigilance is the key. Protocol based management, improvement of medication system, frequent audits, improved communication, good team work, a blame free environ-ment, inclusion of a pharmacist, leadership involvement and use of information technology in the ICU are possible solutions.

  14. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Hypoxaemia on arrival in a multidisciplinary intensive care unit | de ...

    African Journals Online (AJOL)

    It is, however, potentially preventable. Objective. To determine the incidence of hypoxaemia on arrival in a tertiary multidisciplinary intensive care unit (ICU) and to identify risk factors for this complication. Method. A retrospective observational study was conducted at King Edward VIII Hospital, Durban, South Africa, from May ...

  16. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

    2005-04-01

    To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

  17. Distribution of specialized care centers in the United States.

    Science.gov (United States)

    Wang, Henry E; Yealy, Donald M

    2012-11-01

    ,282 persons (IQR 441,525 to 942,254). The national distribution patterns differed for each type of specialized care center. The distribution of specialized care centers varies across the United States. These observations highlight unanswered questions about the regional organization of specialized care in the United States. Copyright © 2012. Published by Mosby, Inc.

  18. Hand hygiene in the intensive care unit.

    Science.gov (United States)

    Tschudin-Sutter, Sarah; Pargger, Hans; Widmer, Andreas F

    2010-08-01

    Healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the World Health Organization. In intensive care units, the burden of healthcare-associated infections is greatly increased, causing additional morbidity and mortality. Multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging. Proper hand hygiene is the single most important, simplest, and least expensive means of preventing healthcare-associated infections. In addition, it is equally important to stop transmission of multidrug-resistant pathogens. According to the Centers for Disease Control and Prevention and World Health Organization guidelines on hand hygiene in health care, alcohol-based handrub should be used as the preferred means for routine hand antisepsis. Alcohols have excellent in vitro activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, Mycobacterium tuberculosis, a variety of fungi, and most viruses. Some pathogens, however, such as Clostridium difficile, Bacillus anthracis, and noroviruses, may require special hand hygiene measures. Failure to provide user friendliness of hand hygiene equipment and shortage of staff are predictors for noncompliance, especially in the intensive care unit setting. Therefore, practical approaches to promote hand hygiene in the intensive care unit include provision of a minimal number of handrub dispensers per bed, monitoring of compliance, and choice of the most attractive product. Lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of awareness of the risk of cross-transmission of pathogens are barriers to good hand hygiene practices. Multidisciplinary programs to promote increased use of alcoholic handrub lead to an increased compliance of healthcare

  19. Infection control in the intensive care unit.

    Science.gov (United States)

    Osman, Mohamed F; Askari, Reza

    2014-12-01

    It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Dermatology in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2012-10-01

    Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

  1. Safety of milrinone use in neonatal intensive care units.

    Science.gov (United States)

    Samiee-Zafarghandy, Samira; Raman, Sudha R; van den Anker, John N; McHutchison, Kerstin; Hornik, Christoph P; Clark, Reese H; Brian Smith, P

    2015-01-01

    Milrinone use in the neonatal intensive care unit has increased over the last 10 years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care unit. We conducted a retrospective data analysis, identifying all infants who were exposed to milrinone and discharged from 322 neonatal intensive care units managed by the Pediatrix Medical Group from 1997-2010. We identified adverse events (AEs) during milrinone exposure. The unit of observation for clinical AEs was the first course of milrinone and for laboratory AEs it was an infant-day of exposure to milrinone. Overall, 1446 of 716,821 (0.2%) infants received milrinone for a total of 6894 infant-days. The proportion of infants exposed to milrinone increased from 0 in 1997 to 4/1000 infant cases in 2010. Persistent pulmonary hypertension (40%) was the most commonly reported diagnosis at the start of milrinone administration. Overall, 606/1446 (42%) of infants had at least 1 clinical AE recorded during milrinone therapy. Hypotension requiring pressors and thrombocytopenia (milrinone therapy. Among infants hospitalized in the neonatal intensive care unit, there was an increase in the use of milrinone over the past 13 years. The safety, dosing, and efficacy of milrinone in infants should be determined in prospective clinical trials. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Impact of Noise on Nurses in Pediatric Intensive Care Units.

    Science.gov (United States)

    Watson, J'ai; Kinstler, Angela; Vidonish, William P; Wagner, Michael; Lin, Li; Davis, Kermit G; Kotowski, Susan E; Daraiseh, Nancy M

    2015-09-01

    Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses. In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise. Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications. Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes. ©2015 American Association of Critical-Care Nurses.

  3. Intensive care unit audit: invasive procedure surveillance

    Directory of Open Access Journals (Sweden)

    Mariama Amaral Michels

    2013-01-01

    Full Text Available Rationale and objective: currently, Healthcare-associated Infections (HAIs constitute a serious public health problem. It is estimated that for every ten hospitalized patients, one will have infection after admission, generating high costs resulting from increased length of hospitalization, additional diagnostic and therapeutic interventions. The intensive care unit (ICU, due to its characteristics, is one of the most complex units of the hospital environment, a result of the equipment, the available technology, the severity of inpatients and the invasive procedures the latter are submitted to. The aim of the study was to evaluate the adherence to specifi c HAI prevention measures in invasive ICU procedures. Methods: This study had a quantitative, descriptive and exploratory approach. Among the risk factors for HAIs are the presence of central venous access, indwelling vesical catheter and mechanical ventilation, and, therefore, the indicators were calculated for patients undergoing these invasive procedures, through a questionnaire standardized by the Hospital Infection Control Commission (HICC. Results: For every 1,000 patients, 15 had catheter-related bloodstream infection, 6.85 had urinary tract infection associated with indwelling catheter in the fi rst half of 2010. Conclusion: most HAIs cannot be prevented, for reasons inherent to invasive procedures and the patients. However, their incidence can be reduced and controlled. The implementation of preventive measures based on scientifi c evidence can reduce HAIs signifi cantly and sustainably, resulting in safer health care services and reduced costs. The main means of prevention include the cleaning of hands, use of epidemiological block measures, when necessary, and specifi c care for each infection site. KEYWORDS Nosocomial infection. Intensive care units.

  4. The effect of the TIM program (Transfer ICU Medication reconciliation) on medication transfer errors in two Dutch intensive care units : Design of a prospective 8-month observational study with a before and after period

    NARCIS (Netherlands)

    B.E. Bosma (Bertha); E. Meuwese (Edmé); S.S. Tan (Siok Swan); J. van Bommel (Jasper); Melief, P.H.G.J. (Piet Herman Gerard Jan); N.G.M. Hunfeld (Nicola); P.M.L.A. van den Bemt (Patricia)

    2017-01-01

    markdownabstract__Background:__ The transfer of patients to and from the Intensive Care Unit (ICU) is prone to medication errors. The aim of the present study is to determine whether the number of medication errors at ICU admission and discharge and the associated potential harm and costs are

  5. [Environmental noise levels in 2 intensive care units in a tertiary care centre].

    Science.gov (United States)

    Ornelas-Aguirre, José Manuel; Zárate-Coronado, Olivia; Gaxiola-González, Fabiola; Neyoy-Sombra, Venigna

    2017-04-03

    The World Health Organisation (WHO) has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise levels in 2 different intensive care units at a tertiary care centre. Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level. The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points. Noise levels measured in intensive care wards exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of environmental noise. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  6. [Sedation and analgesia practices among Spanish neonatal intensive care units].

    Science.gov (United States)

    Avila-Alvarez, A; Carbajal, R; Courtois, E; Pertega-Diaz, S; Muñiz-Garcia, J; Anand, K J S

    2015-08-01

    Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. A multicenter, observational, longitudinal and prospective study. Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (Pneonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  7. The impact of healthcare professionals' personality and religious beliefs on the decisions to forego life sustaining treatments: an observational, multicentre, cross-sectional study in Greek intensive care units.

    Science.gov (United States)

    Ntantana, Asimenia; Matamis, Dimitrios; Savvidou, Savvoula; Marmanidou, Kyriaki; Giannakou, Maria; Gouva, Μary; Nakos, George; Koulouras, Vasilios

    2017-07-21

    To assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs). Cross-sectional, observational, national study in 18 multidisciplinary Greek ICUs, with >6 beds, between June and December 2015. 149 doctors and 320 nurses who voluntarily and anonymously answered the End-of-Life (EoL) attitudes, Personality (EPQ) and Religion (SpREUK) questionnaires. Multivariate analysis was used to detect the impact of personality and religious beliefs on the DFLSTs. The participation rate was 65.7%. Significant differences in DFLSTs between doctors and nurses were identified. 71.4% of doctors and 59.8% of nurses stated that the family was not properly informed about DFLST and the main reason was the family's inability to understand medical details. 51% of doctors expressed fear of litigation and 47% of them declared that this concern influenced the information given to family and nursing staff. 7.5% of the nurses considered DFLSTs dangerous, criminal or illegal. Multivariate logistic regression identified that to be a nurse and to have a high neuroticism score were independent predictors for preferring the term 'passive euthanasia' over 'futile care' (OR 4.41, 95% CI 2.21 to 8.82, ppersonality trait (OR 2.45, 95% CI 1.25 to 4.80, ppersonality and religious beliefs influence the attitudes of ICU personnel when making decisions to forego life-sustaining treatments. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Palliative care team visits. Qualitative study through participant observation.

    Science.gov (United States)

    Alfaya Góngora, Maria Del Mar; Bueno Pernias, Maria José; Hueso Montoro, César; Guardia Mancilla, Plácido; Montoya Juárez, Rafael; García Caro, Maria Paz

    2016-03-30

    To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

  9. Challenges encountered by critical care unit managers in the large intensive care units.

    Science.gov (United States)

    Matlakala, Mokgadi C; Bezuidenhout, Martie C; Botha, Annali D H

    2014-04-04

    Nurses in intensive care units (ICUs) are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  10. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-04-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  11. Delirium in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Suresh Arumugam

    2017-01-01

    Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  12. Physiotherapy patients in intensive care unit

    Directory of Open Access Journals (Sweden)

    Agnieszka Miszewska

    2017-01-01

    Full Text Available Regulation of the Minister of Health dated 20/12/2012 on medical standards of conduct in the field of Anaesthesiology and intensive therapy, for carrying out the activities of healing in section § 2.2 intense therapy defines as: "any proceedings to maintain vital functions, and treatment of patients in life-threatening States, caused by potentially reversible renal failure one or more basic body systems, in particular the respiration, cardiovascular, central nervous system". However, in point § 12.1. We read that "Treatment of patients under intensive care in the hospital is an interdisciplinary". Annex 1 to this regulation refers to the work of physiotherapist in the ICU (INTENSIVE CARE UNITS and reads as follows: "the equivalent of at least 0.5 FTE-physical therapist-up to a range of benefits to be performed (the third reference level". [6

  13. Patient's dignity in intensive care unit: A critical ethnography.

    Science.gov (United States)

    Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali

    2017-01-01

    Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

  14. Nurse-Patient Communication Interactions in the Intensive Care Unit

    Science.gov (United States)

    Happ, Mary Beth; Garrett, Kathryn; Thomas, Dana DiVirgilio; Tate, Judith; George, Elisabeth; Houze, Martin; Radtke, Jill; Sereika, Susan

    2011-01-01

    Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials. PMID:21362711

  15. Teamwork as a nursing competence at Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Silvia Helena Henriques Camelo

    2013-03-01

    Full Text Available Objective. The aim in this study was to identify how Intensive Care Unit nurses perceive professional competences in thecare team. Methodology. Qualitative multiple case study with an exploratory focus. The sample consisted of 24 nurses from Intensive Care Units (ICU at two large hospitals. To collect the information, direct observation and - structured, non-structuredand participant - interviews were used. Results. Ninety-six percent of the participants were women, 79% were less than 40 years old, and 63% possessed less than five years of professional experience in ICU. Data analysis revealed three study categories: teamwork as a nursing management tool, improving teamwork, and interpersonal communication for teamwork. Conclusion. At the ICU where the nurses work, a teamwork strategy is observed, which demands cooperation and participation by other disciplines.

  16. Opening of Psychiatric Observation Unit Eases Boarding Crisis.

    Science.gov (United States)

    Parwani, Vivek; Tinloy, Bradford; Ulrich, Andrew; D'Onofrio, Gail; Goldenberg, Matthew; Rothenberg, Craig; Patel, Amitkumar; Venkatesh, Arjun K

    2018-04-01

    The objective of this study was to evaluate the effect of a psychiatric observation unit in reducing emergency department (ED) boarding and length of stay (LOS) for patients presenting with primary psychiatric chief complaints. A secondary outcome was to determine the effect of a psychiatric observation unit on inpatient psychiatric bed utilization. This study was a before-and-after analysis conducted in a 1,541-bed tertiary care academic medical center including an adult ED with annual census over 90,000 between February 2013 and July 2014. All adult patients (age > 17 years) requiring evaluation by the acute psychiatry service in the crisis intervention unit (CIU) within the ED were included. Patients who left without being seen, left against medical advice, or were dispositioned to the pediatric hospital, hospice, or court/law enforcement were excluded. In December 2013, a 12-bed locked psychiatric observation unit was opened that included dedicated behavioral health staff and was intended for psychiatric patients requiring up to 48 hours of care. The primary outcomes were ED LOS, CIU LOS, and total LOS. Secondary outcomes included the hold rate defined as the proportion of acute psychiatry patients requiring subsequent observation or inpatient admission and the inpatient psychiatric admission rate. For the primary analysis we constructed ARIMA regression models that account for secular changes in the primary outcomes. We conducted two sensitivity analyses, first replicating the primary analysis after excluding patients with concurrent acute intoxication and second by comparing the 3-month period postintervention to the identical 3-month period of the prior year to account for seasonality. A total of 3,501 patients were included before intervention and 3,798 after intervention. The median ED LOS for the preintervention period was 155 minutes (interquartile range [IQR] = 19-346 minutes), lower than the median ED LOS for the postintervention period of 35

  17. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test......-retest reliability showed a median weighted κ of 0.69 (0.53-0.83). Validation showed significant correlation between total scores and key questions. CONCLUSIONS: The questions were assessed as relevant and understandable, providing high face and content validity. Ceiling effects were comparable to similar...

  18. Financial Viability of Emergency Department Observation Unit Billing Models.

    Science.gov (United States)

    Baugh, Christopher W; Suri, Pawan; Caspers, Christopher G; Granovsky, Michael A; Neal, Keith; Ross, Michael A

    2018-05-16

    Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services. The majority of EDOUs use the "one-service" model, where a single composite professional fee is billed for both emergency and observation services. The financial implications of these models are not well understood. We created a Monte Carlo simulation by building a model that reflects current clinical practice in the United States and uses inputs gathered from the most recently available peer-reviewed literature, national survey and payer data. Using this simulation, we modeled annual staffing costs and payments for professional services under two common models of care in an EDOU. We also modeled cash flows over a continuous range of daily EDOU patient encounters to illustrate the dynamic relationship between costs and revenue over various staffing levels. We estimate the mean (±SD) annual net cash flow to be a net loss of $315,382 ±$89,635 in the one-service model and a net profit of $37,569 ±$359,583 in the two-service model. The two-service model is financially sustainable at daily billable encounters above 20 while in the one-service model, costs exceed revenue regardless of encounter count. Physician cost per hour and daily patient encounters had the most significant impact on model estimates. In the one-service model, EDOU staffing costs exceed payments at all levels of patient encounters, making a hospital subsidy necessary to create a

  19. Nutrition in the neurocritical care unit

    Directory of Open Access Journals (Sweden)

    Swagata Tripathy

    2015-01-01

    Full Text Available The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

  20. Scope of Nursing Care in Polish Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mariusz Wysokiński

    2013-01-01

    Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.

  1. Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study.

    Science.gov (United States)

    Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria

    2014-12-01

    When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.

  2. Discharge from an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian

    2014-01-01

    To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....

  3. Implementation of enteral feeding protocol in an intensive care unit

    DEFF Research Database (Denmark)

    Padar, Martin; Uusvel, Gerli; Starkopf, Liis

    2017-01-01

    AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients. METHODS: An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013......, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population...... the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher...

  4. Incremental cost of PACS in a medical intensive care unit

    Science.gov (United States)

    Langlotz, Curtis P.; Cleff, Bridget; Even-Shoshan, Orit; Bozzo, Mary T.; Redfern, Regina O.; Brikman, Inna; Seshadri, Sridhar B.; Horii, Steven C.; Kundel, Harold L.

    1995-05-01

    Our purpose is to determine the incremental costs (or savings) due to the introduction of picture archiving and communication systems (PACS) and computed radiology (CR) in a medical intensive care unit (MICU). Our economic analysis consists of three measurement methods. The first method is an assessment of the direct costs to the radiology department, implemented in a spreadsheet model. The second method consists of a series of brief observational studies to measure potential changes in personnel costs that might not be reflected in administrative claims. The third method (results not reported here) is a multivariate modeling technique which estimates the independent effect of PACS/CR on the cost of care (estimated from administrative claims data), while controlling for clinical case- mix variables. Our direct cost model shows no cost savings to the radiology department after the introduction of PACS in the medical intensive care unit. Savings in film supplies and film library personnel are offset by increases in capital equipment costs and PACS operation personnel. The results of observational studies to date demonstrate significant savings in clinician film-search time, but no significant change in technologist time or lost films. Our model suggests that direct radiology costs will increase after the limited introduction of PACS/CR in the MICU. Our observational studies show a small but significant effect on clinician film search time by the introduction of PACS/CR in the MICU, but no significant effect on other variables. The projected costs of a hospital-wide PACS are currently under study.

  5. Parental perceptions of clown care in paediatric intensive care units.

    Science.gov (United States)

    Mortamet, Guillaume; Merckx, Audrey; Roumeliotis, Nadia; Simonds, Caroline; Renolleau, Sylvain; Hubert, Philippe

    2017-05-01

    The objective of this study was to report family satisfaction with regards to the presence of clowns in the paediatric intensive care unit (PICU). This is a single-centre survey-based study, conducted over 4 months in a 12-bed third level PICU in a university hospital. All parents present at the bedside of their child during clowning were considered as potential participants. Eligible parents were approached by one of the two intensivists as investigators and asked to complete a survey within the 48 h following the clowns' intervention. Thirty-three parents consented to complete the survey. Median age of children was 14 months (15 days to 16 years) and median Pediatric Logistic Organ Dysfunction (PELOD) score was 1 (0-22). Twenty-four (72.7%) were considered as clinically stable while the clowns intervened. Twenty-eight parents (84.8%) and 27 (81.8%) considered that clowns had a positive effect on themselves and on their child, respectively. Clown care was considered as necessary in 19 cases (57.6%), optional in 13 (39.4%) and unnecessary in 1 (3.0%). The degree of parental satisfaction was not significantly associated with the child's clinical stability. We suggested that medical clowning in the PICU is well accepted by parents, regardless of severity of their child's condition. This study supports the adoption of medical clowning in PICUs as a patient- and family-centred care practice. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  6. The experiences of family caregiving in a chronic care unit.

    Science.gov (United States)

    Cho, Myung Ok

    2005-12-01

    The main purpose of this critical ethnography was to examines the process and discourses through which family caregivers experience while caring for their sick family member in a hospital. This was achieved by conducting in-depth interviews with 12 family caregivers, and by observing their caring activities and daily lives in natural settings. The study field was a unit for neurologic patients. Data was analyzed using taxonomy, discourse analysis, and proxemics. All research work was iteratively processed from March 2003 to December 2004. Constant comparative analysis of the data yielded the process of becoming a successful family caregiver: encountering the differences and chaos as novice; constructing their world of skilled caregivers; and becoming a hospital family as experienced caregivers. During the process of becoming an experienced hospital family, the discourse of family centered idea guided their caring behaviors and daily lives. The paternalistic family caregivers struggled, cooperated, and harmonized with the patriarchal world of professional health care system. During this process of becoming hospital family, professional nurses must act as cultural brokers between the lay family caring system and the professional caring system.

  7. [Developmental centered care. Situation in Spanish neonatal units].

    Science.gov (United States)

    López Maestro, M; Melgar Bonis, A; de la Cruz-Bertolo, J; Perapoch López, J; Mosqueda Peña, R; Pallás Alonso, C

    2014-10-01

    Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  8. Informed consent for anaesthesiological and intensive care unit ...

    African Journals Online (AJOL)

    2013-03-04

    Mar 4, 2013 ... care unit research: a South African perspective. De Roubaix JAM, MBChB, .... (g) the development of new applications of health technology. The last two items .... Consent in emergency and ICU care: SA regulatory guidelines.

  9. Auditing an intensive care unit recycling program.

    Science.gov (United States)

    Kubicki, Mark A; McGain, Forbes; O'Shea, Catherine J; Bates, Samantha

    2015-06-01

    The provision of health care has significant direct environmental effects such as energy and water use and waste production, and indirect effects, including manufacturing and transport of drugs and equipment. Recycling of hospital waste is one strategy to reduce waste disposed of as landfill, preserve resources, reduce greenhouse gas emissions, and potentially remain fiscally responsible. We began an intensive care unit recycling program, because a significant proportion of ICU waste was known to be recyclable. To determine the weight and proportion of ICU waste recycled, the proportion of incorrect waste disposal (including infectious waste contamination), the opportunity for further recycling and the financial effects of the recycling program. We weighed all waste and recyclables from an 11-bed ICU in an Australian metropolitan hospital for 7 non-consecutive days. As part of routine care, ICU waste was separated into general, infectious and recycling streams. Recycling streams were paper and cardboard, three plastics streams (polypropylene, mixed plastics and polyvinylchloride [PVC]) and commingled waste (steel, aluminium and some plastics). ICU waste from the waste and recycling bins was sorted into those five recycling streams, general waste and infectious waste. After sorting, the waste was weighed and examined. Recycling was classified as achieved (actual), potential and total. Potential recycling was defined as being acceptable to hospital protocol and local recycling programs. Direct and indirect financial costs, excluding labour, were examined. During the 7-day period, the total ICU waste was 505 kg: general waste, 222 kg (44%); infectious waste, 138 kg (27%); potentially recyclable waste, 145 kg (28%). Of the potentially recyclable waste, 70 kg (49%) was actually recycled (14% of the total ICU waste). In the infectious waste bins, 82% was truly infectious. There was no infectious contamination of the recycling streams. The PVC waste was 37% contaminated

  10. Noise, stress, and annoyance in a pediatric intensive care unit.

    Science.gov (United States)

    Morrison, Wynne E; Haas, Ellen C; Shaffner, Donald H; Garrett, Elizabeth S; Fackler, James C

    2003-01-01

    To measure and describe hospital noise and determine whether noise can be correlated with nursing stress measured by questionnaire, salivary amylase, and heart rate. Cohort observational study. Tertiary care center pediatric intensive care unit. Registered nurses working in the unit. None. Eleven nurse volunteers were recruited. An audiogram, questionnaire data, salivary amylase, and heart rate were collected in a quiet room. Each nurse was observed for a 3-hr period during patient care. Heart rate and sound level were recorded continuously; saliva samples and stress/annoyance ratings were collected every 30 mins. Variables assessed as potential confounders were years of nursing experience, caffeine intake, patients' Pediatric Risk of Mortality Score, shift assignment, and room assignment. Data were analyzed by random effects multiple linear regression using Stata 6.0. The average daytime sound level was 61 dB(A), nighttime 59 dB(A). Higher average sound levels significantly predicted higher heart rates (p =.014). Other significant predictors of tachycardia were higher caffeine intake, less nursing experience, and daytime shift. Ninety percent of the variability in heart rate was explained by the regression equation. Amylase measurements showed a large variability and were not significantly affected by noise levels. Higher average sound levels were also predictive of greater subjective stress (p =.021) and annoyance (p =.016). In this small study, noise was shown to correlate with several measures of stress including tachycardia and annoyance ratings. Further studies of interventions to reduce noise are essential.

  11. Transition from neonatal intensive care unit to special care nurseries: Experiences of parents and nurses

    NARCIS (Netherlands)

    Dr. A.L. van Staa; O.K. Helder; J.C.M. Verweij

    2011-01-01

    To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five

  12. Invasive candidiasis in pediatric intensive care units.

    Science.gov (United States)

    Singhi, Sunit; Deep, Akash

    2009-10-01

    Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

  13. Intelligent ventilation in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Sigal Sviri

    2012-08-01

    Full Text Available Objectives. Automated, microprocessor-controlled, closed-loop mechanical ventilation has been used in our Medical Intensive Care Unit (MICU at the Hadassah Hebrew-University Medical Center for the past 15 years; for 10 years it has been the primary (preferred ventilator modality. Design and setting. We describe our clinical experience with adaptive support ventilation (ASV over a 6-year period, during which time ASV-enabled ventilators became more readily available and were used as the primary (preferred ventilators for all patients admitted to the MICU. Results. During the study period, 1 220 patients were ventilated in the MICU. Most patients (84% were ventilated with ASV on admission. The median duration of ventilation with ASV was 6 days. The weaning success rate was 81%, and tracheostomy was required in 13%. Sixty-eight patients (6% with severe hypoxia and high inspiratory pressures were placed on pressure-controlled ventilation, in most cases to satisfy a technical requirement for precise and conservative administration of inhaled nitric oxide. The overall pneumothorax rate was less than 3%, and less than 1% of patients who were ventilated only using ASV developed pneumothorax. Conclusions. ASV is a safe and acceptable mode of ventilation for complicated medical patients, with a lower than usual ventilation complication rate.

  14. Airborne fungi in an intensive care unit

    Directory of Open Access Journals (Sweden)

    C. L. Gonçalves

    2017-07-01

    Full Text Available Abstract The presence of airborne fungi in Intensive Care Unit (ICUs is associated with increased nosocomial infections. The aim of this study was the isolation and identification of airborne fungi presented in an ICU from the University Hospital of Pelotas – RS, with the attempt to know the place’s environmental microbiota. 40 Petri plates with Sabouraud Dextrose Agar were exposed to an environment of an ICU, where samples were collected in strategic places during morning and afternoon periods for ten days. Seven fungi genera were identified: Penicillium spp. (15.18%, genus with the higher frequency, followed by Aspergillus spp., Cladosporium spp., Fusarium spp., Paecelomyces spp., Curvularia spp., Alternaria spp., Zygomycetes and sterile mycelium. The most predominant fungi genus were Aspergillus spp. (13.92% in the morning and Cladosporium spp. (13.92% in the afternoon. Due to their involvement in different diseases, the identified fungi genera can be classified as potential pathogens of inpatients. These results reinforce the need of monitoring the environmental microorganisms with high frequency and efficiently in health institutions.

  15. Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.

    Science.gov (United States)

    Rudy, E B; Daly, B J; Douglas, S; Montenegro, H D; Song, R; Dyer, M A

    1995-01-01

    The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.

  16. The process of implementation of emergency care units in Brazil.

    Science.gov (United States)

    O'Dwyer, Gisele; Konder, Mariana Teixeira; Reciputti, Luciano Pereira; Lopes, Mônica Guimarães Macau; Agostinho, Danielle Fernandes; Alves, Gabriel Farias

    2017-12-11

    To analyze the process of implementation of emergency care units in Brazil. We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

  17. The process of implementation of emergency care units in Brazil

    Directory of Open Access Journals (Sweden)

    Gisele O'Dwyer

    2017-12-01

    Full Text Available ABSTRACT OBJECTIVE To analyze the process of implementation of emergency care units in Brazil. METHODS We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the

  18. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  19. Safety of milrinone use in neonatal intensive care units

    NARCIS (Netherlands)

    S. Samiee-Zafarghandy; S.R. Raman (Sudha R.); J.N. van den Anker (John); K. McHutchison (Kerstin); C.P. Hornik; R.H. Clark; P.B. Smith; D.K. Benjamin (Daniel K.); K. Berezny (Katherine); J. Barrett (Jeffrey); E.V. Capparelli (Edmund); M. Cohen-Wolkowiez (Michael); G.L. Kearns (Greg); M. Laughon (Matthew); A. Muelenaer (Andre); T. Michael O'Shea; I.M. Paul (Ian M.); K. Wade (Kelly); T.J. Walsh (Thomas J.)

    2015-01-01

    textabstractBackground: Milrinone use in the neonatal intensive care unit has increased over the last 10. years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care unit. Methods: We conducted a

  20. Burnout in the intensive care unit professionals: A systematic review.

    Science.gov (United States)

    Chuang, Chien-Huai; Tseng, Pei-Chi; Lin, Chun-Yu; Lin, Kuan-Han; Chen, Yen-Yuan

    2016-12-01

    Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level

  1. The influence of care interventions on the continuity of sleep of intensive care unit patients.

    Science.gov (United States)

    Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado

    2015-01-01

    to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit. descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software. 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8%) caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients. it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

  2. The influence of care interventions on the continuity of sleep of intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Fernanda Luiza Hamze

    2015-10-01

    Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

  3. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels

    2014-01-01

    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...

  4. Medication administration errors in an intensive care unit in Ethiopia

    Directory of Open Access Journals (Sweden)

    Agalu Asrat

    2012-05-01

    Full Text Available Abstract Background Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU. In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. Objective To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH, Southwest Ethiopia. Methods Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study. Results Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%. Common administration errors were attributed to wrong timing (30.3%, omission due to unavailability (29.0% and missed doses (18.3% among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%. Conclusion Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don’t occur as frequently as observed in this study.

  5. Observations of oral hygiene care interventions provided by nurses to hospitalized older people.

    Science.gov (United States)

    Coker, Esther; Ploeg, Jenny; Kaasalainen, Sharon; Carter, Nancy

    Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  7. Bringing quality improvement into the intensive care unit.

    Science.gov (United States)

    McMillan, Tracy R; Hyzy, Robert C

    2007-02-01

    During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

  8. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. Copyright © 2011 Wiley-Liss, Inc.

  9. Sleep and sedation in the pediatric intensive care unit.

    Science.gov (United States)

    Carno, Margaret-Ann; Connolly, Heidi V

    2005-09-01

    Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.

  10. Well-being of nursing staff on specialized units for older patients with combined care needs.

    Science.gov (United States)

    Collet, J; de Vugt, M E; Schols, J M G A; Engelen, G J J A; Winkens, B; Verhey, F R J

    2018-03-01

    Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown. Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs. Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown. To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff. Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units

  11. The need for pharmaceutical care in an intensive care unit at a ...

    African Journals Online (AJOL)

    Interventions to assess therapy ... and trauma intensive care unit (ICU) at Steve Biko Academic Hospital. ... of programme success, such as improving the quality of service by .... saving and extra quality assurance opportunity for the unit.[11].

  12. Effects of Patient Care Unit Design and Technology on Nurse and Patient Care Technician Communication.

    Science.gov (United States)

    Beck, Mary S; Doscher, Mindy

    2018-04-01

    The current study described RN and patient care technician (PCT) communication in centralized and hybrid decentralized workstation designs using hands-free communication technology and infrared locator badge technology to facilitate communication. New construction of an oncology unit provided the opportunity to compare staff communication in two different workstation designs. Observations and questionnaires compared nurse and PCT communication in the two-unit designs. Descriptive statistics were used to analyze the differences. The hybrid decentralized unit had increased use of hands-free communication technology and hallway communication by nurses and PCTs, and increased patient room communication by nurses. Perceptions of communication between nurses and PCTs and congruency of priorities for care were similar for both units. The locator badge technology had limited adoption. Replacement of nurse workstations with new construction or remodeling impact staff communication patterns, necessitating that nurse leaders understand the impact of design and technology on communication. [Journal of Gerontological Nursing, 44(4), 17-22.]. Copyright 2018, SLACK Incorporated.

  13. The role of a palliative care inpatient unit in disease management of ...

    African Journals Online (AJOL)

    Objectives. To monitor the success of an inpatient palliative care unit combining private and state patients, and accessible to patients with cancer and AIDS. Design. An observational study was conducted of patients admitted to the unit in the first 3 months following opening of the ward (1 March - 31 May 2006). Methods.

  14. A comparison of private and public sector intensive care unit ...

    African Journals Online (AJOL)

    achieving the optimal physical structure that facilitates the care of ... patients with varying levels of need in terms of ICU equipment. As part of .... Prevention and Control Unit and is based on the R158 regulations, ..... and organizational aspects.

  15. Health care in the United States: organization, management, and policy

    National Research Council Canada - National Science Library

    Greenwald, Howard P

    2010-01-01

    "Health Care in the United States discusses the basic structures and operations of the U.S. health system. This resource includes examples, tables, and a glossary with key terms and acronyms to help understand important concepts...

  16. The care unit in nursing home research: evidence in support of a definition.

    Science.gov (United States)

    Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G

    2011-04-14

    Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A

  17. Incidence of constipation in an intensive care unit

    OpenAIRE

    Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Guimarães Marshall, Norma

    2013-01-01

    Objectives To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. Methods The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipati...

  18. The Living, Dynamic and Complex Environment Care in Intensive Care Unit.

    Science.gov (United States)

    Backes, Marli Terezinha Stein; Erdmann, Alacoque Lorenzini; Büscher, Andreas

    2015-01-01

    to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care. Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units. built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions); "Providing a suitable environment" and "having relatives with concern" (context); "Mediating facilities and difficulties" (intervenienting conditions); "Organizing the environment and managing the dynamics of the unit" (strategy) and "finding it difficult to accept and deal with death" (consequences). confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  19. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  20. Population pharmacokinetics of amikacin in neonatal intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Paulo Caceres Guido

    2017-02-01

    Full Text Available Background Amikacin treatment requires close monitoring of blood concentrations to increase the probability that levels achieved are both effective and safe. Aims We described population pharmacokinetics parameters of amikacin in newborns from a Neonatal Intensive Care Unit with suspected or documented sepsis. Methods A nonlinear mixed-effect model approach was used to analyse the data. Results Twenty seven neonates were enrolled. Final parameter estimates were: Ke(h-1=0.232x(CR Exp-0.85; V(mL/kg=497. Conclusion Weight and serum creatinine are associated with neonatal amikacin volume of distribution and elimination constant rate, respectively. The presence of sepsis may decrease amikacin elimination, although this observation should be further explored. These results could help to individualize amikacin dosage for neonates.

  1. The role of anaesthetists in paediatric intensive care units

    African Journals Online (AJOL)

    Adele

    to various surgical and critical care disciplines, the usefulness of a paediatric intensive care unit (PICU) rotation was investigated. A brief overview of the experiences of anaesthetic registrars at a. South African teaching hospital rotating through a PICU is pre- sented, as well as the potential advantages for both trainees and.

  2. Magnesium, calcium and phosphorus in the intensive care unit: Do ...

    African Journals Online (AJOL)

    Magnesium, calcium and phosphorus are important electrolytes involved in the regulation of homeostasis. However the utility in monitoring them in critically ill patients is still unclear. We therefore undertook a prospective, non-interventional, single center study in the intensive care unit of a tertiary care hospital in ...

  3. Empowerment of parents in the neonatal intensive care unit by ...

    African Journals Online (AJOL)

    Parents of infants who are admitted to the neonatal intensive care unit (NICU) need to be empowered to improve bonding, attachment and care-giving skills. Neonatal nurses play a critical role in the empowerment of such parents, but often find it difficult due to a lack of clarity on how it has to be done. A qualitative contextual ...

  4. Neonatal intensive care unit: Reservoirs of Nosocomial pathogens ...

    African Journals Online (AJOL)

    Improvement in the care and treatment of neonates had contributed to their increased survival. Nosocomial infection remains an important problem in intensive care units. Hospital wards had been shown to act as reservoirs of pathogenic microorganisms associated with infection. To assess the prevalence of pathogenic ...

  5. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  6. Environmental Design for Patient Families in Intensive Care Units

    OpenAIRE

    Mahbub Rashid

    2010-01-01

    The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...

  7. Seeking optimal renal replacement therapy delivery in intensive care units.

    Science.gov (United States)

    Kocjan, Marinka; Brunet, Fabrice P

    2010-01-01

    Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.

  8. [The coma awakening unit, between intensive care and rehabilitation].

    Science.gov (United States)

    Mimouni, Arnaud

    2015-01-01

    After intensive care and before classic neurological rehabilitation is possible, patients in an altered state of consciousness are cared for at early stages in so-called coma awakening units. The care involves, on the one hand, the complex support of the patient's awakening from coma as a neurological and existential process, and on the other, support for their families. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...

  10. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien......-friendly care and environment.......Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep...

  11. [Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia].

    Science.gov (United States)

    Bullich-Marín, Ingrid; Miralles Basseda, Ramón; Torres Egea, Pilar; Planas-Campmany, Carme; Juvé-Udina, María Eulalia

    A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Patterns of research utilization on patient care units

    Directory of Open Access Journals (Sweden)

    Lander Janice

    2008-06-01

    Full Text Available Abstract Background Organizational context plays a central role in shaping the use of research by healthcare professionals. The largest group of professionals employed in healthcare organizations is nurses, putting them in a position to influence patient and system outcomes significantly. However, investigators have often limited their study on the determinants of research use to individual factors over organizational or contextual factors. Methods The purpose of this study was to examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use. A comparative ethnographic case study design was used to examine seven patient care units (two adult and five pediatric units in four hospitals in two Canadian provinces (Ontario and Alberta. Data were collected over a six-month period by means of quantitative and qualitative approaches using an array of instruments and extensive fieldwork. The patient care unit was the unit of analysis. Drawing on the quantitative data and using correspondence analysis, relationships between various factors were mapped using the coefficient of variation. Results Units with the highest mean research utilization scores clustered together on factors such as nurse critical thinking dispositions, unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education, environmental complexity (as measured by changing patient acuity and re-sequencing of work, and nurses' attitudes towards research. Units with moderate research utilization clustered on organizational support, belief suspension, and intent to use research. Higher nursing workloads and lack of people support clustered more closely to units with the lowest research utilization scores. Conclusion Modifiable characteristics of organizational context at the patient care unit

  13. Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort.

    Science.gov (United States)

    Abdul-Aziz, Mohd H; Lipman, Jeffrey; Akova, Murat; Bassetti, Matteo; De Waele, Jan J; Dimopoulos, George; Dulhunty, Joel; Kaukonen, Kirsi-Maija; Koulenti, Despoina; Martin, Claude; Montravers, Philippe; Rello, Jordi; Rhodes, Andrew; Starr, Therese; Wallis, Steven C; Roberts, Jason A

    2016-01-01

    We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT>MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving β-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P = 0.012]. Additionally, in patients with a SOFA score of ≥9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P = 0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P = 0.025]. Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e

  14. Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

    Directory of Open Access Journals (Sweden)

    Dr. Nagla Hamdi Kamal Khalil El- Meanawi

    2015-08-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

  15. Advancing Neurologic Care in the Neonatal Intensive Care Unit with a Neonatal Neurologist

    Science.gov (United States)

    Mulkey, Sarah B.; Swearingen, Christopher J.

    2014-01-01

    Neonatal neurology is a growing sub-specialty area. Given the considerable amount of neurologic problems present in the neonatal intensive care unit, a neurologist with expertise in neonates is becoming more important. We sought to evaluate the change in neurologic care in the neonatal intensive care unit at our tertiary care hospital by having a dedicated neonatal neurologist. The period post-neonatal neurologist showed a greater number of neurology consultations (Pneurology encounters per patient (Pneurology became part of the multi-disciplinary team providing focused neurologic care to newborns. PMID:23271754

  16. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

    Directory of Open Access Journals (Sweden)

    A Gupta

    2016-01-01

    Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  17. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

    Science.gov (United States)

    Gupta, A; Gupta, A; Singh, T K; Saxsena, A

    2016-01-01

    Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  18. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

    OpenAIRE

    A Gupta; A Gupta; T K Singh; A Saxsena

    2016-01-01

    Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  19. Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units.

    Science.gov (United States)

    Rochefort, Christian M; Clarke, Sean P

    2010-10-01

    This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.

  20. Frequency and determinants of drug administration errors in the intensive care unit

    NARCIS (Netherlands)

    van den Bemt, PMLA; Fijn, R; van der Voort, PHJ; Gossen, AA; Egberts, TCG; Brouwers, JRBJ

    Objective., The study aimed to identify both the frequency and the determinants of drug administration errors in the intensive care unit. Design: Administration errors were detected by using the disguised-observation technique (observation of medication administrations by nurses, without revealing

  1. History of surface weather observations in the United States

    Science.gov (United States)

    Fiebrich, Christopher A.

    2009-04-01

    In this paper, the history of surface weather observations in the United States is reviewed. Local weather observations were first documented in the 17th Century along the East Coast. For many years, the progression of a weather observation from an initial reading to dissemination remained a slow and laborious process. The number of observers remained small and unorganized until agencies including the Surgeon General, Army, and General Land Office began to request regular observations at satellite locations in the 1800s. The Smithsonian was responsible for first organizing a large "network" of volunteer weather observers across the nation. These observers became the foundation for today's Cooperative Observer network. As applications of weather data continued to grow and users required the data with an ever-decreasing latency, automated weather networks saw rapid growth in the later part of the 20th century. Today, the number of weather observations across the U.S. totals in the tens of thousands due largely to privately-owned weather networks and amateur weather observers who submit observations over the internet.

  2. The pediatric intensive care unit business model.

    Science.gov (United States)

    Schleien, Charles L

    2013-06-01

    All pediatric intensivists need a primer on ICU finance. The author describes potential alternate revenue sources for the division. Differentiating units by size or academic affiliation, the author describes drivers of expense. Strategies to manage the bottom line including negotiations for hospital services are covered. Some of the current trends in physician productivity and its described metrics, with particular focus on clinical FTE management is detailed. Methods of using this data to enhance revenue are discussed. Some of the other current trends in the ICU business related to changes at the federal and state level as well as in the insurance sector, moving away from fee-for-service are covered. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Needs of Parents in Caring for Their Children in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mery Luz Valderrama Sanabria

    Full Text Available Objective.This work sought to describe the needs of parents to participate in caring for their children hospitalized in a pediatric intensive care unit (PICU. Methods. This is a qualitative study based on the ethno-nursing research method proposed by Leininger. For data collection and analysis, in-depth open interviews were used, along with field notes and enabler guidelines proposed by Leininger: stranger-friend, observation, participation, reflexion, and the Sunrise model. Parents of children hospitalized in a PICU in the city of Tunja (Boyacá, Colombia participated between February 2012 and October 2013. Results. The needs of parents to care for their children were described in the following themes: clear and timely communication, familiarization with technology, the value of the family, favoring the parent-children interaction during visits, and valuing and respecting generic (folk knowledge. Conclusion. The study provides knowledge, from the cultural perspective of parents with children hospitalized in PICU, as input to plan and develop care actions with them, according to their own needs.

  4. [Oral communication between colleagues in geriatric care units].

    Science.gov (United States)

    Maury-Zing, Céline

    2014-01-01

    Transmitting information orally between colleagues in gerontology care units. While the only certified method of transmitting nursing information is in writing, the oral tradition remains firmly rooted in the practice of health care providers. Professionals caring for elderly patients need to exchange information--whether it be considered important or trivial-, anywhere and at any time. In this article, professionals describe how they were able to identify which configurations of players and teams enable information to flow and benefit the care of elderly patients.

  5. Multifaceted bench comparative evaluation of latest intensive care unit ventilators.

    Science.gov (United States)

    Garnier, M; Quesnel, C; Fulgencio, J-P; Degrain, M; Carteaux, G; Bonnet, F; Similowski, T; Demoule, A

    2015-07-01

    Independent bench studies using specific ventilation scenarios allow testing of the performance of ventilators in conditions similar to clinical settings. The aims of this study were to determine the accuracy of the latest generation ventilators to deliver chosen parameters in various typical conditions and to provide clinicians with a comprehensive report on their performance. Thirteen modern intensive care unit ventilators were evaluated on the ASL5000 test lung with and without leakage for: (i) accuracy to deliver exact tidal volume (VT) and PEEP in assist-control ventilation (ACV); (ii) performance of trigger and pressurization in pressure support ventilation (PSV); and (iii) quality of non-invasive ventilation algorithms. In ACV, only six ventilators delivered an accurate VT and nine an accurate PEEP. Eleven devices failed to compensate VT and four the PEEP in leakage conditions. Inspiratory delays differed significantly among ventilators in invasive PSV (range 75-149 ms, P=0.03) and non-invasive PSV (range 78-165 ms, Pventilation algorithms efficiently prevented the decrease in pressurization capacities and PEEP levels induced by leaks in, respectively, 10 and 12 out of the 13 ventilators. We observed real heterogeneity of performance amongst the latest generation of intensive care unit ventilators. Although non-invasive ventilation algorithms appear to maintain adequate pressurization efficiently in the case of leakage, basic functions, such as delivered VT in ACV and pressurization in PSV, are often less reliable than the values displayed by the device suggest. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Smoking cessation following admission to a coronary care unit.

    Science.gov (United States)

    Rigotti, N A; Singer, D E; Mulley, A G; Thibault, G E

    1991-01-01

    To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting. Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital discharge to determine subsequent smoking behavior. Coronary care unit of a teaching hospital. Preadmission smoking status was assessed in all 828 patients admitted to the CCU during one year. The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months. None. Six months after discharge, 32% of survivors were not smoking; the rate of sustained cessation at one year was 25%. Smokers with a new diagnosis of coronary heart disease (CHD) made during hospitalization had the highest cessation rate (53% vs. 31%, p = 0.01). On multivariate analysis, smoking cessation was more likely if patients were discharged with a diagnosis of CHD, had no prior history of CHD, were lighter smokers (less than 1 pack/day), and had congestive heart failure during hospitalization. Among smokers admitted because of suspected myocardial infarction (MI), cessation was more likely if the diagnosis was CHD than if it was noncoronary (37% vs. 19%, p less than 0.05), but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency. Hospitalization in a CCU is a stimulus to long-term smoking cessation, especially for lighter smokers and those with a new diagnosis of CHD. Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention. Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality, even when quitting occurs after the onset of CHD.

  7. Geriatric patient profile in the cardiovascular surgery intensive care unit.

    Science.gov (United States)

    Korhan, Esra Akin; Hakverdioglu, Gulendam; Ozlem, Maryem; Ozlem, Maryem; Yurekli, Ismail; Gurbuz, Ali; Alp, Nilgun Akalin

    2013-11-01

    To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis ofcoronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57 +/- 0.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%) had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit. The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis.

  8. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  9. Is there a Role of Palliative Care in the Neonatal Intensive Care Unit in India?

    OpenAIRE

    Dighe, Manjiri P; Muckaden, Maryann A; Manerkar, Swati A; Duraisamy, Balaji P

    2011-01-01

    Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU) is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. P...

  10. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    Loovere, L.; Boyle, E.M.; Blatz, S.; Bowslaugh, M.; Kereliuk, M.; Paes, B.

    2008-01-01

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  11. Observation unit management of acute decompensated heart failure.

    Science.gov (United States)

    Schrock, Jon W; Emerman, Charles L

    2009-01-01

    Acute decompensated heart failure (ADHF) is a common illness presenting to the emergency department (ED) that is amenable to observation unit (OU) treatment. As the number of baby boomers continues to grow and the incidence of heart failure increases, the financial implications of ADHF treatment will become more prominent. Obtaining institutional support and developing a good working relationship with cardiology colleagues is vital to creating workable ADHF protocols for whichever type of OU an institution decides to use.

  12. Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

    Science.gov (United States)

    Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

    2017-07-01

    Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

  13. Nursing workload in a trauma intensive care unit

    Directory of Open Access Journals (Sweden)

    Luana Loppi Goulart

    2014-06-01

    Full Text Available Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient’s mortality risk. doi: 10.5216/ree.v16i2.22922.

  14. A mobility program for an inpatient acute care medical unit.

    Science.gov (United States)

    Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

    2014-10-01

    For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

  15. Is there a role of palliative care in the neonatal intensive care unit in India?

    Directory of Open Access Journals (Sweden)

    Manjiri P Dighe

    2011-01-01

    Full Text Available Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to "build a case" for palliative care in the Indian NICU setting.

  16. Prevalence of nursing diagnoses in an intensive care unit

    Directory of Open Access Journals (Sweden)

    Vinicia de Holanda Cabral

    2017-01-01

    Full Text Available To identify the main nursing diagnostic titles used in the care of critically ill patients hospitalized in an Intensive Care Unit, verifying the presence thereof in the diagnoses of NANDA International’s Taxonomy II. Methods: descriptive and documental study, in which 69 medical records of patients aged over 18 years were consulted. Results: 22 nursing diagnostic titles were found; the most frequent was risk for infection (99.0%, risk for skin integrity (75.0% and risk for aspiration (61.0%. Most diagnoses were in the domains safety/ protection (43.0% and activity/rest (26.5%. Conclusions: authors identified the main nursing diagnostic titles used in the care of critically ill patients admitted to the Intensive Care Unit and the presence thereof in the diagnoses of NANDA International’s Taxonomy II.

  17. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  18. Home iv antibiotic therapy through a medical day care unit

    OpenAIRE

    Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

    1993-01-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-pa...

  19. Fighting antibiotic resistance in the intensive care unit using antibiotics.

    Science.gov (United States)

    Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

  20. Striving for Optimum Noise-Decreasing Strategies in Critical Care: Initial Measurements and Observations.

    Science.gov (United States)

    Disher, Timothy C; Benoit, Britney; Inglis, Darlene; Burgess, Stacy A; Ellsmere, Barbara; Hewitt, Brenda E; Bishop, Tanya M; Sheppard, Christopher L; Jangaard, Krista A; Morrison, Gavin C; Campbell-Yeo, Marsha L

    To identify baseline sound levels, patterns of sound levels, and potential barriers and facilitators to sound level reduction. The study setting was neonatal and pediatric intensive care units in a tertiary care hospital. Participants were staff in both units and parents of currently hospitalized children or infants. One 24-hour sound measurements and one 4-hour sound measurement linked to observed sound events were conducted in each area of the center's neonatal intensive care unit. Two of each measurement type were conducted in the pediatric intensive care unit. Focus groups were conducted with parents and staff. Transcripts were analyzed with descriptive content analysis and themes were compared against results from quantitative measurements. Sound levels exceeded recommended standards at nearly every time point. The most common code was related to talking. Themes from focus groups included the critical care context and sound levels, effects of sound levels, and reducing sound levels-the way forward. Results are consistent with work conducted in other critical care environments. Staff and families realize that high sound levels can be a problem, but feel that the culture and context are not supportive of a quiet care space. High levels of ambient sound suggest that the largest changes in sound levels are likely to come from design and equipment purchase decisions. L10 and Lmax appear to be the best outcomes for measurement of behavioral interventions.

  1. Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center

    Directory of Open Access Journals (Sweden)

    Lekhjung Thapa

    2013-06-01

    Full Text Available Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country. Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed. Results: Total 44 (10.25% patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale, uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3% patients had hemorrhagic stroke and 21(47.7% patients had ischemic stroke. 13 (29.54% patients of stroke died within 7 days, 9 (69.23% patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76% of ischemic stroke died within 7 days. 6 (13.63% patients left hospital against medical advice. All of these patients had ischemic stroke. Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countries Keywords: intensive care unit; mortality; stroke; stroke care unit.

  2. Family-Centered Care in Neonatal Intensive Care Units: Combining Intensive Care and Family Support.

    Science.gov (United States)

    Araki, Shunsuke; Saito, Tomoko; Ichikawa, Saori; Saito, Kaori; Takada, Tsuzumi; Noguchi, Satoko; Yamada, Miki; Nakagawa, Fumi

    Advances in treatment in neonatal intensive care units (NICU) for preterm and sick newborns have improved the mortality rate of patients, but admission to the NICU may disrupt parent-infant interaction, with adverse consequences for infants and their families because of physical, psychological, and emotional separation. The concept of family centered care (FCC), in which family members are part of the care team and infants are close to the family, is important and has become popular in NICU. In 2013, we created a team called "Kodomo-Kazoku Mannaka" to promote FCC in Japan, and visited the NICU at Uppsala University Hospital in Sweden, which is internationally famous for FCC. Since this fruitful visit, we have been promoting FCC in Japan by exhibitions and presentations of the FCC ideas at academic conferences and using internet services. A questionnaire survey conducted in 2015 revealed that the importance and the benefits of FCC in NICU are recognized, although there are some barriers to FCC in each facility. It is hard to change facilities and social systems right away, but it is easier and more important to change people's minds. Our role is to spread the concept of FCC and to help each facility find its own way to adopt it. We will continue to make efforts encourage to promote FCC in Japan.

  3. Pharmacy collected medication histories in an observation unit

    Directory of Open Access Journals (Sweden)

    Gabrielle L Procopio

    2015-08-01

    Full Text Available Background: Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical. Objectives: The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients. Methods: Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies. Results: A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37% matched medication records and 1467 discrepancies identified, including 808 (55% omissions, 296 (20.2% wrong frequency, 278 (19% wrong dose, 51 (3.5% discontinued, and 34 (2.3% wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15% of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1–48 min. Conclusion: Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.

  4. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels

    2014-01-01

    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...... critically ill patients in the ICU outside the context of randomized controlled trials (GRADE 1C). No robust evidence supports recommendations for subpopulations in the ICU such as septic, burn, trauma, cardiothoracic or enterally fed patients. However, if SUP is considered clinically indicated in individual...

  5. 76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

    Science.gov (United States)

    2011-03-10

    ... of Texas v. United Regional Health Care System, Civil Action No. 7:11-cv- 00030-O. On February 25..., ambulatory surgery center or radiology center in [a] 15 mile radius of United Regional Health Care System... 95% of billed charges for all inpatient and outpatient services at United Regional Health Care System...

  6. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    Science.gov (United States)

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Advance Care Planning in palliative care: a qualitative investigation into the perspective of Paediatric Intensive Care Unit staff.

    Science.gov (United States)

    Mitchell, Sarah; Dale, Jeremy

    2015-04-01

    The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.

  8. Care zoning in a psychiatric intensive care unit: strengthening ongoing clinical risk assessment.

    Science.gov (United States)

    Mullen, Antony; Drinkwater, Vincent; Lewin, Terry J

    2014-03-01

    To implement and evaluate the care zoning model in an eight-bed psychiatric intensive care unit and, specifically, to examine the model's ability to improve the documentation and communication of clinical risk assessment and management. Care zoning guides nurses in assessing clinical risk and planning care within a mental health context. Concerns about the varying quality of clinical risk assessment prompted a trial of the care zoning model in a psychiatric intensive care unit within a regional mental health facility. The care zoning model assigns patients to one of 3 'zones' according to their clinical risk, encouraging nurses to document and implement targeted interventions required to manage those risks. An implementation trial framework was used for this research to refine, implement and evaluate the impact of the model on nurses' clinical practice within the psychiatric intensive care unit, predominantly as a quality improvement initiative. The model was trialled for three months using a pre- and postimplementation staff survey, a pretrial file audit and a weekly file audit. Informal staff feedback was also sought via surveys and regular staff meetings. This trial demonstrated improvement in the quality of mental state documentation, and clinical risk information was identified more accurately. There was limited improvement in the quality of care planning and the documentation of clinical interventions. Nurses' initial concerns over the introduction of the model shifted into overall acceptance and recognition of the benefits. The results of this trial demonstrate that the care zoning model was able to improve the consistency and quality of risk assessment information documented. Care planning and evaluation of associated outcomes showed less improvement. Care zoning remains a highly applicable model for the psychiatric intensive care unit environment and is a useful tool in guiding nurses to carry out routine patient risk assessments. © 2013 John Wiley & Sons

  9. A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital.

    Science.gov (United States)

    Smith, Thomas J

    2012-01-01

    This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

  10. Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

    Science.gov (United States)

    Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

    2017-12-01

    Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

  11. [Nurses' perception, experience and knowledge of palliative care in intensive care units].

    Science.gov (United States)

    Piedrafita-Susín, A B; Yoldi-Arzoz, E; Sánchez-Fernández, M; Zuazua-Ros, E; Vázquez-Calatayud, M

    2015-01-01

    Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  12. General surgical admissions in the intensive care unit in Ibadan ...

    African Journals Online (AJOL)

    Objectives:The Intensive Care Unit (ICU) has improved patient outcome in complex surgeries while the costs of maintaining services are high. ICU services in developing countries are often inadequate due to lack of funds. This study reviews the pattern and outcomes of General Surgical patients admitted to the ICU of our ...

  13. Management of Tracheostomy: A Survey of Dutch Intensive Care Units

    NARCIS (Netherlands)

    Veelo, Denise P.; Schultz, Marcus J.; Phoa, Kai Y. N.; Dongelmans, Dave A.; Binnekade, Jan M.; Spronk, Peter E.

    2008-01-01

    OBJECTIVE: To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. METHODS: We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have : 5 beds suitable for mechanical ventilation. The survey asked for

  14. Seasonal and recurrent intensive care unit admissions for acute ...

    African Journals Online (AJOL)

    Life-threatening attacks of asthma requiring intensive care unit (ICU) management at Red Cross War Memorial Children's Hospital in Cape Town were noted to occur in some patients in the same or adjacent months of different years. A retrospective case-controlled study was performed of 21 such 'seasonal' patients who ...

  15. Preterm Admissions in a Special Care Baby Unit: The Nnewi ...

    African Journals Online (AJOL)

    A review of all preterm admissions into the Special Care Bay Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a period of 29 months (May 1998 October 2000) was carried out. Out of a total of 699 neonatal admissions, 133 (19 percent) were preterms with gestational ages ranging from 24 to ...

  16. Pet Care Teaching Unit: 1st-3rd Grades.

    Science.gov (United States)

    Peninsula Humane Society, San Mateo, CA.

    Activities in this unit are designed to familiarize primary grade students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons involving social studies, language arts, math, and health sciences. Activities adaptable for readers and non-readers focus on pet overpopulation, care of pets when…

  17. [Benefits of aromatherapy in dementia special care units].

    Science.gov (United States)

    Bilien, Corinne; Depas, Nathalie; Delaporte, Ghislaine; Baptiste, Nathalie

    2016-01-01

    Aromatherapy is classed as a non-pharmacological treatment, recognised as a therapy for certain disorders. This practice was the subject of a study in a special care unit for patients with dementia. The objective was to demonstrate the benefit of aromatherapy diffusion on major behavioural disorders. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Intelligent ventilation in the intensive care unit | Sviri | Southern ...

    African Journals Online (AJOL)

    Objectives. Automated, microprocessor-controlled, closed-loop mechanical ventilation has been used in our Medical Intensive Care Unit (MICU) at the Hadassah Hebrew-University Medical Center for the past 15 years; for 10 years it has been the primary (preferred) ventilator modality. Design and setting. We describe our ...

  19. Assessment of delirium in the intensive care unit | Kallenbach ...

    African Journals Online (AJOL)

    Delirium poses a significant burden on our healthcare, with patients in the intensive care unit (ICU) at an increased risk for developing this disorder. In addition, the ICU environment poses unique challenges in the assessment of delirium. It is paramount that the healthcare provider has an understanding of delirium in ICU, ...

  20. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU

  1. Fighting antibiotic resistance in the intensive care unit using antibiotics

    NARCIS (Netherlands)

    Plantinga, Nienke L.; Wittekamp, Bastiaan H J; Van Duijn, Pleun J.; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to

  2. Communication and Culture in the Surgical Intensive Care Unit: Boundary Production and the Improvement of Patient Care.

    Science.gov (United States)

    Conn, Lesley Gotlib; Haas, Barbara; Cuthbertson, Brian H; Amaral, Andre C; Coburn, Natalie; Nathens, Avery B

    2016-06-01

    This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. © The Author(s) 2015.

  3. [Palliative care in the intensive cardiac care unit: a new competence for the cardiac intensivist].

    Science.gov (United States)

    Romanò, Massimo; Bertona, Roberta; Zorzoli, Federica; Villani, Rosvaldo

    2017-10-01

    Admissions to the intensive care unit at the end of life of patients with chronic non-malignant diseases are increasing. This involves the need for the development of palliative care culture and competence, also in the field of intensive cardiology. Palliative care should be implemented in the treatment of all patients with critical stages of disease, irrespective of prognosis, in order to improve the quality of care at the end of life.This review analyzes in detail the main clinical, ethical and communicational issues to move toward the introduction of basics of palliative care in cardiac intensive care units. It outlines the importance of shared decision-making with the patient and his family, with special attention to withholding/withdrawing of life-sustaining treatments, palliative sedation, main symptom control, patient and family psychological support.

  4. Parental involvement and kangaroo care in European neonatal intensive care units

    DEFF Research Database (Denmark)

    Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice

    2012-01-01

    To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out....

  5. Acinetobacter infections as an emerging threat in intensive care units

    International Nuclear Information System (INIS)

    Tahseen, U.; Talib, M.T.

    2015-01-01

    Nosocomial infections caused by Acinetobacter species (Spp.) is an emerging threat in health care setups especially intensive care units (ICU). The objective of this observational study was to determine the pattern of Acinetobacter infections and its association with length of stay in patients admitted to our medical ICU from January to August 2011. Methods: All patients above 16 years of age with stay of more than 48 hours were checked for any development of new infections not present or incubating at the time of admission. Nosocomial infections were documented in the light of clinical findings and lab results. Data was analysed using statistical software SPSS 15.0. Results: A total of 146 patients had a stay of at least 48 hours; frequency of nosocomial infection was 30.8% out of which 57.8% were Acinetobacter infections. Respiratory system was most commonly involved. Acinetobacter Spp showed high resistance (96.2%) to penicillins, cephalosporins and even extended spectrum antibiotics including carbepenems, quinolones and piperacillin plus tazobactam. Extended drug resistance was seen in 92.3% isolates; while we found high susceptibility to tigecycline (88.5%) and polymyxins (100%). Acinetobacter Spp. infected patients had mean length of stay (LOS) of 12.92 days when compared to patients with other nosocomial infections and no infection with mean LOS of 7.05 days (p=0.05) and 4.86 days (p=0.00) respectively. Conclusions: Acinetobacter Spp infections increase with longer duration of stay in ICU. Emergence of multi-drug and extended-drug resistant Acinetobacter Spp is alarming and overwhelming at this rate for already stretched out health system with its economic and health implications. (author)

  6. Review of noise in neonatal intensive care units - regional analysis

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez Abril, A [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Terron, A; Boschi, C [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Gomez, M [National Technological University, La Rioja (Argentina)

    2007-11-15

    This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

  7. Patients’ Admissions in Intensive Care Units: A Clustering Overview

    Directory of Open Access Journals (Sweden)

    Ana Ribeiro

    2017-02-01

    Full Text Available Intensive care is a critical area of medicine having a multidisciplinary nature requiring all types of healthcare professionals. Given the critical environment of intensive care units (ICUs, the need to use information technologies, like decision support systems, to improve healthcare services and ICU management is evident. It is proven that unplanned and prolonged admission to the ICU is not only prejudicial to a patient's health, but also such a situation implies a readjustment of ICU resources, including beds, doctors, nurses, financial resources, among others. By discovering the common characteristics of the admitted patients, it is possible to improve these outcomes. In this study clustering techniques were applied to data collected from admitted patients in an intensive care unit. The best results presented a silhouette of 1, with a distance to centroids of 6.2 × 10−17 and a Davies–Bouldin index of −0.652.

  8. Review of noise in neonatal intensive care units - regional analysis

    International Nuclear Information System (INIS)

    Alvarez Abril, A; Terron, A; Boschi, C; Gomez, M

    2007-01-01

    This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed

  9. Geriatric patient profile in the cardiovascular surgery intensive care unit

    International Nuclear Information System (INIS)

    Korha, E.A.; Hakverdioglu, G.; Ozlem, M.; Yurekli, I.; Gurbuz, A.; Alp, N.A

    2013-01-01

    Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)

  10. Antimicrobial usage in an intensive care unit: a prospective analysis.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2012-01-31

    Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

  11. Nursing praxis, compassionate caring and interpersonal relations: an observational study.

    Science.gov (United States)

    Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy

    2013-05-01

    The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.

  12. Artificial intelligence applications in the intensive care unit.

    Science.gov (United States)

    Hanson, C W; Marshall, B E

    2001-02-01

    To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.

  13. Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience.

    Science.gov (United States)

    Atar, Funda; Gedik, Ender; Kaplan, Şerife; Zeyneloğlu, Pınar; Pirat, Arash; Haberal, Mehmet

    2015-11-01

    We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure. We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed. Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041). Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

  14. Environmental Design for Patient Families in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mahbub Rashid

    2010-01-01

    Full Text Available The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs. It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healing environment of care” can be an effective family integration model. This paper presents evidence showing how environmental design may affect families in ICUs, and proposes design recommendations for creating a healing environment of care promoting family integration in ICUs.

  15. Health care aides use of time in a residential long-term care unit: a time and motion study.

    Science.gov (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A

    2013-09-01

    Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides

  16. Diabetic ketoacidosis in a pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Clarice L.S. Lopes

    Full Text Available Abstract Objective: To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications. Methods: A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24 h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups. Results: Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p < 0.01, reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p < 0.01. This study also observed a higher prevalence of hypokalemia (p < 0.01 and longer hospital stay in this group. Conclusions: No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.

  17. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  18. Competence of nurses in the intensive cardiac care unit

    Science.gov (United States)

    Nobahar, Monir

    2016-01-01

    Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method. Results The main categories were “clinical competence,” comprising subcategories of ‘routine care,’ ‘emergency care,’ ‘care according to patients’ needs,’ ‘care of non-coronary patients’, as well as “professional competence,” comprising ‘personal development,’ ‘teamwork,’ ‘professional ethics,’ and ‘efficacy of nursing education.’ Conclusion The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing. PMID:27382450

  19. Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.

    Science.gov (United States)

    Smith, Judith M; Van Aman, M Nancy; Schneiderhahn, Mary Elizabeth; Edelman, Robin; Ercole, Patrick M

    2017-05-01

    Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. Participants (N = 34) showed a significant increase (p education. No statistical change in knowledge of delirium existed following the education. A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244. Copyright 2017, SLACK Incorporated.

  20. How the United States exports managed care to developing countries.

    Science.gov (United States)

    Waitzkin, H; Iriart, C

    2001-01-01

    As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States.

  1. Firm handling; the information exchange interaction by parents in paediatric care – An observational study

    Directory of Open Access Journals (Sweden)

    Carina Berterö

    2011-01-01

    Full Text Available Background: Information exchange is fundamental in the paediatric care encounter. Health care professionals need further background knowledge to encounter the parents/guardians from their perspective in their minors’ paediatric care. The parents’/guardians’ ability to manage the situation is dependent on their receiving optimal information, which is why it is important to study how information is exchanged.Aim: The aim of this study was to identify, describe and conceptualize how parents/guardians resolved their main concern ininformation exchange with health care professionals in paediatric care situations involving their minors.Methodology: Glaser’s grounded theory method was used and all data were analysed using constant comparative analysis. The observational study took place at three paediatric outpatient units at a university hospital and 24 parents/guardians participated. Data sources were field notes from 37 observations of paediatric care situations and five adherent excerpts from the minors’ medical records. Grounded theory is a method of conceptualising behaviour, which is why an observational study of parents’/guardians’ information exchange and social interaction in the context of nursing care is relevant as research design.Results: Firm handling was revealed as the way the parents/guardians resolved their main concerns when they were exchanging information about their minors’ paediatric care. Firm handling is built on five inter-related categories: representative advocating, collaborating, aim sharing, supportive resourcing and minor bypassing.Conclusions: This knowledge suggests possible ways for health care professionals to design paediatric care that supports, facilitates, strengthens and improves the parents’/guardians’ firm handling. The key issue is to find ways to support parents/guardians and minors so they can participate in health care encounters according to their preferences. Firm handling gives an

  2. Seeing beyond monitors-Critical care nurses' multiple skills in patient observation: Descriptive qualitative study.

    Science.gov (United States)

    Alastalo, Mika; Salminen, Leena; Lakanmaa, Riitta-Liisa; Leino-Kilpi, Helena

    2017-10-01

    The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. Data from semi-structured interviews were analysed using thematic analysis. Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Status of neonatal intensive care units in India.

    Directory of Open Access Journals (Sweden)

    Fernandez A

    1993-04-01

    Full Text Available Neonatal mortality in India accounts for 50% of infant mortality, which has declined to 84/1000 live births. There is no prenatal care for over 50% of pregnant women, and over 80% deliver at home in unsafe and unsanitary conditions. Those women who do deliver in health facilities are unable to receive intensive neonatal care when necessary. Level I and Level II neonatal care is unavailable in most health facilities in India, and in most developing countries. There is a need in India for Level III care units also. The establishment of neonatal intensive care units (NICUs in India and developing countries would require space and location, finances, equipment, staff, protocols of care, and infection control measures. Neonatal mortality could be reduced by initially adding NICUs at a few key hospitals. The recommendation is for 30 NICU beds per million population. Each bed would require 50 square feet per cradle and proper climate control. Funds would have to be diverted from adult care. The largest expenses would be in equipment purchase, maintenance, and repair. Trained technicians would be required to operate and monitor the sophisticated ventilators and incubators. The nurse-patient ratio should be 1:1 and 1:2 for other infants. Training mothers to work in the NICUs would help ease the problems of trained nursing staff shortages. Protocols need not be highly technical; they could include the substitution of radiant warmers and room heaters for expensive incubators, the provision of breast milk, and the reduction of invasive procedures such as venipuncture and intubation. Nocosomial infections should be reduced by vacuum cleaning and wet mopping with a disinfectant twice a day, changing disinfectants periodically, maintaining mops to avoid infection, decontamination of linen, daily changing of tubing, and cleaning and sterilizing oxygen hoods and resuscitation equipment, and maintaining an iatrogenic infection record book, which could be used to

  4. The Chinese family-centered care survey for adult intensive care unit: A psychometric study.

    Science.gov (United States)

    Wang, Wen-Ling; Feng, Jui-Ying; Wang, Chi-Jen; Chen, Jing-Huei

    2016-02-01

    This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  6. Dominance of paternalism in family-centered care in the pediatric intensive care unit (PICU): an ethnographic study.

    Science.gov (United States)

    Vasli, Parvaneh; Dehghan-Nayeri, Nahid; Borim-Nezhad, Leili; Vedadhir, AbouAli

    2015-06-01

    This article examines the culture of family-centered care (FCC) in the pediatric intensive care unit (PICU) using focused ethnography. Data collection strategy was participant observation, fieldwork, and interviews with main actors of the PICU, namely supervisors, nurses, and parents. This study took place in one PICU in a hospital in Tehran, Iran. The results were in the main named as paternalism and were presented as five themes: "non-possessed environment," "separation of the children from their parents," non-interactive communication," "limited participation," and "affection and sympathy combined with superiority." In conclusion, the prevailing atmosphere in care was paternalistic as there was a huge gap between conceptually or theoretically accepted application of FCC in PICU and what is practically administrated. Bridging such a gap between theory and practice can be helpful in improving social, environment, and organizational culture for the children, their parents, and health care providers as well as their performance in the context of PICU.

  7. Digital remote viewing system for coronary care unit

    International Nuclear Information System (INIS)

    Cho, P.S.; Tillisch, J.; Huang, H.K.

    1987-01-01

    A digital remote viewing system developed for the coronary care unit at the UCLA Medical Center has been in clinical operation since March 1, 1987. The present system consists of three 512-line monitors, VAX 11/750, Gould IP8500 image processor and a broad-band communication system. The patients' images are acquired with a computed radiography system and are transmitted to the coronary care unit, which is five floors above the radiology department. This exhibit presents the architecture and the performance characteristics of the system. Also, the second-generation system, which consists of an intelligent local work station with three 1,024-line monitors and a fast digital communication network, will be introduced

  8. Constipation in intensive care unit: incidence and risk factors.

    Science.gov (United States)

    Nassar, Antonio Paulo; da Silva, Fernanda Maria Queiroz; de Cleva, Roberto

    2009-12-01

    Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (constipation, a finding that persisted at multivariable analysis (P Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function.

  9. Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

    Science.gov (United States)

    Day, Jennifer

    2017-01-01

    Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.

  10. Post-traumatic stress disorder in intensive care unit patients.

    Science.gov (United States)

    Caiuby, Andrea Vannini Santesso; Andreoli, Paola Bruno de Araújo; Andreoli, Sergio Baxter

    2010-03-01

    Post-traumatic stress disorder has been detected in patients after treatment in intensive care unit. The main goal of this study is to review the psychological aspects and therapeutic interventions on those patients after their treatment on intensive care unit. Thirty eight articles have been included. The prevalence of post-traumatic stress disorder has varied from 17% up to 30% and the incidence from 14% to 24%. The risk factors were: previous anxiety historic, depression or panic, having delusional traumatic memories (derived from psychic formations as dreams and delirium), belief effects, depressive behavior, stressing experiences and mechanical ventilation. High doses of opiates, symptoms caused by sedation or analgesia reduction and the use of lorazepam were related with the increase of delirium and delusional memory. The disorder sintomatology can be reduced with hydrocortisone administration, with daily sedation interruption. No other effectiveness psychological intervention study was found.

  11. ISO 9001 in a neonatal intensive care unit (NICU).

    Science.gov (United States)

    Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

    2011-01-01

    The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

  12. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units.

    Science.gov (United States)

    Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J

    2016-01-01

    Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments. ©2016 American Association of Critical-Care Nurses.

  13. Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms.

    Science.gov (United States)

    Hopman, Joost; Donskey, Curtis J; Boszczowski, Icaro; Alfa, Michelle J

    2018-05-23

    The efficacy of discharge cleaning and disinfection of high-touch surfaces of intensive care unit patient rooms in Brazil, Canada, the Netherlands, and the United States was evaluated and the effect of an educational intervention was determined. Significant site-to-site differences in cleaning regimens and baseline cleanliness levels were observed using ATP levels, colony-forming units, and reflective surface marker removal percent pass rates. An educational intervention that includes rapid feedback of the ATP measurements could significantly improve the quality of the cleaning and disinfection regimens. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  14. Bloodstream Infections in a Neonatal Intensive Care Unit

    OpenAIRE

    Mehmet Sah Ipek

    2016-01-01

    Aim: To determine the pattern of bloodstream infections (BSIs) and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU).Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common micr...

  15. Incidence of intravenous drug incompatibilities in intensive care units

    Czech Academy of Sciences Publication Activity Database

    Machotka, O.; Maňák, J.; Kuběna, Aleš Antonín; Vlček, J.

    2015-01-01

    Roč. 159, č. 4 (2015), s. 652-656 ISSN 1213-8118 Institutional support: RVO:67985556 Keywords : medical error * graph theory * graph coloring * drug administration * drug incompatibilities * applied combinatorics * decision theory * medical * medication safety * intensive care units Subject RIV: FN - Epidemiology, Contagious Diseases ; Clinical Immunology Impact factor: 0.924, year: 2015 http://library.utia.cas.cz/separaty/2014/E/kubena-0437509.pdf

  16. Strategies to address management challenges in larger intensive care units.

    Science.gov (United States)

    Matlakala, M C; Bezuidenhout, M C; Botha, A D H

    2015-10-01

    To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

  17. Human-centered environment design in intensive care unit

    OpenAIRE

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland based on related standards. We also premeditate the indoor environment from planning perspective, analyze patients, their families, medical staff and space requirement to conduct research in ICU desi...

  18. Nutritional support of children in the intensive care unit.

    OpenAIRE

    Seashore, J. H.

    1984-01-01

    Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional su...

  19. Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study.

    Science.gov (United States)

    Dellenmark-Blom, Michaela; Wigert, Helena

    2014-03-01

    A descriptive study of parents' experiences with neonatal home care following initial care in the neonatal intensive care unit. As survival rates improve among premature and critically ill infants with an increased risk of morbidity, parents' responsibilities for neonatal care grow in scope and degree under the banner of family-centred care. Concurrent with medical advances, new questions arise about the role of parents and the experience of being provided neonatal care at home. An interview study with a phenomenological hermeneutic approach. Parents from a Swedish neonatal (n = 22) home care setting were extensively interviewed within one year of discharge. Data were collected during 2011-2012. The main theme of the findings is that parents experience neonatal home care as an inner emotional journey, from having a child to being a parent. This finding derives from three themes: the parents' experience of leaving the hospital milieu in favour of establishing independent parenthood, maturing as a parent and processing experiences during the period of neonatal intensive care. This study suggests that neonatal home care is experienced as a care structure adjusted to incorporate parents' needs following discharge from a neonatal intensive care unit. Neonatal home care appears to bridge the gap between hospital and home, supporting the family's adaptation to life in the home setting. Parents become empowered to be primary caregivers, having nurse consultants serving the needs of the whole family. Neonatal home care may therefore be understood as the implementation of family-centred care during the transition from NICU to home. © 2013 John Wiley & Sons Ltd.

  20. Health care units and human resources management trends.

    Science.gov (United States)

    André, Adriana Maria; Ciampone, Maria Helena Trench; Santelle, Odete

    2013-02-01

    To identify factors producing new trends in basic health care unit management and changes in management models. This was a prospective study with ten health care unit managers and ten specialists in the field of Health in São Paulo, Southeastern Brazil, in 2010. The Delphi methodology was adopted. There were four stages of data collection, three quantitative and the fourth qualitative. The first three rounds dealt with changing trends in management models, manager profiles and required competencies, and the Mann-Whitney test was used in the analysis. The fourth round took the form of a panel of those involved, using thematic analysis. The main factors which are driving change in basic health care units were identified, as were changes in management models. There was consensus that this process is influenced by the difficulties in managing teams and by politics. The managers were found to be up-to-date with trends in the wider context, with the arrival of social health organizations, but they are not yet anticipating these within the institutions. Not only the content, but the professional development aspect of training courses in this area should be reviewed. Selection and recruitment, training and assessment of these professionals should be guided by these competencies aligned to the health service mission, vision, values and management models.

  1. Home iv Antibiotic Therapy through a Medical Day Care Unit

    Directory of Open Access Journals (Sweden)

    Marie Gourdeau

    1993-01-01

    Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

  2. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  3. Ameliorating the emergency department workflow by involving the observation unit: effects on crowding

    Directory of Open Access Journals (Sweden)

    Primiano Iannone

    2015-06-01

    Full Text Available Crowding adversely affects the performance of emergency departments (EDs by worsening efficiency, timeliness of care, clinical outcomes and patients’ satisfaction. We describe in this study our attempt at improving crowding by modifying the roles and workflow of the ED physicians. The observation unit physician was given the additional duty of prioritizing admissions and managing unclear, complex cases, which were previously under the responsibility of front line emergency physicians. We analyzed two corresponding periods, both before the intervention (9897 ED attendances in 2012 and after the intervention (10,297 attendances in 2013. Most of the crowding indices improved significantly, including timeliness of triage, of first medical contact, access to resus area, and overall length of stay in ED. Also, emergency hospital admissions, average specialist consultations and imaging studies per patient decreased significantly. The observation unit workload increased. There was no significant excess of adverse events.

  4. Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis.

    Science.gov (United States)

    Coombs, Maureen; Mitchell, Marion; James, Stephen; Wetzig, Krista

    2017-10-01

    End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n = 54, 85·3%), from the public sector (n = 51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n = 39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n = 145, 77·5%), educational provision to support staff (n = 15, 8%) and organisational challenges (n = 27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death

  5. X-ray investigations in intensive care units

    Energy Technology Data Exchange (ETDEWEB)

    Pokieser, H.

    1981-10-01

    From special care following surgery and from arteficial respiration of polio patients the modern and very special intensive medical care has developed. At the same time the provisional bedside radiology was improved to one branch of clinical radiology with special organisation and methods of investigation. Importance and urgency of radiological information are requiring close cooperation of all medical branches. Functions of these different groups have to be defined. The movable X-ray apparatus of 20 kV output is necessary for every intensive care unit. Hard beam technique for lung X-rays, scattered radiation grids and adequate positioning of the patient are important to get the same high quality pictures than from the radiological department.

  6. X-ray investigations in intensive care units

    International Nuclear Information System (INIS)

    Pokieser, H.

    1981-01-01

    From special care following surgery and from arteficial respiration of polio patients the modern and very special intensive medical care has developed. At the same time the provisional bedside radiology was improved to one branch of clinical radiology with special organisation and methods of investigation. Importance and urgency of radiological information are requiring close cooperation of all medical branches. Functions of these different groups have to be defined. The movable X-ray apparatus of 20 kV output is necessary for every intensive care unit. Hard beam technique for lung X-rays, scattered radiation grids and adequate positioning of the patient are important to get the same high quality pictures than from the radiological department. (orig.) [de

  7. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Morten Brøgger; Perner, A; Wetterslev, J

    2013-01-01

    Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate...... incidence of gastrointestinal (GI) bleeding varies considerably. Data on the incidence and severity of GI bleeding in general ICUs in the developed world as of today are lacking. The best intervention for SUP is yet to be settled by balancing efficacy and harm. In essence, it is unresolved if intensive care...... patients benefit overall from SUP. The following clinically research questions are unanswered: (1) What is the incidence of GI bleeding, and which interventions are used for SUP in general ICUs today?; (2) Which criteria are used to prescribe SUP?; (3) What is the best SUP intervention?; (4) Do intensive...

  8. Provision of bereavement care in neonatal units in the United Kingdom.

    Science.gov (United States)

    Robertson, Meredith J P; Aldridge, Anne; Curley, Anna E

    2011-05-01

    To establish what bereavement care services are available in neonatal units in the United Kingdom and to establish the availability to staff (doctors, nurses, and chaplains) of bereavement education, training, communication, and multicultural support. For families who lose a baby in the neonatal period, the support they receive from hospital staff can be pivotal in their ability to cope with their grief. Hospital staff are not always trained to provide this support. Limited evidence is available regarding hospital-based bereavement care in neonatology or its impact on outcome. Questionnaire survey of selected doctors, nurses, and chaplains in 200 neonatal units in the United Kingdom. We had responses from 100% of neonatal units surveyed. Of 600 individuals, 320 responded; 11% of doctors had never received any formal training in bereavement care, compared with 0.8% of nurses and 1.2% and chaplains. In addition, 31% of respondents thought the training they received was inadequate. Knowledge of grief theorists was poor. Up to 99% of units were helping parents create memories through photographs or handprints. Parents were uniformly given the chance to be with their baby at the time of death (99% overall). Siblings were encouraged to be present 71% of the time; 75% of respondents felt that information about the needs of different faith groups was available. Formal psychological support was offered to 45% of families after bereavement. Studies have shown that parents value clear communication, education about grieving, and demonstrated emotional support by staff. Our study has shown that there are deficiencies in staff training and education in this area. Educators must promote the inclusion of content on bereavement/end-of-life care. Additional education on cultural issues would be helpful. Managing the bereavement process well to minimize morbidity for families and healthcare providers is an important challenge for the future.

  9. Neonatal Intensive Care Unit Layout and Nurses' Work.

    Science.gov (United States)

    Doede, Megan; Trinkoff, Alison M; Gurses, Ayse P

    2018-01-01

    Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.

  10. Adverse respiratory events in a post-anesthesia care unit.

    Science.gov (United States)

    Xará, Daniela; Santos, Alice; Abelha, Fernando

    2015-02-01

    Adverse respiratory events (ARE) are a leading causes of postoperative morbidity and mortality. This study investigated the incidence and determinants of postoperative ARE. This observational prospective study was conducted in a post anesthesia care unit (PACU). A total of 340 adult subjects were admitted consecutively, and AREs were measured after elective surgery. Population demographics, perioperative parameters, ARE occurrence, and length of stay in the postoperative PACU and in hospital were recorded. Data were analyzed descriptively using the Mann-Whitney U-test and the Chi-square or Fisher's exact test. Multivariate analyses were carried outusing logistic binary regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. Postoperative AREs occurred in 67 subjects (19.7%). AREs were more frequent after high-risk procedures (42% vs 24%; P=.003), in patients undergoing major surgery (37% vs 25%; P=.041), those receiving general anesthesia (85% vs 67%; P=.004), and in patients administered intraoperative muscle relaxants (79% vs 55%; P<.001) and neostigmine (69% vs 49%; P=.002). Hypoactive emergence (13% vs 5%; P=.015) and residual neuromuscular blockade (46% versus 11%; P<.001) were more frequent in subjects with postoperative ARE. On multivariate analyses, residual neuromuscular blockade was an independent risk factor for ARE in the PACU (OR 6.4; CI 3.0-13.4; P<.001). ARE is an important and common postoperative complication. Residual neuromuscular blockade was an independent risk factor for ARE in the PACU. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  11. [Application and evalauation of care plan for patients admitted to Intensive Care Units].

    Science.gov (United States)

    Cuzco Cabellos, C; Guasch Pomés, N

    2015-01-01

    Assess whether the use of the nursing care plans improves outcomes of nursing care to patients admitted to the intensive care unit (ICU). The study was conducted in a University Hospital of Barcelona in Spain, using a pre- and post-study design. A total of 61 patient records were analysed in the pre-intervention group. A care plan was applied to 55 patients in the post-intervention group. Specific quality indicators in a medical intensive care unit to assess the clinical practice of nursing were used. Fisher's exact test was used to compare the degree of association between quality indicators in the two groups. A total of 116 records of 121 patients were evaluated: 61 pre-intervention and 55 post-intervention. Fisher test: The filling of nursing records, p=.0003. Checking cardiorespiratory arrest equipment, p <.001. Central vascular catheter related bacteraemia (B-CVC) p=.622. Ventilator associated pneumonia (VAP) p=.1000. Elevation of the head of the bed more than 30° p=.049, and the pain management in non-sedated patients p=.082. The implementation of nursing care plans in patients admitted to the intensive care area may contribute to improvement in the outcomes of nursing care. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  12. Behavior observation of major noise sources in critical care wards.

    Science.gov (United States)

    Xie, Hui; Kang, Jian; Mills, Gary H

    2013-12-01

    This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

  13. Observations of radiation fog chemistry in the Eastern United States

    Science.gov (United States)

    Straub, D.; Hutchings, J.; Herckes, P.

    2010-07-01

    The chemical composition of radiation fog in the Mid-Atlantic region of the United States has been the focus of an ongoing field campaign based in Selinsgrove, PA. This field study was established to provide a long term record that can be used to identify the effects of meteorology and air mass source regions on fog composition and to shed light on the role that fog can play in the production of secondary inorganic and organic aerosol mass. In the United States, studies that focus on radiation fog have been relatively rare. For the most part, they have been limited geographically to the Central Valley of California, though individual studies have also been conducted in the Central United States and along the Texas-Louisiana Gulf Coast. Sample collection for the current study began during the fall of 2007. Through 2009, samples from 25 radiation fog events have been obtained. A Caltech Heated Rod Cloudwater Collector (CHRCC) having a Dp50 of approximately 8 microns was used to collect one fog sample per event. Samples were typically collected between 2:00 AM and 7:00 AM under conditions of light winds, clear skies, and recent rainfall. Sample volumes ranged from 2.9 ml to 150 ml. Following collection, samples were analyzed for pH and then one of the following: major inorganic ions, dissolved total organic carbon, N-nitrosodimethylamine (NDMA), metals, or organic speciation. Through 2009, sample pH varied between 4.28 and 6.86 and averaged 5.03 based on H+ concentration. Ammonium and sulfate were found to be the most abundant ionic species in the fog samples. Sufficient ammonium was detected in nearly every sample to fully neutralize nitrate and sulfate. The concentrations of sulfate, nitrate, and ammonium observed in this study were lower than values reported in the literature for most other cloud and fog studies conducted in the US. Due to significant ammonium input, pH in the current study was higher than most other studies. Concentrations of total organic carbon

  14. Family members' informal roles in end-of-life decision making in adult intensive care units.

    Science.gov (United States)

    Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

    2012-01-01

    To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

  15. A Turkish Version of the Critical-Care Pain Observation Tool: Reliability and Validity Assessment.

    Science.gov (United States)

    Aktaş, Yeşim Yaman; Karabulut, Neziha

    2017-08-01

    The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. A repeated measures design was used for the study. A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery. The Turkish version of the Critical-Care Pain Observation Tool has shown statistically acceptable levels of validity and reliability. Inter-rater reliability was supported by moderate-to-high-weighted κ coefficients (weighted κ coefficient = 0.55 to 1.00). For concurrent validity, significant associations were found between the scores on the Critical-Care Pain Observation Tool and the Behavioral Pain Scale scores. Discriminant validity was also supported by higher scores during suctioning (a nociceptive procedure) versus non-nociceptive procedures. The internal consistency of the Critical-Care Pain Observation Tool was 0.72 during a nociceptive procedure and 0.71 during a non-nociceptive procedure. The validity and reliability of the Turkish version of the Critical-Care Pain Observation Tool was determined to be acceptable for pain assessment in critical care, especially for patients who cannot communicate verbally. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  16. The reality of waste management in primary health care units in Brazil.

    Science.gov (United States)

    Alves, Sergiane B; e Souza, Adenícia C S; Tipple, Anaclara F V; Rezende, Keyti C A D; de Resende, Fabiana R; Rodrigues, Érika G; Pereira, Milca S

    2014-09-01

    A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075 kg user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households. © The Author(s) 2014.

  17. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.

    Science.gov (United States)

    Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

    2009-10-01

    This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

  18. Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project.

    Science.gov (United States)

    Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey

    Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.

  19. Nurses' care practices at the end of life in intensive care units in Bahrain.

    Science.gov (United States)

    O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L

    2017-12-01

    The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

  20. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe.

  1. Insurance coverage for male infertility care in the United States.

    Science.gov (United States)

    Dupree, James M

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.

  2. Benchmarking and audit of breast units improves quality of care.

    Science.gov (United States)

    van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; Peeters, M; Tjalma, W

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on "QIs and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload.

  3. No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

    Science.gov (United States)

    Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.

    2016-01-01

    Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514

  4. Nursing care of the newborn in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Taysa Costa da Silva

    2017-06-01

    Full Text Available Objective: To verify the main measures of care for the newborn in the neonatal intensive care unit. Method: This is an integrative review, in which, it is possible to identify, analyze and synthesize research results with the inclusion of experimental and non-experimental studies. A total of 133 articles were collected. After reading titles, exclusion criteria and reading resumes, 10 were left, in which the sample was composed. Results: The selected publications were placed in 3 thematic categories: The importance of knowledge in nursing care, to the internal NB in ​​NICU; Nursing evaluation and care used for pain relief in NB; Main factors and adverse events that may lead to the hospitalization of the newborn and the increase of morbidity and mortality in an NICU. Conclusion: The analysis of the aforementioned study exposes the importance and main nursing care that can be administered in newborns in a NICU, so that the reduction of neonatal mortality can be provided. Descriptors: Neonatal Intensive Care Unit; Nursing care; Newborn.

  5. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz

    2016-08-01

    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  6. Racial differences in parental satisfaction with neonatal intensive care unit nursing care.

    Science.gov (United States)

    Martin, A E; D'Agostino, J A; Passarella, M; Lorch, S A

    2016-11-01

    Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. A prospective cohort was constructed of families with a premature infant presenting to primary care between 1 January 2010 and 1 January 2013 (N=249, 52% white, 42% black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using the standard qualitative methodology. One hundred and twenty (48%) parents commented on nursing. Fifty-seven percent of the comments were positive, with black parents more negative (58%) compared with white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay.

  7. Extracorporeal membrane oxygenation in a Scottish intensive care unit.

    Science.gov (United States)

    Berryman, Sean

    2010-01-01

    I reflected on the training I had on an extraordinary treatment for profound respiratory failure. The result of training enabled us to successfully treat a young female with the influenza A virus with extracorporeal membrane oxygenation (ECMO). I report the positive outcome that occurred, while continuing to run a busy general intensive care unit (ICU). She was the first of six patients who were all successfully treated with ECMO. Ten trained and experienced critical care nurses and two doctors attended the ECMO training course provided by the national centre in the UK. Five patients had already received ECMO therapy in the Scottish specialist unit (over the period of 8 years). As our Scottish specialist unit purchased exactly the same equipment as the national centre, it was easier for the multidisciplinary team to utilize their new-found knowledge and treat future patients with ECMO. With the predicted swine flu (H1N1) pandemic and the subsequent demand for critical care beds, funding was obtained to facilitate ECMO training. The potential need for increased provision of ECMO therapies was highlighted by recent events in Australia and New Zealand. Their most recent winter produced 68 patients requiring ECMO, whereas the previous year had manifested only three. Using our new equipment and adapted protocols from the national centre, we used these new skills to treat our first patient in October 2009. Johns' reflective practice tool was used to evaluate the care provided. Our patient was on ECMO for 9 days. She went on to make a remarkable recovery and was discharged from the ICU 1 week after ECMO was discontinued. She was discharged to the cardiothoracic high-dependency unit, where she was successfully rehabilitated. We were able to successfully treat a young lady, while providing the care for all other patients. This was a complex treatment, one that uses many resources including time and finance. Now that we have all the equipment, the necessary training and the

  8. Protective mechanical ventilation in United Kingdom critical care units: A multicentre audit.

    Science.gov (United States)

    Newell, Christopher P; Martin, Matthew J; Richardson, Neil; Bourdeaux, Christopher P

    2017-05-01

    Lung protective ventilation is becoming increasingly used for all critically ill patients being mechanically ventilated on a mandatory ventilator mode. Compliance with the universal application of this ventilation strategy in intensive care units in the United Kingdom is unknown. This 24-h audit of ventilation practice took place in 16 intensive care units in two regions of the United Kingdom. The mean tidal volume for all patients being ventilated on a mandatory ventilator mode was 7.2(±1.4) ml kg -1 predicted body weight and overall compliance with low tidal volume ventilation (≤6.5 ml kg -1 predicted body weight) was 34%. The mean tidal volume for patients ventilated with volume-controlled ventilation was 7.0(±1.2) ml kg -1 predicted body weight and 7.9(±1.8) ml kg -1 predicted body weight for pressure-controlled ventilation ( P  < 0.0001). Overall compliance with recommended levels of positive end-expiratory pressure was 72%. Significant variation in practice existed both at a regional and individual unit level.

  9. Needs of Parents in Caring for Their Children in a Pediatric Intensive Care Unit.

    Science.gov (United States)

    Valderrama Sanabria, Mery Luz; Muñoz de Rodríguez, Lucy

    2016-04-01

    This work sought to describe the needs of parents to participate in caring for their children hospitalized in a pediatric intensive care unit (PICU). This is a qualitative study based on the ethno-nursing research method proposed by Leininger. For data collection and analysis, in-depth open interviews were used, along with field notes and enabler guidelines proposed by Leininger: stranger-friend, observation, participation, reflexion, and the Sunrise model. Parents of children hospitalized in a PICU in the city of Tunja (Boyacá, Colombia) participated between February 2012 and October 2013. The needs of parents to care for their children were described in the following themes: clear and timely communication, familiarization with technology, the value of the family, favoring the parent-children interaction during visits, and valuing and respecting generic (folk) knowledge. The study provides knowledge, from the cultural perspective of parents with children hospitalized in PICU, as input to plan and develop care actions with them, according to their own needs.Objetivo.Describir las necesidades de padres para participar del cuidado de sus hijos hospitalizados en la Unidad de Cuidado Intensivo Pediátrico (UCIP). Métodos. Investigación cualitativa basada en el método de la etnoenfermería propuesto por Leininger. Para la recolección y análisis de la información se utilizaron la entrevista abierta a profundidad, las notas de campo y guías facilitadoras propuestas por Leininger: Extraño amigo, Observación, Participación Reflexión y el modelo del sol naciente. Participaron los padres de niños hospitalizados en una UCIP de Tunja (Boyacá, Colombia) entre febrero de 2012 y Octubre de 2013. Resultados. Se describen las necesidades de los padres para cuidar a sus hijos en los siguientes temas: Comunicación clara y oportuna, Familiarización con la Tecnología, El valor de la familia, Favorecer la interacción de padres-hijos durante la visita y Valorar y

  10. The Neonatal Intensive Care Unit: Environmental Stressors and Supports.

    Science.gov (United States)

    Williams, Kristen G; Patel, Kayla T; Stausmire, Julie M; Bridges, Christy; Mathis, Mary W; Barkin, Jennifer L

    2018-01-03

    The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six ( n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically. Five themes related to the NICU environment emerged as being either stressful or helpful: (1) amount and quality of communication with medical staff, (2) bedside manner of medical staff, (3) feeling alienated from infant's care, (4) support from other NICU mothers and families, and (5) NICU Physical Environment and Regulations. There is a need for medical staff training on awareness, communication, empathy, and other behaviors that might improve maternal (and parental) experiences in the NICU. The physical environment, including rules and regulations of the NICU, should be reexamined with family comfort in mind in addition to the clinical care of the infant.

  11. Nursing diagnosis in intensive care unit: the Turkey experience.

    Science.gov (United States)

    Korhan, Esra Akn; Yönt, Gülendam Hakverdioğlu; Erdemir, Firdevs; Müller-Staub, Maria

    2014-01-01

    The purpose of this study was to determine intensive care unit nurses diagnostic abilities and diagnoses that they provide. A vignette study was performed. The vignette contained a patient's history, treatment, and signs/symptoms of 18 nursing diagnoses based on NANDA-I as the criterion standard. Turkish intensive care unit nurses (N = 45) stated nursing diagnoses described by patient data in the vignette. The resulting nursing diagnoses were grouped into Gordon's Functional Health Patterns, and descriptive analyses were performed. One-way analysis of variance was used to detect possible differences in diagnostic abilities based on nurses' education levels. Nurses identified 14 nursing diagnoses. Four of the predetermined psychosocial nursing diagnoses were not identified. The highest percentage of diagnoses was risk for impaired skin integrity (62.2%) and impaired oral mucous membrane (60.0%). The lowest number of diagnoses was impaired verbal communication (2.2%). A statistically significant difference was found between the educational level of nurses and their abilities to determine nursing diagnoses (P < .05). The findings are important for nursing education. They demonstrate the need to focus on patients as complete human beings, covering not only biological aspects but also cultural and social values, as well as emotional and spiritual care needs.

  12. Teamwork in a coronary care unit: facilitating and hindering aspects

    Directory of Open Access Journals (Sweden)

    Bethania Ferreira Goulart

    2016-06-01

    Full Text Available Abstract OBJECTIVE To identify, within a multidisciplinary team, the facilitating and hindering aspects for teamwork in a coronary care unit. METHOD A descriptive study, with qualitative and quantitative data, was carried out in the coronary care unit of a public hospital. The study population consisted of professionals working in the unit for at least one year. Those who were on leave or who were not located were excluded. The critical incident technique was used for data collection, by means of semi-structured interviews. For data analysis, content analysis and the critical incident technique were applied. RESULTS Participants were 45 professionals: 29 nursing professionals; 11 physicians; 4 physical therapists; and 1 psychologist. A total of 49 situations (77.6% with negative references; 385 behaviors (54.2% with positive references; and 182 consequences emerged (71.9% with negative references. Positive references facilitate teamwork, whereas negative references hinder it. A collaborative/communicative interprofessional relationship was evidenced as a facilitator; whereas poor collaboration among agents/inadequate management was a hindering aspect. CONCLUSION Despite the prevalence of negative situations and consequences, the emphasis on positive behaviors reveals the efforts the agents make in order to overcome obstacles and carry out teamwork.

  13. Radiofrequency exposure in the Neonatal Medium Care Unit.

    Science.gov (United States)

    Calvente, I; Vázquez-Pérez, A; Fernández, M F; Núñez, M I; Múñoz-Hoyos, A

    2017-01-01

    The aims of this study were to characterize electromagnetic fields of radiofrequency (RF-EMF) levels generated in a Neonatal Medium Care Unit and to analyze RF-EMF levels inside unit's incubators. Spot and long-term measurements were made with a dosimeter. The spot measurement mean was 1.51±0.48V/m. Higher values were found in the proximity to the window and to the incubator evaluated. Mean field strength for the entire period of 17h was 0.81 (±0.07)V/m and the maximum value was 1.58V/m for long-term RF-EMF measurements in the incubator. Values found during the night period were higher than those found during the day period. It is important to consider RF-EMF exposure levels in neonatal care units, due to some evidence of adverse health effects found in children and adults. Characterization of RF-EMF exposure may be important to further investigate the mechanisms and underlying effects of electromagnetic fields (EMF) on infant health. A prudent avoidance strategy should be adopted because newborns are at a vulnerable stage of development and the actual impact of EMF on premature infants is unknown. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Improvement in intensive care unit: Effect on mortality

    Directory of Open Access Journals (Sweden)

    Adeniyi Adesida

    2017-01-01

    Full Text Available Background: The Lagos University Teaching Hospital's Intensive Care Unit (ICU was founded in 1975. It was designed as an eight-bedded ICU, a previous review of outcome of surgical admissions in the ICU in 2002 placed mortality at 40.3%, however, presently run as a five-bed unit with new ICU equipment procured in 2012, arterial blood gas machines, patient monitors, and ventilators with sustained multidisciplinary approach to patient management. We compared the number of admissions, mortality, and discharges to the ward 1 year before (Period I and after the upgrade of the ICU facilities (Period II. Methods: This was a retrospective study of all patients admitted into the ICU between June 2011 and May 2013. We looked at the admission register of the ICU and retrieved biometric data, diagnosis, age, pattern of units admitting patients into ICU, length of stay (LOS, and outcome of ICU care whether the patient died in ICU or was discharged to the ward. Results: There were 122 patients admitted into the ICU in Period I and 156 patients were admitted in Period II with a mean LOS of 6.3 ± 5.4 days and 7.8 ± 7.3 days, respectively. Mortality rate in Period I was 74.6% while mortality fell to 57.7% in Period II (P = 0.005. Conclusion: There was a significant improvement in the ICU outcome with the upgrade of the ICU facilities.

  15. Accounting for health-care outcomes: implications for intensive care unit practice and performance.

    Science.gov (United States)

    Sorensen, Roslyn; Iedema, Rick

    2010-08-01

    The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.

  16. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units

    DEFF Research Database (Denmark)

    Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni

    2018-01-01

    , the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region...

  17. Pseudomonas aeruginosa outbreak in a pediatric oncology care unit caused by an errant water jet into contaminated siphons.

    Science.gov (United States)

    Schneider, Henriette; Geginat, Gernot; Hogardt, Michael; Kramer, Alexandra; Dürken, Matthias; Schroten, Horst; Tenenbaum, Tobias

    2012-06-01

    We analyzed an outbreak of invasive infections with an exotoxin U positive Pseudomonas aeruginosa strain within a pediatric oncology care unit. Environmental sampling and molecular characterization of the Pseudomonas aeruginosa strains led to identification of the outbreak source. An errant water jet into the sink within patient rooms was observed. Optimized outbreak management resulted in an abundance of further Pseudomonas aeruginosa infections within the pediatric oncology care unit.

  18. The effect of physician staffing model on patient outcomes in a medical progressive care unit.

    Science.gov (United States)

    Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

    2016-04-01

    Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  20. Fathers' Stress in a Neonatal Intensive Care Unit

    DEFF Research Database (Denmark)

    Noergaard, Betty; Ammentorp, Jette; Garne, Ester

    2018-01-01

    BACKGROUND: Healthcare professionals in neonatal intensive care units (NICUs) tend to focus attention on the mothers and the newborn infants. Thus, fathers may find it difficult to establish an optimal father-child relationship and their stress may increase and persist during hospitalization...... and expect fathers to be involved, and support them to establish a father-child relationship, although they might become more stressed. IMPLICATIONS FOR RESEARCH: More adequate outcome measures are needed to determine the effect of interventions on paternal stress.This is an open-access article distributed....... PURPOSE: To investigate the impact of a more father-friendly NICU on paternal stress and their participation in childcare. METHODS: A quasiexperimental design was conducted on Danish-speaking fathers of newborn infants 28 or more weeks' gestational age. The Parental Stressor Scale: Neonatal Intensive Care...

  1. Medical staffing in Ontario neonatal intensive care units.

    Science.gov (United States)

    Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D

    1989-06-01

    Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

  2. Urinary catheter related nosocomial infections in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Tullu M

    1998-04-01

    Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

  3. Respiratory virology and microbiology in intensive care units

    DEFF Research Database (Denmark)

    Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben

    2013-01-01

    Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care-patients >18...... years with acute respiratory symptoms were collected upon admission and analysed with multiplex real-time polymerase chain reaction, for 12 community respiratory viruses. Blood and respiratory tract specimens were analysed for bacteria and fungi upon clinicians' request. Clinical and paraclinical data...... were collected. Viruses were detected in 19 (16%) of the 122 study patients. Five virus-positive patients (26%) had possible clinically relevant bacteria or fungi co-detected. Patients with exacerbation in COPD were associated with a viral infection (p = 0.02). Other comorbidities, clinical...

  4. Critical incidents connected to nurses’ leadership in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Elaine Cantarella Lima

    Full Text Available ABSTRACT Objective: The goal of this study is to analyze nurses’ leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses’ behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses’ activities; people management; and the setting of high quality care targets. Final considerations: Researchers identified a mixed leadership model, leading them to the conclusion that nurses’ knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization’s results.

  5. Intensive Care Unit Nurses' Beliefs About Delirium Assessment and Management.

    Science.gov (United States)

    Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara

    2016-10-01

    Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.

  6. [Factors affecting the recovery in the intensive care unit].

    Science.gov (United States)

    Turkov, P N; Nikitin, V V; Antsupova, M A; Podkopaev, V N; Panfilova, R P; Ivanova, I N; Nesterova, L I

    2013-01-01

    Urgency of the problem is defined by economical, regulatory and legislative acts, regional social and moral factors. There is critical situation in Russian Pediatric Healthcare system. This situation is due to inadequate funding, high medical technologies inaccessibility for some Russian children, their adverse health state. The article presents a retrospective analysis of intensive therapy and resuscitation outcomes with technical equipment and work environment assessment in the intensive care unit of Tushinskaya city pediatric clinic for the period from 2007 to 2011. Anaesthetic and emergency care quality and safety depend on several factors: permanent equipment improvement, comprehensive analysis of every fatal case and full implementation of "Anti-epidemic (prophylactic) actions plan" and "Program of monitoring compliance with the sanitary norms".

  7. Effective leadership within hospice and specialist palliative care units.

    Science.gov (United States)

    Barker, L

    2000-01-01

    In this study the Repertory Grid interview technique was used to investigate constructs of leadership held by a group of male and female senior managers from within hospice and Specialist Palliative Care Units (SPCUs) in the UK. The themes that emerged were compared with those from existing research models of leadership. Men and women in these roles describe different constructs of effective leadership. The women's constructs that emerged were predominantly transformational, whilst the men's were predominantly transactional. Themes were also identified in this study, which differed from previous studied, i.e. those of political and environment awareness and the valuing of others' views regardless of their status. These themes do not feature highly in other research, and may be in response to the environment within which hospice and specialist palliative care functions.

  8. Nurses Empathy and Family Needs in the Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Sima Moghaddasian

    2013-08-01

    Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.

  9. The Social Work in the Continuous Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Rita dos Santos de Pina Duarte

    2014-06-01

    Full Text Available The Social Worker is a qualified professional who, by proper training intervention and by research and analysis of social reality, is ready to act, execute and evaluate services, programs and social policies aiming to preserve, protect and expand human rights and social justice. The Portuguese National Network of Integrated Continuous Care (RNCCI emerged in 2006 considering the health care needs with the recognition that the system could not cope with the rehabilitation needs of the different groups of patients. Thus, this health structure was created to establish an intermediary between health and social care and as a way to connect hospitalization and clinical discharge, as well as re-integration into the community. The primary goal was to clearly assess the importance of the social service in one Continuous Care Unit by using, as methodology, questioner applications for different professionals (social service team and other health team members. The results were helpful and positive, allowing us to conclude that the social service area is valued by the team members at different levels with a fundamental goal of supporting patients, families / caregivers and the other health professionals in their interventions.

  10. Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

    Science.gov (United States)

    Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

    2016-03-01

    Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

  11. Occupational Therapy in the Intensive Care Unit: A Systematic Review.

    Science.gov (United States)

    Weinreich, Mark; Herman, Jennifer; Dickason, Stephanie; Mayo, Helen

    2017-07-01

    This paper is a synthesis of the available literature on occupational therapy interventions performed in the adult intensive care unit (ICU). The databases of Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and CINAHL databases were systematically searched from inception through August 2016 for studies of adults who received occupational therapy interventions in the ICU. Of 1,938 citations reviewed, 10 studies met inclusion criteria. Only one study explicitly discussed occupational therapy interventions performed and only one study specifically tested the efficacy of occupational therapy. Future research is needed to clarify the specific interventions and role of occupational therapy in the ICU and the efficacy of these interventions.

  12. Glucocorticoid-induced myopathy in the intensive care unit

    DEFF Research Database (Denmark)

    Eddelien, Heidi Shil; Hoffmeyer, Henrik Westy; Lund, Eva Charlotte Løbner

    2015-01-01

    Glucocorticoids (GC) are used for intensive care unit (ICU) patients on several indications. We present a patient who was admitted to the ICU due to severe respiratory failure caused by bronchospasm requiring mechanical ventilation and treated with methylprednisolone 240 mg/day in addition...... to antibiotics and bronchiolytics. When the sedation was lifted on day 10, the patient was awake but quadriplegic. Blood samples revealed elevated muscle enzymes, electromyography showed myopathy, and a muscle biopsy was performed. Glucocorticoid-induced myopathy was suspected, GC treatment was tapered...

  13. Magnetic fields in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    Aasen, S.E.; Johansson, A.; Cristensen, T.

    1995-06-01

    In this study the magnetic flux density in and around the infant incubators of a neonatal intensive care unit were registered and mapped. The mean 50 Hz magnetic flux densities in an incubator was typically in the region 0.2 - l μT, with maximum values around 1.5μT. The field levels are quite varying dependent on type of incubator, position in the incubator, position of the electronic surveillance and treatment equipment and the position of the 220 V main plugs. 8 refs., 21 figs., 2 tabs

  14. Respiratory Acid-Base Disorders in the Critical Care Unit.

    Science.gov (United States)

    Hopper, Kate

    2017-03-01

    The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco 2 may have a significant impact on outcome. Monitoring Pco 2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis. Published by Elsevier Inc.

  15. Reinventing primary care: lessons from Canada for the United States.

    Science.gov (United States)

    Starfield, Barbara

    2010-05-01

    Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation's health statistics have become increasingly superior. Although the costs of Canada's health system are high by international standards, they are much lower than U.S. costs. This paper describes several factors likely to be responsible for Canada's better health at lower cost: universal financial coverage through a so-called single payer; features conducive to a strong primary care infrastructure; and provincial autonomy under general principles set by national law.

  16. Comparative study of 2 oral care protocols in intensive care units.

    Science.gov (United States)

    Ory, Jérôme; Raybaud, Evelyne; Chabanne, Russell; Cosserant, Bernard; Faure, Jean Sébastien; Guérin, Renaud; Calvet, Laure; Pereira, Bruno; Mourgues, Charline; Guelon, Dominique; Traore, Ousmane

    2017-03-01

    The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Incidence of constipation in an intensive care unit.

    Science.gov (United States)

    Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Marshall, Norma Guimarães

    2013-01-01

    To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization.

  18. Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units.

    Science.gov (United States)

    Grudzen, Corita; Richardson, Lynne D; Baumlin, Kevin M; Winkel, Gary; Davila, Carine; Ng, Kristen; Hwang, Ula

    2015-05-01

    Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined. Project HOPE—The People-to-People Health Foundation, Inc.

  19. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps.

    Science.gov (United States)

    Manrique-Rodríguez, S; Sánchez-Galindo, A C; Fernández-Llamazares, C M; Calvo-Calvo, M M; Carrillo-Álvarez, Á; Sanjurjo-Sáez, M

    2016-10-01

    To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. A tertiary level hospital pediatric intensive care unit. Infusions delivered with infusion pumps in all pediatric intensive care unit patients. Design of a drug library with safety limits for all intravenous drugs prescribed. Users' compliance with drug library as well as number and type of errors prevented were analyzed. Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  20. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit.

    Science.gov (United States)

    Costa, Jaquilene Barreto da; Marcon, Sonia Silva; Macedo, Claudia Rejane Lima de; Jorge, Amaury Cesar; Duarte, Péricles Almeida Delfino

    2014-01-01

    To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation.

  1. Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit.

    Science.gov (United States)

    Lei, Jin'e; Han, Shaoshan; Wu, Wenjing; Wang, Xue; Xu, Jiru; Han, Lei

    2016-11-01

    Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013. Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak. A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures. This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Microbiological contamination of mobile phones of clinicians in intensive care units and neonatal care units in public hospitals in Kuwait.

    Science.gov (United States)

    Heyba, Mohammed; Ismaiel, Mohammad; Alotaibi, Abdulrahman; Mahmoud, Mohamed; Baqer, Hussain; Safar, Ali; Al-Sweih, Noura; Al-Taiar, Abdullah

    2015-10-15

    The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination. This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological identification using standard laboratory methods. Self-administered questionnaire was used to gather data on mobile phones disinfection practices. Out of 213 mobile phones, 157 (73.7 %, 95 % CI [67.2-79.5 %]) were colonized. Coagulase-negative staphylococci followed by Micrococcus were predominantly isolated from the mobile phones; 62.9 % and 28.6 % of all mobile phones, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria were identified in 1.4 % and 7.0 % of the mobile phones, respectively. Sixty-eight clinicians (33.5 %) reported that they disinfected their mobile phones, with the majority disinfecting their mobile phones only when they get dirty. The only factor that was significantly associated with mobile phone contamination was whether a clinician has ever disinfected his/her mobile phone; adjusted odds ratio 2.42 (95 % CI [1.08-5.41], p-value = 0.031). The prevalence of mobile phone contamination is high in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Although some of the isolated organisms can be considered non-pathogenic, various reports described their potential harm particularly among patients in ICU and NCU settings. Isolation of MRSA and Gram-negative bacteria from mobile phones of clinicians treating patients in high-risk healthcare

  3. Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran.

    Science.gov (United States)

    Ghorbani, Azam; Sadeghi, Leila; Shahrokhi, Akram; Mohammadpour, Asghar; Addo, Mary; Khodadadi, Esmail

    2016-11-01

    Nosocomial infections are considered a major risk factor in hospital wards, and hand hygiene is the first step in their control. An observational study was conducted in 2015 with 200 nurses working in intensive care units in teaching hospitals of Tabriz, Iran. Data were collected by using the Hand Hygiene Observation Tool questionnaire. The researchers monitored nurses' opportunities for hand hygiene during the 8-week period from February 3-April 4, 2015. A total of 1,067 opportunities occurred for hand hygiene before and after wearing gloves. The results show that hand hygiene compliance before wearing gloves is poor among nurses who work in intensive care units (14.8%). Therefore it is necessary to conduct effective interventions through continuing education programs to improve hand hygiene compliance. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Intensive care unit team perception of palliative care: the discourse of the collective subject.

    Science.gov (United States)

    Gulini, Juliana El Hage Meyer de Barros; Nascimento, Eliane Regina Pereira do; Moritz, Rachel Duarte; Rosa, Luciana Martins da; Silveira, Natyele Rippel; Vargas, Mara Ambrosina de Oliveira

    2017-05-25

    To learn the perception of health professionals in an intensive care unit towards palliative care. This was a descriptive and qualitative study based on the converging care approach conducted at an intensive care unit in the South of Brazil. Semi-structured interviews were used to investigate the understanding of the professionals about palliative care in this unit. The data were organized and analyzed using the discourse of the collective subject method with the help of Qualiquantisoft® software. Participants included 37 professionals (12 nurses, 11nursing technicians, 5 physical therapists and 9 doctors). The key ideas extracted from the interviews were: care in the end stage of life that avoids futile measures; comfort care; lack of standardized care and lack of team training. The professionals perceived palliative care as appropriate in the last stages of life, with no need for futile treatment or as comfort measures. However, they are aware of the lack of standardization and lack of capacity building in this area, which leads them to conceive palliative care as terminal care, and measures are recommended to break with this stigma. Conhecer a percepção dos profissionais de saúde de uma Unidade de Terapia Intensiva acerca do cuidado paliativo. Pesquisa descritiva, qualitativa do tipo Convergente Assistencial realizada em uma Unidade de Terapia Intensiva da região sul do Brasil. Utilizou-se de entrevista semiestruturada que investigou o entendimento e a compreensão sobre cuidado paliativo nesta unidade. Os dados foram organizados e analisados pela técnica do discurso do sujeito coletivo com auxílio do software Qualiquantisoft®. Participaram do estudo 37 profissionais (12 enfermeiros, 11 técnicos de enfermagem, cinco fisioterapeutas e nove médicos). As ideias centrais extraídas dos relatos: cuidado na fase terminal da vida sem medidas fúteis; cuidados de conforto; falta uniformizar a assistência e falta capacitação para a equipe. Os profissionais

  5. Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units.

    Science.gov (United States)

    Kidd, Sean A; McKenzie, Kwame; Collins, April; Clark, Carrie; Costa, Lucy; Mihalakakos, George; Paterson, Jane

    2014-02-01

    This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

  6. Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study.

    Science.gov (United States)

    Cook, Deborah; Swinton, Marilyn; Toledo, Feli; Clarke, France; Rose, Trudy; Hand-Breckenridge, Tracey; Boyle, Anne; Woods, Anne; Zytaruk, Nicole; Heels-Ansdell, Diane; Sheppard, Robert

    2015-08-18

    Dying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death. To bring peace to the final days of a patient's life and to ease the grieving process. Mixed-methods study. 21-bed medical-surgical intensive care unit. Dying patients and their families and clinicians. To honor each patient, a set of wishes was generated by patients, family members, or clinicians. The wishes were implemented before or after death by patients, families, clinicians (6 of whom were project team members), or the project team. Quantitative data included demographic characteristics, processes of care, and scores on the Quality of End-of-Life Care-10 instrument. Semistructured interviews of family members and clinicians were transcribed verbatim, and qualitative description was used to analyze them. Participants included 40 decedents, at least 1 family member per patient, and 3 clinicians per patient. The 159 wishes were implemented and classified into 5 categories: humanizing the environment, tributes, family reconnections, observances, and "paying it forward." Scores on the Quality of End-of-Life Care-10 instrument were high. The central theme from 160 interviews of 170 persons was how the 3 Wishes Project personalized the dying process. For patients, eliciting and customizing the wishes honored them by celebrating their lives and dignifying their deaths. For families, it created positive memories and individualized end-of-life care for their loved ones. For clinicians, it promoted interprofessional care and humanism in practice. Impaired consciousness limited understanding of patients' viewpoints. The 3 Wishes Project facilitated personalization of the dying process through explicit integration of palliative and spiritual care into critical care practice. Hamilton Academy of Health Science Research Organization, Canadian Intensive Care Foundation.

  7. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  8. Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

    Science.gov (United States)

    Rashid, Mahbub; Khan, Nayma; Jones, Belinda

    2016-01-01

    This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed.

  9. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia

    DEFF Research Database (Denmark)

    Lunn, T H; Kristensen, B B; Gaarn-Larsen, L

    2012-01-01

    patients operated with primary unilateral total hip or knee arthroplasty (THA or TKA) under spinal anaesthesia were included in this hypothesis-generating, prospective, observational cohort study during a 4-month period. Surgical technique, analgesia, and perioperative care were standardized. Well......BACKGROUND: Post-anaesthesia care unit (PACU) admission must be well founded and the stay as short as possible without compromising patient safety. However, within the concept of fast-track surgery, studies are limited in addressing the question: why are patients staying in the PACU? METHODS: All...

  10. Exploring interprofessional, interagency multimorbidity care: case study based observational research

    Science.gov (United States)

    McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

    2017-01-01

    Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

  11. Clinical Predictors of Intensive Care Unit Admission for Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Kargar Maher

    2015-07-01

    Full Text Available IntroductionChildren with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack and probable requirement for Pediatric Intensive Care Unit (PICU admission.Materials and MethodsIn a cross sectional and analytical study 120 patients with asthma attack were enrolled from April 2010 to April 2014 (80 admitted in the ward and 40 in pediatric intensive care unit. Predictors of PICU admission were investigated regarding to initial heart rate(HR, respiratory rate (RR, Arterial Oxygen Saturation(SaO2 and PaCo2 and clinically evident cyanosis.ResultsInitial heart rate(p-value=0.02, respiratory rate (p-value=0.03, Arterial Oxygen Saturation(p-value=0.02 and PaCo2(p-value=0.03 and clinically evident cyanosis were significantly different in two groups(Ward admitted and PICU admittedConclusion There was a significant correlation between initial vital sign and blood gas analysis suggesting usefulness of these factors as predictors of severe asthma attack and subsequent clinical course.

  12. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel

    2014-08-01

    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  13. Noise pollution levels in the pediatric intensive care unit.

    Science.gov (United States)

    Kramer, Bree; Joshi, Prashant; Heard, Christopher

    2016-12-01

    Patients and staff may experience adverse effects from exposure to noise. This study assessed noise levels in the pediatric intensive care unit and evaluated family and staff opinion of noise. Noise levels were recorded using a NoisePro DLX. The microphone was 1 m from the patient's head. The noise level was averaged each minute and levels above 70 and 80 dBA were recorded. The maximum, minimum, and average decibel levels were calculated and peak noise level great than 100 dBA was also recorded. A parent questionnaire concerning their evaluation of noisiness of the bedside was completed. The bedside nurse also completed a questionnaire. The average maximum dB for all patients was 82.2. The average minimum dB was 50.9. The average daily bedside noise level was 62.9 dBA. The average % time where the noise level was higher than 70 dBA was 2.2%. The average percent of time that the noise level was higher than 80 dBA was 0.1%. Patients experienced an average of 115 min/d where peak noise was greater than 100 dBA. The parents and staff identified the monitors as the major contribution to noise. Patients experienced levels of noise greater than 80 dBA. Patients experience peak noise levels in excess of 100 dB during their pediatric intensive care unit stay. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. [Audit of artificial nutrition in an intensive care unit].

    Science.gov (United States)

    Blesa Malpica, A L; Salaverría Garzón, I; Prado López, L M; Simón García, M J; Reta Pérez, O; Ramos Polo, J

    2001-01-01

    To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a second stage and after introducing the modifications considered appropriate in the protocol, to verify its implementation and compare both series. REFERENCE POPULATION: All patients with artificial nutrition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial preparations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, including propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not considered to be AN. The period of observation was two months in both cases. The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being collected for patients with AN during a similar period. The study of the first series revealed the provisions of energy and nitrogen were below theoretical levels (both in the corrected Harris-Benedict test and at the fixed prescription of 25 kcal/kg). In the second series, there was greater agreement between the theoretical values and the amounts actually received. The deviation in energy and nitrogen was significantly less in the second series. And although the total nitrogen load per patient did not reveal any differences, there were discrepancies in the daily provision per patient. On most days, the diet provided covered over 75% of the energy requirements. With parenteral nutrition on its own or in combination with enteral nutrition, the requirements of energy and nitrogen were exceeded. There were no differences between the two series. The type of provision was enteral on 55% of the days and parenteral on 18%. There was no difference in the type of provision between the two series, although there was a difference in the type

  15. Managed care market share and cesarean section rates in the United States: is there a link?

    Science.gov (United States)

    Hueston, W J; Sutton, A

    2000-11-01

    After peaking during the early 1980s, cesarean section rates in the United States have been falling for the last decade. At the same time, managed care enrollment has increased dramatically. This study examines whether managed care penetration in local markets is associated with lower cesarean section rates in those geographic area. A cross-sectional comparison of cesarean section rates and health maintenance organization (HMO) market penetration in 61 selected metropolitan areas in the United States was conducted. National birth certificate data for 1996 were used to calculate crude and race-adjusted cesarean section rates for residents in each area. No relationship between overall cesarean section rates in the metropolitan areas and managed care penetration was observed. Subanalyses of racial groups demonstrated the existence of a weak association between managed care penetration and cesarean section rates for white women (21.2% for the highest quartile of HMO penetration, compared with 19.1% for the lowest quartile; P = .03), but not for African-Americans or other minorities. Managed care penetration in a market may have an association with cesarean section rates for white women, but the strength of this relationship is small. Even if managed care delivery systems reduce cesarean section rates in their own populations, this change is likely to have only a small impact on overall cesarean rates. HMO penetration is unlikely to influence national cesarean section rates, nor does it appear to explain state variations in these rates.

  16. Functioning of primary health care in opinion of managers of primary health care units.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

    2006-01-01

    The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

  17. Relationship between job burnout, psychosocial factors and health care-associated infections in critical care units.

    Science.gov (United States)

    Galletta, Maura; Portoghese, Igor; D'Aloja, Ernesto; Mereu, Alessandra; Contu, Paolo; Coppola, Rosa Cristina; Finco, Gabriele; Campagna, Marcello

    2016-06-01

    Burnout is a serious problem for critical care unit workers because they are exposed to chronic psychosocial stressors, including high responsibility, advanced technology and high patient acuity. Recent evidence showed that staff burnout was directly associated with hospital infections, thus affecting quality and safety of care provided. The research aim was to investigate how burnout was associated with some psychosocial factors and with health care-associated infections in hospitalised patients. A total of 130 healthcare professionals from critical care units completed a self-reported questionnaire. The infection data were collected prospectively over a six-month period. The results showed that emotional exhaustion was related to cynicism due to high work demands. Cynicism affected team communication, which in turn was positively related to team efficacy, thus acting as a mediator. Finally, team efficacy was negatively related to infections. The study showed that emotional exhaustion and cynicism were related to psychosocial aspects, which in turn had a significant impact on healthcare-associated infections. Our findings suggest how burnout can indirectly affect healthcare-related infections as a result of the quality of teamwork. Thus, reducing burnout can be a good strategy to decrease infections, thus increasing workers' well-being while improving patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. The strategy role of transitional care units to support Integrated Care and Personalised pathways for frail persons

    OpenAIRE

    Morando, Verdiana; Tozzi, Valeria D.

    2017-01-01

    The paper presents a comparative analysis of three models of transitional care units that have been set up in Italy in the last three years within the processes of Regional Healthcare Services and healthcare organisations’ reforms. The comparative analysis is worth of providing interesting insights and generalizable lessons learnt from integrated care in practice. The three cases of transitional care units belong to a similar background wherein greater needs for care coordination across the s...

  19. Identifying an Education Gap in Wound Care Training in United States Dermatology.

    Science.gov (United States)

    Ruiz, Emily Stamell; Ingram, Amber; Landriscina, Angelo; Tian, Jiaying; Kirsner, Robert S; Friedman, Adam

    2015-07-01

    As restoration of the integument is paramount to wound healing, dermatologists should be central to managing wounds; yet this is often not the case. If a training gap exists during residency training, this may account for the observed discrepancy. To identify United States (US) dermatology residents' impressions regarding their preparedness to care for wounds, and to assess the amount and type of training devoted to wound care during residency. An online survey among current US dermatology residents enrolled in a residency training program. The primary goal was to determine whether dermatology residents believe more wound care education is needed, evaluate preparedness to care for wounds, and identify future plans to manage wounds. Responses were received from 175 of 517 (33.8%) US Dermatology residents contacted. The majority of residents did not feel prepared to manage acute (78.3%) and chronic (84.6%) wounds. Over three quarters (77.1%) felt that more education is needed. Fewer than half (49.1% and 35.4%) of residents planned to care for acute and chronic wounds, respectively, when in practice. There is a gap in wound care education in US dermatology residency training. This translates to a low percentage of dermatology residents planning to care for wounds in future practice. Dermatology residents need to receive focused wound care training in order to translate the underpinnings of wound healing biology and ultimately better serve patients.

  20. Mothers’ perceptions of family centred care in neonatal intensive care units

    OpenAIRE

    Finlayson, Kenneth William; Dixon, Annie; Smith, Chris; Dykes, Fiona Clare; Flacking, Renee

    2014-01-01

    Objective\\ud \\ud To explore mothers’ perceptions of family centred care (FCC) in neonatal intensive care units (NICUs) in England.\\ud Design\\ud \\ud The qualitative experiences of 12 mothers from three NICUs in the UK were elicited using individual interviews. A thematic network analysis was conducted on the transcribed interviews\\ud Main outcome measures\\ud \\ud A central global theme supported by a number of organizing themes were developed reflecting the views of the mothers and their experi...

  1. Radiologic assessment in the pediatric intensive care unit

    International Nuclear Information System (INIS)

    Markowitz, R.I.

    1984-01-01

    The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient's condition and establishing a diagnosis, but also in monitoring the patient's progress and the effects of interventional therapeutic measures. Bedside studies obtained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpretation and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient's condition and thus to improved patient care and management. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown

  2. Phenobarbital in intensive care unit pediatric population: predictive performances of population pharmacokinetic model.

    Science.gov (United States)

    Marsot, Amélie; Michel, Fabrice; Chasseloup, Estelle; Paut, Olivier; Guilhaumou, Romain; Blin, Olivier

    2017-10-01

    An external evaluation of phenobarbital population pharmacokinetic model described by Marsot et al. was performed in pediatric intensive care unit. Model evaluation is an important issue for dose adjustment. This external evaluation should allow confirming the proposed dosage adaptation and extending these recommendations to the entire intensive care pediatric population. External evaluation of phenobarbital published population pharmacokinetic model of Marsot et al. was realized in a new retrospective dataset of 35 patients hospitalized in a pediatric intensive care unit. The published population pharmacokinetic model was implemented in nonmem 7.3. Predictive performance was assessed by quantifying bias and inaccuracy of model prediction. Normalized prediction distribution errors (NPDE) and visual predictive check (VPC) were also evaluated. A total of 35 infants were studied with a mean age of 33.5 weeks (range: 12 days-16 years) and a mean weight of 12.6 kg (range: 2.7-70.0 kg). The model predicted the observed phenobarbital concentrations with a reasonable bias and inaccuracy. The median prediction error was 3.03% (95% CI: -8.52 to 58.12%), and the median absolute prediction error was 26.20% (95% CI: 13.07-75.59%). No trends in NPDE and VPC were observed. The model previously proposed by Marsot et al. in neonates hospitalized in intensive care unit was externally validated for IV infusion administration. The model-based dosing regimen was extended in all pediatric intensive care unit to optimize treatment. Due to inter- and intravariability in pharmacokinetic model, this dosing regimen should be combined with therapeutic drug monitoring. © 2017 Société Française de Pharmacologie et de Thérapeutique.

  3. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Delsing, M.J.M.H.; Geijsen, L.; Kroes, G.; Veerman, J.W.; Engels, R.C.M.E.

    2014-01-01

    The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. The aim of the current study was to observe the pedagogical interventions of group care

  4. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    Science.gov (United States)

    Bastiaanssen, Inge L. W.; Delsing, Marc J. M. H.; Geijsen, Luuk; Kroes, Gert; Veerman, Jan W.; Engels, Rutger C. M. E.

    2014-01-01

    Background: The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. Objective: The aim of the current study was to observe the pedagogical interventions of group care workers within residential…

  5. Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

    Directory of Open Access Journals (Sweden)

    Tunde-Ayinmode Mosunmola

    2012-07-01

    Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score  In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p  Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of

  6. Correlation of neonatal intensive care unit performance across multiple measures of quality of care.

    Science.gov (United States)

    Profit, Jochen; Zupancic, John A F; Gould, Jeffrey B; Pietz, Kenneth; Kowalkowski, Marc A; Draper, David; Hysong, Sylvia J; Petersen, Laura A

    2013-01-01

    To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Twenty-two regional NICUs in California. In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Pneumothorax, growth velocity, health care-associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (ρ < .05). Correlations between pairs of measures of quality of care were strong (ρ ≥ .5) for 1 pair, moderate (range, ρ ≥ .3 to ρ < .5) for 8 pairs, weak (range, ρ ≥ .1 to ρ < .3) for 5 pairs, and negligible (ρ < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care-associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

  7. The importance of parents in the neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Hercília Guimarães

    2015-10-01

    Full Text Available The premature birth and the hospitalization in a neonatal intensive care unit (NICU are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed as a result of the initial separation of the premature newborn and the mother after the admission to the NICU. Added to these difficulties, there is the distortion of infant’s “ideal image”, created by the family, in contrast with the real image of the preterm. This relationship-based family-centered approach, the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP, promotes the idea that infants and their families are collaborators in developing an individualized program to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for the high risk newborns. The presence of parents in NICUs and their involvement caring their babies, in a family centered care philosophy, is vital to improve the outcome of their infants and the relationships within each family. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  8. Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

    Science.gov (United States)

    Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

    2016-05-01

    Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery.

  9. Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model.

    Science.gov (United States)

    Dodek, Peter M; Wong, Hubert; Jaswal, Danny; Heyland, Daren K; Cook, Deborah J; Rocker, Graeme M; Kutsogiannis, Demetrios J; Dale, Craig; Fowler, Robert; Ayas, Najib T

    2012-02-01

    The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P organizational and safety culture. Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

    OpenAIRE

    Wen-Ping Zeng; Han Su; Chein-Wen Chen; Shu-Meng Cheng; Li-Fang Chang; Wen-Chii Tzeng; Bing-Hsiean Tzeng

    2015-01-01

    Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this stud...

  11. Establishment and assessment of cataract surgery in Day-care Unit at northwest of China

    OpenAIRE

    Xiu-Li Zhang; Xing Yang; Juan-Juan Yang; Bao-Jian Yan; Jing-Ming Li; Cheng Pei; Li Qin

    2018-01-01

    AIM: To describe the protocol and economic cost of the Day-care Unit cataract surgery procedure in northwest of China.METHODS: Patients who received phacoemulcification and intraocular lens implantation in both Day-care Unit and regular Unit were recruited from January 2016 to December 2016. The baseline data and average cost were recorded and analyzed. Furthermore, satisfaction questionnaire of patients were collected.RESULTS: Patients with Day-care Unit showed shorter registration duration,...

  12. Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

    Directory of Open Access Journals (Sweden)

    Abbass, Ibrahim

    2015-05-01

    Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

  13. Fathers' Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark.

    Science.gov (United States)

    Noergaard, Betty; Ammentorp, Jette; Fenger-Gron, Jesper; Kofoed, Poul-Erik; Johannessen, Helle; Thibeau, Shelley

    2017-08-01

    Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers' experiences and needs is important because men's roles in society, especially as fathers, are changing. To describe fathers' needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices. This qualitative study used participant observation, interviews, multiple sequential interviews, and a focus group discussion. Data were analyzed using grounded theory principles. Analysis of the fathers' needs generated 2 primary themes: (1) Fathers as caregivers and breadwinners and (2) fathers and emotions. Fathers wished to be involved and to take care of their infants but have to balance cultural and social norms and expectations of being breadwinners with their wishes to be equal coparents. Health professionals in neonatal intensive care units must be aware of fathers' need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children's progress. Further research in other cultural settings would contribute to knowledge regarding fatherhood and the role of fathers in childcare.

  14. Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units

    Directory of Open Access Journals (Sweden)

    Paula Ceballos-Vásquez

    2015-04-01

    Full Text Available OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A a biosociodemographic history questionnaire; (b the SUSESO-ISTAS 21 questionnaire; and (c the Mental Work Load Subjective Scale (ESCAM, in Spanish. RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions.

  15. The epidemic profiles of intensive care units in Hospital oncologico SOLCA, Quito

    International Nuclear Information System (INIS)

    Caballero, Henry; Marin, Karina; Gonzalez, Alba; Vega, Mireya; Castelo, Marcelo; Trujillo Cruz, Freddy

    2006-01-01

    The epidemic profiles of intensive care units are very few and they have not been published recently, punctual epidemic studies of morbidity, mortality and quality controls of intensive care exist, but we could not find the profiles of the oncological units. Since the establishment of the intensive care unit of Oncological Hospital Solca in Quito city. It was not possible to find any epidemiological profile of this unit because it is important to know their morbidity rates, mortality, the main complications and to relate these with the study of the index prognostic, to plan the annual operative programs and the innovations according to the specific necessities, justified by realities studied, to observe the organic shortcoming that in critical patients are present, for a planning adapted in the outlines with the rational use of medication, since the critical users have specific characteristics especially in the infectious processes, due to their immunosuppression condition and for the chemotherapy administration and the radiotherapy, oncological patient for their condition they are poly medicates and it requires the use of interventionist processes, that triggers major risks of complications and infection with opportunist germs. (The author)

  16. Digital scrapbooking as a standard of care in neonatal intensive care units: initial experience.

    Science.gov (United States)

    Subhani, Muhammad T; Kanwal, Ifrah

    2012-01-01

    In this article, we describe a digital photo scrapbooking project as a standard of care for the parents of infants admitted in a neonatal intensive care unit (NICU). Photographs were taken from birth until discharge or expiry at special moments during the infant's hospitalization and used to create a digital scrapbook with daily notes by the parents. The scrapbook and original photos were provided on a CD at discharge or at expiry. Parents and their families unanimously appreciated the photos and the opportunity to record their thoughts, and considered the CDs as a lifetime treasure. Digital photo journaling could be implemented as a standard of care at other institutions with a commitment from the nursing and ancillary staff of the NICU and labor and delivery department, with possible support from volunteers.

  17. An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit.

    Science.gov (United States)

    Macdonald, Mary Ellen; Liben, Stephen; Carnevale, Franco A; Cohen, S Robin

    2012-09-01

    Although the modern pediatric intensive care unit (PICU) has followed general pediatrics and adopted the family-centered care model, little is known about how families prospectively experience PICU care. The authors' goal was to better understand the experiences of families whose child was hospitalized in a PICU. They conducted a 12-month prospective ethnographic study in a PICU in a tertiary care hospital in a large North American urban center. Data were obtained via participant-observation and formal and informal interviews with 18 families and staff key informants. Findings revealed a disconnect between the espoused model of family-centered care and quotidian professional practices. This divergence emerged in the authors' analysis as a heuristic that contrasts a professional "office" to a sick child's "bedroom." PICU practices and protocols transformed the child into a patient and parents into visitors; issues such as noise, visitation, turf, and privacy could favor staff comfort and convenience over that of the child and family. The authors' discussion highlights suggestions to overcome this divergence in order to truly make the PICU family centered.

  18. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

    Science.gov (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

    2015-04-01

    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

  19. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  20. Nosocomial bloodstream infection in a tertiary care paediatric intensive care unit

    International Nuclear Information System (INIS)

    Hamid, M.H.; Maqbool, S.

    2007-01-01

    To determine the frequency, causative organisms and susceptibility pattern of nosocomial bloodstream infections in children. All children admitted to the unit during the study period were daily evaluated for features suggestive of nosocomial infection. In addition to other investigations, blood cultures were done in all suspected cases for the confirmation of nosocomial bloodstream infection (BSI). Nosocomial infection was defined according to the criteria set by Centre for Disease Control and Prevention. Demographic, microbiological and other variables were carefully studied to analyze frequency, incidence rate, spectrum of isolates and susceptibility pattern. Children with and without nosocomial BSI were compared with regard to age, duration of stay in hospital, need and duration of ventilation and the outcome. Of the total 406 admissions, 134 children were suspected to have nosocomial infection on at least 214 occasions (episodes). Blood cultures yielded growth of pathological organisms in 62 of these episodes, giving the frequency of nosocomial BSI as 15.2 per 100 admissions (62/406 episodes). Children with nosocomial bloodstream infection were found to have younger mean age (2.1 vs. 4.1 years), longer average duration of stay (13.1 vs. 6.6 days), more frequent need for ventilation (64% vs. 34%) and longer duration of ventilation (9.7 vs. 4.8 days). Majority of isolates (77%) were gram-negative bacteria; Klebsiella being the most common isolate (n= 23). Aztreonam, Ceftiazidime, Ceforuxime and Ciprofloxacin showed high resistance pattern (33-50%). Isolates showed good sensitivity to Vancomycin (100%), Imipenem (80%), Meropenem (100%) and Co-amoxiclav (88%). The frequency of nosocomial BSI in the observed setting was quite high, having marked impact on the duration of stay and outcome. Emergence of resistant pathogens is alarming. (author)

  1. Posttraumatic stress in intensive care unit survivors - a prospective study

    DEFF Research Database (Denmark)

    Ratzer, Mette; Brink, Ole; Knudsen, Linda

    2014-01-01

    Aims: This study aimed to estimate the prevalence of severe Posttraumatic Stress Disorder (PTSD) symptoms and to identify factors associated with PTSD in survivors of intensive care unit (ICU) treatment following traumatic injury. Methods: Fifty-two patients who were admitted to an ICU through...... the emergency ward following traumatic injury were prospectively followed. Information on injury severity and ICU treatment were obtained through medical records. Demographic information and measures of acute stress symptoms, experienced social support, coping style, sense of coherence (SOC) and locus...... of control were assessed within one-month post-accident (T1). At the six months follow-up (T2), PTSD was assessed with the Harvard Trauma Questionnaire (HTQ). Results: In the six months follow-up, 10 respondents (19.2%) had HTQ total scores reaching a level suggestive of PTSD (N = 52), and 11 respondents (21...

  2. Prescribing errors in a Brazilian neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Ana Paula Cezar Machado

    2015-12-01

    Full Text Available Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU, are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.

  3. Electronic Whiteboards and Intensive Care Unit follow up

    DEFF Research Database (Denmark)

    Østergaard, Kija Lin; Brandrup, Morten

    -ended dry-erase whiteboard (make-up-your-own-sentences). In conclusion the primary feature in the two subjects is to optimize communication/collaboration and information between ICU and general wards in the transition. To make it a long term solution the content of such a support would need involvement...... of the end-users in the design process (Participatory Design). Hence these two findings, this review is setting the stage for further research on how electronic whiteboards can support the initial follow up when patients are transferred from an ICU to a general ward.......This paper is reviewing the existing literature on Intensive Care Unit (ICU) Outreach, in-hospital follow up 24 hours after the transition to a general ward from an ICU. It also touches upon the use of Electronic Whiteboards in a hospital setting and how the electronic whiteboards might support...

  4. Genetically enhanced T lymphocytes and the intensive care unit

    Science.gov (United States)

    Tat, Tiberiu; Li, Huming; Constantinescu, Catalin-Sorin; Onaciu, Anca; Chira, Sergiu; Osan, Ciprian; Pasca, Sergiu; Petrushev, Bobe; Moisoiu, Vlad; Micu, Wilhelm-Thomas; Berce, Cristian; Tranca, Sebastian; Dima, Delia; Berindan-Neagoe, Ioana; Shen, Jianliang; Tomuleasa, Ciprian; Qian, Liren

    2018-01-01

    Chimeric antigen receptor-modified T cells (CAR-T cells) and donor lymphocyte infusion (DLI) are important protocols in lymphocyte engineering. CAR-T cells have emerged as a new modality for cancer immunotherapy due to their potential efficacy against hematological malignancies. These genetically modified receptors contain an antigen-binding moiety, a hinge region, a transmembrane domain, and an intracellular costimulatory domain resulting in lymphocyte T cell activation subsequent to antigen binding. In present-day medicine, four generations of CAR-T cells are described depending on the intracellular signaling domain number of T cell receptors. DLI represents a form of adoptive therapy used after hematopoietic stem cell transplant for its anti-tumor and anti-infectious properties. This article covers the current status of CAR-T cells and DLI research in the intensive care unit (ICU) patient, including the efficacy, toxicity, side effects and treatment. PMID:29662667

  5. Modes of death in neonatal intensive care units.

    LENUS (Irish Health Repository)

    Finan, E

    2006-04-01

    With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).

  6. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J

    2015-01-01

    BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection...... for SUP varies both within and between countries. METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about...... adverse effects. Fisher's exact test was used to assess differences between groups. RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP...

  7. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

  8. [Infection prevention and control in neonatal intensive care unit].

    Science.gov (United States)

    Lorenzini, Elisiane; Lorenzini, Elisiane; da Costa, Tatiane Costa; da Silva, Eveline Franco

    2013-12-01

    This study was aimed to identify the knowledge of the nursing team of a Neonatal Intensive Care Unit (NICU) on infection control, identijfying the factors that facilitate or hinder the prevention and control of Healthcare Associated Infections (HICAI). A descriptive study using a qualitative research method conducted with three nurses and 15 nurse technicians, who work in a NICU of a charitable organization, in southern Brazil. It became evident that the nursing staff had great knowledge about the factors that facilitate the prevention and control of HCAI in NICU, the most important factor being proper hand hygiene. Among the factors that hinder infection prevention and control are to overcrowding and excessive workload. The efficient performance of the nursing staff is an important part of the strategy for prevention and control of HCAI.

  9. Stress ulcer prophylaxis in the intensive care unit trial

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J

    2017-01-01

    BACKGROUND: In this statistical analysis plan, we aim to provide details of the pre-defined statistical analyses of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. The aim of the SUP-ICU trial is to assess benefits and harms of stress ulcer prophylaxis with a proton pump......-year mortality, and a health economic analysis. Two formal interim analyses will be performed. The statistical analyses will be conducted according to the outlined pre-defined statistical analysis plan. The primary analysis will be a logistic regression analysis adjusted for stratification variables...... comparing the two intervention groups in the intention-to-treat population. In a secondary analysis, we will additionally adjust the primary outcome for potential random differences in baseline characteristics. The conclusion will be based on the intention-to-treat population. CONCLUSION: Stress ulcer...

  10. Patients' and Health Care Providers' Perception of Stressors in the Intensive Care Units.

    Science.gov (United States)

    Abuatiq, Alham

    2015-01-01

    The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care

  11. Radiofrequency exposure in the Neonatal Medium Care Unit

    International Nuclear Information System (INIS)

    Calvente, I.; Vázquez-Pérez, A.; Fernández, M.F.; Núñez, M.I.; Múñoz-Hoyos, A.

    2017-01-01

    The aims of this study were to characterize electromagnetic fields of radiofrequency (RF-EMF) levels generated in a Neonatal Medium Care Unit and to analyze RF-EMF levels inside unit’s incubators. Spot and long-term measurements were made with a dosimeter. The spot measurement mean was 1.51±0.48 V/m. Higher values were found in the proximity to the window and to the incubator evaluated. Mean field strength for the entire period of 17 h was 0.81 (±0.07) V/m and the maximum value was 1.58 V/m for long-term RF-EMF measurements in the incubator. Values found during the night period were higher than those found during the day period. It is important to consider RF-EMF exposure levels in neonatal care units, due to some evidence of adverse health effects found in children and adults. Characterization of RF-EMF exposure may be important to further investigate the mechanisms and underlying effects of electromagnetic fields (EMF) on infant health. A prudent avoidance strategy should be adopted because newborns are at a vulnerable stage of development and the actual impact of EMF on premature infants is unknown. - Highlights: • The increasing use of RF-EMF suggests an urgent need for more research in this field. • Health consequences of RF-EMF exposure on infants are not well known. • Description of RF-EMF exposure is vital in further study mechanisms on infant health. • Considering newborns vulnerability, it is wise to adopt a prudent avoidance strategy.

  12. Radiofrequency exposure in the Neonatal Medium Care Unit

    Energy Technology Data Exchange (ETDEWEB)

    Calvente, I. [Unit Research Support of the San Cecilio University Hospital, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada (Spain); Department of Radiology and Physical Medicine, School of Medicine, University of Granada, Av. de la Investigación, 11, torre A, planta 11, 18016 Granada (Spain); Vázquez-Pérez, A. [Department of Pediatrics, University of Granada (Spain); Fernández, M.F. [Unit Research Support of the San Cecilio University Hospital, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada (Spain); Department of Radiology and Physical Medicine, School of Medicine, University of Granada, Av. de la Investigación, 11, torre A, planta 11, 18016 Granada (Spain); CIBER en Epidemiología y Salud Pública (CIBERESP) (Spain); Núñez, M.I., E-mail: isabeln@ugr.es [Unit Research Support of the San Cecilio University Hospital, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada (Spain); Department of Radiology and Physical Medicine, School of Medicine, University of Granada, Av. de la Investigación, 11, torre A, planta 11, 18016 Granada (Spain); Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada (Spain); CIBER en Epidemiología y Salud Pública (CIBERESP) (Spain); Múñoz-Hoyos, A. [Department of Pediatrics, University of Granada (Spain)

    2017-01-15

    The aims of this study were to characterize electromagnetic fields of radiofrequency (RF-EMF) levels generated in a Neonatal Medium Care Unit and to analyze RF-EMF levels inside unit’s incubators. Spot and long-term measurements were made with a dosimeter. The spot measurement mean was 1.51±0.48 V/m. Higher values were found in the proximity to the window and to the incubator evaluated. Mean field strength for the entire period of 17 h was 0.81 (±0.07) V/m and the maximum value was 1.58 V/m for long-term RF-EMF measurements in the incubator. Values found during the night period were higher than those found during the day period. It is important to consider RF-EMF exposure levels in neonatal care units, due to some evidence of adverse health effects found in children and adults. Characterization of RF-EMF exposure may be important to further investigate the mechanisms and underlying effects of electromagnetic fields (EMF) on infant health. A prudent avoidance strategy should be adopted because newborns are at a vulnerable stage of development and the actual impact of EMF on premature infants is unknown. - Highlights: • The increasing use of RF-EMF suggests an urgent need for more research in this field. • Health consequences of RF-EMF exposure on infants are not well known. • Description of RF-EMF exposure is vital in further study mechanisms on infant health. • Considering newborns vulnerability, it is wise to adopt a prudent avoidance strategy.

  13. The evaluation of primary care unit of Mahasarakham Hospital.

    Science.gov (United States)

    Asavatanabodee, Paibool

    2010-02-01

    To evaluate the one-year performance outcome of Community Medical Care Unit (CMU) in Mahasarakham Hospital. This cross-sectional descriptive study used the CIPP model. The target population was divided into two groups. The first group consisted of the executive committee of Mahasarakham Hospital including one director, five Vice-directors, and 16 CMU paramedical personnel and public health administrators. The second group consisted of 281 randomized people in the service area of CMU, Mahasarakham Hospital. The overall outcome evaluation of both groups was high with mean of 3.53 and 3.86, respectively. The evaluation of context, input, and output was ranked high in both groups while the process ranking was moderate in the first group and high in the other group. The present study proposed that project guidelines be explicit policies, improvement in behavioral service, appropriate workload, adequate parking lot, and network sharing of hospital data bank. The quality and efficiency of CMU project are dependent upon explicit policy, well-planned structure of organization, efficient-informative systems, good development plan, and adequate manpower. The personnel should plan the project process and continuously improve the system. CMU project would be neither successful nor beneficial for the development ofpublic health care system if it lacked the participation of the people in the community and associated networks. The results of the present study might be the useful data for improving and developing the pattern of community healthcare service in urban area.

  14. Evaluation of Intensive Care Unit Ventilators at Altitude.

    Science.gov (United States)

    Blakeman, Thomas; Rodriquez, Dario; Petro, Michael; Branson, Richard

    Devices may forgo US military air worthiness and safety testing in an attempt to expedite the availability of critical assets such as mechanical ventilators with a waiver for one-time use in extenuating circumstances. We evaluated two Intensive Care Unit (ICU) level ventilators: Drager Evita XL and Puritan Bennett (PB) 840 in an altitude chamber at sea level and altitudes of 8,000 and 16,000 feet. Altitude affected delivered tidal volumes (VTs) in volume control mode (VCV) and Pressure Regulated Volume Controlled (PRVC) mode at altitude with the Evita XL but the differences were not considered clinically important with the PB 840. Sixty-seven percent of the V T s were outside the ASTM standard of ± 10% of set V T with the Evita XL at altitude. The PB 840 did not deliver V T s that were larger than the ASTM standard up to an altitude of 16,000 feet while the majority of the delivered V T s with the Därger XL were greater than the ASTM standard. This could present a patient safety issue. Caregivers must be aware of the capabilities and limitations of ICU ventilators when utilized in a hypobaric environment in order to provide safe care. Copyright © 2017 Air Medical Journal Associates. All rights reserved.

  15. Bloodstream Infections in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mehmet Sah Ižpek

    2016-09-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  16. Hyperdynamic left ventricular ejection fraction in the intensive care unit.

    Science.gov (United States)

    Paonessa, Joseph R; Brennan, Thomas; Pimentel, Marco; Steinhaus, Daniel; Feng, Mengling; Celi, Leo Anthony

    2015-08-07

    Limited information exists on the etiology, prevalence, and significance of hyperdynamic left ventricular ejection fraction (HDLVEF) in the intensive care unit (ICU). Our aim in the present study was to compare characteristics and outcomes of patients with HDLVEF with those of patients with normal left ventricular ejection fraction in the ICU using a large, public, deidentified critical care database. We conducted a longitudinal, single-center, retrospective cohort study of adult patients who underwent echocardiography during a medical or surgical ICU admission at the Beth Israel Deaconess Medical Center using the Multiparameter Intelligent Monitoring in Intensive Care II database. The final cohort had 2867 patients, of whom 324 had HDLVEF, defined as an ejection fraction >70%. Patients with an ejection fraction <55% were excluded. Compared with critically ill patients with normal left ventricular ejection fraction, the finding of HDLVEF in critically ill patients was associated with female sex, increased age, and the diagnoses of hypertension and cancer. Patients with HDLVEF had increased 28-day mortality compared with those with normal ejection fraction in multivariate logistic regression analysis adjusted for age, sex, Sequential Organ Failure Assessment score, Elixhauser score for comorbidities, vasopressor use, and mechanical ventilation use (odds ratio 1.38, 95% confidence interval 1.039-1.842, p =0.02). The presence of HDLVEF portended increased 28-day mortality, and may be helpful as a gravity marker for prognosis in patients admitted to the ICU. Further research is warranted to gain a better understanding of how these patients respond to common interventions in the ICU and to determine if pharmacologic modulation of HDLVEF improves outcomes.

  17. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    Directory of Open Access Journals (Sweden)

    Susan J. Armstrong

    2015-05-01

    Full Text Available Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36. Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision

  18. Translation of oral care practice guidelines into clinical practice by intensive care unit nurses.

    Science.gov (United States)

    Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie

    2013-12-01

    The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was

  19. Parental involvement and kangaroo care in European neonatal intensive care units: a policy survey in eight countries.

    Science.gov (United States)

    Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice; Greisen, Gorm; Pierrat, Veronique; Warren, Inga; Haumont, Dominique; Westrup, Björn; Smit, Bert J; Sizun, Jacques; Cuttini, Marina

    2012-09-01

    To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out. Prospective multicenter survey. Neonatal intensive care units in eight European countries (Belgium, Denmark, France, Italy, The Netherlands, Spain, Sweden, and the United Kingdom). Patients were not involved in this study. None. A structured questionnaire was mailed to 362 units (response rate 78%); only units with ≥50 very-low-birth-weight annual admissions were considered for this study. Facilities for parents such as reclining chairs near the babies' cots, beds, and a dedicated room were common, but less so in Italy and Spain. All units in Sweden, Denmark, the United Kingdom, and Belgium reported encouraging parental participation in the care of the babies, whereas policies were more restrictive in Italy (80% of units), France (73%), and Spain (41%). Holding babies in the kangaroo care position was widespread. However, in the United Kingdom, France, Italy, and Spain, many units applied restrictions regarding its frequency (sometimes or on parents request only, rather than routinely), method (conventional rather than skin-to-skin), and clinical conditions (especially mechanical ventilation and presence of umbilical lines) that would prevent its practice. In these countries, fathers were routinely offered kangaroo care less frequently than mothers (p involvement as well as the role played by mothers and fathers varied within and between countries.

  20. Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China.

    Science.gov (United States)

    Li, Xiao-Ying; Lee, Shoo; Yu, Hua-Feng; Ye, Xiang Y; Warre, Ruth; Liu, Xiang-Hong; Liu, Jian-Hong

    2017-04-01

    Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China. Visitation is not usually permitted or may be strictly limited, and NICU care for most neonates is provided by health-care professionals with little participation of the parents. An exception to this rule is the level 2 "Room-In" ward in Qilu Children's Hospital, Shandong University, where parents have 24-hour access to their infants and participate in providing care. This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group, n=428), admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group, n=1018), or admitted straight to the Room-In ward (RIn only group, n=629). There were no significant differences in the rates of nosocomial infection, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity between the NICU-NICU and NICU-RIn groups. The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04), while weight gain and duration of hospital stay were significantly higher (both Pneonatal care in China.

  1. Statistical transformation and the interpretation of inpatient glucose control data from the intensive care unit.

    Science.gov (United States)

    Saulnier, George E; Castro, Janna C; Cook, Curtiss B

    2014-05-01

    Glucose control can be problematic in critically ill patients. We evaluated the impact of statistical transformation on interpretation of intensive care unit inpatient glucose control data. Point-of-care blood glucose (POC-BG) data derived from patients in the intensive care unit for 2011 was obtained. Box-Cox transformation of POC-BG measurements was performed, and distribution of data was determined before and after transformation. Different data subsets were used to establish statistical upper and lower control limits. Exponentially weighted moving average (EWMA) control charts constructed from April, October, and November data determined whether out-of-control events could be identified differently in transformed versus nontransformed data. A total of 8679 POC-BG values were analyzed. POC-BG distributions in nontransformed data were skewed but approached normality after transformation. EWMA control charts revealed differences in projected detection of out-of-control events. In April, an out-of-control process resulting in the lower control limit being exceeded was identified at sample 116 in nontransformed data but not in transformed data. October transformed data detected an out-of-control process exceeding the upper control limit at sample 27 that was not detected in nontransformed data. Nontransformed November results remained in control, but transformation identified an out-of-control event less than 10 samples into the observation period. Using statistical methods to assess population-based glucose control in the intensive care unit could alter conclusions about the effectiveness of care processes for managing hyperglycemia. Further study is required to determine whether transformed versus nontransformed data change clinical decisions about the interpretation of care or intervention results. © 2014 Diabetes Technology Society.

  2. Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

    Science.gov (United States)

    Neill, Sara; Haithcock, Sarah; Smith, P. Brian; Goldberg, Ronald; Bidegain, Margarita; Tanaka, David; Carriker, Charlene; Ericson, Jessica E.

    2015-01-01

    Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership. PMID:25915573

  3. Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

    Directory of Open Access Journals (Sweden)

    Wen-Ping Zeng

    2015-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs. Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days was significantly lower than that in the control group (0.495 cases per 1000 ventilator days. We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an

  4. Effects of a psychiatric intensive care unit in an acute psychiatric department.

    Science.gov (United States)

    Vaaler, A E; Morken, G; Fløvig, J C; Iversen, V C; Linaker, O M

    2006-01-01

    Psychiatric acute units use different levels of segregation to satisfy needs for containment and decrease in sensory input for behaviourally disturbed patients. Controlled studies evaluating the effects of the procedure are lacking. The aim of the present study was to compare effects in acutely admitted patients with the use of a psychiatric intensive care unit (PICU) and not in a psychiatric acute department. In a naturalistic study, one group of consecutively referred patients had access only to the PICU, the other group to the whole acute unit. Data were obtained for 56 and 62 patients using several scales. There were significant differences in reduction of behaviour associated with imminent, threatening incidents (Broset Violence Checklist), and actual number of such incidents (Staff Observation Aggression Scale-Revised) in favour of the group that was treated in a PICU. The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents.

  5. Drug utilization study in a burn care unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Santoshkumar R Jeevangi

    2011-03-01

    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  6. Patient-care time allocation by nurse practitioners and physician assistants in the intensive care unit.

    Science.gov (United States)

    Carpenter, David L; Gregg, Sara R; Owens, Daniel S; Buchman, Timothy G; Coopersmith, Craig M

    2012-02-15

    Use of nurse practitioners and physician assistants ("affiliates") is increasing significantly in the intensive care unit (ICU). Despite this, few data exist on how affiliates allocate their time in the ICU. The purpose of this study was to understand the allocation of affiliate time into patient-care and non-patient-care activity, further dividing the time devoted to patient care into billable service and equally important but nonbillable care. We conducted a quasi experimental study in seven ICUs in an academic hospital and a hybrid academic/community hospital. After a period of self-reporting, a one-time monetary incentive of $2,500 was offered to 39 affiliates in each ICU in which every affiliate documented greater than 75% of their time devoted to patient care over a 6-month period in an effort to understand how affiliates allocated their time throughout a shift. Documentation included billable time (critical care, evaluation and management, procedures) and a new category ("zero charge time"), which facilitated record keeping of other patient-care activities. At baseline, no ICUs had documentation of 75% patient-care time by all of its affiliates. In the 6 months in which reporting was tied to a group incentive, six of seven ICUs had every affiliate document greater than 75% of their time. Individual time documentation increased from 53% to 84%. Zero-charge time accounted for an average of 21% of each shift. The most common reason was rounding, which accounted for nearly half of all zero-charge time. Sign out, chart review, and teaching were the next most common zero-charge activities. Documentation of time spent on billable activities also increased from 53% of an affiliate's shift to 63%. Time documentation was similar regardless of during which shift an affiliate worked. Approximately two thirds of an affiliate's shift is spent providing billable services to patients. Greater than 20% of each shift is spent providing equally important but not reimbursable

  7. Small scale homelike special care units and traditional special care units: effects on cognition in dementia; a longitudinal controlled intervention study.

    Science.gov (United States)

    Kok, Jeroen S; van Heuvelen, Marieke J G; Berg, Ina J; Scherder, Erik J A

    2016-02-16

    Evidence shows that living in small scale homelike Special Care Units (SCU) has positive effects on behavioural and psychological symptoms of patients with dementia. Effects on cognitive functioning in relation to care facilities, however, are scarcely investigated. The purpose of this study is to gain more insight into the effects of living in small scale homelike Special Care Units, compared to regular SCU's, on the course of cognitive functioning in dementia. A group of 67 patients with dementia who moved from a regular SCU to a small scale homelike SCU and a group of 48 patients with dementia who stayed in a regular SCU participated in the study. Cognitive and behavioural functioning was assessed by means of a neuropsychological test battery and observation scales one month before (baseline), as well as 3 (post) and 6 months (follow-up) after relocation. Comparing the post and follow-up measurement with the baseline measurement, no significant differences on separate measures of cognitive functioning between both groups were found. Additional analyses, however, on 'domain clusters' revealed that global cognitive functioning of the small scale homelike SCU group showed significantly less cognitive decline three months after the transfer (p Effect sizes (95% CI) show a tendency for better aspects of cognition in favour of the homelike small scaled SCU group, i.e., visual memory, picture recognition, cognitive decline as observed by representatives and the clustered domains episodic memory and global cognitive functioning. While there is no significant longitudinal effect on the progression of cognitive decline comparing small scaled homelike SCU's with regular SCU's for patients with dementia, analyses on the domain clusters and effect sizes cautiously suggest differences in favour of the small scaled homelike SCU for different aspects of cognition.

  8. Realising participation within an action research project on two Care Innovation Units providing care for older people.

    NARCIS (Netherlands)

    Drs Miranda Snoeren; MSc Donna Frost

    2011-01-01

    Background: On two Care Innovation Units in the Netherlands, staff, students and Lecturer Practitioners work intensively together to provide care, create a rich learning environment, and to foster innovation and research. In striving to advance the quality of care and to develop person centred

  9. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Lumley Judith

    2006-07-01

    Full Text Available Abstract Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73, exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning. Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives providing postnatal care

  10. Obstacles and facilitators of open visiting policy in Intensive Care Units:A qualitative study

    Directory of Open Access Journals (Sweden)

    Shiva Khaleghparast

    2016-07-01

    Full Text Available Open visiting policy in intensive care units is proposed as an essential requirement for patients and their families, so this study is aimed to explain open visiting policy obstacles and facilitators from patients, families and health team members’ viewpoint. This qualitative study implemented in intensive care units of a hospital specialized in cardiology in Tehran-Iran. Patients’, families’, nurses’, doctors’ and guards’ viewpoint was determined regarding open visiting policy obstacles and facilitators by semi-structured interviews. Data analysis method was conventional approach of qualitative content analysis with thematic technique. Data analysis was performed using Max QDA10 software. Two main categories of data regarding open visiting obstacles and facilitators were extracted. Factors related to service systems and visitors derived from open visiting obstacles, and factors related to management system and personnel derived from open visiting facilitators. One of the most important obstacles of open visiting policy implementation is shortage of staff and personnel negative attitude. Regarding open visiting policy facilitators, designing visiting cards for close family and observing specific rules, modification of intensive care unit structure and facilities for families are useful. Finally, what is important as an open visiting policy implementation facilitator is presence of nursing profession as a humanitarian and ethical profession.

  11. Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units : Precision medicine in intermediate care units.

    Science.gov (United States)

    Masa, Juan F; Utrabo, Isabel; Gomez de Terreros, Javier; Aburto, Myriam; Esteban, Cristóbal; Prats, Enric; Núñez, Belén; Ortega-González, Ángel; Jara-Palomares, Luis; Martin-Vicente, M Jesus; Farrero, Eva; Binimelis, Alicia; Sala, Ernest; Serrano-Rebollo, José C; Barrot, Emilia; Sánchez-Oro-Gomez, Raquel; Fernández-Álvarez, Ramón; Rodríguez-Jerez, Francisco; Sayas, Javier; Benavides, Pedro; Català, Raquel; Rivas, Francisco J; Egea, Carlos J; Antón, Antonio; Peñacoba, Patricia; Santiago-Recuerda, Ana; Gómez-Mendieta, M A; Méndez, Lidia; Cebrian, José J; Piña, Juan A; Zamora, Enrique; Segrelles, Gonzalo

    2016-07-07

    Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. ACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.

  12. Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.

    Science.gov (United States)

    West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin

    2014-05-01

    To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

  13. The physical environment and patients' activities and care: A comparative case study at three newly built stroke units.

    Science.gov (United States)

    Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie

    2018-04-20

    To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  14. Modern Management and Diagnosis of Hypertension in the United Kingdom: Home Care and Self-care.

    Science.gov (United States)

    Sheppard, James P; Schwartz, Claire L; Tucker, Katherine L; McManus, Richard J

    2016-01-01

    The effective diagnosis and management of hypertension is one of the most important parts of cardiovascular prevention internationally and this is no different in the United Kingdom. Approximately 14% of the UK population currently receive treatment for hypertension. Recent UK guidelines from the National Institute of Health and Care Excellence have placed greater emphasis on the utilization of out-of-office measurement of blood pressure to more accurately diagnose hypertension. The aim of the present study was to provide a state-of-the-art review of the evidence for screening, diagnosing, and managing hypertension, as implemented in the United Kingdom, with an emphasis on the role of self-monitored and ambulatory blood pressure monitoring in routine clinical care. Consideration was given to the use of ambulatory and home monitoring to confirm a diagnosis of hypertension and the use of self-monitoring and self-management to monitor and guide treatment. The evidence for the use of self-monitoring in patients with hypertension was examined, both in isolation, and in combination with lifestyle and treatment interventions. There is a place for self-monitored blood pressure in specific underresearched populations such as the elderly, specialist conditions, ethnic groups, and during pregnancy and this is discussed here. The evidence supporting the use of out-of-office monitoring in all aspects of routine clinical care has increased substantially in recent years and is reflected in increased utilization by patients and clinicians alike. Several areas require further research but it is clear that out-of-office monitoring is here to stay and is fast becoming an important part of hypertension management in the United Kingdom. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.

    Science.gov (United States)

    Rosenthal, Victor D; Guzman, Sandra; Safdar, Nasia

    2005-09-01

    Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance. We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.

  16. Care to patient in heart arrest at the intensive care unit

    Directory of Open Access Journals (Sweden)

    Luiza Taciana Rodrigues de Moura

    2012-06-01

    Full Text Available Care to heart arrest patient should be performed in a systematic way, based on basic protocol as well as advanced life support. The objective of this study is to assess the knowledge of the nursing staff of an intensive care unit in relation to the recognition of heart arrest and the establishment of resuscitation according to the protocols above. It is a descriptive and quantitative study which was conducted from April to June 2011. Of the 33 professionals who participated in the study, 54.5% had not undergone previous training on the theme, 93.9% partially agreed the rates of heart arrest, and only 15.2 % got all the maneuvers in ventilating intubated patient. The low hit total demonstrates the need to update the nursing staff, with periodical theoretical-practical training, and systematic assessments of the performance of the team.

  17. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani

    2011-01-01

    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  18. A Business Case Analysis of the Special Care Unit at Moncrief Army Community Hospital

    National Research Council Canada - National Science Library

    Unruh, Charles

    2002-01-01

    The goal of this project is to develop and evaluate four courses of action (COA) in order to determine the most efficient and effective method to care for Moncrief Army Community Hospitals Special Care Unit (SCU) inpatients...

  19. Ventilator-associated pneumonia in surgical emergency intensive care unit.

    Science.gov (United States)

    Ertugrul, Bulent M; Yildirim, Ayse; Ay, Pinar; Oncu, Serkan; Cagatay, Atahan; Cakar, Nahit; Ertekin, Cemalettin; Ozsut, Halit; Eraksoy, Haluk; Calangu, Semra

    2006-01-01

    To investigate the incidence, risk factors and the etiology of ventilator-associated pneumonia (VAP) in surgical emergency intensive care unit (ICU) patients. We conducted this prospective cohort study in the surgical emergency ICU of Istanbul Medical Faculty between December 1999 and May 2001. We included 100 mechanically ventilated patients in this study. We diagnosed VAP according to the current diagnostic criteria. We identified the etiology of VAP cases by both quantitative cultures of endotracheal aspiration and blood cultures. To analyze the predisposing factors for the development of VAP, we recorded the following variables: age, gender, acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma scale (GCS), sequential organ failure assessment (SOFA) score, serum albumin level, duration of mechanical ventilation (MV) prior to the development of VAP, and underlying diseases. We determined the VAP incidence rate as 28%. We found the APACHE II score and the duration of MV to be statistically significant variables for the development of VAP. There were no significant differences regarding age, gender, GCS, SOFA score, albumin level, or underlying diseases for the development of VAP. The isolated bacteria among VAP cases were as follows: Staphylococcus aureus (n=12, 43%), Acinetobacter spp. (n=6, 21%), coagulase-negative Staphylococci (n=4, 15%), Pseudomonas aeruginosa (n=3, 10.7%) and Klebsiella pneumoniae (n=3, 10.7%). Ventilator-associated pneumonia is a common infection, and certain interventions might affect the incidence of VAP. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to minimize the risk of VAP.

  20. Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

    Science.gov (United States)

    Profit, J; Zupancic, JAF; Gould, JB; Pietz, K; Kowalkowski, MA; Draper, D; Hysong, SJ; Petersen, LA

    2014-01-01

    Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P quality measures were strong (ρ > .5) for 1 pair, moderate (.3 quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest. PMID:23403539

  1. Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care.

    Science.gov (United States)

    Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A

    2008-08-01

    We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

  2. Alarm management in a single-patient room intensive care units

    NARCIS (Netherlands)

    van Pul, C.; Joshi, R.; Dijkman, W.; van de Mortel, H.; Mohns, T.; Andriessen, P.; Chen, Wei; Carlos Augusto, Juan; Seoane, Fernando; Lehocki, Fedor; Wolf, Klaus-Henderik; Arends, Johan; Ungureanu, Constantin; Wichert, Reiner

    2015-01-01

    An international trend in intensive care is the shift from open, bay area intensive care units towards single-patient room care, since this is considered optimal for patient healing and family privacy. However, in the intensive care setting, an increasing number of devices and parameters are being

  3. Impact of outlier status on critical care patient outcomes: Does boarding medical intensive care unit patients make a difference?

    Science.gov (United States)

    Ahmad, Danish; Moeller, Katherine; Chowdhury, Jared; Patel, Vishal; Yoo, Erika J

    2018-04-01

    To evaluate the impact of outlier status, or the practice of boarding ICU patients in distant critical care units, on clinical and utilization outcomes. Retrospective observational study of all consecutive admissions to the MICU service between April 1, 2014-January 3, 2016, at an urban university hospital. Of 1931 patients, 117 were outliers (6.1%) for the entire duration of their ICU stay. In adjusted analyses, there was no association between outlier status and hospital (OR 1.21, 95% CI 0.72-2.05, p=0.47) or ICU mortality (OR 1.20, 95% CI 0.64-2.25, p=0.57). Outliers had shorter hospital and ICU lengths of stay (LOS) in addition to fewer ventilator days. Crossover patients who had variable outlier exposure also had no increase in hospital (OR 1.61; 95% CI 0.80-3.23; p=0.18) or ICU mortality (OR 1.05; 95% CI 0.43-2.54; p=0.92) after risk-adjustment. Boarding of MICU patients in distant units during times of bed nonavailability does not negatively influence patient mortality or LOS. Increased hospital and ventilator utilization observed among non-outliers in the home unit may be attributable, at least in part, to differences in patient characteristics. Prospective investigation into the practice of ICU boarding will provide further confirmation of its safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Rehabilitation of patients admitted to a respiratory intensive care unit.

    Science.gov (United States)

    Nava, S

    1998-07-01

    Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. A prospective, randomized study. A respiratory intensive care unit (RICU). Eighty COPD patients recovering from an episode of acute respiratory failure were randomized in a 3:1 fashion to receive stepwise pulmonary rehabilitation (group A, n=60 patients) or standard medical therapy (group B, n=20 patients). Improvements in exercise tolerance, sense of breathlessness, respiratory muscle function, and pulmonary function test values were measured, respectively, by exercise capacity (6-minute walking distance [6MWD]), dyspnea score (Visual Analog Scale [VAS]), maximal inspiratory pressure (MIP), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Group A received pulmonary rehabilitation that consisted of passive mobilization (step I), early deambulation (step II), respiratory and lower skeletal muscle training (step III), and if the patients were able, complete lower extremity training on a treadmill (step IV). Group B received standard medical therapy plus a basic deambulation program. Sixty-one of 80 patients were mechanically ventilated at admission to the unit and most of them were bedridden. Twelve of the 60 group A patients and 4 of the 20 group B patients died during their RICU stay, and 9 patients required invasive mechanical ventilation at home after their discharge. The total length of RICU stay was 38+/-14 days for patients in group A versus 33.2+/-11 days for those in group B. Most patients from both groups regained the ability to walk, either unaided or aided. At discharge, 6 MWD results were significantly improved (p respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early

  5. Ketamine for Analgosedation in the Intensive Care Unit: A Systematic Review.

    Science.gov (United States)

    Patanwala, Asad E; Martin, Jennifer R; Erstad, Brian L

    2017-07-01

    To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients. One trial evaluated opioid consumption as an outcome in postoperative critically ill patients who were randomized to ketamine or saline infusions. The mean cumulative morphine consumption at 48 hours was significantly lower in the ketamine group (58 ± 35 mg) compared to the morphine-only group (80 ± 37 mg; P ketamine in terms of cerebral hemodynamics in patients with traumatic brain injury, improved gastrointestinal motility, and decreased vasopressor requirements. The observational study and case reports suggest that ketamine is safe and effective and may have a role in patients who are refractory to other therapies. Ketamine use may decrease analgesic consumption in the intensive care unit. Additional trials are needed to further delineate the role of ketamine for analgosedation.

  6. Observations of Health Care in China: Four Perspectives.

    Science.gov (United States)

    Attwood, Madge, Ed.

    This collection consists of four papers dealing with the delivery of health care in the People's Republic of China. The papers resulted from a study tour of the Chinese health care system in June 1980. Included in the volume are the following papers: "A Comparison of Selected Aspects of the Health Care Systems of the Socialist Federal…

  7. Allocation of nursing care hours in a combined ophthalmic nursing unit.

    Science.gov (United States)

    Navarro, V B; Stout, W A; Tolley, F M

    1995-04-01

    Traditional service configuration with separate nursing units for outpatient and inpatient care is becoming ineffective for new patient care delivery models. With the new configuration of a combined nursing unit, it was necessary to rethink traditional reporting methodologies and calculation of hours of care. This project management plan is an initial attempt to develop a standard costing/productivity model for a combined unit. The methodology developed from this plan measures nursing care hours for each patient population to determine the number of full time equivalents (FTEs) for a combined unit and allocates FTEs based on inpatient (IP), outpatient (OP), and emergency room (ER) volumes.

  8. [Analysis of the web pages of the intensive care units of Spain].

    Science.gov (United States)

    Navarro-Arnedo, J M

    2009-01-01

    In order to determine the Intensive Care Units (ICU) of Spanish hospitals that had a web site, to analyze the information they offered and to know what information they needed to offer according to a sample of ICU nurses, a cross-sectional observational, descriptive study was carried out between January and September 2008. For each ICU website, an analysis was made on the information available on the unit, its care, teaching and research activity on nursing. Simultaneously, based on a sample of intensive care nurses, the information that should be contained on an ICU website was determined. The results, expressed in absolute numbers and percentage, showed that 66 of the 292 hospitals with ICU (22.6%) had a web site; 50.7% of the sites showed the number of beds, 19.7% the activity report, 11.3% the published articles/studies and followed research lines and 9.9% the organized formation courses. 14 webs (19.7%) displayed images of nurses. However, only 1 (1.4%) offered guides on the actions followed. No web site offered a navigation section for nursing, the E-mail of the chief nursing, the nursing documentation used or if any nursing model of their own was used. It is concluded that only one-fourth of the Spanish hospitals with ICU have a web site; number of beds was the data offered by the most sites, whereas information on care, educational and investigating activities was very reduced and that on nursing was practically omitted on the web pages of intensive care units.

  9. United States Forest Disturbance Trends Observed Using Landsat Time Series

    Science.gov (United States)

    Masek, Jeffrey G.; Goward, Samuel N.; Kennedy, Robert E.; Cohen, Warren B.; Moisen, Gretchen G.; Schleeweis, Karen; Huang, Chengquan

    2013-01-01

    Disturbance events strongly affect the composition, structure, and function of forest ecosystems; however, existing U.S. land management inventories were not designed to monitor disturbance. To begin addressing this gap, the North American Forest Dynamics (NAFD) project has examined a geographic sample of 50 Landsat satellite image time series to assess trends in forest disturbance across the conterminous United States for 1985-2005. The geographic sample design used a probability-based scheme to encompass major forest types and maximize geographic dispersion. For each sample location disturbance was identified in the Landsat series using the Vegetation Change Tracker (VCT) algorithm. The NAFD analysis indicates that, on average, 2.77 Mha/yr of forests were disturbed annually, representing 1.09%/yr of US forestland. These satellite-based national disturbance rates estimates tend to be lower than those derived from land management inventories, reflecting both methodological and definitional differences. In particular the VCT approach used with a biennial time step has limited sensitivity to low-intensity disturbances. Unlike prior satellite studies, our biennial forest disturbance rates vary by nearly a factor of two between high and low years. High western US disturbance rates were associated with active fire years and insect activity, while variability in the east is more strongly related to harvest rates in managed forests. We note that generating a geographic sample based on representing forest type and variability may be problematic since the spatial pattern of disturbance does not necessarily correlate with forest type. We also find that the prevalence of diffuse, non-stand clearing disturbance in US forests makes the application of a biennial geographic sample problematic. Future satellite-based studies of disturbance at regional and national scales should focus on wall-to-wall analyses with annual time step for improved accuracy.

  10. Patient safety event reporting in critical care: a study of three intensive care units.

    Science.gov (United States)

    Harris, Carolyn B; Krauss, Melissa J; Coopersmith, Craig M; Avidan, Michael; Nast, Patricia A; Kollef, Marin H; Dunagan, W Claiborne; Fraser, Victoria J

    2007-04-01

    To increase patient safety event reporting in three intensive care units (ICUs) using a new voluntary card-based event reporting system and to compare and evaluate observed differences in reporting among healthcare workers across ICUs. Prospective, single-center, interventional study. A medical ICU (19 beds), surgical ICU (24 beds), and cardiothoracic ICU (17 beds) at a 1,371-bed urban teaching hospital. Adult patients admitted to these three study ICUs. Use of a new, internally designed, card-based reporting program to solicit voluntary anonymous reporting of medical errors and patient safety concerns. During a 14-month period, 714 patient safety events were reported using a new card-based reporting system, reflecting a significant increase in reporting compared with pre-intervention Web-based reporting (20.4 reported events/1,000 patient days pre-intervention to 41.7 reported events/1,000 patient days postintervention; rate ratio, 2.05; 95% confidence interval, 1.79-2.34). Nurses submitted the majority of reports (nurses, 67.1%; physicians, 23.1%; other reporters, 9.5%); however, physicians experienced the greatest increase in reporting among their group (physicians, 43-fold; nurses, 1.7-fold; other reporters, 4.3-fold) relative to pre-intervention rates. There were significant differences in the reporting of harm by job description: 31.1% of reports from nurses, 36.2% from other staff, and 17.0% from physicians described events that did not reach/affect the patient (p = .001); and 33.9% of reports from physicians, 27.2% from nurses, and 13.0% from other staff described events that caused harm (p = .005). Overall reported patient safety events per 1,000 patient days differed by ICU (medical ICU = 55.5, cardiothoracic ICU = 25.3, surgical ICU = 40.2; p reporting system increased reporting significantly compared with pre-intervention Web-based reporting and revealed significant differences in reporting by healthcare worker and ICU. These differences may reveal

  11. Important questions asked by family members of intensive care unit patients.

    Science.gov (United States)

    Peigne, Vincent; Chaize, Marine; Falissard, Bruno; Kentish-Barnes, Nancy; Rusinova, Katerina; Megarbane, Bruno; Bele, Nicolas; Cariou, Alain; Fieux, Fabienne; Garrouste-Orgeas, Maite; Georges, Hugues; Jourdain, Merce; Kouatchet, Achille; Lautrette, Alexandre; Legriel, Stephane; Regnier, Bernard; Renault, Anne; Thirion, Marina; Timsit, Jean-Francois; Toledano, Dany; Chevret, Sylvie; Pochard, Frédéric; Schlemmer, Benoît; Azoulay, Elie

    2011-06-01

    Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit. This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering. The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients. This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.

  12. Exemplars from an acute care geriatric psychiatry unit.

    Science.gov (United States)

    Cutillo-Schmitter, T A; Massara, E B; Wynne, P; Martin, P; Sliner, B J; Cunningham, F; Bigdeli, S P

    1996-04-01

    The exemplars in this article reflect caring contexts and creative nursing solutions to dementia, depression, and addiction, common mental health problems afflicting elderly patients and for which inpatient evaluation and treatment are necessitated. Optimal functioning and quality of life for elderly individuals depend substantially upon both physical and mental capacity. The coexistence of mental and physical illness leads to rapid impairment of functioning and interrupts the individual's zest for living. Although in most cases dementia is irreversible, other treatable comorbid conditions like delirium can exacerbate suffering and decline. Conversely, mental disorders, like depression and addiction, can amplify the negative effects associated with other health conditions, causing excess disability and mortality, and are associated with older individuals having the highest suicide rate of any age group in the United States. Nurses are well positioned to identify mental health problems and humanely treat primary and secondary symptoms associated with these disorders in their elderly patients. A document to guide medical professionals' assessment of mental disorders is now available (Spitzer et al., 1994). Remaining attentive to early identification of high-risk individuals and mobilizing resources in their behalf will substantially contribute to their well-being. There is ample research evidence on the benefits and efficacy of mental health interventions (Lebowitz, 1994). Much of the challenge and hard work for nurses lies in getting to know the patient, grasping what is happening for the individual and determining which treatment interventions will be most effective given the present circumstances surrounding the illness episode (Benner, 1984).

  13. Caffeine use in the neonatal intensive care unit.

    Science.gov (United States)

    Abu-Shaweesh, Jalal M; Martin, Richard J

    2017-10-01

    Caffeine is the most frequently used medication in the neonatal intensive care unit. It is used for the prevention and treatment of apnea, although this has been associated with lower incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus as well as intact survival at 18-21 months of life. Although neurodevelopmental advantage was no longer statistically significant at age 5 years, caffeine was associated with sustained improvement in co-ordination and less gross motor impairment than placebo. The mechanism of action of caffeine on prevention of apnea and activation of breathing seems to be through central inhibition of adenosine receptors. However, its impact on BPD and neurodevelopmental outcomes might be induced through its effects as anti-inflammatory mediator, protection of white matter, and induction of surfactant protein B. Whereas long-term studies have documented the safety of caffeine as used in current practice, further studies are clearly needed to identify optimum dosing, and time of starting and discontinuing caffeine. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Applications of Temporal Reasoning to Intensive Care Units

    Directory of Open Access Journals (Sweden)

    J. M. Juarez

    2010-01-01

    Full Text Available Intensive Care Units (ICUs are hospital departments that focus on the evolution of patients. In this scenario, the temporal dimension plays an essential role in understanding the state of the patients from their temporal information. The development of methods for the acquisition, modelling, reasoning and knowledge discovery of temporal information is, therefore, useful to exploit the large amount of temporal data recorded daily in the ICU. During the past decades, some subfields of Artificial Intelligence have been devoted to the study of temporal models and techniques to solve generic problems and towards their practical applications in the medical domain. The main goal of this paper is to present our view of some aspects of practical problems of temporal reasoning in the ICU field, and to describe our practical experience in the field in the last decade. This paper provides a non-exhaustive review of some of the efforts made in the field and our particular contributions in the development of temporal reasoning methods to partially solve some of these problems. The results are a set of software tools that help physicians to better understand the patient's temporal evolution.

  15. Elective open bedside tracheostomy in the neurosurgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Niran Maharjan

    2015-09-01

    Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

  16. Burnout syndrome in nurses in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Faustino Eduardo dos Santos

    2009-03-01

    Full Text Available Objective: To identify if nurses working in cardiac and general Intensive Care Units are subject to burnout, correlating it with demographic and occupational information. Methods: This is a descriptive exploratory, cross-sectional, prospective and correlational study utilizing  quantitative resources. The sample was composed of 34 nurses who answered the Maslach and Jackson inventory (MBI-HSS, which consists of 22 questions plus a questionnaire on demographic and occupational data. The study was carried out at a large private hospital in the city of São Paulo, Brazil. Rresults: Of 34 nurses, nine had high emotional exhaustion, nine high depersonalization, ten had a high score of reduced professional accomplishment (decreased personal fulfillment at work. Most nurses presented alterations in more than one dimension regarding burnout. Cconclusions: The majority of nurses presented burnout and there was a positive correlation between burnout and the variables: sex, advanced professional degrees, time working in nursing, workload and working at more than one hospital.

  17. Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients

    Science.gov (United States)

    Hafner, Gert; Neuhuber, Andreas; Hirtenfelder, Sylvia; Schmedler, Brigitte

    2007-01-01

    Aspiration in critically ill patients frequently causes severe co-morbidity. We evaluated a diagnostic protocol using routine FEES in critically ill patients at risk to develop aspiration following extubation. We instructed intensive care unit physicians on specific risk factors for and clinical signs of aspiration following extubation in critically ill patients and offered bedside FEES for such patients. Over a 45-month period, we were called to perform 913 endoscopic examinations in 553 patients. Silent aspiration or aspiration with acute symptoms (cough or gag reflex as the bolus passed into the trachea) was detected in 69.3% of all patients. Prolonged non-oral feeding via a naso-gastric tube was initiated in 49.7% of all patients. In 13.2% of patients, a percutaneous endoscopic gastrostomy was initiated as a result of FEES findings, and in 6.3% an additional tracheotomy to prevent aspiration had to be initiated. In 59 out of 258 patients (22.9%), tracheotomies were closed, and 30.7% of all 553 patients could be managed with the immediate onset of an oral diet and compensatory treatment procedures. Additional radiological examinations were not required. FEES in critically ill patients allows for a rapid evaluation of deglutition and for the immediate initiation of symptom-related rehabilitation or for an early resumption of oral feeding. PMID:17968575

  18. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  19. Factors associated with mortality in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Flávia Emília Cavalcante Valença Fernandes

    2017-05-01

    Full Text Available Aims: To describe the factors associated with mortality of newborns hospitalized in a Neonatal Intensive Care Unit in the period from 2012 to 2015. Methods: This was a descriptive, quantitative study of secondary data, correlated with the causes of death and hospitalization according to classification by ICD-10.  The categorical variables were presented in absolute and relative frequencies, with measurements of central tendency and dispersion. Evaluation of the factors associated with neonatal death was made by the logit model of analysis with correction of robust errors by the statistical program Stata 12.0, considering values of p<0.05 and interval of confidence of 95%.  Results: Of the 563 newborns, 58.6% were of the male sex; 89.0% were early newborns, 73.0% were premature. 181 newborns died (32.3%. The main causes of hospitalization were: difficulties during birth, conditions of birth and immaturity (45.0%, pathologies associated with the respiratory system (21.1%, congenital malformations (9.7%. The main causes of death were: septicemia of the NB (40.4%, respiratory discomfort of the NB (22.4%. The significant associations for mortality were the use of ventilatory supports: Mechanical Ventilation (p=0.001, Hallo (p=0.000, CPAP (p=0.000, VNI (p=0.005. Conclusions: The major risk factors for neonatal mortality were associated with septicemia and use of mechanical ventilation.

  20. [Airway humidification practices in Chilean intensive care units].

    Science.gov (United States)

    Retamal, Jaime; Castillo, Juan; Bugedo, Guillermo; Bruhn, Alejandro

    2012-11-01

    In patients with an artificial airway, inspired gases can be humidified and heated using a passive (heat and moisture exchange filter - HMEF), or an active system (heated humidifier). To assess how humidification is carried out and what is the usual clinical practice in this field in Chilean intensive care units (ICUs). A specific survey to evaluate humidification system features as well as caregivers' preferences regarding humidification systems, was carried out on the same day in all Chilean ICUs. Fifty-five ICUs were contacted and 44 of them completed the survey. From a total of 367 patients, 254 (69%) required humidification because they were breathing through an artificial airway. A heated humidifier was employed only in 12 patients (5%). Forty-three ICUs (98%) used HMEF as their routine humidification system. In 52% of surveyed ICUs, heated humidifiers were not available. In Chile the main method to humidify and heat inspired gases in patients with an artificial airway is the HMEF. Although there are clear indications for the use of heated humidifiers, they are seldom employed.

  1. Radiation dose to neonates on a Special Care Baby Unit

    International Nuclear Information System (INIS)

    Faulkner, K.; Barry, J.L.; Smalley, P.

    1989-01-01

    The skin entrance dose to neonates on a special care baby unit was estimated from a knowledge of the technique factors, X-ray tube output and backscatter factors. Normalized organ dose data were employed to estimate radiation dose to a number of critical organs. Methods of reducing radiation dose to neonates were investigated. Initially, this involved changing the radiographic technique factors and introducing a lead rubber adjustable collimator, placed on top of the incubator, in addition to light beam diaphragms on the X-ray tube. These modifications to the examination technique appeared to reduce average entrance dose per radiograph from 92 μGy, to 58 μGy, a reduction of 37%. Later, a rare-earth film-screen combination was introduced to replace existing fast calcium tungstate screens. This enabled average entrance dose per radiograph to be reduced to 39 μGy, a further reduction of 33%. The mean radiation dose to a neonate is mainly determined by the number of radiographs. (author)

  2. Radiation dose to neonates on a Special Care Baby Unit

    Energy Technology Data Exchange (ETDEWEB)

    Faulkner, K.; Barry, J.L.; Smalley, P.

    1989-03-01

    The skin entrance dose to neonates on a special care baby unit was estimated from a knowledge of the technique factors, X-ray tube output and backscatter factors. Normalized organ dose data were employed to estimate radiation dose to a number of critical organs. Methods of reducing radiation dose to neonates were investigated. Initially, this involved changing the radiographic technique factors and introducing a lead rubber adjustable collimator, placed on top of the incubator, in addition to light beam diaphragms on the X-ray tube. These modifications to the examination technique appeared to reduce average entrance dose per radiograph from 92 ..mu..Gy, to 58 ..mu..Gy, a reduction of 37%. Later, a rare-earth film-screen combination was introduced to replace existing fast calcium tungstate screens. This enabled average entrance dose per radiograph to be reduced to 39 ..mu..Gy, a further reduction of 33%. The mean radiation dose to a neonate is mainly determined by the number of radiographs.

  3. Percutaneous drainage with ultrasound guidance in the intensive care unit

    International Nuclear Information System (INIS)

    Kang, Doo Kyung; Won, Je Hwan; Kim, Jai Keun; Lee, Kwang Hun; Kim, Ji Hyung

    2004-01-01

    To determine the efficacy and safety of bedside percutaneous drainage procedures with ultrasound guidance in critically ill patients in the intensive care unit (ICU). Sixty five percutaneous drainage procedures performed at the bedside, in 39 ICU patients, were evaluated. All of the procedures were performed with ultrasound guidance alone. The procedures consisted of percutaneous drainage of abdominal (n=35) and pleural (n=27) fluids, percutaneous cholecystostomy (n=2) and percutaneous nephrostomy (n=1). The clinical responses were classified as 'complete response', 'partial response', 'failure' or 'undetermined'. The medical records were reviewed retrospectively to evaluate the clinical response. Technical success was achieved in 64 of the 65 procedures (98.5%). The complication rate was 13.8% (9 cases). There was no immediate procedure-related death or worsening of the clinical condition of the patients. The clinical responses after drainage were 'complete response' in 39 cases (60.9%). 'partial response' in 14 (21.9%), 'failure' in 3 (4.7%), and 'undetermined' in 8 (12.5%). Bedside drainage procedures with ultrasound guidance are effective and safe to perform when patients are too critically ill to be moved from the ICU to the angiography room

  4. Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ying Li; Shoo Lee; Hua-Feng Yu; Xiang Y Ye; Ruth Warre; Xiang-Hong Liu; Jian-Hong Liu

    2017-01-01

    Background:Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China.Visitation is not usually permitted or may be strictly limited,and NICU care for most neonates is provided by health-care professionals with little participation of the parents.An exception to this rule is the level 2 "Room-In" ward in Qilu Children's Hospital,Shandong University,where parents have 24-hour access to their infants and participate in providing care.Methods:This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group,n=428),admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group,n=1018),or admitted straight to the Room-In ward (RIn only group,n=629).Results:There were no significant differences in the rates of nosocomial infection,bronchopulmonary dysplasia,intraventricular hemorrhage,and retinopathy of prematurity between the NICU-NICU and NICURIn groups.The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04),while weight gain and duration of hospital stay were significantly higher (both P<0.001).Rates of adverse outcomes were lower in RIn-only infants due to their low severity of illness on admission.Conclusions:Allowing parents access to their infant in the NICU is feasible and safe in China,and may result in improvements in infant outcomes.Further studies are required to generate stronger evidence that can inform changes to neonatal care in China.

  5. Moral distress in end-of-life care in the intensive care unit.

    Science.gov (United States)

    St Ledger, Una; Begley, Ann; Reid, Joanne; Prior, Lindsay; McAuley, Danny; Blackwood, Bronagh

    2013-08-01

    To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit. Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown. A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011). In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on 'Healthtalkonline' by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012). This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy. © 2012 Blackwell Publishing Ltd.

  6. Establishment and assessment of cataract surgery in Day-care Unit at northwest of China

    Directory of Open Access Journals (Sweden)

    Xiu-Li Zhang

    2018-04-01

    Full Text Available AIM: To describe the protocol and economic cost of the Day-care Unit cataract surgery procedure in northwest of China.METHODS: Patients who received phacoemulcification and intraocular lens implantation in both Day-care Unit and regular Unit were recruited from January 2016 to December 2016. The baseline data and average cost were recorded and analyzed. Furthermore, satisfaction questionnaire of patients were collected.RESULTS: Patients with Day-care Unit showed shorter registration duration, less cost including housing and nursing charge as well as higher rate of patient satisfaction. Meanwhile, Day-care Unit shorten the time the doctors and nurses spending on filling the medical charts.CONCLUSION:Day-care Unit cataract surgery procedure could benefit both patients and medical staffs and is worthy to generalize.

  7. Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Jørgensen, Christoffer Calov; Laursen, Mogens Berg

    2017-01-01

    Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to signifcantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations...... or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignifcant tendency toward increased adverse events during the frst 24h in the ward was discovered, further safety data are needed in patients without...

  8. Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

    Directory of Open Access Journals (Sweden)

    Paulo Yuri Milen Firmino

    2015-09-01

    Full Text Available Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC as capable of decreasing cardiovascular risk rate (%CVR on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG, which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG, which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04 and systolic blood pressure levels (SBP (137.69 to 131.54; p<0.01 in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.

  9. Epoxy matrix with triaromatic mesogenic unit in dielectric spectroscopy observation

    Science.gov (United States)

    Włodarska, Magdalena; Mossety-Leszczak, Beata; Bąk, Grzegorz W.; Kisiel, Maciej; Dłużniewski, Maciej; Okrasa, Lidia

    2018-04-01

    This paper describes the dielectric response of a selected liquid crystal epoxy monomer (plain and in curing systems) in a wide range of frequency and temperature. The dielectric spectroscopy, thanks to its sensitivity, is a very good tool for studying phase transitions, reaction progress, or material properties. This sensitivity is important in the case of liquid crystal epoxy resins, where properties of the final network depend on the choice of monomers, curing agents, curing conditions and post-curing treatment, or applying an external electric or magnetic field during the reaction. In most of the obtained cured products, the collected dielectric data show two relaxation processes. The α-process is related to a structural reorientation; it can usually be linked with the glass transition and the mechanical properties of the material. The β-process can be identified as a molecular motion process, probably associated with the carboxyl groups in the mesogen. A transient Maxwell-Wagner relaxation observed in one of the compositions after the initial curing is removed by post-curing treatment at elevated temperatures. Post-curing is therefore necessary for obtaining uniformly cured products in those cases. In the investigated systems, the choice of a curing agent can change the glass transition temperature by at least 70 °C. The obtained results are in a good agreement with an earlier study employing other techniques. Finally, we assess the influence of the direction of mesogen alignment on the dielectric properties of one selected system, where a global order was induced by applying an external magnetic field in the course of curing.

  10. Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

    Science.gov (United States)

    Min, Ari; Scott, Linda D; Park, Chang; Vincent, Catherine; Ryan, Catherine J; Lee, Taewha

    2018-04-10

    This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Small scale homelike special care units and traditional special care units : effects on cognition in dementia; a longitudinal controlled intervention study

    NARCIS (Netherlands)

    Kok, Jeroen S.; van Heuvelen, Marieke J. G.; Berg, Ina J.; Scherder, Erik J. A.

    2016-01-01

    Background: Evidence shows that living in small scale homelike Special Care Units (SCU) has positive effects on behavioural and psychological symptoms of patients with dementia. Effects on cognitive functioning in relation to care facilities, however, are scarcely investigated. The purpose of this

  12. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness.

    Science.gov (United States)

    Sanders, M R; Hall, S L

    2018-01-01

    Both babies and their parents may experience a stay in the newborn intensive care unit (NICU) as a traumatic or a 'toxic stress,' which can lead to dysregulation of the hypothalamic-pituitary-adrenal axis and ultimately to poorly controlled cortisol secretion. Toxic stresses in childhood or adverse childhood experiences (ACEs) are strongly linked to poor health outcomes across the lifespan and trauma-informed care is an approach to caregiving based on the recognition of this relationship. Practitioners of trauma-informed care seek to understand clients' or patients' behaviors in light of previous traumas they have experienced, including ACEs. Practitioners also provide supportive care that enhances the client's or patient's feelings of safety and security, to prevent their re-traumatization in a current situation that may potentially overwhelm their coping skills. This review will apply the principles of trauma-informed care, within the framework of the Polyvagal Theory as described by Porges, to care for the NICU baby, the baby's family and their professional caregivers, emphasizing the importance of social connectedness among all. The Polyvagal Theory explains how one's unconscious awareness of safety, danger or life threat (neuroception) is linked through the autonomic nervous system to their behavioral responses. A phylogenetic hierarchy of behaviors evolved over time, leveraging the mammalian ventral or 'smart' vagal nucleus into a repertoire of responses promoting mother-baby co-regulation and the sense of safety and security that supports health and well-being for both members of the dyad. Fostering social connectedness that is mutual and reciprocal among parents, their baby and the NICU staff creates a critical buffer to mitigate stress and improve outcomes of both baby and parents. Using techniques of trauma-informed care, as explained by the Polyvagal Theory, with both babies and their parents in the NICU setting will help to cement a secure relationship

  13. [End-of-life care in a Spanish Pediatric Intensive Care Unit: staff and parental evaluation].

    Science.gov (United States)

    Tagarro García, A; Dorao Martínez-Romillo, P; Moraleda, S; López, P; Moreno, T; San-José, B; Martínez Biarge, M; Tapia Moreno, R; Ruza-Tarrío, F

    2008-04-01

    To evaluate end-of-life care in a Paediatric Intensive Care Unit (PICU). Retrospective study developed in a PICU. 41 workers from the PICU and parents of 26 deceased children (from 2001 to 2005). A questionnaire was designed to investigate end-of-life care. An age parents were with their children at the time of death; 64 % of all parents consider this "positive", and 13 % consider it "negative". Forty per cent of staff stated that it is "positive" for parents to be by the side of their child at the time of death, and 52 % do not know. Seventy-three per cent of staff, but only 29 % of parents want further professional psychological support for parents. Twenty per cent of children died following withdrawal of life support. The most important factors for this decision were the possibility of survival and quality of life. The majority (73 %) of caregivers express the view that often, this decision should be taken earlier. Analysis of staff opinions underlines the importance of the way news is communicated, the timing of withdrawal of life support, and the need for psychological support. Parents emphasized the role of the family during time spent in a PICU and during the last moments.

  14. Noise level in intensive care units of a public university hospital in Santa Marta (Colombia).

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2016-10-01

    To evaluate the noise level in adult, pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta (Colombia). A descriptive, observational, non-interventional study with follow-up over time was carried out. Continuous sampling was conducted for 20 days for each unit using a type i sound level meter, filter frequency in A weighting and Fast mode. We recorded the maximum values, the 90th percentile as background noise, and the continuous noise level. The mean hourly levels in the adult unit varied between 57.40±1.14-63.47±2.13dBA, with a maximum between 71.55±2.32-77.22±1.94dBA, and a background noise between 53.51±1.16-60.26±2.10dBA; in the pediatric unit the mean hourly levels varied between 57.07±3.07-65.72±2.46dBA, with a maximum of 68.69±3.57-79.06±2.34dBA, and a background noise between 53.33±3.54-61.96±2.85dBA; the neonatal unit in turn presented mean hourly values between 59.54±2.41-65.33±1.77dBA, with a maximum value between 67.20±2.13-77.65±3.74dBA, and a background noise between 55.02±2.03-58.70±1.95dBA. Analysis of variance revealed a significant difference between the hourly values and between the different units, with the time of day exhibiting a greater influence. The type of unit affects the noise levels in intensive care units, the pediatric unit showing the highest values and the adult unit the lowest values. However, the parameter exerting the greatest influence upon noise level is the time of day, with higher levels in the morning and evening, and lower levels at night and in the early morning. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support.

    Science.gov (United States)

    Carlson, Eve B; Spain, David A; Muhtadie, Luma; McDade-Montez, Liz; Macia, Kathryn S

    2015-06-01

    Family members of intensive care unit (ICU) patients are sometimes highly distressed and report lower satisfaction with communication and emotional support from staff. Within a study of emotional responses to traumatic stress, associations between family distress and satisfaction with aspects of ICU care were investigated. In 29 family members of trauma patients who stayed in an ICU, we assessed symptoms of depression and posttraumatic stress disorder (PTSD) during ICU care. Later, family members rated staff communication, support, and skills and their overall satisfaction with ICU care. Ratings of staff competence and skills were significantly higher than ratings of frequency of communication, information needs being met, and support. Frequency of communication and information needs being met were strongly related to ratings of support (rs = .75-.77) and staff skills (rs = .77-.85), and aspects of satisfaction and communication showed negative relationships with symptoms of depression (rs = -.31 to -.55) and PTSD (rs = -.17 to -.43). Although satisfaction was fairly high, family member distress was negatively associated with several satisfaction variables. Increased understanding of the effects of traumatic stress on family members may help staff improve communication and increase satisfaction of highly distressed family members. Published by Elsevier Inc.

  16. Critical incidents connected to nurses' leadership in Intensive Care Units.

    Science.gov (United States)

    Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Camelo, Silvia Helena Henriques; Balsanelli, Alexandre Pazetto

    2017-01-01

    The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses' activities; people management; and the setting of high quality care targets. Researchers identified a mixed leadership model, leading them to the conclusion that nurses' knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization's results. Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois

  17. Identifying medication errors in the neonatal intensive care unit and ...

    African Journals Online (AJOL)

    of the health care professional, patient, or consumer. ... Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, ..... patient safety. ... Clifton-Koeppel R. What nurses can do right now to reduce medication errors.

  18. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals.

    Science.gov (United States)

    van Mol, Margo Mc; Boeter, Trudi Gw; Verharen, Lisbeth; Kompanje, Erwin Jo; Bakker, Jan; Nijkamp, Marjan D

    2017-10-01

    To evaluate the impact of supportive interventions perceived by both the intensive care unit patients' relatives and the healthcare providers, such as deferred intake interviews for providing information and discussing the emotional impacts, encouragement to keep a diary, and the introduction of weekly psychosocial rounds, on the perceptions of relatives of patients in the intensive care unit. Patient- and family-centred care is gaining interest, with a shift from provider-centric norms to care arranged around patients' and relatives individual beliefs and needs. This is expected to have a positive influence on the quality of care. Communication is one of the most important factors impacting the perceived quality of care in the intensive care unit from the perspective of patients' relatives. New interventions have been introduced to help the patients' relatives to meet their communication needs. A time-trend quantitative design. Two convenience samples of relatives were included (in 2012 and 2013) in four different intensive care units from a large university medical centre in the Netherlands. Survey data from 211 relatives (75% net response rate in 2012) and 123 relatives (66% net response rate in 2013) were used for the analysis. The second measurement showed significant improvements regarding informational aspects of care, clarification of roles in participatory caretaking and shared decision-making. The results suggest that the additional support offered to patients' relatives increased perceived quality of care, particularly with respect to informational needs. However, patient- and family-centred care still requires a change in the mindset of healthcare professionals. This new point of view should overcome perceived barriers and foster a culture of partnership with patients' relatives in the intensive care unit. Training in providing psychosocial support for the needs of relatives leads to a stronger perception of patient-centredness. © 2016 John Wiley

  19. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

    NARCIS (Netherlands)

    Bellani, Giacomo; Laffey, John G.; Pham, Tài; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; van Haren, Frank; Larsson, Anders; McAuley, Daniel F.; Ranieri, Marco; Rubenfeld, Gordon; Thompson, B. Taylor; Wrigge, Hermann; Slutsky, Arthur S.; Pesenti, Antonio; Francois, Guy M.; Rabboni, Francesca; Madotto, Fabiana; Conti, Sara; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Simonis, Fabienne D.; Schultz, Marcus J.

    2016-01-01

    IMPORTANCE Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation

  20. Application of lean thinking to health care: issues and observations

    Science.gov (United States)

    Joosten, Tom; Bongers, Inge; Janssen, Richard

    2009-01-01

    Background Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care. Development, theory and application of lean thinking to health care Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles. Discussion We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term. PMID:19696048

  1. Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units.

    Science.gov (United States)

    Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-A; Weiler, Norbert; Chop, Ines; Jonitz, Günther; Schaefer, Henning; Felsenstein, Matthias; Liebeskind, Ursula; Leffmann, Carsten; Jungbluth, Annemarie; Waydhas, Christian; Pronovost, Peter; Spies, Claudia; Braun, Jan-Peter

    2014-01-01

    Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs - representing over 300 patient beds - had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.

  2. Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units

    Science.gov (United States)

    Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-A.; Weiler, Norbert; Chop, Ines; Jonitz, Günther; Schaefer, Henning; Felsenstein, Matthias; Liebeskind, Ursula; Leffmann, Carsten; Jungbluth, Annemarie; Waydhas, Christian; Pronovost, Peter; Spies, Claudia; Braun, Jan-Peter

    2014-01-01

    Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators. PMID:25587245

  3. Hypertension and Health Outcomes in the Pediatric Intensive Care Unit

    Science.gov (United States)

    Ehrmann, Brett J.; Selewski, David T; Troost, Jonathan P.; Hieber, Susan M.; Gipson, Debbie S.

    2014-01-01

    Objectives Reports of the burden of hypertension in hospitalized children are emerging, but the prevalence and significance of this condition within the pediatric intensive care unit (PICU) are not well understood. The aims of this study were to validate a definition of hypertension in the PICU and assess the associations between hypertension and acute kidney injury (AKI), PICU length of stay (LOS), and mortality. Design and Setting Single center retrospective study using a database of PICU discharges between July 2011 and February 2013. Patients All children discharged from the PICU with LOS > 6 hours, aged 1 month through 17 years. Exclusions were traumatic brain injury, incident renal transplant, or hypotension. Measurements and Main Results Potential definitions of hypertension utilizing combinations of standardized cutoff percentiles, durations, initiation or dose escalation of antihypertensives, and/or billing diagnosis codes for hypertension were compared using receiver operator characteristic curves against a manual medical record review. Multivariable logistic and linear regression analyses were conducted using the selected definition of hypertension to assess its independent association with AKI and PICU LOS, respectively. A definition requiring 3 systolic and/or diastolic readings above standardized 99th percentiles plus 5 mmHg over 1 day was selected (area under the curve 0.91, sensitivity 94%, specificity 87%). Among the 1,215 patients in this analysis, the prevalence of hypertension was 25%. Hypertension was independently associated with AKI (OR 2.89, 95% CI 1.64–5.09, Phypertension group—but were statistically different (P=0.02). Conclusions Hypertension is common in the PICU and is associated with worse clinical outcomes. Future studies are needed to confirm these results. PMID:24717906

  4. Bacterial diversity in two Neonatal Intensive Care Units (NICUs.

    Directory of Open Access Journals (Sweden)

    Krissi M Hewitt

    Full Text Available Infants in Neonatal Intensive Care Units (NICUs are particularly susceptible to opportunistic infection. Infected infants have high mortality rates, and survivors often suffer life-long neurological disorders. The causes of many NICU infections go undiagnosed, and there is debate as to the importance of inanimate hospital environments (IHEs in the spread of infections. We used culture-independent next-generation sequencing to survey bacterial diversity in two San Diego NICUs and to track the sources of microbes in these environments. Thirty IHE samples were collected from two Level-Three NICU facilities. We extracted DNA from these samples and amplified the bacterial small subunit (16S ribosomal RNA gene sequence using 'universal' barcoded primers. The purified PCR products were pooled into a single reaction for pyrosequencing, and the data were analyzed using QIIME. On average, we detected 93+/-39 (mean +/- standard deviation bacterial genera per sample in NICU IHEs. Many of the bacterial genera included known opportunistic pathogens, and many were skin-associated (e.g., Propionibacterium. In one NICU, we also detected fecal coliform bacteria (Enterobacteriales in a high proportion of the surface samples. Comparison of these NICU-derived sequences to previously published high-throughput 16S rRNA amplicon studies of other indoor environments (offices, restrooms and healthcare facilities, as well as human- and soil-associated environments, found the majority of the NICU samples to be similar to typical building surface and air samples, with the notable exception of the IHEs which were dominated by Enterobacteriaceae. Our findings provide evidence that NICU IHEs harbor a high diversity of human-associated bacteria and demonstrate the potential utility of molecular methods for identifying and tracking bacterial diversity in NICUs.

  5. Radiation Dose to Newborns in Neonatal Intensive Care Units

    International Nuclear Information System (INIS)

    Bahreyni Toossi, M. T.; Malekzadeh, M.

    2012-01-01

    With the increase of X-ray use for medical diagnostic purposes, knowing the given doses is necessary in patients for comparison with reference levels. The concept of reference doses or diagnostic reference levels has been developed as a practical aid in the optimization of patient protection in diagnostic radiology. To assess the radiation doses to neonates from diagnostic radiography (chest and abdomen). This study has been carried out in the neonatal intensive care unit of a province in Iran. Entrance surface dose was measured directly with thermoluminescent dosimeters. The population included 195 neonates admitted for a diagnostic radiography, in eight NICUs of different hospital types. The mean entrance surface dose for chest and abdomen examinations were 76.3 μGy and 61.5 μGy, respectively. Diagnostic reference levels for neonate in NICUs of the province were 88 μGy for chest and 98 μGy for abdomen examinations that were slightly higher than other studies. Risk of death due to radiation cancer incidence of abdomens examination was equal to 1.88 × 10 -6 for male and 4.43 × 10 -6 for female. For chest X-ray, it was equal to 2.54 × 10 -6 for male and 1.17 × 10 -5 for female patients. Diagnostic reference levels for neonates in our province were slightly higher than values reported by other studies such as European national diagnostic reference levels and the NRPB reference dose. The main reason was related to using a high mAs and a low kVp applied in most departments and also a low focus film distance. Probably lack of collimation also affected some exams in the NICUs.

  6. Fatigue in family caregivers of adult intensive care unit survivors.

    Science.gov (United States)

    Choi, JiYeon; Tate, Judith A; Hoffman, Leslie A; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P; Given, Barbara A; Sherwood, Paula R

    2014-09-01

    Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers' physical health can assist in identifying critical time points and potential targets for intervention. To describe self-reported fatigue in caregivers of ICU survivors from patients' ICU admission to ≤ 2 weeks, two- and four-months post-ICU discharge. Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form 36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution). Forty-seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43%-53% of caregivers across the time points, and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients' symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued. In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Patient ethnicity and three psychiatric intensive care units compared: the Tompkins Acute Ward Study

    NARCIS (Netherlands)

    Bowers, L.; Simpson, A.; Nijman, H.L.I.; Hall, C.

    2008-01-01

    Psychiatric care units provide care to disturbed patients in a context of higher security and staffing levels. Although such units are numerous, few systematic comparisons have been made, and there are indications that ethnic minority groups may be over-represented. The aim of this study was to

  8. The Magnitude and Time Course of Muscle Cross-section Decrease in Intensive Care Unit Patients

    NARCIS (Netherlands)

    Haaf, D. Ten; Hemmen, B.; Meent, H. van de; Bovend'Eerdt, T.J.H.

    2017-01-01

    OBJECTIVE: Bedriddenness and immobilization of patients at an intensive care unit may result in muscle atrophy and devaluation in quality of life. The exact effect of immobilization on intensive care unit patients is not known. The aim of this study was to investigate the magnitude and time course

  9. Partnering With a Family Advisor to Improve Communication in a Pediatric Intensive Care Unit.

    Science.gov (United States)

    Czulada, Laura; Leino, Patience; Willis, Tina Schade

    2016-11-01

    Inadequate communication between medical teams and families can lead to errors and poor-quality care. The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased mean documented communication rate from 13% pre intervention to 65% post intervention that was sustained for more than 2 years (P < .001). Including a family advisor as an equal member of an improvement team provides family empowerment and a greater chance of success in complex areas. © The Author(s) 2015.

  10. Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery.

    Science.gov (United States)

    Vergales, Jeffrey; Addison, Nancy; Vendittelli, Analise; Nicholson, Evelyn; Carver, D Jeannean; Stemland, Christopher; Hoke, Tracey; Gangemi, James

    2015-01-01

    The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity. © 2014 by the American College of Medical Quality.

  11. The advantages and disadvantages of encouraging consumerist notions of health care at two minor injury units.

    Science.gov (United States)

    Sturgeon, David

    2018-03-22

    Over the past four decades, UK governments have moved towards an increasingly pro-market model of healthcare provision. Under this system, patients are not only encouraged, but expected, to take increasing responsibility for healthcare decision-making and the risks that it might entail. This article investigate how and why patients make choices about their health care and how service providers help facilitate this. Between October 2014 and May 2015, the researcher was embedded as an emergency nurse practitioner at two minor injury units in order to undertake direct and participant observation. During this time, 40 patients, 17 service providers and 1 senior manager also consented to semi-structured interview. The findings suggest that patients should continue to be encouraged to make decisions about their health care, but only if they feel confident to do so. The challenge for service providers is to recognise when this is or is not appropriate and tailor interaction accordingly.

  12. Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the intensive care units

    Directory of Open Access Journals (Sweden)

    Saiede Masomeh Tabaeian

    2017-01-01

    Full Text Available Introduction: Ventilator-associated pneumonia (VAP is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units. Materials and Methods: In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist. Results: The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001. Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis. Conclusions: Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.

  13. Analysis of death anxiety levels in nursing staff of critical care units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2011-01-01

    Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.

  14. Catheter Related Blood Stream Infections In Patients Of The Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Carolina Coimbra de Castro

    2017-07-01

    Full Text Available Objective: To identify the prevalence of bloodstream infection associated with the Catheter related Blood stream infections in patients of the Intensive Care Unit, and the characteristics of its use and handling. Methods: Descriptive and transversal study with a sample of 88 participants. Data were collected through the observational method and the records in the medical records. The absolute and relative frequencies were used for data analysis. Results: 73.86% of the patients had central venous access in the subclavian vein, 100% used double lumen Catheter related Blood stream infections, 0.5% chlorhexidine solution for skin antisepsis, dressing coverage is performed mostly with Sterile gauze and tape, with a daily exchange. The rate of infection related to the use of the Catheter related Blood stream infections was (6.81%. The most infused pharmacological drugs were antimicrobials (69.32%. Conclusion: The study showed that care with central venous accesses is performed according to recommendations for prevention of bloodstream infection related to the use of these devices. The infection rate is close to the standards found in the literature. Key words: Central Venous Catheterization. Hospital Infection. Intensive care unit. Risk factors. Catheter-Related Infection..

  15. An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit.

    Science.gov (United States)

    Wong, Rowena S Y; Ismail, Noor Azina; Tan, Cheng Cheng

    2015-04-01

    Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU. A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration. APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P discrimination was not affected. APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

  16. Open intensive care units: a global challenge for patients, relatives, and critical care teams.

    Science.gov (United States)

    Cappellini, Elena; Bambi, Stefano; Lucchini, Alberto; Milanesio, Erika

    2014-01-01

    The aims of this study were to describe the current status of intensive care unit (ICU) visiting hours policies internationally and to explore the influence of ICUs' open visiting policies on patients', visitors', and staff perceptions, as well as on patients' outcomes. A review of the literature was done through MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The following keywords were searched: "visiting," "hours," "ICU," "policy," and "intensive care unit." Inclusion criteria for the review were original research paper, adult ICU, articles published in the last 10 years, English or Italian language, and available abstract. Twenty-nine original articles, mainly descriptive studies, were selected and retrieved. In international literature, there is a wide variability about open visiting policies in ICUs. The highest percentage of open ICUs is reported in Sweden (70%), whereas in Italy there is the lowest rate (1%). Visiting hours policies and number of allowed relatives are variable, from limits of short precise segments to 24 hours and usually 2 visitors. Open ICUs policy/guidelines acknowledge concerns with visitor hand washing to prevent the risk of infection transmission to patients. Patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses. The percentages of open ICUs are very different among countries. It can be due to local factors, cultural differences, and lack of legislation or hospital policy. There is a need for more studies about the impact of open ICUs programs on patients' mortality, length of stay, infections' risk, and the mental health of patients and their relatives.

  17. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit.

    Science.gov (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M

    2012-02-01

    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  18. Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

    Science.gov (United States)

    Haenke, Roger; Stichler, Jaynelle F

    2015-04-01

    Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

  19. Consumer Education: A Teaching-Learning Unit on Consumer Health Care.

    Science.gov (United States)

    Tennessee Univ., Knoxville.

    This health education handbook covers the following topics: (1) the consumer and health care; (2) diet and nutrition; (3) additives, supplements, and health foods; (4) prescription drugs; (5) over-the-counter drugs; (6) doctors, hospitals, and surgery; and (7) providing and paying for health care. A teacher's supplement health care unit is…

  20. Use of primary care data for detecting impetigo trends, United kingdom, 1995-2010.

    Science.gov (United States)

    Shallcross, Laura J; Petersen, Irene; Rosenthal, Joe; Johnson, Anne M; Freemantle, Nick; Hayward, Andrew C

    2013-10-01

    Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995-2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases.

  1. [Complexity of care and organizational effectiveness: a survey among medical care units in nine Lombardy region hospitals].

    Science.gov (United States)

    Pasquali, Sara; Capitoni, Enrica; Tiraboschi, Giuseppina; Alborghetti, Adriana; De Luca, Giuseppe; Di Mauro, Stefania

    2017-01-01

    Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness. Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel. Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units. Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patient's satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.

  2. Impact of a clinical microbiology-intensive care consulting program in a cardiothoracic intensive care unit.

    Science.gov (United States)

    Arena, Fabio; Scolletta, Sabino; Marchetti, Luca; Galano, Angelo; Maglioni, Enivarco; Giani, Tommaso; Corsi, Elisabetta; Lombardi, Silvia; Biagioli, Bonizella; Rossolini, Gian Maria

    2015-09-01

    A preintervention-postintervention study was carried out over a 4-year period to assess the impact of an antimicrobial stewardship intervention, based on clinical microbiologist ward rounds (clinical microbiology-intensive care partnership [CMICP]), at a cardiothoracic intensive care unit. Comparison of clinical data for 37 patients with diagnosis of bacteremia (18 from preintervention period, 19 from postintervention period) revealed that CMICP implementation resulted in (1) significant increase of appropriate empirical treatments (+34%, P = .029), compliance with guidelines (+28%, P = .019), and number of de-escalations (+42%, P = .032); and (2) decrease (average = 2.5 days) in time to optimization of antimicrobial therapy and levofloxacin (Δ 2009-2012 = -74 defined daily dose [DDD]/1,000 bed days) and teicoplanin (Δ 2009-2012 = -28 DDD/1,000 bed days) use. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. [Immobility syndrome in patients being care for in a home care unit].

    Science.gov (United States)

    Vázquez Pedrazuela, C; Lázaro del Nogal, M; Verdejo Bravo, C; Royuela Arte, T; Torrijos Torrijos, M; Ribera Casado, J M

    1995-10-01

    to asses in a group of elderly patients included in a Home Care Unit, the level of immobility, the functional status based on the Katz's index and the Red Cross scale, and their medical, psychological and social consequences. assessment of elderly patients visited during three consecutive months, through and standardized protocol with 14 items related with the previous aspects. 114 elderly patients (71% females) were visited during this time. The mean age was 82.4 years. 71 patients (65.7%) had immobility, with a mean age of 83.4 years and females predominance. Based on the level of immobility, 24 patients were in bed and 44 patients were able to be in bed-armchair. 74% of the patients were severely disabled on the activities daily living (Katz G); 85% of the patients had a severe physical disability (Red Cross scale 4-5), whereas a lower percentage (36%) had severe mental disability (Red Cross scale 4-5). Neurological disorders were the most frequent etiology of immobility (72%), with only one cause in 27 patients, two causes in 20 patients and more than three causes in 24 patients. Medical consequences were the most frequent, mainly urinary and chest infections, pressure sores and constipation. Immobility's syndrome represents a common medical problem in the geriatric care, related specially with the neurological and osteo-articular disorders, conditioning a high mobility.

  4. Improving delirium care in the intensive care unit: The design of a pragmatic study

    Directory of Open Access Journals (Sweden)

    Hui Siu L

    2011-06-01

    Full Text Available Abstract Background Delirium prevalence in the intensive care unit (ICU is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms. Methods/Design This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1 delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98 and (2 delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU. The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence and pharmacist (human intelligence decision support system to increase adherence to the PMD protocol. Discussion The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU. Trial Registration ClinicalTrials.gov: NCT00842608

  5. Prevention of nosocomial infections in intensive care unit and nursing practices

    Directory of Open Access Journals (Sweden)

    Sevilay Yüceer

    2009-01-01

    Full Text Available Nosocomial infections which are considered as the primary indicator of the quality of care in hospitals, cause to prolong hospitalization at intensive care unit and hospital, increase morbidity, mortality, and the cost of treatment. Although only 5-10% of the patients are treated in the intensive care units, 20-25% of all nosocomial infections are seen in these units. Preventing nosocomial infections in intensive care units is a process started at the patient acceptance to unit that requires an interdisciplinary team approach of intensive care staffs’ and Infection Control Committee members.Intensive care nurses who are in constant contact with patients have important responsibilities in preventing nosocomial infections. Intensive care nurses should be aware that the nosocomial infections can be prevented. They should have current knowledge about universal precautions related to prevention and control of infections, which are accepted by the entire world and they reinforce this knowledge by practice and should provide the most effective care to patients.In this article, nursing practices for prevention of nosocomial infections in intensive care units are discussed based on universal precautions.

  6. Markets and medicine: the politics of health care reform in Britain, Germany, and the United States

    National Research Council Canada - National Science Library

    Giaimo, Susan

    2002-01-01

    ...: The Limits of Markets in Health Care 193 Appendix: Information on Interviews and Methodology 225 Notes 233 Bibliography 263 Index 293 List of TablesTables I. Physicians' Earnings Relative to Other Occupations in the United Kingdom, Germany, and the United States, 1965-92 13 2. Physicians' Mean Gross Income in the United Kingdom, Germany, and...

  7. Quality of life after stay in surgical intensive care unit.

    Science.gov (United States)

    Abelha, Fernando J; Santos, Cristina C; Maia, Paula C; Castro, Maria A; Barros, Henrique

    2007-07-24

    In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01-1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31-6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04-5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1

  8. Acute Kidney Injury in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Petar Kes

    2010-04-01

    Full Text Available Acute kidney injury (AKI is a common clinical syndrome with a broad aetiological profile. It complicates about 5% of hospital admissions and 30% of admissions to intensive care units (ICU. During last 20 years has been a significant change in the spectrum of severe AKI such that it is no longer mostly a single organ phenomenon but rather a complex multisystem clinical problem. Despite great advances in renal replacement technique (RRT, mortality from AKI, when part of MOF, remains over 50%. The changing nature of AKI requires a new approach using the new advanced technology. Clinicians can provide therapies tailored to time constraints (intermittent, continuous, or extended intermittent, haemodynamic, and metabolic requirements and aimed at molecules of variable molecular weight. Peritoneal dialysis (PD is technically the simplest form of RRT and is still commonly used worldwide. The problems include difficulty in maintaining dialysate flow, peritoneal infection, leakage, protein losses, and restricted ability to clear fluid and uraemic wastes. PD is the preferred treatment modality for AKI in pediatric practice. Patients that are hemodynamically stable can be managed with intermittent hemodyalisis (IHD, whereby relatively short (3 to 4 h dialysis sessions may be performed every day or every other day. Patients who are haemodynamically unstable are best managed using continuous renal replacement therapies (CRRT, which allow for continuous fine-tuning of intravascular volume, easier correction of hypervolemia, better solute removal, more accurately correction of metabolic acidosis, and offers possibilities for unlimited energy support. Recently, “hybrid” or sustained low-efficiency dialysis (SLED was introduced as a method which combines the advantages of IHD with those of CRRT. In this technique, classic dialysis hardware is used at low blood and dialysate flow rates, for prolonged period of time (6 to 12 h/day. SLED offers more haemodynamic

  9. A systematic review of instruments for assessing parent satisfaction with family-centred care in neonatal intensive care units.

    Science.gov (United States)

    Dall'Oglio, Immacolata; Mascolo, Rachele; Gawronski, Orsola; Tiozzo, Emanuela; Portanova, Anna; Ragni, Angela; Alvaro, Rosaria; Rocco, Gennaro; Latour, Jos M

    2018-03-01

    This systematic review synthesised and described instruments measuring parent satisfaction with the increasing standard practice of family-centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire, and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity. Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  10. Reduction of noise in the neonatal intensive care unit using sound-activated noise meters.

    Science.gov (United States)

    Wang, D; Aubertin, C; Barrowman, N; Moreau, K; Dunn, S; Harrold, J

    2014-11-01

    To determine if sound-activated noise meters providing direct audit and visual feedback can reduce sound levels in a level 3 neonatal intensive care unit (NICU). Sound levels (in dB) were compared between a 2-month period with noise meters present but without visual signal fluctuation and a subsequent 2 months with the noise meters providing direct audit and visual feedback. There was a significant increase in the percentage of time the sound level in the NICU was below 50 dB across all patient care areas (9.9%, 8.9% and 7.3%). This improvement was not observed in the desk area where there are no admitted patients. There was no change in the percentage of time the NICU was below 45 or 55 dB. Sound-activated noise meters seem effective in reducing sound levels in patient care areas. Conversations may have moved to non-patient care areas preventing a similar change there. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Do critical care units play a role in the management of gynaecological oncology patients? The contribution of gynaecologic oncologist in running critical care units.

    Science.gov (United States)

    Davidovic-Grigoraki, Miona; Thomakos, Nikolaos; Haidopoulos, Dimitrios; Vlahos, Giorgos; Rodolakis, Alexandros

    2017-03-01

    Routine post-operative care in high dependency unit (HDU), surgical intensive care unit (SICU) and intensive care unit (ICU) after high-risk gynaecological oncology surgical procedures may allow for greater recognition and correct management of post-operative complications, thereby reducing long-term morbidity and mortality. On the other hand, unnecessary admissions to these units lead to increased morbidity - nosocomial infections, increased length of hospital stay and higher hospital costs. Gynaecological oncology surgeons continue to look after their patient in the HDU/SICU and have the final role in decision-making on day-to-day basis, making it important to be well versed in critical care management and ensure the best care for their patients. Post-operative monitoring and the presence of comorbid illnesses are the most common reasons for admission to the HDU/SICU. Elderly and malnutritioned patients, as well as, bowel resection, blood loss or greater fluid resuscitation during the surgery have prolonged HDU/SICU stay. Patients with ovarian cancer have a worse survival outcome than the patients with other types of gynaecological cancer. Dependency care is a part of surgical management and it should be incorporated formally into gynaecologic oncology training programme. © 2016 John Wiley & Sons Ltd.

  12. Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center - an Indian perspective.

    Science.gov (United States)

    Samudrala, Suvarna; Dandakeri, Sukumar; Bhat, Ramesh M

    2018-05-01

    Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5-8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit. A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed. A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%). This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India. © 2018 The International Society of Dermatology.

  13. The role of health information technology in care coordination in the United States.

    Science.gov (United States)

    Hsiao, Chun-Ju; King, Jennifer; Hing, Esther; Simon, Alan E

    2015-02-01

    Examine the extent to which office-based physicians in the United States receive patient health information necessary to coordinate care across settings and determine whether receipt of information needed to coordinate care is associated with use of health information technology (HIT) (defined by presence or absence of electronic health record system and electronic sharing of information). Cross-sectional study using the 2012 National Electronic Health Records Survey (65% weighted response rate). Office-based physicians. Use of HIT and 3 types of patient health information needed to coordinate care. In 2012, 64% of physicians routinely received the results of a patient's consultation with a provider outside of their practice, whereas 46% routinely received a patient's history and reason for a referred consultation from a provider outside of their practice. About 54% of physicians reported routinely receiving a patient's hospital discharge information. In adjusted analysis, significant differences in receiving necessary information were observed by use of HIT. Compared with those not using HIT, a lower percentage of physicians who used an electronic health record system and shared patient health information electronically failed to receive the results of outside consultations or patient's history and reason for a referred consultation. No significant differences were observed for the receipt of hospital discharge information by use of HIT. Among physicians routinely receiving information needed for care coordination, at least 54% of them did not receive the information electronically. Although a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT, more than one third did not routinely receive the needed patient information at all.

  14. [Incidence of multi-resistant bacteria in Intensive Care Units of Chilean hospitals].

    Science.gov (United States)

    Acuña, M Paz; Cifuentes, Marcela; Silva, Francisco; Rojas, Álvaro; Cerda, Jaime; Labarca, Jaime

    2017-12-01

    Incidence of multi-resistant bacteria is an indicator that permits better estimation of the magnitude of bacterial resistance in hospitals. To evaluate the incidence of relevant multi-drug resistant bacteria in intensive care units (ICUs) of Chile. Participating hospitals submitted information about the number of isolates from infected or colonized patients with 7 epidemiologically relevant multi-resistant bacteria in adult and pediatric ICUs between January 1, 2014 and October 31, 2015 and the number of bed days occupied in these units in the same period was requested. With these data incidence was calculated per 1,000 patient days for each unit. Information from 20 adults and 9 pediatric ICUs was reviewed. In adult ICUs the bacteria with the highest incidence were K. pneumoniae ESBL [4.72 × 1,000 patient day (1.21-13.89)] and oxacillin -resistant S. aureus [3.85 (0.71-12.66)]. In the pediatric units the incidence was lower, highlighting K. pneumoniae ESBL [2.71 (0-7.11)] and carbapenem -resistant P. aeruginosa [1.61 (0.31-9.25)]. Important differences between hospitals in the incidence of these bacteria were observed. Incidence of multi-resistant bacteria in adult ICU was significantly higher than in pediatric ICU for most of the studied bacterias.

  15. Nurses\\' perception of caring behaviors in intensive care units in hospitals of Lorestan University of Medical Sciences, Iran

    Directory of Open Access Journals (Sweden)

    Asadi SE

    2014-11-01

    Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting

  16. Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

    Science.gov (United States)

    Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai

    2017-01-01

    The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ 2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ 2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

  17. Quality of pharmaceutical care at the pharmacy counter : Patients’ experiences versus video observation

    NARCIS (Netherlands)

    Koster, Ellen S.; Blom, Lyda; Overbeeke, Marloes R.; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

    2016-01-01

    Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods: Pharmaceutical

  18. Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation.

    NARCIS (Netherlands)

    Koster, E.S.; Blom, L.; Overbeeke, M.R.; Philbert, D.; Vervloet, M.; Koopman, L.; Dijk, L. van

    2016-01-01

    Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods: Pharmaceutical

  19. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nalan Muhammedoğlu

    2014-09-01

    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years. There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc. and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9% and individuals of young age (median age: 27.45 years. Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7

  20. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities.

    Science.gov (United States)

    Zanoni, Brian C; Mayer, Kenneth H

    2014-03-01

    Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIV-infected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.

  1. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

  2. Views of parents and health-care providers regarding parental presence at bedside rounds in a neonatal intensive care unit.

    Science.gov (United States)

    Grzyb, M J; Coo, H; Rühland, L; Dow, K

    2014-02-01

    To examine the views of parents and health-care providers regarding parental presence during neonatal intensive care rounds. Cross-sectional survey of parents whose children were admitted to a tertiary-care neonatal intensive care unit (n=81). Medical trainees (n=67) and nurses (n=28) were also surveyed. The majority of parents reported that attending rounds reduced their anxiety and increased their confidence in the health-care team. Nurses were more likely than medical trainees to support parental presence at rounds (P=0.02). About three-quarters of medical trainees and nurses thought discussion is inhibited and 69% of trainees felt teaching is decreased when parents attend rounds. Most parents who attended rounds found the experience beneficial, but medical trainees' views were mixed. The positive impact on parents, and the learning opportunities created in family-centered care and communication when parents are present on rounds, should be highlighted for trainees and other neonatal intensive care personnel.

  3. Estimating the cost-effectiveness of stroke units in France compared with conventional care.

    Science.gov (United States)

    Launois, R; Giroud, M; Mégnigbêto, A C; Le Lay, K; Présenté, G; Mahagne, M H; Durand, I; Gaudin, A F

    2004-03-01

    The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

  4. Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States.

    Science.gov (United States)

    Mizuno, Yuko; Frazier, Emma L; Huang, Ping; Skarbinski, Jacek

    2015-09-01

    Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.

  5. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  6. Unit root tests for cross-sectionally dependent panels : The influence of observed factors

    NARCIS (Netherlands)

    Becheri, I.G.; Drost, F.C.; van den Akker, R.

    This paper considers a heterogeneous panel unit root model with cross-sectional dependence generated by a factor structure—the factor common to all units being an observed covariate. The model is shown to be Locally Asymptotically Mixed Normal (LAMN), with the random part of the limiting Fisher

  7. Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit.

    Science.gov (United States)

    Salzmann-Erikson, Martin

    2018-06-22

    Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness. © 2018 Australian College of Mental Health Nurses Inc.

  8. Time Series Analysis for Forecasting Hospital Census: Application to the Neonatal Intensive Care Unit.

    Science.gov (United States)

    Capan, Muge; Hoover, Stephen; Jackson, Eric V; Paul, David; Locke, Robert

    2016-01-01

    Accurate prediction of future patient census in hospital units is essential for patient safety, health outcomes, and resource planning. Forecasting census in the Neonatal Intensive Care Unit (NICU) is particularly challenging due to limited ability to control the census and clinical trajectories. The fixed average census approach, using average census from previous year, is a forecasting alternative used in clinical practice, but has limitations due to census variations. Our objectives are to: (i) analyze the daily NICU census at a single health care facility and develop census forecasting models, (ii) explore models with and without patient data characteristics obtained at the time of admission, and (iii) evaluate accuracy of the models compared with the fixed average census approach. We used five years of retrospective daily NICU census data for model development (January 2008 - December 2012, N=1827 observations) and one year of data for validation (January - December 2013, N=365 observations). Best-fitting models of ARIMA and linear regression were applied to various 7-day prediction periods and compared using error statistics. The census showed a slightly increasing linear trend. Best fitting models included a non-seasonal model, ARIMA(1,0,0), seasonal ARIMA models, ARIMA(1,0,0)x(1,1,2)7 and ARIMA(2,1,4)x(1,1,2)14, as well as a seasonal linear regression model. Proposed forecasting models resulted on average in 36.49% improvement in forecasting accuracy compared with the fixed average census approach. Time series models provide higher prediction accuracy under different census conditions compared with the fixed average census approach. Presented methodology is easily applicable in clinical practice, can be generalized to other care settings, support short- and long-term census forecasting, and inform staff resource planning.

  9. Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness

    Directory of Open Access Journals (Sweden)

    Ahmad-Ali Asadi-Noghabi

    2015-07-01

    Full Text Available Objectives: The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU. Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness. Methods: Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT. Post-implementation of the tool, the researchers re-evaluated trained the nurses’ pain management. Results: Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient’s pain and the relief measures used. Conclusion: Use of the CPOT can increase nurse’s sensitivity to pain in non-conscious patients and drive them to track and perform pain management.

  10. Intensive care unit ventilation for the non-intensivist

    African Journals Online (AJOL)

    Mode classification: volume versus pressure targeting. There is no evidence to ... and so most modern ventilators can be set up by the technician to directly display the .... mechanics: transpulmonary pressure and lung volume. Crit Care. 2013 ...

  11. Health care in the United States: organization, management, and policy

    National Research Council Canada - National Science Library

    Greenwald, Howard P

    2010-01-01

    .... Through an accessible approach, this text clarifies the complexities of health care services and health system finance, as well as presents an overview of how all of the components fit together...

  12. Residents Living in Residential Care Facilities: United States, 2010

    Science.gov (United States)

    ... analyses, the 12% of residents chair-ridden or bedridden were defined as receiving assistance in the transferring ... MD: National Center for Health Statistics. 2011. Mollica R, Sims-Kastelein K, O'Keeffe J. Residential care ...

  13. Ethics and law in the intensive care unit.

    Science.gov (United States)

    Danbury, C M; Waldmann, C S

    2006-12-01

    Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care.

  14. Caring for our youngest: public attitudes in the United States.

    Science.gov (United States)

    Sylvester, K

    2001-01-01

    Families make choices about employment and care for their children in a context that is shaped by public policies and colored by public opinion. Debates over whether the government should increase funding for child care or do more to help parents stay home with their children reflect tensions among strongly held ideas about family life, work, and the role of government. This article summarizes the results of public opinion polls that probe attitudes about parent and government roles and responsibilities with respect to children's care. The polling findings yield three main lessons: The American public believes that parents should be the primary influence in their children's lives and that it is best if mothers can be home to care for the very young. The public also values family self-sufficiency and understands that low-income families may need child care assistance to balance child rearing and employment responsibilities. However, skepticism about the appropriateness of government involvement in family life limits public support for proposals that the government act directly to provide or improve child care. From these lessons, the author draws several conclusions for policymakers: Policies focused on caregiving should respect the rights of parents to raise their children by ensuring that an array of options is available. Public programs should help families who are struggling economically to balance their obligations to work and family. Rather than directly providing child care services, government should fund community-based child care programs, and provide flexible assistance to help families secure the services they need and want.

  15. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Nosocomial Infections in Patients Admitted in Intensive Care Unit of ...

    African Journals Online (AJOL)

    9] ... Detailed history and physical examination notes were reviewed in all ... related. UTI was related to the catheter and pneumonia to ventilator. ... protein. UTI: Urinary tract infection, CVP: Central venous pressure, CFU: Colony-forming unit,.

  17. The impact of a lean rounding process in a pediatric intensive care unit.

    Science.gov (United States)

    Vats, Atul; Goin, Kristin H; Villarreal, Monica C; Yilmaz, Tuba; Fortenberry, James D; Keskinocak, Pinar

    2012-02-01

    Poor workflow associated with physician rounding can produce inefficiencies that decrease time for essential activities, delay clinical decisions, and reduce staff and patient satisfaction. Workflow and provider resources were not optimized when a pediatric intensive care unit increased by 22,000 square feet (to 33,000) and by nine beds (to 30). Lean methods (focusing on essential processes) and scenario analysis were used to develop and implement a patient-centric standardized rounding process, which we hypothesize would lead to improved rounding efficiency, decrease required physician resources, improve satisfaction, and enhance throughput. Human factors techniques and statistical tools were used to collect and analyze observational data for 11 rounding events before and 12 rounding events after process redesign. Actions included: 1) recording rounding events, times, and patient interactions and classifying them as essential, nonessential, or nonvalue added; 2) comparing rounding duration and time per patient to determine the impact on efficiency; 3) analyzing discharge orders for timeliness; 4) conducting staff surveys to assess improvements in communication and care coordination; and 5) analyzing customer satisfaction data to evaluate impact on patient experience. Thirty-bed pediatric intensive care unit in a children's hospital with academic affiliation. Eight attending pediatric intensivists and their physician rounding teams. Eight attending physician-led teams were observed for 11 rounding events before and 12 rounding events after implementation of a standardized lean rounding process focusing on essential processes. Total rounding time decreased significantly (157 ± 35 mins before vs. 121 ± 20 mins after), through a reduction in time spent on nonessential (53 ± 30 vs. 9 ± 6 mins) activities. The previous process required three attending physicians for an average of 157 mins (7.55 attending physician man-hours), while the new process required two

  18. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

  19. Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

    Science.gov (United States)

    Reddy, Anita J; Guzman, Jorge A

    2016-11-01

    Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

  20. Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

    Directory of Open Access Journals (Sweden)

    Zineb Lachhab

    2017-01-01

    Full Text Available Objectives. We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU of Mohammed V Military Teaching Hospital of Rabat (Morocco. Methods. The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance. Results. During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases with Acinetobacter baumannii being the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs in Enterobacteriaceae and 100% of carbapenemase in Acinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases. Conclusions. Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

  1. Prospective cohort study on noise levels in a pediatric cardiac intensive care unit.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Sheppard, Cathy; Pugh, Jodie; Moez, Elham Khodayari; Dinu, Irina A; Jou, Hsing; Hartling, Lisa; Vohra, Sunita

    2018-04-01

    To describe noise levels in a pediatric cardiac intensive care unit, and to determine the relationship between sound levels and patient sedation requirements. Prospective observational study at a pediatric cardiac intensive care unit (PCICU). Sound levels were measured continuously in slow A weighted decibels dB(A) with a sound level meter SoundEarPro® during a 4-week period. Sedation requirement was assessed using the number of intermittent (PRNs) doses given per hour. Analysis was conducted with autoregressive moving average models and the Granger test for causality. 39 children were included in the study. The average (SD) sound level in the open area was 59.4 (2.5) dB(A) with a statistically significant but clinically unimportant difference between day/night hours (60.1 vs. 58.6; p-value noise levels were > 90 dB. There was a significant association between average (p-value = 0.030) and peak sound levels (p-value = 0.006), and number of sedation PRNs. Sound levels were above the recommended values with no differences between day/night or open area/single room. High sound levels were significantly associated with sedation requirements. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

    Science.gov (United States)

    van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

    2016-05-01

    Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Feelings of women accompanying children hospitalized in a Paediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Cassiana Mendes Bertoncello Fontes

    2017-03-01

    Full Text Available Objective: Analise feelings of women accompanying children in a paediatric intensive care unit Materials and Methods: Data were collected from August to October 2015 by the authors from individual interviews recorded with 15 women. The instrument was structured with the identification of qualitative variables, described in absolute and relative frequencies, and a guiding question. The "corpus" of each interview was electronically transcribed, floating readings were held and statements were categorized and analysed according Analise Content.  Results: 14 (93% are biological mothers; average age 30 years; 11 (73% have completed primary education; six (46% have an occupation or a profession. The four themes were inferred: ambivalence of feelings and coping were related to how individuals express and deal with the hospitalized patient’s situation; empathy with the health team and the structural condition of the critical environment can also generate feelings. Nursing diagnoses were formulated from the reported feelings. Conclusion: It was observed that the feelings identified could be originated by the health-illness hospitalization process as well as the structural components of the critical environment. Keywords: Paediatric Intensive Care Units; Women; Feelings.

  4. Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.

    Science.gov (United States)

    Sánchez-Carrillo, Laura Arelí; Rodríguez-López, Juan Manuel; Galarza-Delgado, Dionisio Ángel; Baena-Trejo, Laura; Padilla-Orozco, Magaly; Mendoza-Flores, Lidia; Camacho-Ortiz, Adrián

    2016-08-01

    The importance of hand hygiene in the prevention of health care-associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce. This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance. A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P hand hygiene compliance. Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Differences in nursing practice environment among US acute care unit types: a descriptive study.

    Science.gov (United States)

    Choi, JiSun; Boyle, Diane K

    2014-11-01

    The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical-surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. Cross-sectional study. 5322 nursing units in 519 US acute care hospitals. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical-surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse-physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered

  6. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  7. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

    Science.gov (United States)

    Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

    2016-01-01

    To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  8. Participation of radiotherapy in interdisciplinary palliative care units. Challenge and chance

    International Nuclear Information System (INIS)

    Momm, F.; Frommhold, H.; Becker, G.; Ewald, H.; Baumgartner, J.; Adamietz, I.A.

    2004-01-01

    Background: in Germany, a sufficient system of palliative care does not exist. Possibilities for participation of radiooncologists in the further development of this promising part of medical action are reported. Material and methods: experiences from interdisciplinary work in the field of palliative care are described. This experience is communicated for use in the actual discussion about the future of palliative care in Germany, especially in the field of radiooncology. Results: a palliative care unit can only work in a team of different professions,