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Critical Care Units (critical + care_unit)
Selected AbstractsReview of patient safety incidents submitted from Critical Care Units in England & Wales to the UK National Patient Safety Agency*ANAESTHESIA, Issue 11 2009A. N. Thomas Summary We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1,268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient's death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents. [source] Intermittent and Continuous Enteral Nutrition in Critically Ill Dogs: A Prospective Randomized TrialJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2010M. Holahan Background: Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals. Objectives: To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit. Animals: Fifty-four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube. Methods: Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured. Results: PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation. Conclusions and Clinical Importance: There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding. [source] Tracheal esophageal combitube: a useful airway for morbidly obese patients who cannot intubate or ventilateACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2002A. Della Puppa The tracheal esophageal combitube has been successfully used in many difficult airway circumstances. We report the dramatic case of a morbidly obese patient with a well-known difficult airway who was successfully rescued from a cannot ventilate,cannot intubate situation in our critical care unit by using the tracheal esophageal combitube. Surgical tracheostomy was performed while she was mechanically ventilated through the tracheal esophageal combitube. The tracheal esophageal combitube is a very important device that should be kept available in all cases of morbidly obese airway management. [source] Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bedPEDIATRIC ANESTHESIA, Issue 2 2009ELI HERSHMAN MD Summary Objective:, To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed. Design:, Case report. Setting:, A tertiary pediatric critical care unit. Patient:, A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure. Interventions:, Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy. Conclusion:, In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered. [source] The role of nursing unit culture in shaping research utilization behaviors,RESEARCH IN NURSING & HEALTH, Issue 4 2008Shannon D. Scott Abstract We conducted a focused ethnography of a pediatric critical care unit to examine the role of nursing unit culture related to research utilization. Four significant aspects of the unit culture shaped nurses' research utilization. A hierarchical structure of authority, routinized and technology-driven work at the bedside, a workplace ethos that discouraged innovation, and an emphasis on clinical experience acted together to teach nurses both that they were to do as they were told and that they were not expected to use research. Nurses perceived that the behaviors expected of them were arbitrarily determined by physicians and managers in charge. Consequently, they were reluctant to step outside of routine and physician-ordered nursing care. This left little opportunity for research utilization. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:298,309, 2008 [source] Brachial plexopathy as a complication of induced hypothermia following cardiac arrestANAESTHESIA, Issue 10 2010C. L. Hammell Summary Induced hypothermia following cardiac arrest is a common treatment in the critical care unit. Topical cooling measures are easy to initiate and widely utilised. We report a case of brachial plexopathy occurring in association with topical cooling measures and discuss the diagnosis, management and avoidance of such complications. [source] Pandemic (H1N1) 2009 influenza: experience from the critical care unitANAESTHESIA, Issue 11 2009M. Patel Summary This case series details experience of critical care admissions with pandemic (H1N1) 2009 influenza from an intensive care unit in the West Midlands. We present four critically ill patients admitted with severe hypoxia. Two of the patients failed a trial of continuous positive airway pressure and all underwent controlled ventilation within 24 h of admission. Bilevel and high frequency oscillatory ventilation were the most useful modes. Our patients generally had one organ failure and were ventilator dependent for relatively short periods of time. Three of the patients made a full recovery and one required ongoing dialysis. We also discuss service planning and our response to the pandemic. We were well prepared with stocks of personal protective equipment but had to modify plans as the outbreak progressed. Our cases and discussion provide useful information for other intensive care units preparing for the predicted autumn surge of H1N1 cases. [source] Refractory thrombotic thrombocytopenic purpura following influenza vaccinationANAESTHESIA, Issue 4 2009P. J. Dias Summary Thrombotic thrombocytopenic purpura (TTP) is characterised by the systemic microvascular aggregation of platelets causing ischaemia of the brain and other organs. We describe the case of a 54 year-old man who presented with neurological signs, fever, severe thrombocytopenia, microangiopathic haemolytic anaemia and renal failure 5 days after receiving an influenza vaccination. He was diagnosed with acute refractory TTP caused by autoantibody-mediated ADAMTS-13 deficiency. He required stabilisation on the critical care unit before being successfully treated with 3 l plasma exchanges for 21 days and rituximab (MabThera®) at a dose of 375 mg.m,2, given weekly for a total of 4 weeks. Vaccination is an important part of preventative medicine and reduces morbidity and mortality. Only in a few rare cases has vaccination been associated with autoimmune pathology. We could find only one similar case report of thrombotic thrombocytopenic purpura following influenza vaccination. In addition to plasma exchange, rituximab appears to be effective and well tolerated in the treatment of refractory thrombotic thrombocytopenic purpura. [source] Survival to discharge among patients treated with CRRTHEMODIALYSIS INTERNATIONAL, Issue 1 2005R. Wald Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute renal failure (ARF). The survival of patients who require CRRT and the factors predicting their outcomes are not well defined. We sought to identify clinical features to predict survival in patients treated with CRRT. We reviewed the charts of all patients who received CRRT at the Toronto General Hospital during the year 2002. Our cohort (n = 85) represented 97% of patients treated with this modality in 3 critical care units. We identified demographic variables, underlying diagnoses, transplantation status, location (medical-surgical, coronary or cardiovascular surgery intensive care units), CRRT duration, baseline creatinine clearance (CrCl), and presence of oliguria (<400 ml/d) on the day of CRRT initiation. The principal outcome was survival to hospital discharge. Among those alive at discharge, we assessed whether there was an ongoing need for renal replacement therapy. Greater than one-third (38%, 32/85) of patients survived to hospital discharge. Three (9%) of the survivors remained dialysis-dependent at the time of discharge. Survivors were younger than non-survivors (mean age 56 vs 60 y.), were on CRRT for a shorter duration (7 vs 13 d.), and had a higher baseline CrCl (79 vs 68 ml/min). Patient survival varied among different critical care units (medical surgical 33%, coronary 38%, and cardiovascular surgery 45%). Multivariable logistic regression revealed that shorter duration of CRRT, non-oliguria, and baseline CrCl > 60 ml/min were independently associated with survival to hospital discharge (p < 0.05). Critically ill patients with ARF who require CRRT continue to have high in-hospital mortality. A shorter period of CRRT dependence, non-oliguria, and higher baseline renal function may predict a more favorable prognosis. The majority of CRRT patients who survive their critical illness are independent from dialysis at the time of hospital discharge. [source] The challenges of caring in a technological environment: critical care nurses' experiencesJOURNAL OF CLINICAL NURSING, Issue 8 2008ITU cert, Mary McGrath MSc Purpose., This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. Background., While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how ,high tech' and ,high touch' are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years' experience in the critical care area. Method., Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. Findings., The findings provide research-based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life-saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: ,alien environment', ,pulling together' and ,sharing the journey' were linked by a common thread of caring. Conclusion., Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice., It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration. [source] Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approachesJOURNAL OF NURSING MANAGEMENT, Issue 5 2004PG Dip., Renee Adomat BA (Hons) Background, A huge range of patient classification systems/tools are used in critical care units to inform workforce planning, however, they are not always applied appropriately. Many of these systems/tools were not originally developed for the purposes of workforce planning and so their use in determining the nurse:patient ratio required in critical care settings raises a number of issues for the organisation and management of these services. Aim, The aim of this paper is to review the three main assessment systems that are commonly used in critical care settings in the UK and evaluate their effectiveness in accurately determining nurse : patient ratios. If the application of these systems/tools is to enhance care, a thorough understanding of their origins and purpose is necessary. If this is lacking, then decisions relating to workload planning, particularly when calculating nurse : patient ratios, may be flawed. Conclusions, Patient dependency/classification systems and patient dependency scoring systems for severity of illness are robust measures for predicting morbidity and mortality. However, they are not accurate if used to calculate nurse : patient ratios because they are not designed to measure nursing input. Nursing intensity measures provide a useful framework for calculating the cost of providing a nursing service in critical care and can serve as a measure of nursing input, albeit a fairly basic one. However, many components of the nursing role are not ,accounted' for in these measures. Implications, The implications of these findings for the organization and management of critical care services are discussed. Careful consideration of these areas is vital if a cost efficient and cost-effective critical care service is to be delivered. [source] Exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit: a mixed methods studyNURSING IN CRITICAL CARE, Issue 2 2009Donna Goodridge Abstract Rationale for the study:, Improving the quality of end-of-life (EOL) care in critical care settings is a high priority. Patients with advanced chronic obstructive pulmonary disease (COPD) are frequently admitted to and die in critical care units. To date, there has been little research examining the quality of EOL care for this unique subpopulation of critical care patients. Aims:, The aims of this study were (a) to examine critical care clinician perspectives on the quality of dying of patients with COPD and (b) to compare nurse ratings of the quality of dying and death between patients with COPD with those who died from other illnesses in critical care settings. Design and sample:, A sequential mixed method design was used. Three focus groups provided data describing the EOL care provided to patients with COPD dying in the intensive care unit (ICU). Nurses caring for patients who died in the ICU completed a previously validated, cross-sectional survey (Quality of Dying and Death) rating the quality of dying for 103 patients. Data analysis:, Thematic analysis was used to analyse the focus group data. Total and item scores for 34 patients who had died in the ICU with COPD were compared with those for 69 patients who died from other causes. Results:, Three primary themes emerged from the qualitative data are as follows: managing difficult symptoms, questioning the appropriateness of care and establishing care priorities. Ratings for the quality of dying were significantly lower for patients with COPD than for those who died from other causes on several survey items, including dyspnoea, anxiety and the belief that the patient had been kept alive too long. The qualitative data allowed for in-depth explication of the survey results. Conclusions:, Attention to the management of dyspnoea, anxiety and treatment decision-making are priority concerns when providing EOL care in the ICU to patients with COPD. [source] An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unitNURSING IN CRITICAL CARE, Issue 6 2007Brian McFetridge Abstract The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. [source] The use of physical restraint in critical careNURSING IN CRITICAL CARE, Issue 1 2007Karen Hine Abstract Critically ill patients are at high risk for the development of delirium and agitation, resulting in non-compliance with life-saving treatment. The use of physical restraint appears to be a useful and simple solution to prevent this treatment interference. In reality, restraint is a complex topic, encompassing physical, psychological, legal and ethical issues. This article briefly discusses the incidence of delirium and agitation in critically ill patients and examines in detail the method of physical restraint to manage treatment interference. The historical background of physical restraint is discussed and the prevalence of its use in critical care units across the world examined. Studies into the use of physical restraint are analysed, and in particular the physical effects on patients discussed. The use of physical restraint raises many legal, ethical and moral questions for all health care professionals; therefore, this study aims to address these questions. This article concludes by emphasizing areas of future practice development in intensive care units throughout the UK. [source] Health care assistants' role, function and development: results of a national surveyNURSING IN CRITICAL CARE, Issue 4 2003The British Association of Critical Care NursesArticle first published online: 31 JUL 200 Summary ,,Intensive care has developed as a speciality since the 1950s; during this time there have been major technological advances in health care provision leading to a rapid expansion of all areas of critical care ,,The ongoing problem of recruiting appropriately qualified nurses has affected staffing levels in many units and continues to be a national problem. For many, the answer lies in employing health care assistants to support the work of registered nurses ,,A key aim of the British Association of Critical Care Nurses is to promote the art and science of critical care nursing by providing representation for its members, by responding to political and professional change and by producing and publishing position statements ,,A primary component of the work surrounding the development of this second position statement was the gathering of contemporary information in relation to the role of health care assistants within critical care units throughout the UK, through a survey of 645 critical care units within the UK ,,At present the impact upon the role of the critical care nurse is not fully understood, with research in this area suggesting that although there is a role for the health care assistant in the critical care environment, this should only be undertaken with a full analysis of this impact upon the work of the registered nurse [source] Review of patient safety incidents submitted from Critical Care Units in England & Wales to the UK National Patient Safety Agency*ANAESTHESIA, Issue 11 2009A. N. Thomas Summary We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1,268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient's death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents. [source] Modelling the impact of an influenza A/H1N1 pandemic on critical care demand from early pathogenicity data: the case for sentinel reportingANAESTHESIA, Issue 9 2009A. Ercole Summary Projected critical care demand for pandemic influenza H1N1 in England was estimated in this study. The effect of varying hospital admission rates under statistical uncertainty was examined. Early in a pandemic, uncertainty in epidemiological parameters leads to a wide range of credible scenarios, with projected demand ranging from insignificant to overwhelming. However, even small changes to input assumptions make the major incident scenario increasingly likely. Before any cases are admitted to hospital, 95% confidence limit on admission rates led to a range in predicted peak critical care bed occupancy of between 0% and 37% of total critical care bed capacity, half of these cases requiring ventilatory support. For hospital admission rates above 0.25%, critical care bed availability would be exceeded. Further, only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest that 30% of patients requiring critical care will be children. Paediatric intensive care facilities are likely to be quickly exhausted and suggest that older children should be managed in adult critical care units to allow resource optimisation. Crucially this study highlights the need for sentinel reporting and real-time modelling to guide rational decision making. [source] Patient safety incidents associated with airway devices in critical care: a review of reports to the UK National Patient Safety AgencyANAESTHESIA, Issue 4 2009A. N. Thomas Summary We used key words and letter sequences to identify airway-associated patient safety incidents submitted to the UK National Patient Safety Agency from critical care units in England and Wales. We identified 1085 such airway incidents submitted in the two years from October 2005 to September 2007. Three hundred and twelve incidents (28.8%) involved neonates or babies. Of the total 1085 incidents, 200 (18.4%) were associated with tracheal intubation, 53 (4.9%) with tracheostomy and 893 (82.3%) were post-procedure problems. One hundred and ten incidents (10.1%) were associated with more than temporary harm. Eighty-eight intubation incidents were associated with equipment problems. Partial displacement of tubes resulted in more than temporary harm to the patient more frequently than complete tube displacement (15.7% vs 3.8%). Capnography was not described in any cases of displacement or blockage of tracheal or tracheostomy tubes. Recommendations concerning minimum standards for capnography, availability and checking of equipment and tracheostomy placement are made. [source] Brain stem death testing after thiopental use: a survey of UK neuro critical care practice,ANAESTHESIA, Issue 11 2006O. W. Pratt Summary A postal survey was conducted to determine how thiopental is used in UK neurosurgery critical care units. Thirty units were contacted and 26 replied. Thiopental is used in 23 units. The majority (60%) of these units govern the use of thiopental with protocols or guidelines and 74% use cerebral monitoring to guide dosage. When patients have had thiopental, 20 units delay brain stem testing, two will not perform tests and one unit incorporates cerebral angiography into their protocol. Twelve units use serum thiopental assays in their brain stem testing procedures, but there is wide variation in the interpretation of the results. We found inconsistency and confusion surrounding brain stem testing in this patient group, raising the possibility of misdiagnosis of brain stem death. [source] Prescription errors in UK critical care unitsANAESTHESIA, Issue 12 2004S. A. Ridley Summary Drug prescription errors are a common cause of adverse incidents and may be largely preventable. The incidence of prescription errors in UK critical care units is unknown. The aim of this study was to collect data about prescription errors and so calculate the incidence and variation of errors nationally. Twenty-four critical care units took part in the study for a 4-week period. The total numbers of new and re-written prescriptions were recorded daily. Errors were classified according to the nature of the error. Over the 4-week period, 21 589 new prescriptions (or 15.3 new prescriptions per patient) were written. Eighty-five per cent (18 448 prescriptions) were error free, but 3141 (15%) prescriptions had one or more errors (2.2 erroneous prescriptions per patient, or 145.5 erroneous prescriptions per 1000 new prescriptions). The five most common incorrect prescriptions were for potassium chloride (10.2% errors), heparin (5.3%), magnesium sulphate (5.2%), paracetamol (3.2%) and propofol (3.1%). Most of the errors were minor or would have had no adverse effects but 618 (19.6%) errors were considered significant, serious or potentially life threatening. Four categories (not writing the order according to the British National Formulary recommendations, an ambiguous medication order, non-standard nomenclature and writing illegibly) accounted for 47.9% of all errors. Although prescription rates (and error rates) in critical care appear higher than elsewhere in hospital, the number of potentially serious errors is similar to other areas of high-risk practice. [source] | ||||||||||||||||||||||