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Quality improvement intensive care

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https://www.readbyqxmd.com/read/29151000/implementing-clinical-practice-changes-in-critical-care-lessons-learned-in-a-national-collaborative-of-over-60-icu-teams
#1
Ruth Kleinpell, Jerry J Zimmerman
Improving care in the intensive care unit (ICU) is a global area of focus for clinicians worldwide. The complexity of the ICU environment, compounded by multiple patient comorbidities and high acuity levels, makes the ICU a unique and challenging area of clinical practice. The essence of quality improvement - designing and implementing strategies to enhance care - fit well with the ICU setting. However, implementing clinical change is challenging, regardless of the clinical setting. A national collaborative targeting ICU settings was initiated which provided a number of lessons learned regarding implementing quality of care initiatives in critical care...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150180/family-centre-bereavement-practices-in-danish-intensive-care-units-a-cross-sectional-national-survey
#2
Ingrid Egerod, Gudrun Kaldan, Maureen Coombs, Marion Mitchell
BACKGROUND: Mortality in Danish intensive care units (ICUs) continues at 27%, resulting in a large number of bereaved family members being cared for in the ICU. OBJECTIVES: To investigate the provision of bereavement care and follow-up services for bereaved families in Danish ICUs. METHODOLOGY: Self-administered computerized cross-sectional nation-wide survey of Danish ICUs. RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded...
November 14, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29148635/admission-patterns-and-outcomes-in-the-medical-intensive-care-unit-of-st-paul%C3%A2-s-hospital-millennium-medical-college-addis-ababa-ethiopia
#3
Seman Kedir, Abreham Berhane, Tola Bayisa, Tewodros Wuletaw
Background: Knowledge of the characteristics and outcomes of critically ill patients admitted to Medical Intensive Care Unit (MICU) helps with identification of priorities and the resources required to improve care. The objective of this study was to examine admission patterns and outcomes in MICU at St. Paul’s Hospital Millennium Medical College. Materials: A retrospective review of 1256 patients’ case notes who were admitted to the MICU at St. Paul’s Hospital Millennium Medical College from 2007 to 2012 was carried out...
January 2017: Ethiopian Medical Journal
https://www.readbyqxmd.com/read/29144250/case-not-closed-prescription-errors-12-years-after-computerized-physician-order-entry-implementation
#4
Gili Kadmon, Michal Pinchover, Avichai Weissbach, Shirley Kogan Hazan, Elhanan Nahum
OBJECTIVE: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016)...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29143487/nurses-implementation-of-ventilator-associated-pneumonia-prevention-guidelines-an-observational-study-in-jordan
#5
Sami M Aloush
BACKGROUND: Ventilator-associated pneumonia prevention guidelines from the Center for Disease Control and Prevention, the American Thoracic Society, and the Institute for Health Care and Improvement have been published to reduce the rate of ventilator-associated pneumonia in the clinical settings; however, nurses' compliance with these guidelines is still questionable. AIMS: The purpose of this study was to assess nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that influence their compliance...
November 15, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/29141664/prevalence-and-prognosis-of-acutely-ill-patients-with-organ-failure-at-arrival-to-hospital-protocol-for-a-systematic-review
#6
Peter Bank Pedersen, Asbjorn Hrobjartsson, Daniel Lykke Nielsen, Daniel Pilsgaard Henriksen, Mikkel Brabrand, Annmarie Touborg Lassen
BACKGROUND: Acutely ill patients are a heterogeneous group, and some of these suffer from organ failure. As the prognosis of organ failure improves with early treatment, it is important to identify these patients as early as possible. Most studies on organ failure have been performed in intensive care settings, or on selected groups of patients, where a high prevalence and mortality have been reported. Before patients arrive to the intensive care unit, or the general ward, most of them have passed through the emergency department (ED), where diagnosis and treatment has been initiated...
November 15, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29139007/adding-high-intensity-interval-training-to-conventional-training-modalities-optimizing-health-related-outcomes-during-chemotherapy-for-breast-cancer-the-optitrain-randomized-controlled-trial
#7
Sara Mijwel, Malin Backman, Kate A Bolam, Anna Jervaeus, Carl Johan Sundberg, Sara Margolin, Maria Browall, Helene Rundqvist, Yvonne Wengström
PURPOSE: Exercise training is an effective and safe way to counteract cancer-related fatigue (CRF) and to improve health-related quality of life (HRQoL). High-intensity interval training has proven beneficial for the health of clinical populations. The aim of this randomized controlled trial was to compare the effects of resistance and high-intensity interval training (RT-HIIT), and moderate-intensity aerobic and high-intensity interval training (AT-HIIT) to usual care (UC) in women with breast cancer undergoing chemotherapy...
November 14, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29137035/enteral-nutrition-tube-placement-assisted-by-ultrasonography-in-patients-with-severe-acute-pancreatitis-a-novel-method-for-quality-improvement
#8
Gang Li, Yiyuan Pan, Jing Zhou, Zhihui Tong, Lu Ke, Weiqin Li
To evaluate the effect of a novel procedure using real-time ultrasonography to assist nasojejunal tube placement at bedside in patients with severe acute pancreatitis (SAP).Single center, prospective descriptive study in a 15-bed surgery intensive care unit of a university hospital. Thirty SAP patients were enrolled. The whole procedure of placing nasojejunal tube was performed by a single physician, who places nasojejunal tube at the bedside and performs ultrasonography to guide the tube positioning. The final nasojejunal tube position was confirmed by abdominal radiograph...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29135753/prevention-of-neonatal-unplanned-extubations-in-the-neonatal-intensive-care-unit-a-best-practice-implementation-project
#9
Xiaojing Hu, Yuxia Zhang, Yun Cao, Guoying Huang, Yan Hu, Alexa McArthur
BACKGROUND: Adverse events of mechanically ventilated neonates such as unplanned extubations may be associated with serious negative outcomes. Unplanned extubation rates have been monitored by many neonatal intensive care units as a quality of care metric. OBJECTIVES: The objective was to implement evidence-based best practice and assess the effects of these strategies on minimizing unplanned extubation in the neonatal intensive care unit in a large tertiary children's hospital...
November 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29132597/retrospective-review-of-pediatric-transport-where-do-our-patients-go-after-transport
#10
REVIEW
Emily Krennerich, Curtis G Sitler, Manish Shah, Fong Lam, Jeanine Graf
OBJECTIVE: This review describes disposition of transported children and identifies contributing factors affecting optimal patient placement. The study describes timing and patient placement indicators in transport patients to identify areas of improvement, re-education, and training. METHODS: A retrospective chart review for transports via our pediatric specialty transport team from January 1, 2012, to December 31, 2014, was performed. Patients were identified by the transport quality assurance performance improvement database, hospital electronic medical records, and transport medical records...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29132505/the-mobility-and-impact-of-frailty-in-the-intensive-care-unit
#11
REVIEW
Bellal Joseph, Faisal S Jehan
Prevalence of pre-existing frailty in patients admitted to the intensive care unit (ICU) is increasing. Critical illness leads to a catabolic state that further diminishes body reserves and contributes to frailty independent of age and prehospital functional status. Because early mobilization of patients in the ICU results in accelerated recovery and improvement in functional status and quality of life, frailty can severely affect the mobility of patients in ICU ultimately prolonging recovery. Understanding the concept of frailty and the association of frailty and its impact on mobility in the ICU, identifying patients, and timely resource allocation helps in optimum care and improves clinical outcomes...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29132404/comparison-of-the-efficacy-and-safety-of-fp-1201-lyo-intravenously-administered-recombinant-human-interferon-beta-1a-and-placebo-in-the-treatment-of-patients-with-moderate-or-severe-acute-respiratory-distress-syndrome-study-protocol-for-a-randomized-controlled
#12
Geoff Bellingan, David Brealey, Jordi Mancebo, Alain Mercat, Nicolò Patroniti, Ville Pettilä, Michael Quintel, Jean-Louis Vincent, Mikael Maksimow, Markku Jalkanen, Ilse Piippo, V Marco Ranieri
BACKGROUND: Acute respiratory distress syndrome (ARDS) results in vascular leakage, inflammation and respiratory failure. There are currently no approved pharmacological treatments for ARDS and standard of care involves treatment of the underlying cause, and supportive care. The vascular leakage may be related to reduced concentrations of local adenosine, which is involved in maintaining endothelial barrier function. Interferon (IFN) beta-1a up-regulates the cell surface ecto-5'-nucleotidase cluster of differentiation 73 (CD73), which increases adenosine levels, and IFN beta-1 may, therefore, be a potential treatment for ARDS...
November 13, 2017: Trials
https://www.readbyqxmd.com/read/29123370/assessing-hand-hygiene-compliance-among-healthcare-workers-in-six-intensive-care-units
#13
REVIEW
M Musu, A Lai, N M Mereu, M Galletta, M Campagna, M Tidore, M F Piazza, L Spada, M V Massidda, S Colombo, P Mura, R C Coppola
Introduction: Healthcare associated infections (HAIs) are a cause of high morbidity, disability and reduced quality of life, as well as mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health. Methods: The study aimed to evaluate the presence of procedures and protocols for infection control, to assess the adhesion to the different aspects of hand hygiene (HH) and hand washing technique by healthcare workers in six ICUs...
September 2017: Journal of Preventive Medicine and Hygiene
https://www.readbyqxmd.com/read/29121961/a-multicomponent-intervention-for-the-management-of-chronic-pain-in-older-adults-study-protocol-for-a-randomized-controlled-trial
#14
Sheung-Tak Cheng, Ka Long Chan, Rosanna W L Lam, Monique H T Mok, Phoon Ping Chen, Yu Fat Chow, Joanne W Y Chung, Alexander C B Law, Jenny S W Lee, Edward M F Leung, Cindy W C Tam
BACKGROUND: Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i...
November 9, 2017: Trials
https://www.readbyqxmd.com/read/29121480/palliative-care-planner-pcplanner-a-pilot-study-to-evaluate-acceptability-and-usability-of-an-electronic-health-records-system-integrated-needs-targeted-app-platform
#15
Christopher E Cox, Derek M Jones, Wen Reagan, Mary D Key, Vinca Chow, Jessica McFarlin, David Casarett, Claire J Creutzfeldt, Sharron L Docherty
RATIONALE: The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery is highly variable. OBJECTIVE: To develop and pilot an app platform for clinicians, ICU patients, and their family members that enhances the delivery of needs-targeted palliative care. METHODS: In the Development Phase of the study, we developed an electronic health record (EHR) system-integrated mobile web app system prototype, PCplanner (Palliative Care Planner)...
November 9, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29121281/epidemiology-of-sepsis-and-septic-shock-in-critical-care-units-comparison-between-sepsis-2-and-sepsis-3-populations-using-a-national-critical-care-database
#16
M Shankar-Hari, D A Harrison, G D Rubenfeld, K Rowan
Background: New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions. Methods: We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Primary outcome was acute hospital mortality. We compared old (Sepsis-2) and new (Sepsis-3) incidence, outcomes, trends in outcomes, and predictive validity of sepsis and septic shock populations...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29119023/improvement-in-quality-metrics-outcomes-and-patient-and-family-satisfaction-in-a-neurosciences-intensive-care-unit-after-creation-of-a-dedicated-neurocritical-care-team
#17
Yaw Sarpong, Premkumar Nattanmai, Ginger Schelp, Robert Bell, Keerthivaas Premkumar, Erin Stapleton, Ashley McCormick, Christopher R Newey
Introduction: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods: This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/29114416/outcomes-of-antepartum-and-postpartum-obstetric-admissions-to-the-intensive-care-unit-of-a-tertiary-university-hospital-an-8-year-review
#18
Menekşe Özçelik, Sanem Turhan, Onat Bermede, Ali Abbas Yılmaz, Necmettin Ünal, Mustafa Kemal Bayar
Objective: Although their rates are decreasing, pregnancy-related mortality and morbidity are problems worldwide. In this study, we aimed to review the characteristics, diagnoses, required interventions and outcomes of obstetric patients admitted between 2006 and 2014 to the Intensive Care Unit (ICU) of a tertiary university hospital to provide an indicator for improving the management of critically ill obstetric patients. Methods: A retrospective study of hospital records of obstetric admissions to the ICU was conducted...
October 2017: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29109009/rapid-optimized-flow-cytometric-crossmatch-fcxm-assays-the-halifax-and-halifaster-protocols
#19
Robert S Liwski, Anna L Greenshields, David M Conrad, Cathi Murphey, Robert A Bray, Jorge Neumann, Howard M Gebel
The flow cytometric crossmatch (FCXM) assay, which detects the presence of donor specific HLA antibodies in patient sera, is a cornerstone of HLA compatibility testing. Since relatively long FCXM assay turnaround times may contribute to transplant delays and increased graft ischemia time, we developed and validated two modified crossmatch procedures, namely the Halifax and Halifaster FCXM protocols. These protocols reduce FCXM assay time >60% and simplify their set-up without compromising quality or sensitivity...
November 3, 2017: Human Immunology
https://www.readbyqxmd.com/read/29108845/validation-of-the-age-adjusted-shock-index-using-pediatric-trauma-quality-improvement-program-data
#20
Andrew Nordin, Alan Coleman, Junxin Shi, Krista Wheeler, Henry Xiang, Shannon Acker, Denis Bensard, Brian Kenney
PURPOSE: In adults, shock index (SI; heart rate/systolic blood pressure) >0.9 predicts injury severity and trauma outcomes. However, age-adjusted shock index (SIPA) out-performs SI in blunt trauma patients 4-16years old. We sought to confirm these findings and expand this tool to include penetrating trauma and children aged 1-4years. METHODS: We developed cutoff values for patients 1-3years old using age-based vital signs and queried the 2014 Pediatric Trauma Quality Improvement Program (TQIP) database for patients aged 1-16years sustaining blunt or penetrating trauma...
October 12, 2017: Journal of Pediatric Surgery
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