Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

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An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

American Journal of Critical Care ◽

10.4037/ajcc2007.16.6.589 ◽

2007 ◽

Vol 16 (6) ◽

pp. 589-598 ◽

Cited By ~ 36

Author(s):

Mark A. Malesker ◽

Pamela A. Foral ◽

Ann C. McPhillips ◽

Keith J. Christensen ◽

Julie A. Chang ◽

...

Keyword(s):

Intensive Care ◽

Blood Glucose ◽

Glycemic Control ◽

Intensive Care Units ◽

Tight Glycemic Control ◽

Third Party ◽

Full Time ◽

Motion Data ◽

Time Motion ◽

The Impact

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

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Selection of an instrument to evaluate the organizational environment of nurses working in intensive care: an integrative review

Journal of Hospital Administration ◽

10.5430/jha.v3n6p143 ◽

2014 ◽

Vol 3 (6) ◽

pp. 143

Author(s):

Brett Abbenbroek ◽

Christine Duffield ◽

Doug Elliott

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Outcome Measures ◽

Organizational Structures ◽

Survey Instrument ◽

Integrative Review ◽

Organizational Environment ◽

Intensive Care Nurses ◽

Survey Instruments ◽

The Impact

Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses. Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging as the preferred organizational model with benefits resulting from optimizing operational synergies and economies of scale. The impact of this organizational transition on intensive care nurses is not well understood. An appropriate survey instrument for intensive care nurses is required. Design: Integrative literature review. Data Sources: CINAHL, PubMed, EMBASE and OVID Nursing databases searched for studies published between 2005 and 2013. Review methods: An integrative review and quality assessment of the studies was undertaken to select nurse outcome measures associated with organizational structures across a range of acute and critical care settings. Congruence between nurse outcome measures and nurse survey instruments tested in the literature was assessed to select instruments for further psychometric evaluation. Results: Thirty-one cross sectional quantitative studies, from fourteen countries, were reviewed. Twenty one nurse outcome measures associated with organizational factors were identified and a total of twenty five survey instruments used in the studies reviewed. Assessment of congruence and psychometric properties determined that a combination of two instruments is required to comprehensively assess the organizational environment of nurses working in intensive care units. Conclusion: The environment of nurses working in intensive care is effectively evaluated with an instrument that combines subscales from the Practice Environment Scale-Nurse Work Index and Maslach’s Burnout Inventory.

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Implementation of Sepsis Bundles in Intensive Care Units of Bangladesh: A Prospective Observational Study

Bangladesh Critical Care Journal ◽

10.3329/bccj.v1i1.14359 ◽

2013 ◽

Vol 1 (1) ◽

pp. 8-17

Author(s):

Mohammad Omar Faruq ◽

ASM Areef Ahsan ◽

Mirza Nazim Uddin ◽

UH Shahera Khatun ◽

Md Abdul Mannan ◽

...

Keyword(s):

Severe Sepsis ◽

Intensive Care ◽

Intensive Care Units ◽

Positive Impact ◽

Delayed Diagnosis ◽

Outcome Data ◽

Surviving Sepsis Campaign ◽

Sepsis Bundles ◽

Impact On Survival ◽

The Impact

Objective: To assess compliance of Intensive Care Units (ICUs) of Bangladesh to the components of resuscitation & management bundles of Surviving Sepsis Campaign (SSC). Secondary objective was to assess the impact of compliance on mortality and to determine how its compliance & mortality compared with other Asian and Western countries. Design: Prospective Cohort study. Setting: 14 ICUs of Bangladesh. Participants: 65 adult patients with severe sepsis admitted into these ICUs in July 2009. The organizational characteristics of the participating centers, the patients baseline characteristics, the achievement of target within the resuscitation & management bundle & outcome data were recorded. Outcome: Compliance with the Surviving Sepsis Campaigns resuscitation (6 hrs) & management (24 hrs) bundles. Results: Hospital mortality in ICU patients of Bangladesh suffering from severe sepsis was 49·2%. It was significantly higher than countries reported. Compliance to entire components of both resuscitation & management bundles were reported to be zero in ICUs of Bangladesh. Compliance of individual components of the bundles did not predict improved survival. Conclusion: In ICUs of Bangladesh, high mortality of severe sepsis and failure of compliance of SSC bundle guidelines to have positive impact on survival were presumably attributed to delayed diagnosis, poor adherence to & delayed application of SSC guidelines on sepsis bundles. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14359 Bangladesh Crit Care J March 2013; 1: 8-17

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The impact of formulary restriction on the relative consumption of carbapenems in intensive care units at an academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.170 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1056-1058

Author(s):

Jacob W. Pierce ◽

Andrew Kirk ◽

Kimberly B. Lee ◽

John D. Markley ◽

Amy Pakyz ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Medical Center ◽

Academic Medical Center ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Surgical Intensive Care ◽

Academic Medical ◽

The Impact ◽

Formulary Restriction

AbstractAntipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.

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Clinical review: The impact of noise on patients' sleep and the effectiveness of noise reduction strategies in intensive care units

Critical Care ◽

10.1186/cc7154 ◽

2009 ◽

Vol 13 (2) ◽

pp. 208 ◽

Cited By ~ 132

Author(s):

Hui Xie ◽

Jian Kang ◽

Gary H Mills

Keyword(s):

Intensive Care ◽

Noise Reduction ◽

Clinical Review ◽

Intensive Care Units ◽

Reduction Strategies ◽

The Impact

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Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

10.21203/rs.3.rs-123399/v1 ◽

2020 ◽

Author(s):

Ravena Melo Ribeiro da Silva ◽

Ana Cláudia de Brito Câmara ◽

Ellen Karla Chaves Vieira Koga ◽

Iza Maria Fraga Lobo ◽

Wellington Barros da Silva

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Polymyxin B ◽

Intervention Period ◽

Post Intervention ◽

Short Period ◽

Active Feedback ◽

The Impact ◽

Antimicrobial Administration

Abstract Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

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