Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Sandra Cristina Hernandes ◽  
Talita Teles Teixeira Pereira ◽  
Shana Oliveira ◽  
Denis de Melo Soares ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase 1 ◽  
Phase 2 ◽  
Differential Impact ◽  
Scarce Resources ◽  
Clinical Pharmacists ◽  
Versus Phase ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

scholarly journals Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

2012 ◽  
Vol 21 (1) ◽  
pp. e1-e11 ◽  
Author(s):  
Gail Gesin ◽  
Brittany B. Russell ◽  
Andrew P. Lin ◽  
H. James Norton ◽  
Susan L. Evans ◽  
...  
Keyword(s):  
Intensive Care ◽  
Education Program ◽  
Screening Tool ◽  
Phase 1 ◽  
Surgical Trauma ◽  
Phase 2 ◽  
Phase 3 ◽  
Didactic Lecture ◽  
The Impact ◽  
Nurses Knowledge

BackgroundThe impact of using a validated delirium screening tool and different levels of education on surgical-trauma intensive care unit (STICU) nurses’ knowledge about delirium is unclear.ObjectivesTo measure the impact of using the Intensive Care Delirium Screening Checklist (ICDSC), with or without a multi-faceted education program, on STICU nurses’ knowledge and perceptions of delirium and their ability to evaluate it correctly.MethodsThe knowledge and perceptions of subject nurses about delirium, and agreement between the independent assessments of delirium by the subject nurse and by a validated judge (who always used the ICDSC), were compared across 3 phases. Phase 1: No delirium screening tool and no education. Phase 2: ICDSC and minimal education (ie, ICDSC validation study only). Phase 3: ICDSC and multifaceted education (ie, pharmacist-led didactic lecture, Web-based module, and nurse-led bedside training).ResultsNurses’ knowledge (mean [SD] score out of 10 points) was similar (P = .08) in phase 1 (6.1 [1.4]) and phase 2 (6.5 [1.4]) but was greater (P = .001) in phase 3 (8.2 [1.4]). Agreement between nurses and the validated judge in the assessment of delirium increased from phase 1 (κ = 0.40) to phase 2 (κ = 0.62) to phase 3 (κ = 0.74). Nurses perceived use of the ICDSC as improving their ability to recognize delirium.ConclusionsUse of a multifaceted education program improves both nurses’ knowledge about delirium and their perceptions about its recognition. Implementation of the ICDSC improves the ability of STICU nurses to evaluate delirium correctly.

scholarly journals Implementation of an Interdisciplinary AACN Early Mobility Protocol

2020 ◽  
Vol 40 (4) ◽  
pp. e7-e17 ◽  
Author(s):  
Marilyn Schallom ◽  
Heidi Tymkew ◽  
Kara Vyers ◽  
Donna Prentice ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Units ◽  
American Association ◽  
Phase 1 ◽  
Phase 2 ◽  
Early Mobility ◽  
Protocol Implementation

Background Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. Methods A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. Results The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. Conclusions Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.

scholarly journals The Impact of Clinical Pharmacist Interventions on Medication Errors Management in the Postoperative Cardiac Intensive Care Unit

2020 ◽  
Vol 27 (3) ◽  
pp. 433-438
Author(s):  
Naser Safaie ◽  
Hanieh Azizi ◽  
Sajad Khiali ◽  
Taher Entezari-Maleki
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medication Errors ◽  
Clinical Pharmacist ◽  
Therapeutic Process ◽  
Laboratory Data ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Heart Center ◽  
The Impact

Background: Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them. Methods: This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed. Results: A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant. Conclusion: MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

scholarly journals Use of Text Searching for Trigger Words in Medical Records to Identify Adverse Drug Reactions within an Intensive Care Unit Discharge Summary

2016 ◽  
Vol 07 (03) ◽  
pp. 660-671 ◽  
Author(s):  
Adam MacLasco ◽  
Melissa Saul ◽  
Tiffany R. Smith ◽  
Megan Kloet ◽  
Catherine Kim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Drug Reactions ◽  
Chart Review ◽  
Phase 1 ◽  
Intensive Care Unit Discharge ◽  
Discharge Summary ◽  
Phase 2 ◽  
Drug Reactions ◽  
Icu Discharge

SummaryTo evaluate the performance of using trigger words (e.g. clues to an adverse drug reaction) in unstructured, narrative text to detect adverse drug reactions (ADRs) and compare the use of these trigger words to a targeted chart review for ADR detection within the intensive care unit (ICU) discharge summary note.A retrospective medical record review was conducted. Evaluation of ADRs occurred in two phases – targeted chart review of the ICU discharge summary notes in Phase 1 and targeted chart review using specific words and phrases as triggers for ADRs in Phase 2.Four hundred ADRs were documented in 223 patients for Phase 1. For Phase 2, there were 219 ADRs identified in 120 patients. 138 real or accurate ADRs were identified from Phase 1 and 47 duplicate events. 34 ADRs from Phase 2 were not identified in Phase 1. Fifteen of the ADRs were inaccurately presumed in Phase 2. Fifty-eight of 127 text triggers identified at least one ADR. Low and moderate frequency trigger words were more likely to have PPVs > 5%.Targeted chart review using specific words and phrases as triggers for ADRs is a reasonable approach to identify ADRs and may save time compared to other methods after further refinement leads to a more accurately performing trigger word list. Citation: Kane-Gill SL, MacLasco AM, Saul MI, Politz Smith TR, Kloet MA, Kim C, Anthes AM, Smithburger PL, Seybert AL. Use of text searching for trigger words in medical records to identify adverse drug reactions within an intensive care unit discharge summary.

scholarly journals DEVELOPMENT OF A SCORING SYSTEM FOR THE NURSING WORKLOAD IN A PEDIATRIC INTENSIVE CARE UNIT

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e31-e32
Author(s):  
Alexa Eberle ◽  
Philippe Jouvet ◽  
Sylvie Charette ◽  
Bryan Provost
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase 1 ◽  
Intraclass Correlation ◽  
Mean Difference ◽  
Nursing Workload ◽  
Study Phase ◽  
Phase 2 ◽  
Evaluation Tool ◽  
Limits Of Agreement

Abstract BACKGROUND Nursing workload evaluation tools are designed to determine adequate staffing for a given shift. Only retrospective tools that do not predict the number of nurses needed to start a shift exist. A prospective nursing workload evaluation tool (SJ score), developed by a group of nurses with items based on previously published retrospective scores and clinical experience, includes 16 weighted sections (scored from 0 to >100 with 1 point ≈ 5 min nurse workload). OBJECTIVES This study’s aim is to assess the reliability and validity of the SJ score in the Paediatric Intensive Care Unit (PICU). DESIGN/METHODS Inclusion criteria: children admitted in a PICU, age < 18 yo. Exclusion criteria: already included 3 times in this study (phase 1 only) or children discharged 2 hr after the beginning of the nurse shift studied. Children were scored for 8 hr nursing shifts. Phase 1 (pilot validation) required simultaneous prospective SJ scoring by the nurse in charge (NIC) and chief nurse (SC), then a retrospective SJ score by an independent trained investigator (AE). Phase 2 (validation in the real context of the PICU), which used an improved SJ score, required that each child had an SJ score prospectively by the NIC of the previous shift, then retrospectively by the NIC of the dedicated shift. Statistical analysis included the intraclass correlation (ICC) and a Bland Altman plot. Bland Altman was considered acceptable if mean difference was closed to 0. For ICC: 0.40<ICC<0.59_Fair, 0.60<ICC<0.74_Good, 0.75<ICC<1_Excellent. RESULTS 165 patients’ shifts observations were performed in phase 1. In the comparison between the prospective score performed by the NIC and SC, the Bland Altman mean difference was -0.03 with limits of agreement between -3.63 and 3.58, and the ICC was good: 0.63 with 95%confidence interval (95ICC) from 0.40 to 0.93. In the comparison between the prospective score of the NIC and AE retrospective score, the ICC was fair: 0.52 with 95ICC from 0.32 to 0.78. In phase 2, 2599 patients’ shifts were studied. The Bland Altman mean difference was 0.21 with limits of agreement between -10.5 and 10.9, and the ICC was excellent: 0.86 with 95ICC from 0.85 to 0.87. CONCLUSION The SJ score prospectively predicted well nursing workload in a single PICU. Additional studies are needed to determine the validity in other PICUs.

Impact of Therapeutic Drug Monitoring of Intravenous Theophylline Regimens on Serum Theophylline Concentrations in the Medical Intensive Care Unit

1992 ◽  
Vol 26 (10) ◽  
pp. 1287-1291 ◽  
Author(s):  
William E. Dager ◽  
Timothy E. Albertson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Pharmacist ◽  
Medical Intensive Care Unit ◽  
Phase 1 ◽  
Pharmacokinetic Analysis ◽  
Therapeutic Drug ◽  
Phase 2 ◽  
Serum Theophylline ◽  
Medical Intensive Care

OBJECTIVE: The primary objective of this study was to determine if a clinical pharmacist ensuring appropriate use and performing careful pharmacokinetic analysis of serum theophylline concentrations (STCs) can result in optimal theophylline regimens for patients in a medical intensive care unit (ICU). DESIGN: In phase 1 of the study, housestaff physicians determined the theophylline dosing regimen. A clinical pharmacist prospectively followed these initial patients, but did not intervene. Patients in phase 2 received intravenous theophylline, with all dosing regimens being based on prospective therapeutic drug monitoring (TDM) by a clinical pharmacist. PARTICIPANTS: The first phase enrolled 11 consecutive patients admitted into the medical ICU and requiring intravenous theophylline. This was followed by a second phase of 14 medical ICU patients whose intravenous theophylline regimen was determined by a clinical pharmacist performing pharmacokinetic analysis. MAIN OUTCOME MEASURES: Questions were organized into the following sections: (1) number of STC blood samples drawn, (2) number of emergency STCs performed, (3) number of concentrations per infusion-rate changes, (4) number of STC results in the pharmacist-generated regimens that were within the physicians' predetermined acceptable range. RESULTS: In phase 1, 27 theophylline rate changes occurred, with a mean ± SD of 1.01 ± 0.3 STCs per day. In phase 2, 44 theophylline infusion rates were changed, with a mean ± SD of 0.62 ± 0.3 STCs per day. The TDM group had a significant reduction (p<0.001) in inappropriate concentrations (15 vs. 40 percent) as set by predetermined criteria, and fewer emergency theophylline concentration requests (2 vs. 14). Serum theophylline concentrations ordered by the physician were achieved in 85 percent of the pharmacist-generated regimens. CONCLUSIONS: Pharmacokinetic analysis when performing TDM in the determination of intravenous theophylline regimens can result in optimal therapy for patients, while significantly reducing the number of STCs required.

scholarly journals Prevalence, aetiology, and impact of paediatric feeding disorders in preterm infants admitted to a neonatal intensive care unit in Cyprus

2021 ◽  
Vol 24 (1) ◽  
pp. 45-53
Author(s):  
Panayiota Senekki-Florent ◽  
Margaret Walshe
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Feeding Disorders ◽  
Phase 2

BACKGROUND: Advancements in neonatal care have resulted in increased survival for preterm infants, with associated risk for paediatric feeding disorders (PFDs), the prevalence of which is relatively unexplored. Risk factors for developing PFDs in this population must be identified. OBJECTIVE: The aim of this study was to determine the epidemiology and risk factors for PFDs in preterm infants with Extremely Low Birth Weight (ELBW); Very Low Birth Weight (VLBW) and Low Birth weight (LBW) in the only neonatal intensive care unit (NICU) in Cyprus. METHODS: This study comprised 2 phases: Phase 1, a retrospective 2-year file audit, informing methodology for Phase 2, a prospective epidemiological study. Profiles of 1027 preterm infants were obtained in Phase 1. In Phase 2, clinical assessment data on 458 preterm infants (N = 224) were analyzed. RESULTS: The prevalence of PFDs was 36.5%. All preterm infants with ELBW and 69%with VLBW exhibited PFDs. Risk factors were birth weight (BW), gestational age (GA), bronchopulmonary dysplasia (BPD), neurological disorders, structural anomalies, and congenital heart disease (CHD). CONCLUSIONS: This unique epidemiological data for one country will inform NICU service provision and direct international research on PFDs in neonates.

scholarly journals Effect of Weekly Antibiotic Round on Antibiotic Use in the Neonatal Intensive Care Unit as Antibiotic Stewardship Strategy

2020 ◽  
Vol 8 ◽  
Author(s):  
Bo Wang ◽  
Geng Li ◽  
Fei Jin ◽  
Jingwen Weng ◽  
Yaguang Peng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Phase 2 ◽  
Daily Dose ◽  
Predicted Values

Background: Antibiotics are commonly used in the neonatal intensive care unit (NICU). The objective was to observe the effect of weekly antibiotic round in NICU (WARN) to the antibiotic use in NICU.Methods: A retrospective observational study was performed. Departmental-level diagnosis categories and the parameters of antibiotic usage in NICU for the period of 2016-2017 (Phase 1) and 2018-2019 (Phase 2) were collected. WARN in NICU was started since January 2018. A time series forecasting was used to predict the quarterly antibiotic use in Phase 2, based on data from Phase 1. The actual antibiotic use of each quarter in Phase 2 was compared with the predicted values.Results: Totally 9297 neonates were included (4743 in Phase 1, 4488 in Phase 2). The composition of the disease spectrum between Phase 1 and Phase 2 was not different (P &gt; 0.05). In Phase 1 and Phase 2, the overall antibiotic rate was 94.4 and 74.2%, the average accumulative defined daily dose per month was 199.00 ± 55.77 and 66.80 ± 45.64, the median antibiotic use density per month was 10.31 (9.00-13.27) and 2.48 (1.92-4.66), the median accumulative defined daily dose per case per month was 0.10 (0.09-0.13) and 0.03 (0.02-0.47), the number of patients who received any kind of antibiotic per 1000 hospital days per month was 103.45 (99.30-107.48) and 78.66 (74.62-82.77), rate of culture investigation before antibiotics was 64 to 92%, respectively, and all were better than the predicted values (P &lt; 0.01).Conclusion: The implementation of periodical antibiotic rounds was effective in reducing the antibiotics use in the NICU.

Financial impact of an analgosedation protocol for mechanically ventilated patients in a cardiovascular intensive care unit

2019 ◽  
Vol 77 (1) ◽  
pp. 14-21
Author(s):  
Sandeep Devabhakthuni ◽  
Karan Kapoor ◽  
Avelino C Verceles ◽  
Giora Netzer ◽  
Jonathan Ludmir ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Primary Objective ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Quasi Experimental ◽  
Patient Doses ◽  
The Mean ◽  
The Impact ◽  
Ventilated Patients

Abstract Purpose The primary objective was to evaluate the impact of an analgosedation protocol in a cardiac intensive care unit (CICU) on daily doses and costs of analgesic, sedative, and antipsychotic medications. Methods We conducted a single-center quasi-experimental study in 363 mechanically ventilated patients admitted to our CICU from March 1, 2011, to April 13, 2013. On March 1, 2012, an analgosedation protocol was implemented. Patients in the pre-implementation group were managed at the cardiologist’s discretion, which consisted of a continuous sedative-hypnotic approach and opioids as needed. Patients in the implementation group were managed using this protocol. Results The mean ± S.D. per-patient doses (mg/day) of propofol, lorazepam, and clonazepam decreased with the use of an analgosedation protocol (propofol 132,265.7 ± 12,951 versus 87,980.5 ± 10,564 [p = 0.03]; lorazepam 10.5 ± 7.3 versus 3.3 ± 4.0 [p &lt; 0.001]; clonazepam 9.9 ± 8.3 versus 1.1 ± 0.5 [p = 0.03]). The mean daily cost of propofol and lorazepam also significantly decreased (33.5% reduction in propofol cost [p = 0.03]; 69.0% reduction in lorazepam cost [p &lt; 0.001]). The per-patient dose and cost of fentanyl (mcg/day) declined with analgosedation protocol use (fentanyl 2,274.2 ± 2317.4 versus 1,026.7 ± 981.4 [p &lt; 0.001]; 54.8% decrease in fentanyl cost [p &lt; 0.001]). Conclusion The implementation of an analgosedation protocol significantly decreased both the use and cost of propofol, lorazepam, and fentanyl. Further investigation of the clinical impact and cost-effectiveness of a critical care consultation service with implementation of an analgosedation protocol is warranted in the CICU.

scholarly journals IMPACT OF A VENTILATORY WEANING PROTOCOL IN AN INTENSIVE CARE UNIT FOR ADULTS

2019 ◽  
Vol 28 ◽  
Author(s):  
Sandra Manuela Rebelo Oliveira ◽  
Rui Manuel Freitas Novais ◽  
Amâncio António de Sousa Carvalho
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Study Data ◽  
Base Line ◽  
Quasi Experimental ◽  
A Prospective Study ◽  
The Impact ◽  
Experimental Group

ABSTRACT Objective: to evaluate the impact of a ventilatory weaning protocol on the weaning quality and on the outcomes of the patients. Method: a quasi-experimental quantitative study, consisting of comparing a prospective study with a retrospective study. Data was collected through a weaning log sheet applied between September and December 2015 at an intensive care unit in northern Portugal following the implementation of a weaning protocol and compared with a base-line constituted in the year preceding the implementation of the ventilatory weaning protocol. Results: the experimental group had a score mean of higher overall quality of weaning, with a reduction in the timing for initiating the weaning in 27.3% and the weaning time in 36.6%. Conclusion: the implementation of the ventilatory weaning protocol improved the overall quality of the weaning, facilitating the identification of patients with criteria to initiate the process, starting earlier, resulting in a reduction in ventilatory weaning time.

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