633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
Lauren B Nosanov ◽  
Kaitlyn Libraro ◽  
Jamie Heffernan ◽  
Philip H Chang ◽  
Abraham Houng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ease Of Use ◽  
Convenience Sample ◽  
Team Members ◽  
Sepsis Risk ◽  
Burn Surgery ◽  
Ventilator Management ◽  
Patient Assessments ◽  
Continued Use ◽  
Additional Feedback

Abstract Introduction An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility. Methods A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use. Results Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning. Conclusions Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.

Prescription in Locker Box (PILBOX): Remodeling of the Medication Collection Process (Preprint)

2020 ◽  
Author(s):  
Lim Jit Fan Christina ◽  
Goh Boon Kwang ◽  
Chee Wing Ling Vivian ◽  
Tang Woh Peng ◽  
Goh Qiuling Bandy
Keyword(s):  
Cross Sectional Study ◽  
Ease Of Use ◽  
Prescription Medications ◽  
Pharmacy Staff ◽  
Cross Sectional ◽  
Team Members ◽  
Face To Face ◽  
Ranking Score ◽  
Study Team ◽  
Willingness To Use

BACKGROUND Traditionally, patients wishing to obtain their prescription medications have had to present themselves physically at pharmacy counters and collect their medications via face-to-face interactions with pharmacy staff. Prescription in Locker Box (PILBOX) is a new innovation which allows patients and their caregivers to collect their medication asynchronously, 24/7 at their convenience, from medication lockers instead of from pharmacy staff and at any time convenient to them instead of being restricted to pharmacy operating hours. OBJECTIVE This study aimed to determine the willingness by patients/caregivers to use this new innovation and factors that affect their willingness. METHODS This prospective cross-sectional study was conducted over 2 months at 2 public primary healthcare centres in Singapore. Patients or caregivers who were at least 21 yo and turned up at the pharmacies to collect medications were administered a self-developed 3-part questionnaire face-to-face by trained study team members, if they gave their consent to participate in the study. RESULTS A total of 222 participants completed the study. About 40% of them participants were willing to use the PILBOX to collect their medications. Amongst the participants who were keen to use the PILBOX service, slightly more than half (i.e. 52.8%) of them were willing to pay for the PILBOX service. The participants felt that the ease of use (3.46±1.21 i.e. mean of ranking score ± standard deviation) of the PILBOX was the most important factor that would affect their willingness to use the medication pick up service. This was followed by “waiting time” (3.37±1.33), cost of using the medication pick up service (2.96±1.44) and 24/7 accessibility (2.62±1.35). This study also found that age (p=0.006), language literacy (p=0.000), education level (p=0.000), working status (p=0.011) and personal monthly income (p=0.009) were factors that affected the willingness of the patients or caregivers to use the PILBOX. CONCLUSIONS Patients and caregivers are keen to use PILBOX to collect their medications for its convenience and the opportunity to save time, if it is easy to use and not costly.

scholarly journals Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries

2021 ◽  
Vol 18 (15) ◽  
pp. 8114
Author(s):  
Anjali Joseph ◽  
David Neyens ◽  
Sahar Mihandoust ◽  
Kevin Taaffe ◽  
David Allison ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Work Zones ◽  
Convenience Sample ◽  
Operational Strategies ◽  
Team Members ◽  
Video Recordings ◽  
Safety Risks ◽  
Flow Disruptions

(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR.

scholarly journals The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention

2016 ◽  
Vol 3 (4) ◽  
pp. 108-118 ◽  
Author(s):  
Kelly N Michelson ◽  
Joel Frader ◽  
Lauren Sorce ◽  
Marla L Clayman ◽  
Stephen D Persell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Stakeholder Engagement ◽  
Pediatric Intensive Care ◽  
Healthcare Team ◽  
Team Members ◽  
Core Elements ◽  
Stakeholder Input

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.

Development of Potentially Better Practices for the Neonatal Intensive Care Unit as a Culture of Collaboration: Communication, Accountability, Respect, and Empowerment

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e471-e481
Author(s):  
Judy Ohlinger ◽  
Mark S. Brown ◽  
Sue Laudert ◽  
Sue Swanson ◽  
Ona Fofah ◽  
...  
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Care Quality ◽  
Care Group ◽  
Team Members ◽  
Leadership Management ◽  
Standards Of Conduct ◽  
Year 2000 ◽  
Multidisciplinary Teamwork

Objective. The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement. Methods. The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature. Results. Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management. Conclusions. The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

Ultrasonographic Applications in the Thorax

2021 ◽  
Vol 18 ◽  
Author(s):  
Mehmet Zeki Gunluoglu ◽  
Tugrul Ormeci ◽  
Selva Sen
Keyword(s):  
Emergency Department ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Respiratory System ◽  
Ease Of Use ◽  
Endobronchial Ultrasound ◽  
Access Price ◽  
Wide Range ◽  
Diagnostic Sensitivity And Specificity ◽  
Fast Access

Abstract: Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units. It is also utilized in many clinical branches dealing with the respiratory system—due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations—and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.

scholarly journals Enablers and challenges of caring in the Intensive Care Unit--Part 2: In relation to nurses

2021 ◽  
Vol 12 (2) ◽  
pp. 18
Author(s):  
Hanan Subhi Al-Shamaly
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Care ◽  
Optimal Level ◽  
Ethnographic Study ◽  
Personal Factors ◽  
Team Members ◽  
Educational Backgrounds ◽  
Wide Range ◽  
Different Sources

The concept of caring is vague and complex, especially in critical environments such as the intensive care unit (ICU), where technological dehumanisation is a challenge for nurses. ICU nursing care includes not only patients but also extends to patients’ families, nurses, other health team members and the unit’s environment. Caring in critical care settings is affected by enabling and impeding factors. To explore these enablers and challenges factors, a focused ethnographic study was conducted in an Australian ICU. The data was collected from 35 registered nurses through various resources: participants' observations, documents reviews, interviews, and additional participants’ notes. Data were analysed inductively and thematically. The study outlines comprehensively and widely a wide range of enablers and challenges affecting caring in the ICU - which originate from different sources such as patients, families, nurses, and the ICU environment. This paper is the second in a two-part series which explores the ICU nurses’ experiences and perspectives of the enablers and challenges of caring in the ICU. Part 1 was concerned with the enablers and challenges to caring that are related to ICU patients, families, and environment. While Part 2 introduces readers to the enablers and challenges factors that are concerned with the nurses in ICU. These factors include nurses’ educational backgrounds and professional experience, employment working factors, leadership styles, relationships, and personal factors. Nurses and other stakeholders such as clinicians, educators, researchers, managers, and policymakers need to recognize these factors and their implications for providing quality care, in order to enhance and maintain the optimal level of caring in the ICU.

scholarly journals A Pilot Study of Clinicians' Perceptions of Feasibility, Client-Centeredness, and Usability of the Systematic Tailored Assessment for Responding to Suicidality Protocol

Crisis ◽  
2021 ◽  
Author(s):  
Jacinta Hawgood ◽  
Tamara Ownsworth ◽  
Helen Mason ◽  
Susan H. Spence ◽  
Ella Arensman ◽  
...  
Keyword(s):  
Pilot Study ◽  
Online Survey ◽  
Community Setting ◽  
Ease Of Use ◽  
Diverse Populations ◽  
Semistructured Interview ◽  
Psychosocial Needs ◽  
Convenience Sample ◽  
Training Requirements ◽  
Assessment Protocol

Abstract. Background: The Systematic Tailored Assessment for Responding to Suicidality (STARS) is a client-centered, psychosocial needs-based assessment protocol. This semistructured interview obtains client prioritized indicators that contribute to suicidality and informs commensurate care responses for preventing suicide. Aim: To pilot the feasibility, client-centeredness, and usability of the STARS protocol, including clinicians' perceptions of ease of use; content validity; and administration within the community setting. Method: A convenience sample of clinicians who undertook assessment and/or intervention with suicidal persons and had used STARS between mid-2016 and early 2017 completed an online survey assessing feasibility, client-centeredness, and usability of STARS. Results: Of the 51 clinicians who entered the survey, 42 (82.3%; aged 25–74; 69% female) completed it. Overall, perceptions of feasibility and usability of STARS were positive, particularly regarding client-centeredness of the protocol and confidence in information obtained for screening suicidality and informing needs-based priority responses. Limitations: The pilot findings are limited by the use of a small convenience sample and the low completion rate of clinicians with STARS training. Conclusion: STARS was perceived as a feasible and useful psychosocial needs-based assessment protocol. Suggestions for improving STARS, training requirements, and application to diverse populations are outlined.

Why not be “smarter”? Examining the factors that influence the behavioral intentions of non-smartphone users

2017 ◽  
Vol 117 (1) ◽  
pp. 32-49 ◽  
Author(s):  
Chen-Yu Lin ◽  
Yu-Chuang Chao ◽  
Tzy-Wen Tang
Keyword(s):  
Behavioral Intentions ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
Adoption Process ◽  
Perceived Ease Of Use ◽  
Path Modeling ◽  
Convenience Sample ◽  
Content Type ◽  
Price Consciousness ◽  
Consumer Demographics

Purpose Despite the evident and dramatic increase in smartphone usage worldwide, some consumers continue to use traditional mobile phones. The purpose of this paper is to investigate the behavioral intentions of these laggard and non-smartphone users. Design/methodology/approach This current study examines the effects of consumer demographics, psychographics, and smartphone characteristics on the intentions of non-smartphone consumers to switch or resist the use of smartphones. Data were collected using a convenience sample of non-smartphone users in Taiwan. The proposed model is tested using the consistent partial least squares (PLSc) path modeling technique. Findings PLSc results indicate that consumer psychographics and smartphone characteristics play more important roles than consumer demographics. Specifically, price consciousness, nostalgia, and perceived ease of use are good predictors of intention to switch, whereas perceived usefulness and ease of use are strong predictors of the intention to resist smartphone adoption. Practical implications The results of this study have implications for mobile phone vendors and mobile manufacturers who target non-smartphone users or laggard adopters. Originality/value This study is among the few that focus on non-smartphone users’ perceptions of smartphones. Hence, this empirical study could contribute to the development and testing of theories related to the smartphone adoption process.

Implementation of a multimodal patient safety improvement program “SafetyLEAP” in intensive care units

2018 ◽  
Vol 31 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Chantal Backman ◽  
Paul C. Hebert ◽  
Alison Jennings ◽  
David Neilipovitz ◽  
Omar Choudhri ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Intensive Care Units ◽  
Audit And Feedback ◽  
Improvement Program ◽  
Convenience Sample ◽  
Content Type ◽  
Safety Improvement ◽  
Patient Safety Improvement

Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term “LEAP” is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals. Design/methodology/approach A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three (n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases. Findings A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources. Practical implications The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams. Originality/value The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.

Abstract 9778: Establishing Inter Rater Reliability of the National Early Warning Score (NEWS)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Donna M Miller
Keyword(s):  
Intensive Care ◽  
Acute Care ◽  
Early Warning ◽  
Assessment Tools ◽  
Early Warning Score ◽  
Care Hospital ◽  
Convenience Sample ◽  
Rater Reliability ◽  
National Early Warning Score ◽  
Level Of Agreement

A change in patient condition is a dynamic process which can go unrecognized and result in a failure to rescue. Changes in patients’ vital signs can precede adverse events many hours before critical events such as cardiac arrest or emergent transfer to the Intensive Care Unit occurs. Quantitative assessment tools are used to predict risk and need for additional resources at the bedside. These tools are referred to as Early Warning Scoring Systems. The Royal College of Physicians developed a standardized tool called the National Early Warning Score (NEWS, 2012) that uses a variety of physiologic parameters to assess risk and establish a trigger threshold for summoning additional resources. Purpose: Early warning scoring tools have been found to be reliable and accurate in predicting patient decompensation. However, data from instruments are only as reliable and accurate as the caregiver who obtains and documents the parameters. The purpose of this study was to establish inter rater reliability between the RN and PCA using NEWS. Design, Sample, Setting, Procedures: This study was conducted on the clinical units of a 104 bed Long Term Acute Care Hospital (LTCH) system. These units accept patients directly from Intensive Care Units who require intense services to maintain their trajectory toward recovery. The NEWS provides a way for early detection of patient decompensation which can prevent readmission to acute care and the subsequent financial implications The convenience sample consisted of 22 RNs and 6 PCAs. Consented subjects reviewed an unfolding case study that portrayed a typical patient on the LTCH unit. Subjects were asked to circle the parameter ranges on the NEWS tool that corresponded to physiologic values in the scenario. Findings: Krippendorff’s alpha was utilized to determine the level of agreement among the raters examining the three scenarios. An alpha value of 0.94 was obtained indicating a high level of agreement among the raters. Conclusion: The NEWS can serve as a reliable adjunct to the provision of safe patient care. While it is not the sole source for determining

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