Clinical Pathways for the Continuum of Rehabilitation

2014 ◽  
Author(s):  
Karen Hoffman ◽  
Amanda Thomas ◽  
Stephen Brett
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Pathways ◽  
Information Loss ◽  
System Failure ◽  
Nursing Support ◽  
Serious Illness ◽  
Intensive Care Patients ◽  
Major Illness ◽  
The Continuum

People who experience major illness or injury commonly are admitted to an intensive care unit, yet it is important to recognize that the intensive care unit is merely one part of a journey from the onset of illness or injury to recovery and subsequent rebuilding of life. This journey is characterized by a number of changes in the level of medical and nursing support, location, team, and often focus of care. These ‘way points’ on this journey to recovery represent opportunities for system failure and loss of key pieces of information. The patient-centred focus on treatment and recovery can be compromised by organizational deficits. What is recognized in many clinical fields is the requirement to assemble a continuum of care which anticipates these way points and minimizes the chances of information loss. These organized processes are termed clinical pathways and can be applied to patients recovering from serious illness or injury characterized by a stay in an intensive care unit. This chapter outlines the rationale and background of this concept and how it might be applied in practice for the benefit of recovering intensive care patients.

scholarly journals Completeness of the operating room to intensive care unit handover: a matter of time?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fabian Dusse ◽  
Johanna Pütz ◽  
Andreas Böhmer ◽  
Mark Schieren ◽  
Robin Joppich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Information Transfer ◽  
Time Pressure ◽  
Intraoperative Complications ◽  
Patient Characteristics ◽  
Information Loss ◽  
Ensure Patient Safety ◽  
Underlying Diseases

Abstract Background Handovers of post-anesthesia patients to the intensive care unit (ICU) are often unstructured and performed under time pressure. Hence, they bear a high risk of poor communication, loss of information and potential patient harm. The aim of this study was to investigate the completeness of information transfer and the quantity of information loss during post anesthesia handovers of critical care patients. Methods Using a self-developed checklist, including 55 peri-operative items, patient handovers from the operation room or post anesthesia care unit to the ICU staff were observed and documented in real time. Observations were analyzed for the amount of correct and completely transferred patient data in relation to the written documentation within the anesthesia record and the patient’s chart. Results During a ten-week study period, 97 handovers were included. The mean duration of a handover was 146 seconds, interruptions occurred in 34% of all cases. While some items were transferred frequently (basic patient characteristics [72%], surgical procedure [83%], intraoperative complications [93.8%]) others were commonly missed (underlying diseases [23%], long-term medication [6%]). The completeness of information transfer is associated with the handover’s duration [B coefficient (95% CI): 0.118 (0.084-0.152), p<0.001] and increases significantly in handovers exceeding a duration of 2 minutes (24% ± 11.7 vs. 40% ± 18.04, p<0.001). Conclusions Handover completeness is affected by time pressure, interruptions, and inappropriate surroundings, which increase the risk of information loss. To improve completeness and ensure patient safety, an adequate time span for handover, and the implementation of communication tools are required.

scholarly journals The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
L. J. Delaney ◽  
E. Litton ◽  
K. L. Melehan ◽  
H.-C. C. Huang ◽  
V. Lopez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Moderate Level ◽  
Sleep Monitoring ◽  
Clinical Trial Registration ◽  
Wake Time ◽  
Intensive Care Patients

Abstract Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

Sedation and analgesia in the ICU

2020 ◽  
pp. 3898-3905
Author(s):  
Michael C. Reade
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Extubation ◽  
Organ Support ◽  
Pain Anxiety ◽  
Safe Delivery ◽  
Intensive Care Patients ◽  
Sedation And Analgesia ◽  
Assessment Scales ◽  
Minimization Approach

Patients undergoing mechanical ventilation or other forms of invasive organ support in an intensive care unit should ideally be free of pain, anxiety, and delirium, sufficiently cooperative or sedated to enable safe delivery of essential aspects of their care; sufficiently awake such that tracheal extubation is not unnecessarily delayed; and left with few or no unpleasant memories of their illness and treatment. This ideal is often not achieved. Management should be based on an analgesia-first, delirium-control, sedation-minimization approach. Identifying intensive care unit-associated delirium is not straightforward: most delirious intensive care patients are not agitated, and ‘hypoactive’ delirium can mask substantial psychological distress. Various assessment scales can be used to quantitate, monitor, and communicate sedation and sedation goals, and similar tools can be employed to identify delirium.

Influence of Physical Restraint on Unplanned Extubation of Adult Intensive Care Patients: A Case-Control Study

2008 ◽  
Vol 17 (5) ◽  
pp. 408-415 ◽  
Author(s):  
Li-Yin Chang ◽  
Kai-Wei Katherine Wang ◽  
Yann-Fen Chao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Control Study ◽  
Physical Restraint ◽  
Case Control ◽  
Physical Restraints ◽  
Unplanned Extubation ◽  
Intensive Care Patients ◽  
Increased Risk ◽  
Control Study

Background Unplanned extubation commonly occurs in intensive care units. Various physical restraints have been used to prevent patients from removing their endotracheal tubes. However, physical restraint not only does not consistently prevent injury but also may be a safety hazard to patients. Objectives To evaluate the effect of physical restraint on unplanned extubation in adult intensive care patients. Methods A total of 100 patients with unplanned extubations and 200 age-, sex-, and diagnosis-matched controls with no record of unplanned extubation were included in this case-control study. The 300 participants were selected from a population of 1455 patients receiving mechanical ventilation during a 21-month period in an adult intensive care unit at a medical center in Taiwan. Data were collected by reviewing medical records and incident reports of unplanned extubation. Results The incidence rate of unplanned extubation was 8.7%. Factors associated with increased risk for unplanned extubation included use of physical restraints (increased risk, 3.11 times), nosocomial infection (increased risk, 2.02 times), and a score of 9 or greater on the Glasgow Coma Scale on admission to the unit (increased risk, 1.98 times). Episodes of unplanned extubation also were associated with longer stays in the unit. Conclusions An impaired level of consciousness on admission to the intensive care unit and the presence of nosocomial infection intensify the risk for unplanned extubation, even when physical restraints are used. To minimize the risk of unplanned extubation, nurses must establish better standards for using restraints.

COVID-19 aus Sicht der Intensivmedizin

2020 ◽  
Vol 145 (15) ◽  
pp. 1057-1062
Author(s):  
Stephanie-Susanne Stecher ◽  
Hans Joachim Stemmler ◽  
Dennis Eichenauer ◽  
Matthias Kochanek ◽  
Alexander Shimabukuro-Vornhagen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Best Practice ◽  
Fungal Infections ◽  
Clinical Situation ◽  
Treatment Modalities ◽  
Invasive Ventilation ◽  
Intensive Care Patients ◽  
Inflammatory Parameters ◽  
The Individual

AbstractApprox. 93 % of COVID-19 infections are mild, and not all severely ill patients are transferred to the intensive care unit. But the Corona crisis implies high demands on intensive care medicine. Many treatment modalities of COVID patients are “best practice”, but some aspects remain unclear at present. This article deals with diagnostics, monitoring and therapy with COVID-19 patients in intensive care units and with a suitable hygiene concepts.A hygiene concept is obligatory and must ensure – in addition to general measures – the training of employees and the hygienic discharge of material. Ideally, a cohort isolation is implemented.Monitoring of patients with COVID-19 is not different from other intensive care patients and should be adapted to the clinical situation of the individual patient. In laboratory analysis the typical abnormality of COVID-19 patients should be taken into account. In case of increasing inflammatory parameters, fungal infections should be tested.Due to the formation of aerosols, disconnection of the respiratory system must be avoided in invasive ventilation. If a disconnection from the respirator is necessary, the tube should be disconnected. After extubation, an intermittent NIV treatment for atelectase prophylaxis can be performed.

scholarly journals Nursing Activities Score and Acute Kidney Injury

2017 ◽  
Vol 70 (3) ◽  
pp. 475-480 ◽  
Author(s):  
Filipe Utuari de Andrade Coelho ◽  
Mirian Watanabe ◽  
Cassiane Dezoti da Fonseca ◽  
Katia Grillo Padilha ◽  
Maria de Fátima Fernandes Vattimo
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Disease ◽  
Quantitative Study ◽  
Kidney Injury ◽  
Nursing Workload ◽  
Intensive Care Patients ◽  
Stage 1

ABSTRACT Objective: to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI). Method: A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively. Results: A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001). Conclusion: The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.

A Prediction Rule For Mortality in the Medical Intensive Care Unit Based on Early Acute Organ-System Failure

1994 ◽  
Vol 9 (4) ◽  
pp. 172-178 ◽  
Author(s):  
Victor Gordan ◽  
Roger K. Pitman ◽  
Thérese A. Stukel ◽  
Daniel Teres ◽  
Edward Gillie
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Prediction Rule ◽  
Organ System ◽  
System Failure ◽  
Classification Rate ◽  
Organ System Failure ◽  
Medical Intensive Care

We evaluated early acute organ-system failure (AOSF) as a predictor of mortality in medical intensive care unit (MICU) patients. Prospective data were obtained on 825 men admitted to a Veterans Administraion (VA) Medical Center MICU. Clinical criteria were used to diagnose the presence of 7 types of AOSF. Of the 2,364 AOSFs detected, 1,847 (78%) were “early” (i.e., detected within the first 48 hours of MICU stay). A random sample of 550 patients was selected for derivation of a prediction rule for MICU mortality based on age and number of early AOSFs. For each additional early AOSF, the adjusted odds of mortality increased by 3.3 (95% confidence interval: 2.7, 4.0; p < 0.0001). When applied to the cross-validation sample of 275 patients, this rule yielded a sensitivity of 77%, a specificity of 86%, and an overall correct classification rate of 82%. These results suggest that a simple rule based on number of AOSFs detected in the early portion of a patient's MICU stay may be a useful predictor of mortality.

Detection of Posttraumatic Stress Symptoms in Patients After Discharge From Intensive Care

2016 ◽  
Vol 25 (6) ◽  
pp. 509-515 ◽  
Author(s):  
Heather Warlan ◽  
Lois Howland ◽  
Cynthia Connelly
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Posttraumatic Stress ◽  
Screening Tool ◽  
Screening Instrument ◽  
Post Traumatic Stress ◽  
Posttraumatic Stress Syndrome ◽  
Cross Sectional ◽  
Intensive Care Patients ◽  
Stress Syndrome

Background Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. Objectives To examine the feasibility and acceptability of a screening tool to detect posttraumatic stress syndrome, screen for the syndrome soon after discharge from intensive care to identify patients at risk for post-traumatic stress disorder, and determine personal and clinical factors related to higher scores on the screening instrument. Methods A single-center, cross-sectional design was used. At 2 to 4 weeks after hospital discharge, 41 patients treated in an intensive care unit completed the screening instrument and the Screening Experience Questionnaire via telephone. Associations between participants’ characteristics and scores were examined, and screening experiences were described. Results Participants reported that the screening instrument was easy to understand, caused little distress, and could be completed in an acceptable time frame. Participants reported that they had not been screened via a formal process or received education during or after their stay in the unit. Among the participants, 44% preferred screening in the outpatient setting. Higher scores on the screening tool were associated with history of depression, moderate levels of sedation, and intensive care unit delirium. Conclusions The majority of intensive care patients most likely are not being screened for posttraumatic stress syndrome despite a higher risk for the syndrome in these patients than in the general population.

scholarly journals The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: An observational study

2020 ◽  
Author(s):  
L.J. Delaney ◽  
E. Litton ◽  
K.L Melehan ◽  
H-C.C Huang ◽  
V Lopez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Moderate Level ◽  
Sleep Monitoring ◽  
Clinical Trial Registration ◽  
Wake Time ◽  
Intensive Care Patients

Abstract Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-hour duration to assess agreement between the two methods; total sleep time and wake time. Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371 p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number: ACTRN12615000945527 (Registered 9/9/2015)

Sign in / Sign up

Export Citation Format

Share Document