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

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.

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Sandra Cristina Hernandes ◽  
Talita Teles Teixeira Pereira ◽  
Shana Oliveira ◽  
Denis de Melo Soares ◽  
...  

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 &lt; 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.


2020 ◽  
Vol 40 (4) ◽  
pp. e7-e17 ◽  
Author(s):  
Marilyn Schallom ◽  
Heidi Tymkew ◽  
Kara Vyers ◽  
Donna Prentice ◽  
Carrie Sona ◽  
...  

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 &lt; .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.


2016 ◽  
Vol 07 (03) ◽  
pp. 660-671 ◽  
Author(s):  
Adam MacLasco ◽  
Melissa Saul ◽  
Tiffany R. Smith ◽  
Megan Kloet ◽  
Catherine Kim ◽  
...  

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.


1992 ◽  
Vol 26 (10) ◽  
pp. 1287-1291 ◽  
Author(s):  
William E. Dager ◽  
Timothy E. Albertson

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.


2021 ◽  
Vol 24 (1) ◽  
pp. 45-53
Author(s):  
Panayiota Senekki-Florent ◽  
Margaret Walshe

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.


2020 ◽  
Vol 8 ◽  
Author(s):  
Bo Wang ◽  
Geng Li ◽  
Fei Jin ◽  
Jingwen Weng ◽  
Yaguang Peng ◽  
...  

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.


2018 ◽  
Vol 24 (6) ◽  
pp. 381-386 ◽  
Author(s):  
Ester Góes Oliveira ◽  
Paulo Carlos Garcia ◽  
Clairton Marcos Citolino Filho ◽  
Lilia Nogueira

2021 ◽  
Author(s):  
◽  
Loc Tan Nguyen

<p>Recent years have seen increasing research interest in the teaching of pronunciation in English as a second/foreign language classes (Thomson & Derwing, 2014), with particular strands of this research focused on understanding how pronunciation is represented in instructional materials and actual teaching practices in a range of settings and in teacher cognition (e.g., Couper, 2017; Derwing, Diepenbroek, & Foote, 2012; Foote, Trofimovich, Collins, & Urzúa, 2016). The study reported in this dissertation extends this research by investigating pronunciation teaching in a context where it has hitherto been under-researched, namely tertiary EFL in Vietnam.  The research involved two phases. Phase 1 was an introductory situation analysis which investigated pronunciation teaching practices of six Vietnamese tertiary EFL teachers teaching six intact classes at a Vietnamese university. First, the representation of pronunciation features in prescribed textbooks and supplementary materials of the EFL programme were analysed. Six ninety-minute lessons (one from each of the teachers) were then observed, and the teachers and 24 students across the six groups interviewed. The teacher interviews included both stimulated recall and general questions probing their beliefs about pronunciation teaching. Students were interviewed in focus groups (four each) regarding their teachers’ pronunciation teaching and their own pronunciation needs. The focus of Phase 1 was on how the teachers taught pronunciation, the factors shaping their pedagogical choices, and the students’ beliefs about their teachers’ pronunciation teaching and their instructional needs. The findings revealed that pronunciation was largely absent from course books and curriculum documents and that the teachers’ beliefs were in contrast with what they actually did in class. The teachers reported that they would follow deliberate steps if they taught pronunciation explicitly such as listening discrimination followed by explaining places of articulation and then practice. However, in the observed lessons, they only corrected their students’ pronunciation errors through recasts and/or prompts, with little if any explicit or pre-planned pronunciation teaching. In the interviews, the teachers confirmed that they never used any other techniques and that this was typically the only way they taught pronunciation in class.  The teachers’ pronunciation teaching was textbook-driven and was shaped by contextual factors including the curriculum and the learners. Decision making by all the teachers reflected a general commitment to strictly follow the mandated curriculum, with little evidence of pronunciation being taught explicitly. All the teachers reported a lack of initial training and professional learning in pronunciation pedagogy. In addition, there was a mismatch between the teachers’ and students’ preferences and beliefs about pronunciation teaching. Whereas the teachers believed error correction through recasts and/or prompts was effective, the students did not, and expressed a strong need for more explicit, communicative teaching of pronunciation. This pronunciation instructional need and the teachers’ lack of initial training and PL in pronunciation pedagogy motivated the Phase 2 study.  Phase 2 was an intervention study conducted with the same teachers teaching different classes. At the beginning of Phase 2, the teachers attended a teacher professional learning (TPL) workshop in which they were introduced to a pedagogic framework for teaching English pronunciation communicatively proposed by Celce-Murcia, Brinton, & Goodwin (2010). The teachers then planned communicative pronunciation teaching (CPT) lessons using this framework, and were subsequently observed implementing these lessons in their classes. Both the workshop and subsequent classes of this phase were audio-video recorded. A total of seven lesson plans and 24 classroom observations were made across the six teachers (four observations each). Right after the classroom observations, the teachers were interviewed to obtain their views of the TPL workshop and their implementation of the CPT lessons. Twenty-four students across the six groups were interviewed to reflect on their experience with the CPT lessons.  Observational data showed that the teachers understood and were able to translate what they learned about CPT from the workshop into actual classroom practice as reflected in their lesson planning and subsequent teaching. The lesson plans designed by the teachers closely followed the principles of the communicative framework. Interview data showed that the CPT model was favoured by both teacher and student participants. On the basis of the teachers’ implementation of the CPT lessons, both the teachers and students were confident that CPT has the advantages for promoting learners’ pronunciation knowledge, fostering their phonological ability, and developing their oral communication skills. They also reported that CPT can arouse learners’ interest and engagement in classroom learning.  Taken as a whole, this research highlights the need for pronunciation to be given a more explicit place in teaching and learning in tertiary EFL programmes in Vietnam, and for teachers to be better equipped for teaching pronunciation. Findings from interviews with teachers and learners in the study suggest that they would be receptive to such changes.</p>


2019 ◽  
Vol 47 (2) ◽  
pp. 120-127 ◽  
Author(s):  
Katherine E Triplett ◽  
Bradley A Wibrow ◽  
Richard Norman ◽  
Dana A Hince ◽  
Liesel E Hardy ◽  
...  

Blood gas analysers are point-of-care testing devices used in the management of critically ill patients. Controversy remains over the agreement between the results obtained from blood gas analysers and laboratory auto-analysers for haematological and biochemistry parameters. We conducted a prospective analytical observational study in five intensive care units in Western Australia, in patients who had a full blood count (FBC), urea, electrolytes and creatinine (UEC), and a blood gas performed within 1 h of each other during the first 24 h of their intensive care unit admission. The main outcome measure was to determine the agreement in haemoglobin, sodium, and potassium results between laboratory haematology and biochemistry auto-analysers and blood gas analysers. A total of 219 paired tests were available for haemoglobin and sodium, and 215 for potassium. There was no statistically significant difference between the results of the blood gas and laboratory auto-analysers for haemoglobin (mean difference –0.35 g/L, 95% confidence interval (CI) –1.20 to 0.51, P = 0.425). Although the mean differences between the two methods were statistically significant for sodium (mean difference 1.49 mmol/L, 95% CI 1.23–1.76, P < 0.0001) and potassium (mean difference 0.19 mmol/L, 95% CI 0.15–0.24, P < 0.0001), the mean biases on the Bland–Altman plots were small and independent of the magnitude of the measurements. The two methods of measurement for haemoglobin, sodium and potassium agreed with each other under most clinical situations when their values were within or close to normal range suggesting that routine concurrent blood gas and formal laboratory testing for haemoglobin, sodium and potassium concentrations in the intensive care unit is unwarranted.


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