Occult Tuberculosis in the Intensive Care Unit

1994 ◽  
Vol 9 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Scott E. Eveloff ◽  
Walter E. Donat ◽  
Sidney S. Braman
Keyword(s):  
Critical Care ◽  
Rhode Island ◽  
Hospitalized Patients ◽  
Care Staff ◽  
Delay In Diagnosis ◽  
Critical Care Units ◽  
Patient Morbidity ◽  
Unexplained Fever ◽  
Empiric Antibiotic ◽  
Hypoxic Respiratory Failure

Mycobacterium (TB) is often a subtle disease. Unrecognized TB may occur in hospitalized patients and contribute to increased patient morbidity and even mortality. To determine the magnitude of this problem in the critical care unit, we retrospectively reviewed the records of all patients with cultures positive for TB who were admitted to the critical care units of the Rhode Island Hospital between 1981 and 1991. Fourteen such patients (mean age, 59; range, 31-84 years) wsere identified from a total of 100 cases of proven TB among all hospitalized patients during this 11-year period. Thirteen of 14 patients had risk factors known to predispose to TB, including alcoholism, malnutrition, and immunosuppression. No patient was known to have TB at the time of ICU admission. The median time from admission to definitive diagnosis or death was 25 days; TB was the primary or contributing cause of death in 9 of 14 patients. Reasons for the marked delay in diagnosis and subsequent high mortality include (1) a low yield of initial diagnostic tests for TB, (2) nonspecific radiographic studies, (3) willingness of critical care staff to attribute overwhelming illness to more common conditions seen in the ICU, and (4) empiric antibiotic or immunosuppressive therapy directed at nontuberculous processes. In all patients, TB was a strong diagnostic consideration but was dismissed when initial noninvasive and invasive studies were unrevealing. IN critically ill patients with unexplained fever and hypoxic respiratory failure, TB should be strongly considered despite negative diagnostic studies.

Critical care nurse internships: in theory and practice

1993 ◽  
Vol 13 (4) ◽  
pp. 115-118 ◽  
Author(s):  
ME Kopp ◽  
KA Schell ◽  
L Laskowski-Jones ◽  
PK Morelli
Keyword(s):  
Critical Care ◽  
Staff Nurses ◽  
Theory And Practice ◽  
Care Staff ◽  
Staff Nurse ◽  
Orientation Programs ◽  
Graduate Nurses ◽  
Care Nurse ◽  
Didactic Instruction ◽  
Critical Care Units

The CCNIP is a 6-month program that provides didactic instruction and supervised clinical experience to graduate nurses desiring critical care staff nurse positions. During rotations through four critical care units, interns are cross-trained to handle a variety of patient care scenarios. Upon completion of the program nurses are required to fulfill an 18-month service commitment to a critical care unit within the institution. During its 6 years of operation the CCNIP has promoted clinical competency and assisted in the recruitment and retention of staff nurses in critical care. Considering these outcomes, other critical care educators and administrators may want to consider implementing nurse internships as an alternative to traditional orientation programs.

scholarly journals A quality improvement project for delirium prevention and management over the Greater Manchester Critical Care Network

2020 ◽  
pp. 175114372091270
Author(s):  
Jessica Davis ◽  
Karen Berry ◽  
Rebecca McIntyre ◽  
Daniel Conway ◽  
Anthony Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Best Practice ◽  
Point Prevalence ◽  
Screening Tools ◽  
Care Bundle ◽  
Improvement Project ◽  
Care Network ◽  
Critical Care Units ◽  
Patient Morbidity ◽  
Delirium Prevention

Background Delirium is a common complication of critical illness with a significant impact on patient morbidity and mortality. The Greater Manchester Critical Care Network established the Delirium Reduction Working Group in 2015. This article describes a region-wide delirium improvement project launched by that group. Methods Multiple Plan-Do-Study-Act cycles were undertaken. Cycle 1: April 2015 demonstrated only 48% of patients had a formal delirium screen. Following this a network-wide event took place and the Delirium Standards for the Greater Manchester Critical Care Network were produced. Cycle 2: May 2016 quarterly audits across the network monitored compliance against the agreed standards. Group events involved implementation of a delirium care bundle, sharing best practice, educating staff and providing guidance on the management of delirium. Cycle 3: November 2016 quarterly audit continued and a regional delirium study day was rolled out across the region. Results We have 14 different units across our network, all of which have participated in the audit. The first audit showed a delirium point prevalence of 28%, subsequent point prevalence audits demonstrated rates as low as 13%. There has also been an improvement in the use of delirium screening tools. In the first audit 37% of patients had two delirium screens in 24 h, this has increased to 60% in the latest audit. Improvements were also made in availability of sensory aids and pain assessments. Conclusion The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.

scholarly journals Implementing target range oxygen in critical care: A quality improvement pilot study

2019 ◽  
pp. 175114371989278
Author(s):  
Rosie Heartshorne ◽  
Jenna Cardell ◽  
Ronan O'Driscoll ◽  
Tim Fudge ◽  
Paul Dark
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Pilot Study ◽  
Care Staff ◽  
Target Range ◽  
Baseline Survey ◽  
Staff Attitudes ◽  
Critical Care Units ◽  
Staff Members

Background Iatrogenic hyperoxaemia is common on critical care units and has been associated with increased mortality. We commenced a quality improvement pilot study to analyse the views and practice of critical care staff regarding oxygen therapy and to change practice to ensure that all patients have a prescribed target oxygen saturation range. Methods A baseline measurement of oxygen target range prescribing was undertaken alongside a survey of staff attitudes. We then commenced a programme of change, widely promoting an agreed oxygen target range prescribing policy. The analyses of target range prescribing and staff survey were repeated four to five months later. Results Thirty-three staff members completed the baseline survey, compared to 29 in the follow-up survey. There was no discernible change in staff attitudes towards oxygen target range prescribing. Fifty-four patients were included in the baseline survey and 124 patients were assessed post implementation of changes. The proportion of patients with an oxygen prescription with a target range improved from 85% to 95% (χ2 = 5.17, p = 0.02) and the proportion of patients with an appropriate prescribed target saturation range increased from 85% to 91% (χ2 = 1.4, p = 0.24). The improvement in target range prescribing was maintained at 96% 12 months later. Conclusions The introduction and promotion of a structured protocol for oxygen prescribing were associated with a sustained increase in the proportion of patients with a prescribed oxygen target range on this unit.

Overcoming the obstacles to caring for the long-term critical care patient

1992 ◽  
Vol 12 (5) ◽  
pp. 40-43
Author(s):  
D Recker
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critical Care Patient ◽  
Care Patient ◽  
Care Staff ◽  
Nursing Interventions ◽  
Critical Care Units ◽  
Nursing Expertise ◽  
Two Factors

Caring for the critically ill long-term patient is a challenge. Although such patients must remain in the critical care environment because of the nursing expertise they require, they are often viewed as low-priority patients by the staff because of two factors. One factor relates to the nurse. Critical care nurses, typically action-oriented, function best during crisis intervention and are rewarded for technical skills and efficiency. The other factor relates to the patient. The critically ill long-term patient's needs are different from those of patients most often seen in critical care units; therefore, required nursing interventions are different. These interventions may not be within the nurse's usual repertoire of knowledge and skills and may also be physically and psychologically draining. Implementation of appropriate strategies has the potential for reducing length of stay, cost to the patient and the hospital, and stress for the critical care staff.

Data-Driven Optimization Methodology for Admission Control in Critical Care Units

2016 ◽  
Author(s):  
Amirhossein Meisami ◽  
Jivan Deglise-Hawkinson ◽  
Mark Cowen ◽  
Mark P. Van Oyen
Keyword(s):  
Critical Care ◽  
Admission Control ◽  
Data Driven ◽  
Critical Care Units ◽  
Optimization Methodology

Embodied Spatial Practices and the Power to Care

2019 ◽  
pp. 360-377
Author(s):  
Elise Paradis ◽  
Warren Mark Liew ◽  
Myles Leslie
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Ethnographic Study ◽  
Spatial Practices ◽  
Critical Care Units ◽  
Interprofessional Care ◽  
The Social

Drawing on an ethnographic study of teamwork in critical care units (CCUs), this chapter applies Henri Lefebvre’s ([1974] 1991) theoretical insights to an analysis of clinicians’ and patients’ embodied spatial practices. Lefebvre’s triadic framework of conceived, lived, and perceived spaces draws attention to the role of bodies in the production and negotiation of power relations among nurses, physicians, and patients within the CCU. Three ethnographic vignettes—“The Fight,” “The Parade,” and “The Plan”—explore how embodied spatial practices underlie the complexities of health care delivery, making visible the hidden narratives of conformity and resistance that characterize interprofessional care hierarchies. The social orderings of bodies in space are consequential: seeing them is the first step in redressing them.

Sign in / Sign up

Export Citation Format

Share Document