Pharmacy Personnel’s Involvement in Transitions of Care of Intensive Care Unit Patients: A Systematic Review

2020 ◽  
pp. 089719002091152
Author(s):  
Mikhaila Rice ◽  
Alyssa Lear ◽  
Sandra Kane-Gill ◽  
Amy L. Seybert ◽  
Pamela L. Smithburger
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medication Safety ◽  
English Language ◽  
Health Care Team ◽  
Error Rates ◽  
Transitions Of Care ◽  
Patient Centered ◽  
Safety Measures ◽  
Team Members

Objective: Do pharmacy personnel- (ie, pharmacist or pharmacy technician) driven interventions at transitions of care into or out of the intensive care unit (ICU) improve medication safety measures compared to interventions made by other health-care team members or no intervention? Data Sources: A literature search of MEDLINE and Embase limited to English language and humans was performed (from 1969 until January 2019). Bibliographies of included investigations were reviewed for additional citations. Methods: Investigations were selected if they described a pharmacy-driven intervention at any point of transfer into or out of an ICU setting. Ten investigations were included. Five described interventions relevant to the entire ICU population, and 5 described interventions targeted to specific medications or disease. Results: A variety of interventions were utilized in the 10 included investigations. A significant improvement was demonstrated with pharmacy-driven intervention in all 4 studies that evaluated the entire ICU patient population. Interventions specific to certain medication and disease improved medication safety measures but were not always statistically significant. Medication error rates are high in patients transferred into and out of the ICU, and limited data exist to address this concern. This review compares and evaluates the current literature to guide future interventions and research in this area. Conclusions: Although pharmacy-driven interventions demonstrated some benefit in various medication safety measures in the majority of studies, additional randomized and prospective trials with patient-centered outcomes that assess morbidity and mortality are needed.

scholarly journals Emergency Evacuation of the Neonatal Intensive Care Unit (NICU) During Disasters: A Systematic Literature Review

2021 ◽  
Author(s):  
Sayedeh-Somayyeh Mousavipour ◽  
Sanaz Sohrabizadeh
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
English Language ◽  
Web Search ◽  
Emergency Evacuation ◽  
Team Members ◽  
Vulnerable Patients

The evacuation of hospitals has special complications and sensitivities in terms of the presence of patients. Since infants are the youngest and most vulnerable patients in the hospital, the readiness of the neonatal intensive care unit (NICU) to respond appropriately and evacuate at the time of disasters is very important. This article examines the emergency evacuation of neonatal intensive care units during disasters. The present systematic review was done based on the PRISMA guidelines for systematic review studies. Accordingly, all English-language articles published in this field were extracted by the end of January 2020, through searching Web of Science, PubMed, Scopus, and Science Direct, as well as Google Scholar Web Search. The search and screen of the articles were conducted independently by the research team members, and the content of included articles was analyzed thematically. After the final evaluation, 11 articles were subjected to content analysis, which was divided into seven thematic categories: command, training and maneuver, manpower, communication, equipment, transportation, support. Considering that infants are the most vulnerable preparing the staff of the (NICU) along with providing them with specialized and technical support is suggested. By preparing and implementing response and preparedness plans, it is possible to prevent high complications and mortality among infants admitted to the hospital pre-disasters.

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.

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.

Teaching a DISCHARGE Framework to Hospital Teams to Improve Transitions of Care

2020 ◽  
Author(s):  
Shreya P. Trivedi ◽  
Mack Lipkin ◽  
Mark D. Schwartz
Keyword(s):  
Ad Hoc ◽  
Discharge Planning ◽  
Transitions Of Care ◽  
Hospital Discharges ◽  
Patient Centered ◽  
Team Members ◽  
Informal Curriculum ◽  
Discharge Plan ◽  
Perceived Change ◽  
Hospital Teams

Abstract Background: Residents typically learn about managing transitions of care as part of the informal curriculum in an ad-hoc, reactive manner. Learning may be enhanced by using a framework to proactively practice addressing key domains for a patient soon-to-be-discharged from the hospital. We developed such an evidence-based framework, DISCHARGE , as a cognitive aid. Using this framework, we implemented and evaluated a workshop designed for hospital teams to learn addressing key components of discharging a patient.Methods: All members of 8 Internal Medicine teams across 4 rotations were invited to attend an hour-long workshop ranging from September 2017 - February 2018. Participants completed a retrospective, pre-post survey on their perceived change in discharge-related behaviors. We evaluated the perceived effectiveness of the workshop with a retrospective pre-post questionnaire. We used Wilcoxon signed-rank tests for pairwise comparisons to access perceived changes in discharge behaviors.Results: A total of 90 of 140 team members (64%) attended the workshop and 79 of the 90 (87%) completed the questionnaire. The session was effective in increasing the likelihood of addressing patient-centered behaviors at discharge (mean 1.4 improvement on a 5-point scale, P<0.001, R>0.5). In addition, senior residents and attendings projected they were more likely to discuss the importance of discharge planning with the team early in a rotation. Interns noted they were more comfortable asking the team for help in carrying out a discharge plan (p<0.001, R>0.5).Conclusions: Teaching teams a cognitive aid to practice managing hospital discharges may increase the likelihood of addressing important domains for their patients. Incorporating the team allows for explicit alignment for priorities and communication. Further study is needed to document how such learning is translated into discharge practice.

Organization and Structure of the Cardiothoracic Intensive Care Unit

2015 ◽  
pp. 86-104
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽  
2017 ◽  
pp. 709-727
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study

2020 ◽  
Vol 29 (4) ◽  
pp. 271-282
Author(s):  
Kelly N. Michelson ◽  
Elizabeth Charleston ◽  
Danica Y. Aniciete ◽  
Lauren R. Sorce ◽  
Patricia Fragen ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Health Care Team ◽  
Care Team ◽  
Care Needs ◽  
Family Meetings ◽  
Family Perceptions

Background Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes. Objective To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families’ and health care teams’ perceptions of the intervention. Methods This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a “navigator,” met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups. Results Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive. Conclusions The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.

scholarly journals Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 26 ◽  
pp. 107602962096708
Author(s):  
Belayneh Kefale ◽  
Gobezie T. Tegegne ◽  
Amsalu Degu ◽  
Melaku Tadege ◽  
Desalegn Tesfa
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
English Language ◽  
Meta Analysis ◽  
Thrombotic Event ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
D Dimer

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document