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.

scholarly journals Assessing Nurses’ Knowledge of Noise in the Intensive Care Unit: An Educational Intervention Project

2021 ◽  
Author(s):  
Jennifer Fortes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
Educational Intervention ◽  
Quality Improvement Project ◽  
Minimal Risk ◽  
Improvement Project ◽  
Staff Members ◽  
Nurses Knowledge

Noise in the intensive care unit (ICU) has been studied for over thirty years, but it continues to be a significant problem and a top complaint among patients. Staff members are now reporting detrimental health effects from excessive noise. One of the significant factors of inadequate noise control in the ICU is that nurses have insufficient awareness regarding the hospital noise issue and its negative impact on health status. The level of knowledge of clinical staff on the topic of noise is not known. A quality improvement project to explore noise in the ICU could facilitate better understanding of the phenomenon and formulation of new ways to continue to reduce noise at a community hospital in Massachusetts. The purpose of this quality improvement project was to evaluate nurses’ knowledge of the potentially harmful effects of noise on patients as well as on nurses, to identify opportunities for improvement of the environment, and to conduct an educational intervention aimed at reducing noise in the intensive care unit. The methodology for this project included a pre-test, followed by an educational session, and completion of a post-test. The participants included registered nurse staff members in the Intensive Care Unit (ICU) and the Critical Care Unit (CCU). Exclusion criteria included staff members who are not registered nurses. The project posed minimal risk. No identifying or biographical data was collected, and results included analysis of aggregate data. Descriptive statistics were used to assist with analysis. Results were disseminated to the staff of the ICU and CCU, posted on a bulletin board in the critical care area, presented as a poster presentation at the Spring RIC MSN Symposium, and available as a manuscript on the RIC Digital Commons.

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.

Critical care staff rotation: outcomes of a survey and pilot study

2003 ◽  
Vol 8 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Annette Richardson ◽  
Margaret Douglas ◽  
Rachel Shuttler ◽  
Martin R Hagland
Keyword(s):  
Critical Care ◽  
Pilot Study ◽  
Care Staff

scholarly journals Updated hospital associated venous thromboembolism outcomes with 90-days follow-up after hospitalisation for severe COVID-19 in two UK critical care units

2020 ◽  
Vol 196 ◽  
pp. 454-456
Author(s):  
Andrew J. Doyle ◽  
Will Thomas ◽  
Andrew Retter ◽  
Martin Besser ◽  
Stephen MacDonald ◽  
...  
Keyword(s):  
Critical Care ◽  
Venous Thromboembolism ◽  
Critical Care Units

Prevalence of Sudden Speechlessness in Critical Care Units

2011 ◽  
Vol 20 (4) ◽  
pp. 439-447 ◽  
Author(s):  
Loris A. Thomas ◽  
Carmen S. Rodriguez
Keyword(s):  
Critical Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hospital Data ◽  
Care Environment ◽  
Critical Care Units ◽  
Clinical Diagnoses ◽  
Unit Characteristic

Sudden speechlessness (SS) is commonly experienced by patients admitted to critical care units. Although literature findings document challenges associated with periods of SS, the prevalence is unknown. The purpose of this study is to determine the prevalence and characteristics of adult SS patients in four critical care units at a university-affiliated tertiary care hospital. Data are collected on 9 randomly selected days over a 4-month period. The daily prevalence of SS ranges from 16% to 24% in each unit. Characteristic data collected includes patient age, gender, medical diagnosis related to SS episode, type of speechlessness, days since SS began, and communication strategies in use. Respiratory intubation related to various clinical diagnoses is the main cause for SS. Use of multiple specific strategies to convey needs during SS periods are identified. Follow-up studies to further define the prevalence of SS in settings beyond the critical care environment are recommended.

scholarly journals Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses (Preprint)

2021 ◽  
Author(s):  
Laura Singh ◽  
Marie Kanstrup ◽  
Katherine Depa ◽  
Ann-Charlotte Falk ◽  
Veronica Lindström ◽  
...  
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Data Collection ◽  
Mixed Method ◽  
Traumatic Events ◽  
Psychological Trauma ◽  
Care Staff ◽  
Health Care Staff ◽  
Intrusive Memories

BACKGROUND The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. OBJECTIVE The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. METHODS We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. RESULTS After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. CONCLUSIONS The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

scholarly journals Prototipo para la comparación de patrones temporales secuenciales de arritmias cardíacas [Prototype for comparison of sequential temporal patterns of cardiac arrhythmias]

2012 ◽  
Author(s):  
Alejandro Javier Hadad ◽  
Agustín Benjamín Ezequiel Solano ◽  
Bartolomé Drozdowicz
Keyword(s):  
Critical Care ◽  
Cardiac Arrhythmias ◽  
Temporal Patterns ◽  
Clinical Settings ◽  
Analysis Model ◽  
Reference Case ◽  
Software Application ◽  
Critical Care Units ◽  
Additional Information

Resumen En el presente trabajo se presenta un prototipo para la búsqueda de patrones temporales secuenciales de arritmias cardíacas. Dicha búsqueda está orientada al soporte de tareas de monitoreo en ámbitos clínicos a través de modelos de seguimiento temporal en unidades de cuidados críticos. En el proceso de diseño se abordaron diferentes dimensiones de análisis desde el punto de vista de la abstracción temporal. Para el desarrollo de los modelos de seguimiento se eligió como caso de referencia el monitoreo de las arritmias. Para el análisis de secuencias se construyó un modelo basado en el algoritmo de Smith-Waterman. El seguimiento con este modelo generó información adicional, potencialmente utilizable en el pronóstico de evolución en cuidados críticos. Con estas especificaciones se desarrolló una aplicación de software que tiene como objetivo principal comparar y ponderar registros de electrocardiograma (ECG), clasificados según diferentes tipos de latidos. La aplicación funciona como soporte para la exploración y el análisis con fines diagnósticos de afecciones evidenciadas a partir de arritmias cardíacas, brindando indicios acerca de la evolución temporal entre registros similares. Palabras ClavesPrototipo, Supervisión, Arritmias, Patrones temporales   Abstract This paper presents a prototype for the sequential search for temporal patterns of cardiac arrhythmias. This search is aimed at supporting monitoring tasks in clinical settings through time tracking models in critical care units. In the design process are addressed different dimensions of analysis from the viewpoint of abstraction in time. For the development of monitoring models was taken as the reference case monitoring of arrhythmias. The sequence analysis model was constructed based on the Smith-Waterman algorithm. Follow-up with this model generated information, potentially useful in forecasting trends in critical care. With these specifications the software application was developed to compare and weight electrocardiogram records. The application work like a support to exploration and analysis diagnostic tasks over illness related to cardiac arrhythmias and generate additional information about the evolution based on historical with similar sequential temporal patterns. Keywords Prototype, Supervision, Arrhythmias, Temporal patterns 

Pain Management in the Critically Ill: What Do We Know and How Can We Improve?

1994 ◽  
Vol 5 (2) ◽  
pp. 159-168 ◽  
Author(s):  
Michele A. Alpen ◽  
Marita G. Titler
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Pain Management ◽  
Critically Ill ◽  
Pain Assessment ◽  
Pain Control ◽  
Critical Care Nurses ◽  
Critical Care Units ◽  
Knowledge And Attitudes ◽  
Nurses Knowledge

Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses’ knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities

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