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 Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maja Kopczynska ◽  
Harry Unwin ◽  
Richard J. Pugh ◽  
Ben Sharif ◽  
Thomas Chandy ◽  
...  
Keyword(s):  
Critical Care ◽  
Point Prevalence ◽  
Early Warning Score ◽  
Care Bundle ◽  
Resuscitation Orders ◽  
Prevalence Studies ◽  
Significant Difference ◽  
Patients At Risk ◽  
Sepsis Care ◽  
Critical Care Outreach

AbstractThe ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.

Impact of Integrated Training Programme on Cognizance regarding Fast HUG in Critical Care Units among nursing officers from selected Hospitals of Mysuru

2021 ◽  
pp. 287-290
Author(s):  
Vidya M.
Keyword(s):  
Critical Care ◽  
Quantitative Research ◽  
Best Practice ◽  
Length Of Hospital Stay ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Training Programme ◽  
Randomised Control Trial ◽  
Research Approach ◽  
Critical Care Units

FAST HUG is a checklist which helps to implement best practice at ICU and to decrease mortality, morbity and length of hospital stay at ICU2. Research methodology: Quantitative research approach Research design: Randomised control trial/Quasi experimental design Population: In this study population consists of nursing officers working at selected government and private hospital’s critical care units of Mysore Sampling technique: Simple Random sampling technique. Sample size: 30 nursing officers working at selected government and private hospital’s Critical care units of Mysore Conclusion: FAST HUG is an effective checklist which reduces the complications in ICU patients. It gives guidelines for nurses to follow proper technique in providing essential care to patients.

scholarly journals A survey of antibiotic administration practices involving patients with sepsis in UK critical care units

2019 ◽  
Vol 42 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Gregory J. Barton ◽  
Charles W. Morecroft ◽  
Neil C. Henney
Keyword(s):  
Critical Care ◽  
Best Practice ◽  
Multi Drug Resistance ◽  
Antibiotic Administration ◽  
Message Board ◽  
Minimal Inhibitory Concentrations ◽  
Critical Care Units ◽  
Severe Burns ◽  
Administration Method ◽  
Administration Methods

AbstractBackground Alternative administration methods are emerging as a key area of research to improve clinical efficacy of antibiotics and address concerns regarding multi-drug resistance. Extended intermittent infusions or continuous infusions of antibiotics exhibiting time-dependent kill characteristics may be favourable in critically ill septic patients, but more evidence is needed to determine best practice. Objective To find out whether any common practice exists for intravenous antibiotic administration in critical care units across UK NHS Trusts, and identify factors influencing the adoption of extended or continuous infusions. Setting UK hospitals. Method UK critical care pharmacists were invited to participate in a survey on behalf of all 240 critical care units via a UK Clinical Pharmacy Association message board. The survey focused on administration practices for 22 antibacterial agents. Main outcome measure Antibiotic administration method. Results Responses were received covering 64 units, a response rate of 26.2%. Common, but not uniform administration methods were apparent for 17/22 antibiotics. Four antibiotics (piperacillin/tazobactam, doripenem, meropenem and vancomycin) were more likely to be administered as continuous or extended-intermittent infusions. Choice of administration method was especially influenced by altered pk/pd properties in sepsis or severe burns patients, or by the presence of organisms requiring high minimal inhibitory concentrations. Conclusion Unlicensed alternative practices of antibiotic administration are widespread but only weak evidence exists of any patient benefit, such as reduced length of stay in critical care, and none showing improvement in mortality. Further research is needed to determine whether extended infusion methods offer clinically meaningful advantages over shorter licenced administration methods in patients in critical care units.

scholarly journals Simulation workshops as an adjunct to perioperative care bundles in the management of external ventricular drains: improving surgical technique and reducing infection

2019 ◽  
Vol 131 (5) ◽  
pp. 1620-1624
Author(s):  
Debayan Dasgupta ◽  
Linda D’Antona ◽  
Daniel Aimone Cat ◽  
Ahmed K. Toma ◽  
Carmel Curtis ◽  
...  
Keyword(s):  
Infection Rate ◽  
Perioperative Care ◽  
Best Practice ◽  
Simulation Training ◽  
External Ventricular Drain ◽  
Sampling Technique ◽  
Care Bundle ◽  
Infection Rates ◽  
Improvement Project ◽  
Csf Diversion

OBJECTIVETemporary CSF diversion through an external ventricular drain (EVD) comes with the risk of EVD-related infections (ERIs). The incidence of ERIs varies from 0.8% to 22%. ERIs increase mortality, morbidity, length of stay, and costs; require prolonged courses of antibiotics; and increase the need for subsequent permanent CSF diversion. The authors report the results of a quality improvement project designed to improve infection rates and EVD placement using simulation training in addition to a standardized perioperative care bundle. This project resulted not only in a decrease in ERIs, but also a significant improvement in surgical outcomes.METHODSA best-practice standardized perioperative approach and care bundle was approved by consensus among the senior neurosurgeons at the authors’ institution, and a standardized operative note was designed to encourage adherence to policy and improve documentation. This approach was adapted from the bundle previously described by Kubilay et al. Simulation workshops were introduced to teach safe sampling technique, administration of intrathecal drugs, and a standardized operative technique using the Rowena head surgical model. Effects of the interventions on placement, infection rates, and displacement were measured at two distinct time points over a 2-year period.RESULTSBaseline audits demonstrated satisfactory EVD placement in 74%, an infection rate of 8.5%, and displacement occurring in 20%. In the 2 years following the interventions, satisfactory placement improved to 96%, infection rate fell to 4.8%, and inadvertent displacement occurred in only 1.7%.CONCLUSIONSSimulation training and standardizing the perioperative care of patients requiring EVDs dramatically improved placement accuracy, reduced infection rates, and reduced EVD displacement rate.

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.

scholarly journals Establishing the use of a safety attitudes questionnaire to assess the safety climate across a critical care network

2018 ◽  
Vol 19 (3) ◽  
pp. 219-225 ◽  
Author(s):  
Antony Thomas ◽  
John-Paul Lomas
Keyword(s):  
Critical Care ◽  
Safety Climate ◽  
Inverse Relation ◽  
Point Change ◽  
Safety Attitudes ◽  
Care Network ◽  
Critical Care Units ◽  
Safety Attitudes Questionnaire ◽  
Safety Attitude Questionnaire ◽  
Safety Attitude

Aims We aimed to measure the safety culture across a network of critical care units to compare units, track temporal changes and to present easy to interpret information back to staff. Methods We provided adapted paper versions of the short ICU ‘Safety attitude questionnaire’ to 14 critical care units annually between 2015 and 2017. The responses were analysed to establish scores for individual safety domains. Feedback used colour conditional formatted tables to allow easy identification of high and low scores. Results There was an inverse relation between median unit score and standardised mortality (rs = 0.4). Rates of staff fatigue increased between 2016 and 2017 (two-point change on a 1–5 scale). Conclusions A critical care network can usefully collect and feedback safety attitude questionnaires which show a relationship with patient outcome. Units should monitor overtime working.

scholarly journals Are do-not-resuscitate orders associated with limitations of care beyond their intended purpose in patients with acute intracerebral haemorrhage? Analysis of the ABC-ICH study

2021 ◽  
Vol 10 (1) ◽  
pp. e001113
Author(s):  
Jatinder S Minhas ◽  
Camilla Sammut-Powell ◽  
Emily Birleson ◽  
Hiren C Patel ◽  
Adrian R Parry-Jones
Keyword(s):  
Critical Care ◽  
Supportive Care ◽  
Intracerebral Haemorrhage ◽  
Qualitative Evaluation ◽  
Respiratory Arrest ◽  
Care Bundle ◽  
Do Not Resuscitate ◽  
Improvement Project ◽  
Improvement In Survival ◽  
Dnr Orders

Implementation of an acute bundle of care for intracerebral haemorrhage (ICH) was associated with a marked improvement in survival at our centre, mediated by a reduction in early (<24 hours) do-not-resuscitate (DNR) orders. The aim of this study was to identify possible mechanisms for this mediation. We retrospectively extracted additional data on resuscitation attempts and supportive care. This observational study utilised existing data collected for the Acute Bundle of Care for ICH (ABC-ICH) quality improvement project between from 2013 to 2017. The primary outcome was whether a patient received an early (<24 hours) DNR order. We used multivariable logistic regression to estimate the adjusted association between clinically meaningful factors, including an indicator for a change in treatment on the introduction of the ABC care bundle. Early DNR orders were associated with a reduced odds of escalation to critical care (OR: 0.07, 95% CI: 0.03 to 0.17, p<0.001). Commencement of palliative care within 72 hours was far more likely (OR: 8.76, 95% CI: 4.74 to 16.61, p<0.001) if an early DNR was in place. The cardiac arrest team were not called for an ICH patient before implementation but were called on five occasions overall during and after implementation. Further qualitative evaluation revealed that on only one occasion was there a cardiac or respiratory arrest with cardiopulmonary resuscitation performed. We found no significant increase in resuscitation attempts after bundle implementation but early DNR orders were associated with less admission to critical care and more early palliation. Early DNR orders are associated with less aggressive supportive care and should be judiciously used in acute ICH.

scholarly journals Mucoactive agent use in adult UK Critical Care Units: a survey of health care professionals’ perception, pharmacists’ description of practice, and point prevalence of mucoactive use in invasively mechanically ventilated patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8828 ◽  
Author(s):  
Mark Borthwick ◽  
Danny McAuley ◽  
John Warburton ◽  
Rohan Anand ◽  
Judy Bradley ◽  
...  
Keyword(s):  
Critical Care ◽  
Point Prevalence ◽  
Prevalence Survey ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Critical Care Units ◽  
Unit Level ◽  
Point Prevalence Survey ◽  
The Uk ◽  
Ventilated Patients

Background Mechanical ventilation for acute respiratory failure is one of the most common indications for admission to intensive care units (ICUs). Airway mucus clearance is impaired in these patients medication, impaired mucociliary motility, increased mucus production etc. and mucoactive agents have the potential to improve outcomes. However, studies to date have provided inconclusive results. Despite this uncertainty, mucoactives are used in adult ICUs, although the extent of use and perceptions about place in therapy are not known. Aims and Objectives We aim to describe the use of mucoactive agents in mechanically ventilated patients in UK adult critical care units. Specifically, our objectives are to describe clinicians perceptions about the use of mucoactive agents, understand the indications and anticipated benefits, and describe the prevalence and type of mucoactive agents in use. Methods We conducted three surveys. Firstly, a practitioner-level survey aimed at nurses, physiotherapists and doctors to elucidate individual practitioners perceptions about the use of mucoactive agents. Secondly, a critical care unit-level survey aimed at pharmacists to understand how these perceptions translate into practice. Thirdly, a point prevalence survey to describe the extent of prescribing and range of products in use. The practitioner-level survey was disseminated through the UK Intensive Care Society for completion by a multi-professional membership. The unit-level and point prevalence surveys were disseminated cthrough the UK Clinical Pharmacy Association for completion by pharmacists. Results The individual practitioners survey ranked ‘thick secretions’ as the main reason for commencing mucoactive agents determined using clinical assessment. The highest ranked perceived benefit for patient centred outcomes was the duration of ventilation. Of these respondents, 79% stated that further research was important and 87% expressed support for a clinical trial. The unit-level survey found that mucoactive agents were used in 83% of units. The most highly ranked indication was again ‘thick secretions’ and the most highly ranked expected patient centred clinical benefit being improved gas exchange and reduced ventilation time. Only five critical care units provided guidelines to direct the use of mucoactive agents (4%). In the point prevalence survey, 411/993 (41%) of mechanically ventilated patients received at least one mucoactive agent. The most commonly administered mucoactives were inhaled sodium chloride 0.9% (235/993, 24%), systemic carbocisteine (161/993, 16%) and inhaled hypertonic sodium cloride (127/993, 13%). Conclusions Mucoactive agents are used extensively in mechanically ventilated adult patients in UK ICUs to manage ‘thick secretions’, with a key aim to reduce the duration of ventilation. There is widespread support for clinical trials to determine the optimal use of mucoactive agent therapy in this patient population.

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