The Effect of a Respiratory Algorithm on Respiratory Transition to Extrauterine Life

2019 ◽  
Vol 38 (2) ◽  
pp. 80-87 ◽  
Author(s):  
Susan Michelle Bedwell ◽  
Renee Leasure ◽  
Theresa Gibson
Keyword(s):  
Length Of Stay ◽  
Respiratory Distress ◽  
Chart Review ◽  
Evidence Based Practice ◽  
Retrospective Chart Review ◽  
Respiratory Support ◽  
Evidence Based ◽  
Admission Rates

PurposeThis evidence-based practice project evaluated the efficacy of a respiratory algorithm administered by specially trained transition nurses on the reduction of preventable NICU admissions for infants experiencing mild respiratory distress during transition.DesignA retrospective chart review compared a cohort of newborn admission rates for seven months before and seven months after initiation of a respiratory algorithm.SampleRecords of infants were included if they were born >35 weeks' gestation, had documented mild respiratory distress after birth, required <48 hours of noninvasive respiratory support, and had a length of stay less than four days.ResultsNinety-six infants (before n = 34, after n = 62) were included. Before implementation of the respiratory algorithm, infants requiring noninvasive respiratory support were admitted to the NICU. Following implementation of the algorithm, NICU admissions for mild respiratory distress significantly decreased (86 percent), despite a concurrent increase in maternal acuity.

106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S71-S72
Author(s):  
Erin Wolf Horrell ◽  
Ronnie Mubang ◽  
Sarah A Folliard ◽  
Robel Beyene ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Level Of Care ◽  
Post Discharge ◽  
Patients Âgés ◽  
Injury Characteristics ◽  
Frail Patients ◽  
Discharge Care ◽  
Patients Experience

Abstract Introduction Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population. Methods We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale. Results Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail. Conclusions We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.

Respiratory outcomes in children with congenital myotonic dystrophy

2021 ◽  
pp. 1-5
Author(s):  
Jaclyn C. Omura ◽  
Maida Chen ◽  
Miriam Haviland ◽  
Susan Apkon
Keyword(s):  
Respiratory Distress ◽  
Myotonic Dystrophy ◽  
Invasive Mechanical Ventilation ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Respiratory Support ◽  
Non Invasive ◽  
Congenital Myotonic Dystrophy ◽  
Respiratory Outcomes

PURPOSE: Congenital myotonic dystrophy (CDM) results in hypotonia and acute respiratory distress at birth. Previous studies show that prolonged periods of intubation (>4 weeks) correlate with increased mortality rates. The objective is to describe the use and duration of respiratory support in newborns with CDM and how these relate to mortality. METHODS: A retrospective chart review was performed at a tertiary pediatric hospital among children with confirmed diagnosis of CDM. The main outcome measures were: mortality, duration of invasive mechanical ventilation (IMV) and non-invasive partial pressure ventilation (NIPPV), along with long-term use of respiratory support and equipment. RESULTS: A total of 18 subjects met inclusion criteria, 83%.f which had documented respiratory distress at birth, 39%.equired NIPPV, and 50%.equired intubation in the neonatal period. The earliest NIPPV was initiated at day one of life, and the latest extubation to NIPPV was at 17 days of life. CONCLUSION: This cohort required IMV for shorter periods with earlier transitions to NIPPV which suggests a possible change in practice and earlier transition to NIPPV recently. Further data are needed to determine if there is a possible correlation between the need for NIPPV/IMV and mortality rates.

Tele-ICU Partners Enhance Evidence-Based Practice

2012 ◽  
Vol 23 (3) ◽  
pp. 312-322 ◽  
Author(s):  
Carol Olff ◽  
Cynthia Clark-Wadkins
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Care Delivery ◽  
Health Care Team ◽  
Evidence Based ◽  
New Members ◽  
Management Protocol ◽  
Information Research

Evidence-based practice (EBP) has become more than just a trendy buzzword in health care; EBP validates care delivery methods and grants satisfaction to nurses in knowing the care they provide is based on valid, current information. Research-based enhancements are paramount to the advancement of nursing practice and prompt the implementation of creative methods to improve care. The advent of the tele–intensive care unit (ICU) introduces new members of the health care team to assist with implementation of EBP initiatives. This new partnership results in improved length of stay, mortality rates, and ventilator times for critical care patients. Current literature suggests that a clinician-driven, standardized ventilator management protocol is of significant benefit. Tele-ICU clinicians provide an interactive element to coordinate interdisciplinary team efforts. Enhanced communication, data evaluation, and timely intervention expedite the weaning process and reduce ventilator length of stay. Consistent collaboration between tele-ICU and bedside clinicians successfully improves patient outcomes through standardized adherence to best-practice initiatives.

The Mania Pathway Protocol: An Application of Evidence-Based Interventions for the Treatment of Acute Mania on an Inpatient Psychiatric Unit

2020 ◽  
pp. 107839032091654
Author(s):  
Avishay A. Adri
Keyword(s):  
Chart Review ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Acute Mania ◽  
Evidence Based ◽  
Psychiatric Unit ◽  
Young Mania ◽  
Improvement Project ◽  
Mood Stabilization ◽  
Inpatient Psychiatric Unit

INTRODUCTION: Acute manic episodes are a psychiatric emergency related to violence and poor patient outcomes. Combination psychotropic therapy utilizing a mood stabilizer and an atypical antipsychotic has been shown to be more efficacious for treating acute mania compared to monotherapy with either mood stabilizers or antipsychotics alone. This quality improvement project implemented evidence-based interventions for treating acute mania. The mania pathway protocol was created as a comprehensive clinical guide for guiding mania treatment. The protocol was implemented on an inpatient psychiatric unit for patients with mania diagnoses including manic/mixed episodes of bipolar disorder or schizoaffective disorder. AIMS: (1) to improve the treatment of mania by using evidence-based interventions for rapid mood stabilization and (2) to educate psychiatric providers on up-to-date interventions for treating acute manic states. METHOD: Psychiatric providers were evaluated for knowledge enhancement through a pre-/post–educational session quiz. A retrospective chart review was used for data collection for patients treated with the mania pathway protocol. The retrospective chart review spanned 8 weeks post project implementation. Young Mania Rating Scale (YMRS) scores were analyzed to measure the effect on mania severity. RESULTS: The percentage decrease in mean Young Mania Rating Scale scores from admission to the fifth day of hospitalization was 61%. All psychiatric providers proved knowledge attainment by scoring 100% on the postintervention quiz. CONCLUSIONS: Rapid mood stabilization may be achieved by using a combination therapy–based mania protocol. Educational sessions can enhance psychiatric provider knowledge with regard to evidence-based treatments for mania.

Use of a Pan-Canadian indicator to measure treatment rates relative to evidence-based guidelines for rectal cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 177-177
Author(s):  
Tonia Forte ◽  
Julie Klein-Geltink ◽  
Rami Rahal ◽  
Gina Lockwood ◽  
Heather E. Bryant ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Administrative Data ◽  
Chart Review ◽  
Radiation Treatment ◽  
Retrospective Chart Review ◽  
Cancer Registries ◽  
Patient Choice ◽  
Stage Ii ◽  
Evidence Based ◽  
Evidence Based Guidelines

177 Background: As part of the Canadian Partnership Against Cancer’s (CPAC) System Performance initiative, indicators measuring treatment practice patterns across the country are now available, offering the ability to compare against evidence-based guidelines. We report on the percentage of patients with stage II and III rectal cancer receiving pre-operative radiation treatment (RT) based on an analysis of Canadian administrative data. A retrospective chart review was conducted to examine reasons for non-treatment with RT, set performance targets, and inform quality improvements. Methods: Data on the percentage of stage II and III rectal cancer cases receiving preoperative RT were obtained from five provincial cancer registries using a standardized methodology for 2,854 cases diagnosed between 2007 and 2008, with 2009 data soon to be available. A retrospective chart review was conducted in five provinces on a random sample of 383 patients diagnosed in 2008 to examine reasons for non-referral and non-treatment. Results: Based on administrative data, an average of 45% of cases received RT preceding surgical resection for stage II or III rectal cancer, ranging from 36% to 48% across provinces. Preoperative RT rates were similar for men and women, but were lower in older patients. From 2007 to 2008, the percentage of patients receiving pre-operative RT increased in all provinces. Results from the chart review showed that, of those who did not receive preoperative RT, 33% were not referred by a surgeon to an oncologist. The most common documented reasons for non-referral were co-morbidities (26%) and patient choice (7%). Among patients referred to an oncologist, 42% were treated with preoperative RT, 30% were treated with post-operative RT and 28% received no treatment. Among those receiving no treatment, 29% were seen only by a medical oncologist, and 18% were not treated due to patient choice. Conclusions: Findings are being used to develop national targets for treatment rates and, working with national oncologist associations, to develop quality improvement strategies, including patient education efforts to promote informed decisions on treatment options.

scholarly journals Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19

2020 ◽  
Vol 15 (12) ◽  
pp. 734-738
Author(s):  
William E Soares III ◽  
Elizabeth M Schoenfeld ◽  
Paul Visintainer ◽  
Tala Elia ◽  
Venkatrao Medarametla ◽  
...  
Keyword(s):  
Patient Safety ◽  
Respiratory Distress ◽  
Healthcare System ◽  
Safety Assessment ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Flow ◽  
Adult Patients ◽  
Do Not Resuscitate ◽  
High Flow Nasal Cannula

As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)–related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.

scholarly journals Management of eight labor and delivery patients dependent on buprenorphine (Subutex™): A retrospective chart review

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 7 ◽  
Author(s):  
Solina Tith ◽  
Garinder Bining ◽  
Laurent A. Bollag
Keyword(s):  
Chart Review ◽  
Case Series ◽  
Retrospective Chart Review ◽  
The United States ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Labor And Delivery ◽  
Opioid Agonists ◽  
Opioid Administration ◽  
Evidence Based Guidelines

Background: Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by “The American College of Obstetrics and Gynecology” as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists’ unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia. We reviewed our management and outcomes in this medically complex population. Methods: An Institutional Review Board (IRB) approved retrospective chart review was conducted of women admitted to the University of Washington Medical Center Labor and Delivery unit from July 2012 to November 2013 using buprenorphine. All deliveries, including intrauterine fetal demise, were included. Results: Eight women were admitted during this period to our L&D floor on buprenorphine. All required peri-partum anesthetic management either for labor and/or cesarean delivery management. Analgesic management included dilaudid or fentanyl PCA and/or continued epidural infusion, and in one instance ketamine infusion, while the pre-admission buprenorphine regimen was continued. Five babies were viable, two women experienced intrauterine fetal death at 22 and 36 weeks gestational age (GSA), respectively, and one neonate died shortly after delivery due to a congenital diaphragmatic hernia. Conclusions: This case series illuminates the medical complexity of parturients using buprenorphine. Different treatment modalities in the absence of evidence-based guidelines included additional opioid administration and continued epidural analgesia. The management of post-cesarean pain in patients on partial μ-opioid agonists remains complex and variable, and evidence-based guidelines could be useful for clinicians to direct care.

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