scholarly journals Pengetahuan, Sikap dan Persepsi Petugas Gawat Darurat Terhadap Kesalahan Medik

2009 ◽  
Vol 3 (6) ◽  
pp. 270
Author(s):  
Refi Fitri Hamdani Nasution
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Error ◽  
Health Workers ◽  
Emergency Unit ◽  
Depth Interview ◽  
Number Of Patients ◽  
Study Results ◽  
Compare Study ◽  
Document Review

Kesalahan medik serius paling sering terjadi di intensive care unit, ruang operasi, dan unit gawat darurat. Tujuan penelitian ini mendapat informasi tentang pengetahuan, sikap, dan persepsi tenaga kesehatan terhadap kesalahan medik. Penelitian dilakukan terhadap manajer, kepala seksi, kepala ruangan, ke- tua kelompok perawat, dokter dan perawat pelaksana. Metode yang digunakan adalah metode kualitatif meliputi wawancara mendalam, observasi, dan telaah dokumen. Metode analisis yang digunakan adalah analisis konten yg membandingkan hasil penelitian dengan teori. Ditemukan bahwa pengetahuan, sikap, dan persepsi tenaga kesehatan cukup baik, tetapi belum diikuti tindakan, sarana prasarana dan pengawasan yang memadai. Sistem rujukan pasien yang kurang baik menyulitkan keluarga pasien. Kesalahan medik dipengaruhi oleh kasus sulit, pasien banyak dan tindakan tergesa-gesa. Sumber kesalahan medik adalah manusia, komunikasi, pasien. Keterampilan SDM dan kondisi fasilitas telah memadai. Namun, ruangan yang belum memadai dinilai sebagai sumber kesalahan medis. Selain itu, sikap antispasi atasan terhadap kesalahan medik kurang memadai. Untuk memperkecil kesalahan medik yang dilakukan upaya-upaya pelatihan, refreshing keilmuan, kolaborasi sesama tim, perbaikan komunikasi, dan mengikuti SOP.Kata kunci : Kesalahan medik, unit gawat darurat, pengetahuan, sikap, tenaga medisMedical error is known to occur mostly in the intensive care unit, operation room, and emergency unit. The objective of this study is to obtain information on knowledge, attitude, and perception of health workers on medical error. Study was conducted to manager, head of section, head of room, head of nursing team, doctors, and nurse. Qualitative method was employed including in-depth interview, observation, and document review. Analysis was conducted using content analysis that compare study results with theory. The study found that knowledge, attitude, and perception are relatively good, but has not been fol- lowed by appropriate action and not supported by sufficient facilities and monitoring system. Not very good referral system was an obstacle for patient’s fa- mily. Medical error was infleunced to happen by the presence of difficult cases, big number of patients, and in hurry action. The source of medical error was human factor, communication, and patient. Insufficiency or less equipped room was also perceived as source of medical error. Moreover, the attitude of ma- nagement regarding medical error was not really appropriate. To minimize medical error, it is necessary to conduct trainings, refreshing course, collaboration between teams, communication improvement, and SOP compliance.Key words : Medical error, emergency unit, knowledge, attitude, health workers

scholarly journals Treatment of critically ill COVID-19 patients: Practical guidelines

2021 ◽  
Vol 72 (3) ◽  
pp. 49-64
Author(s):  
Predrag Stevanović
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Health Workers ◽  
Extensive Experience ◽  
Treatment Protocols ◽  
Care Clinic ◽  
Number Of Patients ◽  
Short Period ◽  
Practical Guidelines

The coronavirus disease pandemic (2019) has burdened health systems around the world with a large number of severe patients in a short period of time. According to the law of large numbers, a significant number of critically ill COVID-19 patients appear in such conditions which require treatment in the intensive care unit. That percentage of those patients is around 3 - 5% in different countries. It is similar in Serbia; however, every rule has its exceptions. KBC "Dr Dragiša Mišović-Dedinje" in Belgrade has been determined to take care of the most difficult COVID-19 patients since the beginning of the epidemic due to its space, organizational and personnel possibilities. Out of the total number of patients treated in KBC "Dr Dragiša Mišović-Dedinje", about 25% of patients were treated in the intensive care unit for the above mentioned reasons. Guided by valid treatment protocols, Anesthesiology and Intensive Care clinic of the KBC "Dr Dragiša Mišović-Dedinje" has developed its own work protocols for rapid diagnosis, isolation and clinical management of such difficult patients. These protocols are important not only for the treatment of the most severe COVID-19 patients, but also for the best utilization of hospital resources, as well as for the prevention of the spread of the infection to the medical staff. Extensive experience in the treatment of critically ill patients was gained from the entire engagement during the epidemic, experienced doctors, anesthesiologists-intensivists with great knowledge in the field of work in the intensive care unit, but also managers of clinics and institutions, who can share their experience with health care policy makers. It is clear that in the future, the capacities and organization of work in the field of intensive care medicine should be redefined, as well as health workers should be trained to work in the most demanding field of medicine. Expert experience in the form of practical guidelines, derived from over fourteen months of continuous work in the red zone of COVID-19, where they fought for every breath of the patient, in this review are translated into simplified guidelines for orientation of those who find themselves in a similar situation.

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals Poisoning trends in intensive care unit at secondary care hospital – a pilot study

2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Sri Nanda G ◽  
Balaji S ◽  
Khayati Moudgil
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Small Scale ◽  
Hazardous Substance ◽  
Care Hospital ◽  
Global Issue ◽  
Study Results ◽  
Living Organisms ◽  
Collection Form

Poison is known as a toxic and hazardous substance that is capable of causing illness to the living organisms. It can lead to some fatal outcomes. Self-harming has become a global issue, which is a burden on society. Every year millions of people die due to the consumption of toxic compound and leaving their loved ones behind in grief. The prospective pilot study was performed on a small scale for a period of three months. Each type of poison case admitted to Intensive care unit for the three months from July 2018 to September 2018 were taken into consideration. The informed consent has been obtained from all the patients, whereas demographics details of the patient were obtained using a predesigned data collection form. During the study period, 37 cases of poisoning were reviewed. The incidence is found to be more in males 28 (75.6%) when compared to females 9 (24.3%). Our study results showed that pesticides are the major reason for poisoning with an intention of self- harming. Majority of the poisoning cases were seen in the age group of 21-30 where physical and mental stress is the major reason.

scholarly journals Inter-professional collaboration in an Intensive Care Unit: Challenges and opportunities

Rev Rene ◽  
2016 ◽  
Vol 17 (1) ◽  
pp. 10
Author(s):  
Eveline Rodrigues da Silva Barros ◽  
Ana Ecilda Lima Ellery
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Workers ◽  
Quality Care ◽  
Team Leadership ◽  
Professional Collaboration ◽  
Organizational Boundaries ◽  
Challenges And Opportunities ◽  
Provide Quality Care ◽  
The Times

To understand the relationship between health professionals in an intensive care unit, to explore the inter-professional collaboration. Methods: it is a qualitative study, inspired by the Hermeneutics Phenomenology of Paul Ricoeur, for the production of knowledge. Interviews were conducted with 36 intensive care professionals of a tertiary public hospital. Results: the professionals are satisfied with the work, and there is a commitment to provide quality care despite organizational boundaries such as precarious employment relationships and turnover of professionals. The inter-professional collaboration is an indispensable factor for assistance, but in practice is not effective most of the times by the absence of provisions for the integration of the team, leadership presence, as well as the overcrowding of services that overwhelm health workers. Conclusion: while recognizing the need for inter-professional collaboration, professionals do their work even in a very individualized way, with no strategies to boost this cooperation.

scholarly journals Nutritional therapy of COVID-19 disease in Intensive care units

2021 ◽  
Vol 26 (83) ◽  
pp. 27-52
Author(s):  
Biljana Damnjanović ◽  
Đuro Šijan ◽  
Ivan Rović ◽  
Igor Lazić ◽  
Saša Knežević ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Impact ◽  
Current Knowledge ◽  
Virus Disease ◽  
Nutritional Therapy ◽  
Hospital Treatment ◽  
Omega 3 ◽  
Corona Virus ◽  
Number Of Patients

Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.

scholarly journals Sepsis Criteria and Revision in Toxicological Intensive Care Unit

2020 ◽  
Vol 10 (4) ◽  
pp. 31452.1-31452.10
Author(s):  
Haleh Talaie ◽  
◽  
Maryam Nazari ◽  
Habib Emami ◽  
◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Coagulase Negative Staphylococci ◽  
International Consensus ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Arterial Blood ◽  
Study Results

Background: Sepsis is one of the significant causes of mortality in hospitalized patients. This cross-sectional study was performed to determine the frequency of positive blood culture and assess sepsis criteria based on Third International Consensus Definitions (related to Sequential Organ Failure Assessment score) and clinical and paraclinical findings (i.e., on-admission leukocytosis, increased lactate level, and fever) in poisoned patients admitted to the Toxicological Intensive Care Unit (TICU). Methods: Medical records of a total of 2000 poisoned patients admitted to the TICU of Loghman Hakim Hospital from 2016 to 2018 were assessed. Among them, 189 cases (9.45%) with suspected sepsis were considered eligible to be enrolled in the study. Results: Of 189 cases, 146 (77.24%) had possible signs and symptoms of sepsis as well as SOFA score higher than two with positive blood culture in 81 cases (55%). The Mean±SD serum level of lactate was 25.97±16.32 on admission. The most common pathogen detected in blood culture was coagulase-negative Staphylococci in 35 (24.0%) out of 146 cases. Glasgow Coma Scale (GCS) less than 12, age older than 50 years, and bilirubin more than 1.2 mg/dL were found as independent predictors of sepsis on multivariate analysis. Conclusion: Based on our findings, it is proposed that the sepsis definition should not be restricted to the guidelines. The patients’ poisoning background and presence of many confounding factors, including poisoning-induced on-admission increased lactate levels, leukocytosis, and disturbed arterial blood gas provide a critical decision-making situation to confirm sepsis according to guidelines.

scholarly journals Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.

2020 ◽  
Author(s):  
Minghang Li ◽  
Mingyue Ding ◽  
Huanzhang Shao ◽  
Bingyu Qin ◽  
Xingwei Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Care Group ◽  
China National Knowledge Infrastructure ◽  
Number Of Patients ◽  
Icu Discharge

Abstract Background The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW. Methods We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc. Results The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) . Conclusions Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

2018 ◽  
pp. 104-108
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Oxygen Demand ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Study Results ◽  
Sepsis And Septic Shock

This case focuses on detecting sepsis through early goal-directed therapies by asking the question: Does aggressive correction of hemodynamic disturbances in the early stages of sepsis improve outcomes? Early goal-directed therapies are aimed at restoring a balance between oxygen delivery and oxygen demand. Patients included in the study were adults presenting to the emergency room with severe sepsis or septic shock. Study results indicated that most patients with severe sepsis or septic shock should be managed with aggressive hemodynamic monitoring and support immediately on presentation in the emergency department (or, if this is not possible, in the intensive care unit) for 6 hours or until there is resolution of hemodynamic disturbances.

scholarly journals Student nurses’ ethical views on responses to the severe acute respiratory syndrome outbreak

2020 ◽  
Vol 27 (4) ◽  
pp. 924-934
Author(s):  
Joseph KM Kam ◽  
Eric Chan ◽  
Albert Lee ◽  
Vivian WI Wei ◽  
Kin On Kwok ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Resource Allocation ◽  
Intensive Care ◽  
Nursing Students ◽  
Severe Acute Respiratory Syndrome ◽  
Infectious Diseases ◽  
Health Workers ◽  
Intensive Care Unit Care ◽  
Central Research ◽  
Collateral Damage

Background Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. Objective We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. Research design A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. Ethical considerations This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. Findings Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students’ attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. Conclusion As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.

Overestimation of Bispectral Index in Sedated Intensive Care Unit Patients Revealed by Administration of Muscle Relaxant

2003 ◽  
Vol 99 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Benoît Vivien ◽  
Sophie Di Maria ◽  
Alexandre Ouattara ◽  
Olivier Langeron ◽  
Pierre Coriat ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Muscular Activity ◽  
Electromyographic Activity ◽  
Adductor Pollicis Muscle ◽  
Number Of Patients ◽  
Before And After

Background Electromyographic activity has previously been reported to elevate the Bispectral Index (BIS) in patients not receiving neuromuscular blockade while under sedation in the intensive care unit. This study aimed to investigate the magnitude of the decrease of BIS following administration of muscle relaxant in sedated intensive care unit patients. Methods The authors prospectively investigated 45 patients who were continuously sedated with midazolam and sufentanil to achieve a Sedation-Agitation Scale value equal to 1 and who required administration of muscle relaxant. BIS (BIS version 2.10), electromyography, and acceleromyography at the adductor pollicis muscle were recorded simultaneously before and after neuromuscular blockade. Sixteen of these 45 patients were also studied simultaneously with the new BIS XP. Results After administration of a muscle relaxant, BIS (67 +/- 19 vs. 43 +/- 10, P &lt; 0.001) and electromyographic activity (37 +/- 9 vs. 27 +/- 3 dB, P &lt; 0.001) significantly decreased. Multiple regression analysis showed that the decrease of BIS following administration of myorelaxant was significantly correlated to BIS and electromyographic baseline values. Using standard BIS range guidelines, the number of patients under light or deep sedation versus general anesthesia or deep hypnotic state was markedly overestimated before administration of myorelaxant (53 vs. 2%, P &lt; 0.001). Conclusions The BIS in sedated intensive care unit patients may be lower with paralysis for an equivalent degree of sedation because of high muscular activity. The magnitude of BIS overestimation is significantly correlated to both BIS and electromyographic activity before neuromuscular blockade. The authors conclude that clinicians who determine the amount of sedation in intensive care unit patients only from BIS monitoring may expose them to unnecessary oversedation.

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