scholarly journals Missed Nursing Care in Intensive Care Patients Subjected to Interhospital Capacity Transfers: A Retrospective Matched Case–Control Chart Review

2021 ◽  
Author(s):  
Jonas Karlsson ◽  
Isabell Fridh ◽  
Kristina Schildmeijer ◽  
Magnus Andersson Hagiwara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Care ◽  
Unit Length ◽  
Oral Care ◽  
Positive Pressure ◽  
Control Group ◽  
Case Group ◽  
Unit Capacity ◽  
Missed Nursing Care

Abstract Background The number of patients undergoing an interhospital intensive care unit-to-unit capacity transfer has dramatically increased. These transfers are complex, pose a risk for the patients and have been linked to increased intensive care unit length of stay and mortality, but the reasons for this are not known. We hypothesised that there was a difference in the incidence of missed nursing care among patients subjected to capacity transfer compared with patients not subjected to any transfer during their intensive care stay. Methods A retrospective case–control chart review was conducted on adult patients who between January 1, 2009, and January 31, 2020, underwent an interhospital intensive care unit-to-unit capacity transfer. We applied a matched control group by 1:2 matching. Missed nursing care was based on four variables: mobilisation, tooth brushing, oral care and nutrition. Data were retrieved from the local database and the patient’s medical charts at two general level 3 ICUs. Results The case group (n = 63) received significantly less mobilisation ( p < 0.05), mean 5.94 (2.36), compared with the control group (n = 126), mean 7.74 (2.96). In a subanalysis of the patients treated with invasive positive pressure ventilation and noninvasive positive pressure ventilation, the case group (n = 56) was found to receive significantly less oral care ( p < 0.05), median 3.50 (1.00–6.00), compared with the control group (n = 80), median 5.00 (2.00–7.75). None of the other variables were significantly related to interhospital intensive care unit-to-unit capacity transfers. Conclusion In critically ill patients, interhospital intensive care unit-to-unit capacity transfers were associated with missed nursing care. Future studies, focusing on capacity transfers should consider missed nursing care when the causes of increased intensive care unit length of stay and mortality are to be investigated.

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

2020 ◽  
Vol 163 (2) ◽  
pp. 232-243 ◽  
Author(s):  
Rebecca L. Cherney ◽  
Vinciya Pandian ◽  
Ashly Ninan ◽  
Debra Eastman ◽  
Brian Barnes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Care Pathway ◽  
Interdisciplinary Collaboration ◽  
Unit Length ◽  
Control Group ◽  
Staff Nurse ◽  
Prospective Comparison

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

scholarly journals Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

2017 ◽  
Vol 8 (1-2) ◽  
pp. 26-33
Author(s):  
Mohammad Khan ◽  
Zeehaida Mohamed ◽  
Saedah Ali ◽  
Norkhafizah Saddki ◽  
Sam’an Malik Masudi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Tooth Brushing ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Statistical Software ◽  
Patient Screening ◽  
Experimental Group

Aims and Objectives: Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU). Materials and Methods: Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24. Results: Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate. Conclusion: Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

Procalcitonin-Guided Antibiotic Therapy Duration in Critically Ill Adults

2015 ◽  
Vol 26 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Caroline Walker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Bacterial Infections ◽  
Unit Length ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Control Group ◽  
Duration Of Treatment

Procalcitonin is a promising biomarker for antibiotic therapy because its levels rise and fall quickly with bacterial infections. A multi-database literature search was reviewed with 3 primary prospective randomized control trials used in further analysis. The results indicated that a procalcitonin-guided antibiotic protocol reduces the number of days a patient has to take antibiotics while having no effect on mortality when compared with control groups. Short-term studies did not show a difference in the intensive care unit length of stay, infection relapse rate, super-infection rate, or multidrug-resistant bacteria rate between the procalcitonin-protocol and control group. Because procalcitonin-guided antibiotic therapy has been shown to reduce the duration of treatment with antibiotics in critically ill patients without worsening the mortality rate or other outcomes, the implementation of a procalcitonin-guided antibiotic therapy should be considered for patients with proven or highly suspected bacterial infections in the intensive care unit.

scholarly journals Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199915
Author(s):  
Dicky Ari Risandy ◽  
Desy Rusmawatiningtyas ◽  
Firdian Makrufardi ◽  
Elisabeth Siti Herini ◽  
Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Candida Infection ◽  
Control Group ◽  
Case Group ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Candida Score

Candida infection was previously thought to be rare in intensive care. With the increased use of broad-spectrum antibiotics, the incidence of candida infection increased significantly. Case-control study was done in patients ≤18 years of age treated for 3 days or more in Pediatric Intensive Care Unit (PICU) Dr. Sardjito General Hospital, Yogyakarta from January 2014 to December 2016. Overall, 43 children were included in this study as a case group with positive candida culture and 43 children as a control group with no candida culture. Cut off point of candida score is ≥3 from our subjects. The area under curve (AUC) value for cut off ≥3 was moderate (0,72). Candida score ≥3 has an odd ratio (OR) 6.8 (95% CI 2.4-18.6) with P < .05. All of confounding factors in candida infection have no association with P > .05. Candida score can be used as predictor of candida infection in PICU.

scholarly journals Correlation between nosocomial pneumonia and ventilated patients in pediatric intensive care unit

2016 ◽  
Vol 48 (3) ◽  
pp. 170
Author(s):  
Cahya Dewi ◽  
Purnomo Suryantoro ◽  
Roni Naning
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Case Group ◽  
Mechanical Ventilator ◽  
Significant Difference ◽  
Matched Case

Background NP (NP) especially YAP (ventilator-associated pneu-monia) is the most common infection in intensive care unit, whichcorrelates with the increasing of morbidity and mortality. Thereare some risk factors for development ofNP, the most importantone is duration of mechanical ventilator and reintubation.Objective To determine the correlation between NP and use ofmechanical ventilator in pediatric intensive care unit (PICU).Methods A matched case control study was conducted at Dr.Sardjito Hospital on all patients admitted to the PICU from2004 until 2006. Case group was defined as all patients who hadNP; age and sex matched control group included all patients notdiagnosed as NP. Statistical analysis was done by using chi-squareand t-tests as appropriate. Logistic regression analysis was doneto determine the role of risk factors.Results One-hundred and forty-one patients were included inthis study. The incidence of NP was 25. 7%. There was associa-tion between using mechanical ventilator (OR 1.08; 95%CI 1.07;8.20, P=0.036) and duration of using mechanical ventilator morethan four days (OR 1.75, 95%CI 1.87;18.02) with developmentof NP. There was a significant difference in event free survival ofNP between those using mechanical ventilator group and thosenot using mechanical ventilator group (P<O.OOl).Conclusion There is an association between the use of mechani-cal ventilator and duration of use of mechanical ventilator morethan four days with the development of NP

scholarly journals Association of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit

2019 ◽  
Vol 173 (1) ◽  
pp. 44 ◽  
Author(s):  
Heather L. Tubbs-Cooley ◽  
Constance A. Mara ◽  
Adam C. Carle ◽  
Barbara A. Mark ◽  
Rita H. Pickler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nursing Care ◽  
Neonatal Intensive Care ◽  
Nurse Workload ◽  
Missed Nursing Care

scholarly journals Markers of inflammation as risk predictors of lethal outcome in patients diagnosed with delirium

2016 ◽  
Vol 73 (9) ◽  
pp. 838-843 ◽  
Author(s):  
Ivana Stasevic-Karlicic ◽  
Milena Stasevic ◽  
Slobodan Jankovic ◽  
Slavica Djukic-Dejanovic ◽  
Srdjan Milovanovic
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
White Blood Cells ◽  
Adverse Outcomes ◽  
Control Group ◽  
Case Group ◽  
Lethal Outcome ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Risk Predictors

Background/Aim. Delirium is an acute or subacute, and most frequently reversible syndrome of higher cortical functions disturbances that is manifested as generalized disorder. If not prevented, it is associated with various adverse outcomes. The aim of this study was to determine the connection between the markers of inflammation and lethal outcome in patients diagnosed with delirium, hospitalized in the psychiatric intensive care unit. Methods. This retrospective study included 120 patients hospitalized in the psychiatric intensive care unit in whom examination of differences in inflammation markers was done. The examinees have been divided into two groups: the case group of 40 patients who died during the hospitalization, and the control group of 80 examinees who were discharged with the diagnosis Post delirium status. The following variables were taken into account: age, gender, clinical diagnosis of infection (pneumonia and urinary tract infection), laboratory parameters (total of white blood cells, granulocytes, monocytes, C-reactive protein ? CRP) and type of delirium (withdrawal or organic). Results. The average age of patients was 50.3 ? 13.1 years. The patients who survived delirium, were on the average 10.5 years younger than the deceased (p < 0.001). More than half (57.5%) of the deceased had pneumonia. There was a statistically significant correlation between pneumonia and lethal outcome in the patients with delirium (p < 0.001). The examinees with lethal outcome had significantly higher median CRP levels than the group of examinees who survived (75.6% ? 54.0 vs 30.3 ? 42.5 ng/L, p < 0.001). Conclusion. Aiming to better and more precise diagnostics of this complicated and still unclear neuropsychiatric syndrome it would be useful to consider introduction of more precise diagnostic algorithms in every unit of intensive care. That would significantly reduce the number of delirium diagnosis overlook, decrease complication of clinical features and would also reduce the unfavorable outcome rate, therefore the total cost of treatment.

Intensive Care Unit Capacity Measure

2018 ◽  
Author(s):  
Dawn Opgenorth ◽  
Henry T. Stelfox ◽  
Elaine Gilfoyle ◽  
R. T. Noel Gibney ◽  
Michael Meier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Unit Capacity ◽  
Capacity Measure

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

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