scholarly journals Evaluating the impact of audit interventions on accidental removal of critical care devices in the intensive care unit - Clinical Audit Project

2020 ◽  
Vol 2 (7) ◽  
pp. 01-05
Author(s):  
Alfateh Noor
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Hemodynamic Instability ◽  
Central Venous Line ◽  
Care Bundle ◽  
Central Venous ◽  
Educational Campaign ◽  
Audit Project ◽  
The Impact ◽  
Second Period

Accidental critical care device removals in intensive care units (ICUs) are serious preventable incidents that have major implications. The study aimed to understand possible causes of such events and identify interventions that reduced their occurrence. The researchers conducted a single-center audit by collecting patient data and bundle forms for accidental device removal across two consecutive periods; they retrospectively reviewed the data from the first period (August 1, 2019 to January 31, 2020) and prospectively analyzed the data from the bundle forms obtained in the second (February 1, 2020 to July 31, 2020). From the findings of the first period, the researchers designed an intervention comprising nurses’ adherence to a care bundle checklist and an educational campaign for the care-taking team and applied it in the second period. Patients either accidentally removed the central venous lines secondary to agitation (47%), or it happened by loss of catheter securement (21%), or during daily care (17%) or patient transfer (13%). Such inadvertent incidents resulted in reinsertion with another central venous line (69%), agitation due to sedation interruption (47%), development of hemodynamic instability because of interruption of inotrope administration (30%), significant bleeding that required intervention (21%), and no complications (39%). The overall nurses’ compliance to the care bundle checklist improved from 87% to 97% after introduction of the intervention and the number of devices found in place increased. Therefore, the designed care bundle checklist and educational program successfully decreased the accidental removal of critical care devices.

scholarly journals The Impact of Implementing Critical Care Team on Open General Intensive Care Unit

2012 ◽  
Vol 73 (2) ◽  
pp. 100 ◽  
Author(s):  
Ick Hee Kim ◽  
Seung Bae Park ◽  
Seonguk Kim ◽  
Sang-Don Han ◽  
Seung Seok Ki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Team ◽  
General Intensive Care Unit ◽  
The Impact ◽  
Critical Care Team

scholarly journals 1017. Scratching the Surface with NHSN Data: Defining High Impact Stewardship Targets in Critical Care

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S357-S358
Author(s):  
Kelsie Cowman ◽  
Victor Chen ◽  
Nidhi Saraiya ◽  
Yi Guo ◽  
Rachel Bartash ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Antibiotic Use ◽  
Time Frame ◽  
High Impact ◽  
Chart Audit ◽  
Surgical Intensive Care ◽  
Patient Level ◽  
Clostridioides Difficile ◽  
The Impact

Abstract Background The National Healthcare Safety Network (NHSN) provides risk-adjusted Standardized Antimicrobial Administration Ratios (SAAR) as a benchmark for medical and surgical intensive care units (ICU). Antibiotic use (AU) data does not provide patient-level information (e.g., antibiotic appropriateness, indications, durations, etc.). However, we hypothesize that AU data can help define high impact stewardship targets, particularly in the context of critical care Clostridioides difficile rates. Methods Units with high rates of AU and hospital-onset (HO) C. difficile were selected for review. A monthly AU and C. difficile dashboard was created for ICU providers, inclusive of data from May 2018 onwards. We also performed chart audits for indication, duration, and location of initiation for all medical intensive care unit (MICU) patients receiving piperacillin/tazobactam (P/T) or vancomycin (Van) during February 2019 per request of ICU stakeholders. Data were used to obtain stewardship buy-in from local MICU champions. Results AU data indicated that (1) all 3 MICUs consistently had SAARs >1 for broad-spectrum categories and (2) Van and P/T were the highest volume agents on these units (Figure 1). Chart audit of 135 MICU patients showed that 17 patients received P/T, 34 Van, and 84 (62%) both agents; median duration was 2 days for Van and 3 days for P/T (Figure 2). Approximately half of initiations occurred in the emergency department (ED) (50% Van, 47% P/T); most common indications were “respiratory tract infection” and “severe sepsis/septic shock” for both P/T (77%) and Van (74%) (Figure 2). HO C. difficile in MICUs accounted for 6%, 13%, and 16% of total HO C. difficile cases in campuses A, B, and C, respectively during the time frame (Figure 1). Conclusion We feel that NHSN data scratches the surface of the deep-rooted challenges of ICU stewardship. However, it can identify AU trends and most frequently prescribed antibiotics in the context of unit-specific C. difficile rates. Intensive stewardship audit can further uncover areas for intervention, such as ED Van and P/T overprescribing. We suggest presenting clinical stakeholders with a quarterly “stewardship dashboard” combining AU rates, patient-level data, and C. difficile rates to maximize the impact of stewardship endeavors. Disclosures All authors: No reported disclosures.

scholarly journals The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020 ◽  
Vol 11 (01) ◽  
pp. 182-189
Author(s):  
Ellen T. Muniga ◽  
Todd A. Walroth ◽  
Natalie C. Washburn
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Number Of Patients ◽  
Order Sets ◽  
Critical Care Admission ◽  
The Impact ◽  
Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

scholarly journals Monitoring intensive care unit performance—impact of a novel individualised performance scorecard in critical care medicine: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019165 ◽  
Author(s):  
Shannon M Fernando ◽  
David Neilipovitz ◽  
Aimee J Sarti ◽  
Erin Rosenberg ◽  
Rabia Ishaq ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Performance Metrics ◽  
Quality Standard ◽  
Care Patient ◽  
Critical Care Medicine ◽  
Resource Utilisation ◽  
The Impact

IntroductionPatients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics.Methods and analysisThis will be a mixed-methods, controlled before and after study to assess the impact of a CCM-specific quality scorecard. Scorecard metrics were developed through expert consensus and existing literature. The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation are collected daily from bedside flow sheets. Preintervention baseline data will be collected for 6 months for each participant. After this, each participant will receive their scorecard measures. Following a 3-month washout period, postintervention data will be collected for 6 months. The primary outcome will be change in performance metrics following the provision of scorecard feedback to subjects. A cost analysis will also be performed, with the purpose of comparing total ICU costs prior to implementation of the scorecard with total ICU costs following implementation of the scorecard. The qualitative portion will include interviews with participants following the intervention phase. Interviews will be analysed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement.Ethics and disseminationThis protocol has been approved by the local research ethics board. Publication of results is anticipated in 2019. If this intervention is found to improve patient- and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilisation of such a scorecard as a quality standard in CCM.

scholarly journals Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study (Preprint)

2020 ◽  
Author(s):  
Atiya Dhala ◽  
Farzan Sasangohar ◽  
Bita Kash ◽  
Nima Ahmadi ◽  
Faisal Masud
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Care Physician ◽  
Rapid Expansion ◽  
Code Blue ◽  
Scope Of Application ◽  
Spread Of Infection ◽  
The Impact

BACKGROUND The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. OBJECTIVE The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. METHODS The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. RESULTS Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. CONCLUSIONS Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

scholarly journals Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

10.2196/20143 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e20143
Author(s):  
Atiya Dhala ◽  
Farzan Sasangohar ◽  
Bita Kash ◽  
Nima Ahmadi ◽  
Faisal Masud
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Care Physician ◽  
Rapid Expansion ◽  
Code Blue ◽  
Scope Of Application ◽  
Spread Of Infection ◽  
The Impact

Background The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

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