Empowering critical care nurses to improve Compliance with protocols in the intensive care unit

2007 ◽  
Vol 16 (2) ◽  
pp. 153-156 ◽  
Author(s):  
Gerald Plost ◽  
Delores Privette Nelson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Compliance Rate ◽  
Critical Care Nurses ◽  
Evidence Based ◽  
Audit Tool ◽  
Adult Intensive Care Unit ◽  
Improve Compliance ◽  
Intensive Care Unit Nurses

•Background Practitioners often do not comply with evidence-based protocols. •Objective To improve compliance with evidence-based protocols in an intensive care unit. •Methods A baseline compliance range was obtained by using a sampling of 9 protocols for a 100% audit of 35 beds in an adult intensive care unit. Nurses were given positive rewards to promote an initiative to improve compliance with protocols. The original audit tool was used to assess compliance at intervals during a trial period and for a follow-up audit 3 years after implementation of the initiative. •Results One month after the initiative was started, compliance with protocols increased from a range of 62% to 77% to a compliance of almost 90%. Within 4 months, the compliance rate increased to a mean of more than 95%. Three years later, the compliance rate was greater than 90%. •Conclusion Extrinsic rewards improved compliance with protocols and resulted in a change in the culture in the intensive care unit that had a cumulative outcome.

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

scholarly journals Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective?

2019 ◽  
Vol 39 (4) ◽  
pp. e8-e21
Author(s):  
Joelle Ungarian ◽  
James A. Rankin ◽  
Karen L. Then
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Screening Tools ◽  
Evidence Based ◽  
Antipsychotic Medications ◽  
Delirium Management ◽  
Atypical Antipsychotic Medications ◽  
Published Research ◽  
Evidence Based Nursing

Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. However, dexmedetomidine appears to have a promising role in delirium management. This review includes an overview of the pathophysiology and types of delirium and describes 2 established tools used to screen for delirium. Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.

Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit

2002 ◽  
Vol 23 (3) ◽  
pp. 120-126 ◽  
Author(s):  
Marvin J. Bittner ◽  
Eugene C. Rich ◽  
Paul D. Turner ◽  
William H. Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Trial ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Surgical Intensive Care ◽  
Adult Intensive Care Unit ◽  
Paper Towel

Objective:To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.Design:Prospective trial with a nonequivalent control group.Setting:Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).Subjects:Unit staff.Intervention:Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.Results:Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r= -0.35 for the MICU,r= -0.46 for the SICU).Conclusions:Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.

Is Open Visitation Really “Open” in Adult Intensive Care Units in the United States?

2020 ◽  
Vol 29 (3) ◽  
pp. 221-225 ◽  
Author(s):  
Kerry A. Milner ◽  
Susan Goncalves ◽  
Suzanne Marmo ◽  
Sheri Cosme
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Best Practice ◽  
The United States ◽  
National Study ◽  
Adult Intensive Care Unit ◽  
Centered Care ◽  
Intensive Care Unit Nurses ◽  
Family Centered

Background Evidence indicates that open visitation in adult intensive care units is a best practice for patient- and family-centered care, and nurses substantially influence such visitation patterns. However, it is unclear whether intensive care units in Magnet and Pathway to Excellence (MPE) facilities nationwide implement this in practice. Objective To describe current national visitation practices in adult intensive care units and determine whether they have changed since the last national study, which used data from 2008 to 2009. Methods From February through April 2018, websites of MPE hospitals were reviewed in order to identify their adult intensive care unit visitation policy. If this information was unavailable online, the hospital was telephoned to obtain the policy. From May through August 2018, follow-up telephone calls were made to hospitals that reported open visitation, during which intensive care unit nurses at the hospitals were asked to verify that the policy did not restrict visiting hours or the number, type, or age of visitors. Results Among the 536 MPE hospitals contacted, 51% (n = 274) indicated that they allowed open visitation. Further examination, however, revealed that 64% (n = 175) restricted the number (68.2%), age (59.5%), or type (4.4%) of visitors, or visiting hours (19.8%). Only 18.5% of MPE hospitals (n = 99) allowed unrestricted visitation. Conclusion This study suggests a lack of progress toward implementing open visitation in adult intensive care units nationwide. Research on MPE hospitals that have adopted truly open visitation policies is needed to identify successful methods for implementing and sustaining open visitation.

Using Evidence and Process Improvement Strategies to Enhance Healthcare Outcomes for the Critically Ill: A Pilot Project

2006 ◽  
Vol 15 (6) ◽  
pp. 549-555 ◽  
Author(s):  
Carol W. Hatler ◽  
Deanna Mast ◽  
Jeannie Corderella ◽  
Gina Mitchell ◽  
Kathleen Howard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Evidence Based Practice ◽  
Care Delivery ◽  
Bloodstream Infections ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Outcomes ◽  
Tertiary Referral Hospital ◽  
Adult Intensive Care Unit

• Background Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice. • Objectives To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection in patients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest. • Methods The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that “fit” with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information. • Results During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients’ care resulted in estimated cost savings of $1.0 million to $2.3 million. • Conclusions Early, consistent communication about the project’s rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.

scholarly journals Physical Restraint in Adult Intensive Care Unit - Why and how are they used?

2016 ◽  
Vol 4 (2) ◽  
pp. 110-113
Author(s):  
Sushil Khanal ◽  
Subhash Prasad Acharya
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Patient Autonomy ◽  
Physical Restraint ◽  
Evidence Based ◽  
Adult Intensive Care Unit ◽  
Risk Of Injury ◽  
Ensure Patient Safety ◽  
Evidence Based Guidelines

Background: Physical restraint is preferred practice in adult critical care to reduce the risk of injury and ensure patient safety. However, data on the extent of restraint practice intensive care unit is unknown in our setting to develop evidence based guidelines to promote the scientific use of this modalityMethods: This observational study was conducted for determining the prevalence, motives and ongoing practices of physical restraint. Data were collected from direct observation of physically restrained patients, review of patients’ record and from the nursing staff.Results: The results revealed that physical restraint was commonly used to prevent device dislodgment and to ensure patient safety. The results illustrated a lack of documentation on initiation and monitoring of use physical restraint.Conclusion: For a better care of patients, it is very important to develop a restraint policy for rational use of physical restrain respecting the patient autonomy and freedom.Bangladesh Crit Care J September 2016; 4 (2): 110-113

scholarly journals A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

2019 ◽  
Vol 23 (58) ◽  
pp. 1-92 ◽  
Author(s):  
Ira Madan ◽  
Vaughan Parsons ◽  
Georgia Ntani ◽  
Alison Wright ◽  
John English ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Behaviour Change ◽  
Student Nurses ◽  
Quality Adjusted Life Years ◽  
Hand Dermatitis ◽  
Intention To Treat ◽  
Life Years ◽  
Intensive Care Unit Nurses

Background Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear. Objectives The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants’ beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care. Design Cluster randomised controlled trial. Setting Thirty-five NHS hospital trusts/health boards/universities. Participants First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses. Intervention Sites were randomly allocated to be ‘intervention plus’ or ‘intervention light’. Participants at ‘intervention plus’ sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at ‘intervention light’ sites received usual care, including a dermatitis prevention leaflet. Main outcome measure The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up. Randomisation Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm. Blinding The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment. Numbers analysed An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses. Results The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained. Harms No adverse events were reported. Limitations Only 44.5% of participants in the intervention plus arm accessed the behaviour change package. Conclusion The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group. Future work Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned. Trial registration Current Controlled Trials ISRCTN53303171. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.

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