Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review

Background Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E–mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. Objective To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. Methods This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. Results Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. Conclusions Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.

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Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

American Journal of Critical Care ◽

10.4037/ajcc2020661 ◽

2020 ◽

Vol 29 (4) ◽

pp. e81-e91

Author(s):

Renea L. Beckstrand ◽

Jasmine B. Jenkins ◽

Karlen E. Luthy ◽

Janelle L. B. Macintosh

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

End Of Life ◽

Health Care Providers ◽

End Of Life Care ◽

Critical Care Nurses ◽

Life Care ◽

Care Providers ◽

Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

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Barriers to Addressing the Spiritual and Religious Needs of Patients and Families in the Intensive Care Unit: A Qualitative Study of Critical Care Physicians

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120970903 ◽

2020 ◽

pp. 104990912097090

Author(s):

Christian K. Alch ◽

Christina L. Wright ◽

Kristin M. Collier ◽

Philip J. Choi

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Spiritual Care ◽

Spiritual Needs ◽

Care Providers ◽

Structured Interviews ◽

Care Services ◽

Qualitative Research Design ◽

Data Saturation

Objectives: Though critical care physicians feel responsible to address spiritual and religious needs with patients and families, and feel comfortable in doing so, they rarely address these needs in practice. We seek to explore this discrepancy through a qualitative interview process among physicians in the intensive care unit (ICU). Methods: A qualitative research design was constructed using semi-structured interviews among 11 volunteer critical care physicians at a single institution in the Midwest. The physicians discussed barriers to addressing spiritual and religious needs in the ICU. A code book of themes was created and developed through a regular and iterative process involving 4 investigators. Data saturation was reached as no new themes emerged. Results: Physicians reported feeling uncomfortable in addressing the spiritual needs of patients with different religious views. Physicians reported time limitations, and prioritized biomedical needs over spiritual needs. Many physicians delegate these conversations to more experienced spiritual care providers. Physicians cited uncertainty into how to access spiritual care services when they were desired. Additionally, physicians reported a lack of reminders to meet these needs, mentioning frequently the ICU bundle as one example. Conclusions: Barriers were identified among critical care physicians as to why spiritual and religious needs are rarely addressed. This may help inform institutions on how to better meet these needs in practice.

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Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

American Journal of Critical Care ◽

10.4037/ajcc2009131 ◽

2010 ◽

Vol 19 (3) ◽

pp. 272-276 ◽

Cited By ~ 21

Author(s):

Mohamad F. El-Khatib ◽

Salah Zeineldine ◽

Chakib Ayoub ◽

Ahmad Husari ◽

Pierre K. Bou-Khalil

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Providers ◽

Care Experience ◽

Respiratory Therapists ◽

Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Moral distress among health care workers in the intensive care unit; a systematic review and meta-analysis

10.22514/sv.2021.101 ◽

2021 ◽

Keyword(s):

Systematic Review ◽

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Health Care Providers ◽

Moral Distress ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Care Providers ◽

Distress Scale

Background: The effect of moral distress among healthcare providers is significant on disease morbidity, especially within the intensive care unit (ICU). In this systematic review and meta-analysis, we aimed to gather all evidence regarding moral distress frequency and severity/intensity among ICU health care providers. Methods: We conducted a systematic search to gather all relevant studies from six databases, followed by a manual search of references. Fourteen studies consisting of 5905 participants were included in the final moral distress scale analyses. Results: Overall, there was moderate moral distress severity/intensity among all participants (Mean = 27.79; 95% confidence interval (CI) = 7.40–64.18). On further stratification of the results according to countries, Canada (Mean = 91.99; 95% CI = 80.10–105.65) and USA (Mean = 52.54; 95% CI = 44.78–61.64) showed the highest distress scores, followed by Iran (Mean = 21.20; 95% CI = 7.21–62.30) and Italy (Mean = 3.42; 95% CI = 3.15–3.72). Studies conducted in high income-earning countries reported more severity/intensity (Mean = 22.65; 95% CI = 6.58–78.02) compared to those in the upper-middle income-earning ones (Mean = 18.89; 95% CI = 2.80–127.34). There was significant heterogeneity among the included studies, which could not be explained by the difference in scales, country of the participants, or the female proportion. Moreover, there was a moderate frequency of moral distress (Mean = 46.83; 95% CI = 8.34–262.87), which was found to be much higher (Mean = 87.94; 95% CI = 83.55–92.57), in performing analysis. Conclusion: Moral distress is a major problem in the ICU setting, in terms of both severity/intensity and frequency. Future large-scale studies are required, through a unified framework, to develop appropriate interventions to address ICU-related moral distress.

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Improving the Quality of Handoffs in Patient Care Between Critical Care Providers in the Intensive Care Unit

American Journal of Medical Quality ◽

10.1177/1062860616654758 ◽

2016 ◽

Vol 32 (4) ◽

pp. 376-383 ◽

Cited By ~ 7

Author(s):

Sumedh S. Hoskote ◽

Carlos J. Racedo Africano ◽

Andrea B. Braun ◽

John C. O’Horo ◽

Ronaldo A. Sevilla Berrios ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Care ◽

Care Providers

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Experiences of Newly Qualified Nurses in Critical Care: A qualitative systematic review

Journal of the Intensive Care Society ◽

10.1177/1751143720926794 ◽

2020 ◽

Vol 21 (4) ◽

pp. 334-343

Author(s):

Charlotte E Elias ◽

Tina Day

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Unit Commitment ◽

Eligibility Criteria ◽

Nurse Satisfaction ◽

Data Intensive ◽

Qualitative Systematic Review ◽

First Job

Recent nursing shortages have been particularly felt in specialist areas, like Critical Care, which require higher staffing quotas; leading to increased recruitment of Newly Qualified Nurses in an area once reserved for the more experienced. This qualitative systematic review aimed to explore the experiences of Newly Qualified Nurses working in Critical Care, as their first job post-registration. A systematic search was undertaken between December 2017 and May 2018, yielding eight studies for inclusion in this review. Eligibility criteria included a qualitative design; Newly Qualified Nurses with less than two years post-registration experience, working in adult Intensive Care Units. Data were extracted and synthesised using the Thematic Synthesis approach. Five main themes emerged from the data: Intensive Care Unit Readiness; An Emotional Spectrum; Developing Relationships; The Journey to Self-Satisfaction and Intensive Care Unit Commitment. Conclusions are that an undergraduate placement in Critical Care should be facilitated where possible, consistent mentorship enhances Newly Qualified Nurse satisfaction, peer support is an important coping mechanism and opportunities for socialisation should be facilitated.

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Rapid Cycle Deliberate Practice to Facilitate “Nano” In Situ Simulation: An Interprofessional Approach to Just-in-Time Training

Critical Care Nurse ◽

10.4037/ccn2021552 ◽

2021 ◽

Vol 41 (1) ◽

pp. e1-e8

Author(s):

Kristen M. Brown ◽

Shawna S. Mudd ◽

Julianne S. Perretta ◽

Adam Dodson ◽

Elizabeth A. Hunt ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Patient Safety ◽

Intensive Care ◽

Simulation Training ◽

Deliberate Practice ◽

Care Providers ◽

In Situ Simulation ◽

Practice Method

Background Simulation is increasingly used to identify latent threats to patient safety, such as delays in recognition and management of time-sensitive conditions. The Rapid Cycle Deliberate Practice teaching method may facilitate “nano” (brief) in situ simulation training in a critical care setting to improve multidisciplinary team performance of time-sensitive clinical tasks. Objective To determine whether nano–in situ simulation training with Rapid Cycle Deliberate Practice can improve pediatric intensive care unit team proficiency in identifying and managing postoperative shock in a pediatric cardiac patient. Methods A quality improvement educational project was conducted involving nano–in situ simulation sessions in a combined pediatric and pediatric cardiac intensive care unit. The Rapid Cycle Deliberate Practice method was used with an expert-driven checklist for 30-minute simulation scenarios. Results A total of 23 critical care providers participated. The proportion of time-sensitive tasks completed within 5 minutes increased significantly from before to after training (52% [13 of 25] vs 100% [25 of 25]; P ≤ .001). Using a 5-point Likert scale, with higher scores indicating higher levels, the participants reported high degrees of performance confidence (mean, 4.42; SD, 0.20) and satisfaction with the simulation experience (mean, 4.96; SD, 0.12). Conclusion The Rapid Cycle Deliberate Practice method was used to facilitate nano–in situ simulation training and identify areas requiring additional education to improve patient safety. In situ simulation can educate providers in a cost-effective and timely manner.

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Keeping a 2009 Design Award–Winning Intensive Care Unit Current: A 13-Year Case Study

HERD Health Environments Research & Design Journal ◽

10.1177/1937586720918225 ◽

2020 ◽

Vol 13 (4) ◽

pp. 190-209

Author(s):

Neil A. Halpern ◽

Diana C. Anderson

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

New Technologies ◽

Medical Center ◽

Real Life ◽

Care Providers ◽

Operational Life

In a complex medical center environment, the occupants of newly built or renovated spaces expect everything to “function almost perfectly” immediately upon occupancy and for years to come. However, the reality is usually quite different. The need to remediate initial design deficiencies or problems not noted with simulated workflows may occur. In our intensive care unit (ICU), we were very committed to both short-term and long-term enhancements to improve the built and technological environments in order to correct design flaws and modernize the space to extend its operational life way beyond a decade. In this case study, we present all the improvements and their background in our 20-bed, adult medical–surgical ICU. This ICU was the recipient of the Society of Critical Care Medicine’s 2009 ICU Design Award Citation. Our discussion addresses redesign and repurposing of ICU and support spaces to accommodate expanding clinical or entirely new programs, new regulations and mandates; upgrading of new technologies and informatics platforms; introducing new design initiatives; and addressing wear and tear and gaps in security and disaster management. These initiatives were all implemented while our ICU remained fully operational. Proposals that could not be implemented are also discussed. We believe this case study describing our experiences and real-life approaches to analyzing and solving challenges in a dynamic environment may offer great value to architects, designers, critical care providers, and hospital administrators whether they are involved in initial ICU design or participate in long-term ICU redesign or modernization.

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