Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk

2021 ◽  
Vol 41 (6) ◽  
pp. 45-53
Author(s):  
Michael T. Ring ◽  
Dale M. Pfrimmer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Activated Carbon ◽  
Health Care Professionals ◽  
Ecological Impact ◽  
High Volume ◽  
Operating Rooms ◽  
Ease Of Use ◽  
Control Mechanisms ◽  
Drug Diversion

Background Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. Local Problem Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol’s potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact. Methods The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses’ workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention. Results Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward. Conclusion Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

scholarly journals Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence

2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Perception Of Support ◽  
Evidence Based Care

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

scholarly journals Outcomes of Triggering the Emergency Response Team at a High-Volume Arthroplasty Center

2019 ◽  
Vol 109 (4) ◽  
pp. 336-342 ◽  
Author(s):  
S. A. Saku ◽  
R. Linko ◽  
R. Madanat
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Emergency Response ◽  
Medical Records ◽  
High Volume ◽  
Low Oxygen ◽  
Response Team ◽  
The Mean

Background and Aims: Emergency Response Teams have been employed by hospitals to evaluate and manage patients whose condition is rapidly deteriorating. In this study, we aimed to assess the outcomes of triggering the Emergency Response Teams at a high-volume arthroplasty center, determine which factors trigger the Emergency Response Teams, and investigate the main reasons for an unplanned intensive care unit admission following Emergency Response Team intervention. Material and Methods: We gathered data by evaluating all Emergency Response Team forms filled out during a 4-year period (2014–2017), and by assessing the medical records. The collected data included age, gender, time of and reason for the Emergency Response Teams call, and interventions performed during the Emergency Response Teams intervention. The results are reported as percentages, mean ± standard deviation, or median (interquartile range), where appropriate. All patients were monitored for 30 days to identify possible intensive care unit admissions, surgeries, and death. Results: The mean patient age was 72 (46–92) years and 40 patients (62%) were female. The Emergency Response Teams was triggered a total of 65 times (61 patients). The most common Emergency Response Team call criteria were low oxygen saturation, loss or reduction of consciousness, and hypotension. Following the Emergency Response Team call, 36 patients (55%) could be treated in the ward, and 29 patients (45%) were transferred to the intensive care unit. The emergency that triggered the Emergency Response Teams was most commonly caused by drug-related side effects (12%), pneumonia (8%), pulmonary embolism (8%), and sepsis (6%). Seven patients (11%) died during the first 30 days after the Emergency Response Teams call. Conclusion: Although all 65 patients met the Emergency Response Teams call criteria, potentially having severe emergencies, half of the patients could be treated in the arthroplasty ward. Emergency Response Team intervention appears useful in addressing concerns that can potentially lead to unplanned intensive care unit admission, and the Emergency Response Teams trigger threshold seems appropriate as only 3% of the Emergency Response Teams calls required no intervention.

scholarly journals An educational strategy for the implementation of a delirium assessment tool

2021 ◽  
Vol 6 (1) ◽  
pp. 015-020
Author(s):  
Bonaga Beatriz ◽  
Taravilla Elena Ruiz-Escribano ◽  
Carrilero-López Carmen ◽  
Castillo-Lag María Dolores ◽  
Boehm Leanne M ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Daily Practice ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Critically Ill Patient ◽  
Daily Routine

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

scholarly journals CLOTHES DEVELOPMENT BASED ON METHODS OF HANDLING OF PREMATURE BABIES IN THE INTENSIVE CARE UNIT

2021 ◽  
Vol 2021 ◽  
pp. 256-262
Author(s):  
V. Danila ◽  
A. Curteza ◽  
S. Balan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Collection ◽  
Work Experience ◽  
Neonatal Intensive Care ◽  
Qualitative Data ◽  
Ease Of Use ◽  
Controlled Study ◽  
Pilot Clinical Study ◽  
Qualitative Data Collection

The health of children born prematurely remains a significant challenge, but clothing products designed considering medical requirements and handling methods used in the intensive care unit, may contribute to the reduction of neonatal mortality. Assistants in the therapy unit implement practices based on the needs of vulnerable infants, from the very first second of life. This pilot clinical study was conducted in a specialised on neonatal intensive care unit, at the IMSP Municipal Clinical Hospital Gheorghe Paladi from Chisinau. Informed consent of parents and/or careers was required. All users (nurses and doctors) were informed about the product and instructed regarding dressing and undressing process. This controlled study was conducted under the supervision of doctors and nurses. As the study was exploratory in nature, aspects of grounded theory have been used for qualitative data collection. The sample studied consists of preterm infants less than 30 weeks GA, admitted by UTIN in 2018. The population eligible for qualitative data collection was made up of neonatology nurses from the clinic. To obtain a heterogeneous sample, aspects such as age, work experience, environment, and education were considered. The method of observation and subsequent testing used of the newly designed products and every manipulation under medical conditions was intensely studied. Local reactions, if any, due to the texture and quality of the textile material that come into contact with the baby's skin, were also carefully monitored. The process of dressing and stripping off the products, carrying out medical manipulations (in case of neonatal emergencies), were also carefully observed for developing ease of use clothes.

Providing Support for Neonatal Intensive Care Unit Health Care Professionals: A Bereavement Debriefing Program

2020 ◽  
Author(s):  
Katheleen Hawes ◽  
Justin Goldstein ◽  
Sharon Vessella ◽  
Richard Tucker ◽  
Beatrice E. Lechner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Health Care Professionals ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Mixed Methods Study ◽  
Emotional Impact ◽  
Key Points ◽  
Close Relationship

Objective The aim of this study is to evaluate formal bereavement debriefing sessions after infant death on neonatal intensive care unit (NICU) staff. Study Design Prospective mixed methods study. Pre- and postbereavement debriefing intervention surveys were sent to clinical staff. Evaluation surveys were distributed to participants after each debriefing session. Notes on themes were taken during each session. Results More staff attended sessions (p < 0.0001) and attended more sessions (p < 0.0001) during the postdebriefing intervention epoch compared with the predebriefing epoch. Stress levels associated with the death of a patient whose family the care provider have developed a close relationship with decreased (p = 0.0123). An increased number of debriefing session participants was associated with infant age at the time of death (p = 0.03). Themes were (1) family and provider relationships, (2) evaluation of the death, (3) team cohesion, (4) caring for one another, and (5) emotional impact. Conclusion Bereavement debriefings for NICU staff reduced the stress of caring for dying infants and contributed to staff well-being. Key Points

High-Volume Hemofiltration in the Intensive Care Unit

2019 ◽  
pp. 1034-1037.e2
Author(s):  
Olivier Joannes-Boyau ◽  
A. Dewitte ◽  
Patrick M. Honoré
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Volume ◽  
High Volume Hemofiltration

Examining Burnout in Interprofessional Intensive Care Unit Clinicians Using Qualitative Analysis

2021 ◽  
Vol 30 (5) ◽  
pp. 391-396
Author(s):  
Gretchen A. Colbenson ◽  
Jennifer L. Ridgeway ◽  
Roberto P. Benzo ◽  
Diana J. Kelm
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Multidisciplinary Team ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Contributing Factors ◽  
Team Members ◽  
Work Related

Background Health care professionals working in intensive care units report a high degree of burnout, but this topic has not been extensively studied from an interdisciplinary perspective. Objective To characterize experiences of burnout among members of interprofessional intensive care unit teams and identify possible contributing factors. Methods This qualitative study involved interviews of registered nurses, respiratory therapists, physicians, pharmacists, and a personal care assistant working in multiple intensive care units of a single academic medical center to assess work stressors. Results Team composition was a factor in burnout, particularly when nonphysician team members felt that their opinions were not valued despite the institution’s emphasis on a multidisciplinary team-based model of care. This was especially true when roles were not well defined at the outset of a code situation. Members of nearly all disciplines stated that there was not enough time in a day to complete all the required tasks. Conclusions Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.

Use of hemosorption in the intensive care unit

1986 ◽  
Vol 67 (6) ◽  
pp. 449-450
Author(s):  
F. I. Kazantsev ◽  
R. S. Sagitov
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Activated Carbon ◽  
Sodium Chloride ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Complex Treatment ◽  
Blood Proteins

In 33 patients we used hemosorption in the complex treatment. There were 20 men and 13 women, the average age of the patients was 46 years. A total of 61 sessions of hemosorption using activated carbon SKT-6A were carried out. When preparing the sorption columns for work the charcoal was thoroughly washed with 0.9% sodium chloride solution followed by autocoating the sorbent with the patient's blood proteins.

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