Patient safety in the critical care environment

Earlier tracheostomy and percutaneous endoscopic gastrostomy in patients with hemorrhagic stroke: associated factors and effects on hospitalization

OBJECTIVE

Existing literature supports benefits of early tracheostomy and percutaneous endoscopic gastrostomy (PEG) in certain patient populations. The aim of this study was to review tracheostomy and PEG placement data in patients with hemorrhagic stroke in order to identify factors associated with earlier placement and to evaluate outcomes.

METHODS

The authors performed a retrospective review of consecutive patients treated for hemorrhagic stroke between June 1, 2011, and June 1, 2015. Data were analyzed by logistic and multiple linear regression.

RESULTS

Of 240 patients diagnosed with hemorrhagic stroke, 31.25% underwent tracheostomy and 35.83% underwent PEG tube placement. Factors significantly associated with tracheostomy and PEG included the presence of pneumonia on admission and subarachnoid hemorrhage. Earlier tracheostomy was significantly associated with shorter ICU length of stay; earlier tracheostomy and PEG placement were associated with shorter overall hospitalization. Timing of tracheostomy and PEG was not significantly associated with patient survival or the incidence of complications in this population.

CONCLUSIONS

This study identified patient risk factors associated with increased likelihood of tracheostomy and PEG in patients with hemorrhagic stroke who were critically ill. Additionally, we found that the timing of tracheostomy was associated with length of ICU stay and overall hospital stay, and that the timing of PEG was associated with overall length of hospitalization. Complication rates related to tracheostomy and PEG in this population were minimal. This retrospective data set supports some benefit to earlier tracheostomy and PEG placement in this population and justifies the need for further prospective study.

Contextual factors to registered nurse research utilisation in an Australian adult metropolitan tertiary intensive care unit: A descriptive study

BACKGROUND

Organisational and unit-level context can have a significant impact on implementation of evidence in practice, the latter being particularly important in the complex intensive care context. Evaluating the context may allow modifiable characteristics to be identified and addressed.

OBJECTIVES

The objective was to examine the relationship between dimensions of the context and research utilisation in one intensive care unit.

METHODS

This study used a quantitative cross-sectional survey. All registered nurses working in one Australian quaternary referral hospital intensive care unit were surveyed using the Alberta Context Tool and research utilisation instrument. Descriptive statistics were used, and bivariate analysis was undertaken to determine associations among demographic data, dimensions of context, and research utilisation.

RESULTS

The survey response rate was 33% (67/205). Most respondents were women with a mean of 8 years of intensive care nursing experience. The dimensions of culture, evaluation, informal interactions, structural/electronic resources, and organisational slack (time and space) were positively correlated with research utilisation.

CONCLUSIONS

Research utilisation was associated with numerous context dimensions, emphasising their effect on knowledge translation in this setting. Intensive care nurses are in a unique position to impact care delivery and provide evidence-based care to ensure optimal outcomes to patients at high risk of morbidity and mortality. Identified dimensions may be targeted and developed in future strategies to optimise the context for translating evidence into this complex practice environment.

Equipment failure: conducts of nurses and implications for patient safety

OBJECTIVES

To identify equipment failures during handling by nurses and analyze the conduct of the professionals when these failures occur.

METHODS

Descriptive, exploratory and qualitative study, whose field was the intensive care unit of a public institution, and the participants were day nurses that worked providing direct care to patients. Data were produced in 2014 through systematic observation and interviews and were examined with thick description and content analysis.

RESULTS

The outcomes evinced the inadequate functioning of infusion bombs, users' errors related to the design of equipment and problems with batteries of artificial fans. These failures related to the management of equipment in the unit.

FINAL CONSIDERATIONS

It is necessary to strengthen the monitoring systems of safety conditions of equipment in intensive nursing care to prevent incidents.

VIOLATIONS OF NURSES IN THE USE OF EQUIPMENT IN INTENSIVE CARE

ABSTRACT Objective: to identify situations of violation in the use of equipment by nurses in the intensive care unit and analyze their implications on patient safety. Method: a descriptive field study with qualitative approach was carried out from March to December 2014, with the use of James Reason's violation concept. The participants were nurses from the day shift, working in direct care at an intensive care unit of a federal hospital. Data production was carried out through systematic observation and interviews, and were analyzed based on thick description of scenes and content of responses. Results: violations in planning care regarding the checking of the equipment functioning before its use and alarms were found, when nurses disconnect them to reduce the effects caused by the overload of noise on the team. Conclusion: the situations reported compromise safety and cause serious risks to patients. Therefore, implementation of strategies to promote a safety culture is required.

Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia

Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia.

Wireless vital signs from a life-supporting medical device exposed to electromagnetic disturbance

OBJECTIVES

To evaluate the level of agreement of simulated wired and Wi-Fi vital signs output from an intra-aortic balloon pump during exposure to electromagnetic interference from frequency overlapping ZigBee sensors.

MATERIAL AND METHODS

A series of experiments with interference from single and multiple ZigBee sensors were benchmarked with wired and Wi-Fi output. Tests included single ZigBee sensor adjacent and co-channel interference, and multiple ZigBee interferences towards the Wi-Fi receiver and transmitter.

RESULTS

Interference-free differences between wired and wireless aortic blood pressure and electrocardiogram were very small, verified by time domain and Bland - Altman plots. Bland - Altman plots comparing level of agreement in wired and wireless aortic blood pressure and ECG output during interference experiments showed a difference from 0.2 to 0.3 mmHg for blood pressure, and from 0.001 to 0.004 mV for electrocardiogram.

CONCLUSIONS

Level of agreement in wired and wireless (Wi-Fi) arterial blood pressure and electrocardiogram during single or multiple sensor interference was high. No clinically relevant degradation of Wi-Fi transmission of aortic blood pressure or ECG signals was observed.