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ELMeneza SAELH, Koriem MAELS, Ibrahim AAE. Mechanical Ventilation Trigger Tool Identify Errors Associated with Mechanical Ventilation in Newborn Infant. Open Access Maced J Med Sci 2023; 11:367-375. [DOI: 10.3889/oamjms.2023.11474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND: Patient safety is the core of quality of health care. Newborn infants who are admitted to NICU are liable to adverse events. Medical errors represent a serious public health problem and pose a threat to patient safety. Mechanical ventilation is a complex procedure that exposes newborn infants to adverse events and complications.
AIM: The objective of this study was to identify medical errors related to mechanical ventilation (MV) in newborn infants using the newly design MV trigger tool.
METHODS: Observational cohort study was conducted for 6-month duration to determine the medical errors related to mechanical ventilation. It was carried out on newborn infants who needed mechanical ventilation and admitted to the NICU. Furthermore, we used the mechanical ventilation trigger tool to estimate number, types, and risk factors for the related errors.
RESULTS: There were 142 errors related to mechanical ventilation. Nearly 21.13% of the errors were related to ventilator settings, 38.39% were related to endotracheal intubation, and 40.14% of the errors were due to manipulation of the ventilators. The adverse events were diagnosed in 73.24% of the detected errors. Error of commission was seen in 53.5% of cases, and omission errors were reported in 46.5% of the cases. Mechanical ventilation trigger tool has 95.87% sensitivity and 95.24% specificity with 95.77% accuracy to detect errors.
CONCLUSION: The mechanical ventilation trigger tool may be efficient and effective in identifying errors and adverse events related to mechanical ventilation; it has high sensitivity and specificity. It might increase awareness to improve MV-related care.
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Standardkonzentrationen für Dauerinfusionen – Ergebnisse einer bundesweiten Befragung auf deutschen Erwachsenenintensivstationen. Med Klin Intensivmed Notfmed 2022:10.1007/s00063-022-00940-6. [PMID: 35838819 PMCID: PMC9284501 DOI: 10.1007/s00063-022-00940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022]
Abstract
Hintergrund Intensivpatienten erhalten zahlreiche Arzneimittel (AM) als Dauerinfusion appliziert. In Deutschland fehlt bisher für die als Dauerinfusion applizierten AM eine einheitliche Liste mit Standardkonzentrationen. Ziel der Arbeit Ziel war es, bundesweit repräsentative Informationen zu Standardkonzentrationen von als Dauerinfusion mittels Spritzenpumpe oder Infusionspumpe applizierten AM auf den Intensivstationen zu gewinnen. Material und Methoden Zur Ermittlung der Akzeptanz und Präferenz für Dauerinfusionen von ausgewählten AM wurde ein Fragenkatalog in einem online- Umfragetool entwickelt und von der DIVI an die jeweils verantwortlichen Leiter*innen von 1816 Intensivstationen versendet. Die Umfrage umfasste Vorschläge zu 59 AM mit insgesamt 73 Konzentrationen. Ergänzend konnten die Teilnehmer in Freitextfeldern eigene Vorschläge zu AM und entsprechenden Konzentrationen angeben. Die Häufigkeit der Verwendung der Arzneimittel als Dauerinfusion und der präferierten Standardkonzentrationen wurde bezogen auf die Zahl der Antworten pro Arzneimittel berechnet. Ergebnisse Die Umfrage wurde von 312 (17 %) Intensivstationen beantwortet. Die Akzeptanzrate für das Prinzip der geschwindigkeitsgesteuerten Dauerinfusion in Standardkonzentrationen ist deutschlandweit sehr hoch, Die Top 10 bzw. 25 der vorgeschlagenen AM werden von über 90 % bzw. 50 % der Teilnehmer regelmäßig als Dauerinfusion eingesetzt. Für viele dieser AM konnte eine oder mehrere präferierte Konzentrationen identifiziert werden. Diskussion Die Top-37-Arzneimittel und die präferierten Konzentrationen sind als Grundlage für eine bundesweit geltende Standardliste mit Standardkonzentrationen für Dauerinfusionen (in der Regel 50 ml) geeignet. Die damit befassten Fachgesellschaften können basierend auf den Umfrageergebnissen eine bundeseinheitliche Standardliste konsentieren.
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Kaldan G, Nordentoft S, Herling SF, Larsen A, Thomsen T, Egerod I. Evidence characterising skills, competencies and policies in advanced practice critical care nursing in Europe: a scoping review protocol. BMJ Open 2019; 9:e031504. [PMID: 31494624 PMCID: PMC6731915 DOI: 10.1136/bmjopen-2019-031504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The management of critically ill patients is challenged by increasing population age and prevalence of comorbid diseases. High-quality intensive care nursing practice is imperative to accommodate these issues. The roles of the nurse practitioner (NP) and the acute care NP have existed for decades in the USA, Canada and Australia but are still evolving in Europe. Some European countries have introduced the advanced practice nurse (APN), but the current standard of the advanced level of nursing is variable and consensus regarding the framework, role and definition is lacking. Literature and evidence are sparse as well. Identification of skills and competencies required for the APN is warranted. Mapping skills and competencies will enable future educational harmonisation and facilitate mobility of the advanced-level intensive care nursing workforce across Europe. The aim of our scoping review is to identify literature describing skills, competencies and policies characterising advanced nursing practice in intensive care across Europe. METHODS AND ANALYSIS We will apply a five-stage scoping review methodology with a comprehensive systematic literature search as outlined by Arksey and O'Malley. In collaboration with a research librarian, we will search nine interdisciplinary databases and grey literature for publications originating in European countries in 1992-2018. Using a two-stage screening process with Covidence to remove duplicates, we will first scan the title and abstract and then perform full-text review to determine the eligibility of the papers. Qualitative content analysis will be used to chart the data. ETHICS AND DISSEMINATION Our study is a part of the European Union-funded INACTIC project (International Nursing Advanced Competency-based Training for Intensive Care) with the overall aim of developing a common European curriculum for advanced practice critical care nursing. Results from this scoping review mapping the evidence of APNs in Europe will be presented at national and international conferences and published in a peer-reviewed journal.
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Affiliation(s)
- Gudrun Kaldan
- Research Unit 7831, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Anders Larsen
- Department UCSF 9701, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Ingrid Egerod
- Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Levkovich BJ, Bui T, Bovell A, Watterson J, Egan A, Poole SG, Dooley MJ. Variability of intravenous medication preparation in Australian and New Zealand intensive care units. J Eval Clin Pract 2016; 22:965-970. [PMID: 27345690 DOI: 10.1111/jep.12574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIM AND OBJECTIVE In Australia and New Zealand, there are no established standards for the final presentations of prepared intravenous medications in Intensive Care Units (ICUs). Variability has the potential to contribute to deficiencies in safety, efficiency and cost effectiveness. This study aimed to examine the variability in the preparation of intravenous medications in ICUs. METHODS An electronic survey was distributed to critical care pharmacists in Australia and New Zealand via an established email group. The preparation of vasopressors, inotropes, sedation, analgesia, heparin, insulin and neuromuscular blockers were examined. Respondents were asked about initial presentation, final concentration prepared, who prepared and current safety practices used. Questions also addressed opinions and attitudes to safety practices and responsibility for leading change. RESULTS Forty responses to the survey were received, representing 17% of ICUs in Australia and New Zealand. Significant variation in final concentration was observed for all infusions except insulin and esmolol. The final volumes varied significantly for all drugs. The majority of infusions were prepared by nursing staff with only a small number of pre-prepared presentations currently in use. Labelling was usually hand-written with some colour-coding. Most respondents identified safety and efficiency but not cost effectiveness as likely to be improved by the use of pre-prepared infusions. Most respondents felt 'government' or peak clinical bodies should lead practice standardization. CONCLUSION Significant variation exists in the preparation of intravenous medications across ICUs in Australia and New Zealand. Nationally or regionally coordinated rationalization and standardization could improve safety and efficiency and potentially reduce the barrier of cost.
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Affiliation(s)
- Bianca J Levkovich
- Lead Clinical Pharmacist Intensive Care Pharmacy Department, Alfred Health; Faculty of Pharmacy and Pharmaceutical Sciences and Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Thuy Bui
- Perioperative Medicine, Pharmacy Department, Alfred Health; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | | | | | - Annette Egan
- Pharmacy Department, Nelson Hospital, Nelson, New Zealand
| | - Susan G Poole
- Pharmacy Department, Alfred Health; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Michael J Dooley
- Pharmacy Department, Alfred Health; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Thongprayoon C, Harrison AM, O'Horo JC, Berrios RAS, Pickering BW, Herasevich V. The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance. J Intensive Care Med 2014; 31:205-12. [PMID: 25392010 DOI: 10.1177/0885066614558015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. METHODS This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. RESULTS Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76). CONCLUSION The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting.
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Affiliation(s)
- Charat Thongprayoon
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA
| | - Andrew M Harrison
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ronaldo A Sevilla Berrios
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian W Pickering
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Vitaly Herasevich
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
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Martín Delgado MC, Merino de Cos P, Sirgo Rodríguez G, Álvarez Rodríguez J, Gutiérrez Cía I, Obón Azuara B, Alonso Ovies Á. Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine. Med Intensiva 2014; 39:263-71. [PMID: 25063357 DOI: 10.1016/j.medin.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN SYREC study pos hoc analysis. SETTING A total of 79 Intensive Care Departments were involved. PATIENTS The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.
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Affiliation(s)
- M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - G Sirgo Rodríguez
- Unidad de Cuidados Intensivos, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, Tarragona, España
| | - J Álvarez Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - I Gutiérrez Cía
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Zaragoza, España
| | - B Obón Azuara
- Servicio de Medicina Preventiva y Salud Pública, Hospital Clínico Universitario, Zaragoza, España
| | - Á Alonso Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Lincoln P, Manning MJ, Hamilton S, Labreque M, Casey D, Kennedy H, Penny KC, Curley MAQ. A pediatric critical care practice group: use of expertise and evidence-based practice in identifying and establishing "best" practice. Crit Care Nurse 2014; 33:85-7. [PMID: 23547131 DOI: 10.4037/ccn2013740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sirgo Rodríguez G, Olona Cabases M, Martin Delgado MC, Esteban Reboll F, Pobo Peris A, Bodí Saera M. Audits in real time for safety in critical care: definition and pilot study. Med Intensiva 2014; 38:473-82. [PMID: 24508337 DOI: 10.1016/j.medin.2013.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/14/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED Adverse events significantly impact upon mortality rates and healthcare costs. PURPOSE To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. METHODS A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. RESULTS The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. CONCLUSIONS Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors.
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Affiliation(s)
- G Sirgo Rodríguez
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain.
| | - M Olona Cabases
- Preventive Medicine Department, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - M C Martin Delgado
- Intensive Care Unit, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain
| | - F Esteban Reboll
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - A Pobo Peris
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - M Bodí Saera
- Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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Ahmed AH, Giri J, Kashyap R, Singh B, Dong Y, Kilickaya O, Erwin PJ, Murad MH, Pickering BW. Outcome of adverse events and medical errors in the intensive care unit: a systematic review and meta-analysis. Am J Med Qual 2013; 30:23-30. [PMID: 24357344 DOI: 10.1177/1062860613514770] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.
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10
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Chaboyer W, Chamberlain D, Hewson-Conroy K, Grealy B, Elderkin T, Brittin M, McCutcheon C, Longbottom P, Thalib L. CNE article: safety culture in Australian intensive care units: establishing a baseline for quality improvement. Am J Crit Care 2013; 22:93-102. [PMID: 23455858 DOI: 10.4037/ajcc2013722] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Workplace safety culture is a crucial ingredient in patients' outcomes and is increasingly being explored as a guide for quality improvement efforts. OBJECTIVES To establish a baseline understanding of the safety culture in Australian intensive care units. METHODS In a nationwide study of physicians and nurses in 10 Australian intensive care units, the Safety Attitudes Questionnaire intensive care unit version was used to measure safety culture. Descriptive statistics were used to summarize the mean scores for the 6 subscales of the questionnaire, and generalized-estimation-equations models were used to test the hypotheses that safety culture differed between physicians and nurses and between nurse leaders and bedside nurses. RESULTS A total of 672 responses (50.6% response rate) were received: 513 (76.3%) from nurses, 89 (13.2%) from physicians, and 70 (10.4%) from respondents who did not specify their professional group. Ratings were highest for teamwork climate and lowest for perceptions of hospital management and working conditions. Four subscales, job satisfaction, teamwork climate, safety climate, and working conditions, were rated significantly higher by physicians than by nurses. Two subscales, working conditions and perceptions of hospital management, were rated significantly lower by nurse leaders than by bedside nurses. CONCLUSIONS Measuring the baseline safety culture of an intensive care unit allows leaders to implement targeted strategies to improve specific dimensions of safety culture. These strategies ultimately may improve the working conditions of staff and the care that patients receive.
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Affiliation(s)
- Wendy Chaboyer
- Wendy Chaboyer is a faculty member and director of the National Health and Medical Research Council Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Queensland, Australia
| | - Di Chamberlain
- Di Chamberlain is a senior lecturer and coordinator of critical care studies, Flinders University, Adelaide, South Australia
| | - Karena Hewson-Conroy
- Karena Hewson-Conroy is research and quality manager, New South Wales Intensive Care Coordination and Monitoring Unit, and honorary associate, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia
| | - Bernadette Grealy
- Bernadette Grealy is a clinical nurse manager in the intensive care department, Queen Elizabeth Hospital, Adelaide, South Australia
| | - Tania Elderkin
- Tania Elderkin is a clinical nurse educator and a clinical research nurse in the intensive care unit, Barwon Health, Victoria, Australia
| | - Maureen Brittin
- Maureen Brittin is codirector of maternal and child health, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Catherine McCutcheon
- Catherine McCutcheon is an intensive care liaison nurse practitioner, Calvary Health Care, Canberra, Australia
| | - Paula Longbottom
- Paula Longbottom is a research assistant, Research Centre for Clinical and Community Practice Innovation, Griffith University
| | - Lukman Thalib
- Lukman Thalib is an associate professor in the Faculty of Medicine, University of Kuwait, Safat, Kuwait
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11
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Safety climate reduces medication and dislodgement errors in routine intensive care practice. Intensive Care Med 2012; 39:391-8. [DOI: 10.1007/s00134-012-2764-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/18/2012] [Indexed: 10/27/2022]
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12
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Abstract
Improving the quality and safety of intensive care unit (ICU) care in the United States is a significant challenge for the future. Obtaining improvement in systems of care is difficult given the reactionary mode physicians tend to enter when dealing with moment-to-moment crises. It will be important to implement quality and safety measures that are already supported by evidence. Improvement of device safety will be critical to reducing the large number of device-related complications that occur in US ICUs. Prospective collection of adverse events with rigorous analysis will be important to allow systematic errors to be exposed and corrected.
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Affiliation(s)
- Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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13
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Chico Fernández M, García Fuentes C, Alonso Fernández M, Toral Vázquez D, Bermejo Aznárez S, Sánchez-Izquierdo Riera J, Alted López E. Desarrollo de una herramienta de comunicación para la seguridad del paciente (Briefing). Experiencia en una unidad de cuidados intensivos de trauma y emergencias. Med Intensiva 2012; 36:481-7. [DOI: 10.1016/j.medin.2011.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 11/20/2011] [Accepted: 11/23/2011] [Indexed: 10/14/2022]
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Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care 2012; 2:2. [PMID: 22339769 PMCID: PMC3310841 DOI: 10.1186/2110-5820-2-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/16/2012] [Indexed: 12/20/2022] Open
Abstract
Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical societies. Surveillance of these indicators is organized at the hospital or national level. Using a combination of methods improves the results. Errors are caused by combinations of human factors and system factors, and information must be obtained on how people make errors in the ICU environment. Preventive strategies are more likely to be effective if they rely on a system-based approach, in which organizational flaws are remedied, rather than a human-based approach of encouraging people not to make errors. The development of a safety culture in the ICU is crucial to effective prevention and should occur before the evaluation of safety programs, which are more likely to be effective when they involve bundles of measures.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Université Joseph Fourier, Unité INSERM, Epidémiologie des cancers et des maladies sévères, Institut Albert Bonniot, La Tronche, France
| | - François Philippart
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
- Infection and Epidemiology department Pasteur Institut, Paris, France
| | - Cédric Bruel
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Adeline Max
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Nicolas Lau
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - B Misset
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
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15
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Mattox EA. Strategies for Improving Patient Safety: Linking Task Type to Error Type. Crit Care Nurse 2012; 32:52-78. [DOI: 10.4037/ccn2012303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This article reviews the connection between task type (skill based, rule based and knowledge based) and human error. Using real-life examples, each task type and error type is described in detail. Understanding how task type contributes to medical error enhances the ability of nurses to make meaningful changes in health care systems. Through error wisdom, nurses and other health care providers can more successfully navigate health care delivery and ultimately provide safer care to patients.
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Affiliation(s)
- Elizabeth Andersson Mattox
- Elizabeth Andersson Mattox is the patient safety manager at the Veteran’s Health Administration Puget Sound Health Care System in the Seattle-Tacoma area, Washington
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Gum LF, Prideaux D, Sweet L, Greenhill J. From the nurses' station to the health team hub: How can design promote interprofessional collaboration? J Interprof Care 2012; 26:21-7. [DOI: 10.3109/13561820.2011.636157] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Teamwork and team training in the ICU: where do the similarities with aviation end? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:313. [PMID: 22136283 PMCID: PMC3388698 DOI: 10.1186/cc10353] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aviation industry has made significant progress in identifying the skills and behaviors that result in effective teamwork. Its conceptualization of teamwork, development of training programs, and design of assessment tools are highly relevant to the intensive care unit (ICU). Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. However, there are substantial differences in the nature of work and structure of teams in the ICU in comparison with those in aviation. While intensive care medicine may wish to use the advances made by the aviation industry for conceptualizing team skills and implementing team training programs, interventions must be tailored to the highly specific demands of the ICU.
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Faye H, Rivera-Rodriguez AJ, Karsh BT, Hundt AS, Baker C, Carayon P. Involving intensive care unit nurses in a proactive risk assessment of the medication management process. Jt Comm J Qual Patient Saf 2010; 36:376-84. [PMID: 20860244 DOI: 10.1016/s1553-7250(10)36056-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vulnerabilities in the medication manage ment process can lead to serious patient harm. In intensive care units (ICUs), nurses represent the last line of defense against medication errors. Proactive risk assessment (PRA) offers methods for determining how processes can break down and how people involved in such processes can contribute to or recover from a breakdown. Such methods can also be used to identify ICU nurses' contribution to the quality and safety of medication management. METHODS Observation and interview data of ICU nurses work were used to develop a rich description of the nursing medication management process. A PRA method was conducted in a cardiovascular ICU to identify and evaluate failure modes in the nursing medication management process. The contributing factors to the failure modes and the recovery processes used by nurses were also characterized. RESULTS A total of 54 failure modes were identified across the seven steps of the medication management process. For the 5 most critical failure modes, nurses listed 21 contributing factors and 21 recovery processes. Ways were identified to redesign the medication management process, one of which consists of dealing with work system factors that contribute to the most critical failure modes. CONCLUSIONS From a data-analysis viewpoint, this PRA method permits one to address a variety of objectives. Different scoring methods can be used to focus on either frequency or criticality of failure modes; one may also focus on a specific step of the process under study. Efforts in eliminating or mitigating contributing factors would help reduce the criticality of the failure modes in terms of their likelihood and impact on patients and/or nurses. Developing systems to support the recovery processes used by nurses may be another approach to process redesign.
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Affiliation(s)
- Hélène Faye
- Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA
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Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med 2009; 37:2775-81. [DOI: 10.1097/ccm.0b013e3181a96379] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med 2009. [DOI: 10.1097/00003246-200910000-00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009; 338:b814. [PMID: 19282436 PMCID: PMC2659290 DOI: 10.1136/bmj.b814] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units. DESIGN Observational, prospective, 24 hour cross sectional study with self reporting by staff. SETTING 113 intensive care units in 27 countries. PARTICIPANTS 1328 adults in intensive care. MAIN OUTCOME MEASURES Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors. RESULTS 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses' shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the unit (per increase of one patient: 0.73, 0.57 to 0.93). CONCLUSIONS Parenteral medication errors at the administration stage are common and a serious safety problem in intensive care units. With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks can reduce the risk for such errors.
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Affiliation(s)
- Andreas Valentin
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
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