Am J Crit Care 2001 Sep;10(5):341-50
University of Kansas School of Nursing, Kansas City, Kan., USA.
[Medline record in process]
BACKGROUND: Collaborative interaction between nurses and physicians on critical care units is significantly related to mortality rates and length of stay in the units. For this reason, collaborative interaction should be an integral part of quality improvement programs. OBJECTIVES: To examine perspectives of nurses and physicians on collaborative interaction in an intensive care unit, to examine differences between groups in perceptions of collaborative interaction in the unit, and to compare this unit with units examined in a national study. METHODS: A modification of the ICU Nurse-Physician Questionnaire was used to collect data from 35 nurses and 45 physicians. Descriptive statistics and analysis of variance were used to determine group scores and to examine differences between groups. RESULTS: The level of collaborative interaction in the unit was high. However, nurses and physicians and all other staff groups examined except one had significant differences in perceptions of collaborative interaction. The high level of collaborative interaction was confirmed by a comparison of the results with the results from a national sample. CONCLUSIONS: Critical care units can use this example to incorporate an assessment of the level of collaborative interaction into their quality improvement program.
PMID: 11548567, UI: 21433235
Order this document
Am J Crit Care 2001 Sep;10(5):298-305
Hospital of the University of Pennsylvania, Philadelphia, Pa., USA.
BACKGROUND: Alterations in mental status are common among patients in the cardiothoracic surgical intensive care unit. Changes in mental status can be caused by metabolic factors, medications, or brain injury. In this setting, reliable, serial neurological evaluations are critical for assessing the effectiveness of treatment and the need for additional studies. OBJECTIVES: To estimate the reliability of the Rancho Los Amigos Cognitive Scale and the newly developed Neurologic Intensive Care Evaluation as measures of cognitive function in the cardiothoracic surgical intensive care unit. METHODS: Nurses used 1 of the 2 scales as part of routine neurological assessments of patients in the cardiothoracic surgical intensive care unit. For each test, scores of different observers were correlated and a reliability estimate formed. RESULTS: Interrater reliability was high for both evaluations (Rancho scale, 0.91; Neurologic Intensive Care Evaluation, 0.94). Correlations between the scores of different pairs of observers were also high (mean rho values, 0.84 for the Rancho scale and 0.77 for the Neurologic Intensive Care Evaluation). CONCLUSIONS: Both scales are reliable indicators of the neurological state of patients in the cardiothoracic surgical intensive care unit. These scales measure different, although limited, aspects of cognitive function. Each test was simple to administer and did not take more time than the standard nursing neurological examination. Most of the variability in scoring was related to the different degrees of stimulation used by examiners when assessing patients, not to differences in the interpretation of patients' responses.
PMID: 11548562, UI: 21433230
BMJ 2001 Sep 15;323(7313):620-4
Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology, and Surgical Intensive Care, Geneva University Hospital, 1211 Geneva 4, Switzerland.
Problem: Need to decrease the number of requests for arterial blood gas analysis and increase their appropriateness to reduce the amount of blood drawn from patients, the time wasted by nurses, and the related cost. Design: Assessment of the impact of a multifaceted intervention aimed at changing requests for arterial blood gas analysis in a before and after study. Background and setting: Twenty bed surgical intensive care unit of a tertiary university affiliated hospital, receiving 1500 patients per year. Key measures for improvement: Number of tests per patient day, proportion of tests complying with current guideline, and safety indicators (mortality, incident rate, length of stay). Comparison of three 10 month periods corresponding to baseline, pilot (first version of the guideline), and consolidated (second version of the guideline) periods from March 1997 to August 1999. Strategies for change: Multifaceted intervention combining a new guideline developed by a multidisciplinary group, educational sessions, and monthly feedback about adherence to the guideline and use of blood gas analysis. Effects of change: Substantial decrease in the number of tests per patient day (from 8.2 to 4.8; P<0.0001), associated with increased adherence to the guideline (from 53% to 80%, P<0.0001). No significant variation of safety indicators. Lessons learnt: A multifaceted intervention can substantially decrease the number of requests for arterial blood gas analysis and increase their appropriateness without affecting patient safety.
PMID: 11557715, UI: 21441285
Clin Infect Dis 2001 Oct 15;33(8):1329-35
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA. dwarren@im.wustl.edu
All patients admitted to the medical and surgical intensive care units of a 500-bed nonteaching suburban hospital were followed prospectively for the occurrence of nosocomial primary bloodstream infections for 21 months. The incidence of primary bloodstream infection was 38 (1%) of 3163 patients; among patients with central venous catheters, it was 34 (4%) of 920 patients, or 4.0 infections per 1000 catheter-days. Ventilator-associated pneumonia, congestive heart failure, and each intravascular catheter inserted were independently associated with the development of a nosocomial primary bloodstream infection. Among infected patients, the crude mortality rate was 53%, and these patients had longer stays in intensive care units and the hospital than did uninfected patients. Bloodstream infection, however, was not an independent risk factor for death. The incidence, risk factors, and serious outcomes of bloodstream infections in a nonteaching community hospital were similar to those seen in tertiary-care teaching hospitals.
PMID: 11550117, UI: 21448270
Clin Infect Dis 2001 Jul 15;33(2):187-90
Publication Types:
PMID: 11418878, UI: 21311465
Heart Lung 2001 Jul-Aug;30(4):269-76
Washington State University College of Nursing, USA.
OBJECTIVE: The purpose of this study was to assess the effect of lateral positions on tissue oxygenation in critically ill patients. DESIGN: The study design was prospective and quasi-experimental, and we used a convenience sample with random assignment. SETTING: The study took place in the intensive care unit and the cardiac intensive care unit of a 450-bed medical center in the northwestern United States. PATIENTS: The sample included 12 adult patients with indwelling pulmonary artery and radial arterial catheters who were receiving mechanical ventilation and who met the criteria of "critical illness" by having impaired arterial oxygenation (PaO2 < or = 70 mm Hg) and/or cardiac index < or = 2.0 L/min/m2. OUTCOME MEASURES: The outcome measures were dependent variables reflecting oxygen delivery including heart rate, cardiac output, arterial oxygen content (CaO2) and oxygen consumption, and the adequacy of tissue oxygenation (serum lactate). INTERVENTION: Each patient was passively turned to each of the three positions (right and left 45 degrees lateral and supine) according to a computer-generated, randomized positioning sequence. Dependent variables were measured 15 minutes after each position change. No changes in ventilator settings or vasoactive drugs occurred during data collection. RESULTS: Analysis of variance for repeated measures was used in the data analysis. Post hoc analysis determined an effect size of 0.558 and power of 0.80 at an alpha level of.05. No statistically significant differences caused by position were found in mean CaO2, cardiac output, heart rate, respiratory rate, PaO2, SaO2, or lactate level. Pearson correlation analysis found no significant relationships between the primary variables reflecting oxygen delivery (cardiac output and CaO2) and serum lactate levels. CONCLUSIONS: These findings suggest that lateral positioning of critically ill patients who are hypoxemic or have low cardiac output does not further endanger tissue oxygenation. Evaluation of individual patient responses to position changes in the clinical setting is encouraged until further studies using more heterogenous populations can provide more definitive guidance.
PMID: 11449213, UI: 21341920
the above reports in Macintosh PC UNIX Text HTML format documents on this page through Loansome Doc