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Reducing Hospital-Acquired Conditions in the Pediatric Intensive Care Unit With a High-Risk Rounding Process. 减少儿童重症监护病房的医院获得性疾病与高风险的围舍过程。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026558
Sara Galt, Laura Barg-Walkow, Heather Bennett, Amy Smith, Elizabeth Diaz, Heather Dunning, Kaitlin Widmer, Lora Byrne, Michele M Loi

Background: Preventing hospital-acquired conditions is paramount to patient safety. Critically ill children are highly susceptible to hospital-acquired harm.

Local problem: To prevent hospital-acquired conditions, the pediatric intensive care unit at a quaternary care center implemented a novel interprofessional high-risk rounding program to improve unit work culture and address increased hospital-acquired condition rates before and during the COVID-19 pandemic.

Methods: Patients at greatest risk for selected hospital-acquired conditions were identified for the high-risk rounding program. This program offered rounds with scripted questions about elements of hospital-acquired conditions followed by education and/or acquisition of needed resources. Primary quality improvement outcomes were overall preimplementation and postimplementation rates of the following hospital-acquired conditions: central line [catheter]-associated bloodstream infection, catheter-associated urinary tract infection, unplanned extubation, and pressure injury. Sustainability of the project was also evaluated.

Results: Over 2 years, 624 rounds for 488 unique patients were conducted. Rounds resulted in 351 interventions, including escalation of concerns, direct patient care, resource procurement, and education. Patients who received high-risk rounds were less likely than those who did not receive rounds to incur a hospital-acquired condition. A χ2 test of association revealed a significant negative association between hospital-acquired conditions and receipt of high-risk rounds (χ2 = 22.5, P < .001). The mean rate of project hospital-acquired conditions decreased from 5.41 to 2.89 events per 1000 patient days following detection of special cause variation. High-risk rounds prevented an estimated 50 hospital-acquired conditions during the project period.

Conclusion: Implementation of high-risk rounds reduced the rate of project-specific hospital-acquired conditions by 46.5%, which was sustained over the 2-year project period.

背景:预防医院获得性疾病对患者安全至关重要。危重儿童极易受到医院获得性伤害。当地问题:为预防医院获得性疾病,一家第四医疗中心的儿科重症监护室实施了一项新的跨专业高风险围诊计划,以改善单位工作文化,并在2019冠状病毒病大流行之前和期间解决不断增加的医院获得性疾病发生率。方法:选定的医院获得性疾病风险最大的患者被确定为高风险围合项目。该计划提供了关于医院获得性条件要素的脚本问题,然后是教育和/或获取所需资源。主要的质量改善结果是实施前和实施后医院获得性疾病的总体发生率:中央静脉导管相关血流感染、导尿管相关尿路感染、计划外拔管和压力损伤。还对该项目的可持续性进行了评价。结果:在2年多的时间里,对488例独特患者进行了624次检查。查房产生了351项干预措施,包括关注升级、直接患者护理、资源采购和教育。接受高风险查房的患者比没有接受查房的患者发生医院获得性疾病的可能性要小。χ2关联检验显示,医院获得性疾病与接受高危查房之间存在显著负相关(χ2 = 22.5, P < 0.001)。在发现特殊原因变异后,项目医院获得性疾病的平均发生率从每1000病人日5.41例下降到2.89例。在项目期间,高风险查房预防了约50例医院获得性疾病。结论:高风险轮次的实施使项目特定医院获得性疾病的发生率降低了46.5%,并在2年的项目期间保持不变。
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引用次数: 0
Using Artificial Intelligence With Rapid Response Teams. 与快速反应小组一起使用人工智能。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026222
Maegen Robledo
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引用次数: 0
The Authors Respond. 作者回应。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026957
Annie George, Anne Griswold Peirce
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引用次数: 0
Adherence to an Intravenous Electrolyte Replacement Order Set for Critically Ill Oncology Patients. 对危重肿瘤患者静脉电解质替代方案的依从性。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026526
Michael Tyler England, Courtney Wilkes, Michelle Hauth, Jeffrey Bruno, Todd Canada

Background: Electrolyte abnormalities occur often in critically ill patients with cancer. Correction of these abnormalities improves patient outcomes. Administration of intravenous electrolytes is associated with risks. Order sets have been implemented to improve standardization, timeliness of administration, and patient safety.

Local problem: At a large academic cancer center, a nurse-driven central venous catheter intravenous electrolyte replacement order set was available in the intensive care unit, but adherence and barriers to use had not been assessed. The purpose of this quality improvement project was to define the baseline adherence rate to the electrolyte replacement order set.

Methods: A retrospective medical record review was conducted of medical intensive care unit patients with an active intravenous electrolyte replacement order set. All intravenous electrolytes administered within the first 72 hours of the intensive care unit stay were assessed for order set adherence.

Results: The order set adherence rate was 78.5%. The mean turnaround time from laboratory result to electrolyte administration was 3.1 hours. Deviations were predominantly characterized by administration of a lower electrolyte dose than indicated by the order set and administration of the incorrect electrolyte salt form.

Conclusion: The intensive care unit intravenous order set adherence rate revealed issues with administration of potassium, magnesium, and phosphate. In response, the interprofessional intensive care unit team implemented an electronic health record feature that displays the most recent electrolyte laboratory result for nurse review before electrolyte administration.

背景:电解质异常常见于癌症危重患者。纠正这些异常可改善患者的预后。静脉注射电解质与风险有关。为了提高规范化、管理及时性和患者安全,已经实施了订单集。局部问题:在一个大型学术癌症中心,重症监护室有一套护士驱动的中心静脉导管静脉电解质替代命令,但依从性和使用障碍尚未评估。本质量改进项目的目的是确定对电解质更换顺序集的基线依从率。方法:回顾性分析重症监护病房主动静脉电解质置换医嘱患者的病历资料。在重症监护病房前72小时内给予的所有静脉电解质都被评估为遵守医嘱。结果:遵医嘱率为78.5%。从化验结果到给药的平均周转时间为3.1小时。偏差的主要特征是施用的电解质剂量低于顺序集所指示的剂量和施用的电解质盐形式不正确。结论:重症监护室静脉输液顺序组依从率揭示了钾、镁、磷酸盐给药的问题。作为回应,跨专业重症监护室团队实施了一项电子健康记录功能,该功能显示最新的电解质实验室结果,供护士在给药前检查。
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引用次数: 0
Developing a Tool to Improve Critical Care Nurses' Access to High-Risk, Low-Volume Resources. 开发一种工具,以改善重症护理护士获得高风险,低容量资源。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026668
Sean Robinson, Kirianne Green, Amber Depew, Michelle Dedeo, Cara Gallegos

Background: The increased complexity of critical care nursing has resulted in nurses performing more high-risk, low-volume (HRLV) procedures, which may increase patient risk.

Local problem: The purpose of this project was to develop a resource for critical care nurses to more effectively manage HRLV scenarios at intensive care units at a large urban hospital to improve nurses' practice.

Methods: CINAHL and Medline databases were searched using the keywords high-risk low-volume, HRLV, badge buddy, just in time, and nurse competency. Twenty articles were identified, and 4 were included in this project. An accessible printed resource packet was created as a form of education and reference in HRLV scenarios. Each packet was laminated and kept at nurses' stations and included summaries, "pearls" (highlights), diagrams, checklists, and QR codes that linked directly to facility policies. Nurses were invited to complete an 8-question survey 8 weeks after implementation.

Results: Forty-three nurses completed the survey: 63% worked day shift, and 100% found the resource relevant. On average, the nurses agreed the packet increased knowledge, saved time, helped access policies, and influenced practice. On a scale of 1 to 10, the nurses rated the packet "very helpful" (mean, 9.09). When asked what was useful, participants indicated "easily accessible" and "finding information."

Conclusion: The resource packet has been used in HRLV scenarios and with new nurses during downtime. It was easy to implement and can be individualized for many units and patient populations. It serves as a bridge to easily bring best practice information to the bedside.

背景:重症监护护理的复杂性增加导致护士执行更多的高风险,低容量(HRLV)程序,这可能增加患者的风险。当地问题:该项目的目的是为重症监护护士开发一种资源,以更有效地管理大型城市医院重症监护病房的HRLV情况,以改善护士的实践。方法:采用高危低容量、HRLV、badge buddy、just in time、护士胜任等关键词对CINAHL和Medline数据库进行检索。共鉴定出20篇文章,其中4篇纳入本项目。创建了一个可访问的印刷资源包,作为HRLV方案的教育和参考形式。每个包都是分层的,保存在护士站,包括摘要、“珍珠”(亮点)、图表、清单和直接与设施政策相关的二维码。实施后8周,请护士完成一份包含8个问题的调查。结果:43名护士完成了调查,63%的护士为白班,100%的护士认为资源相关。平均而言,护士们认为信息包增加了知识,节省了时间,帮助获取政策,并影响了实践。在1到10的范围内,护士们认为这个包“非常有帮助”(平均,9.09)。当被问及什么有用时,参与者表示“容易获取”和“查找信息”。结论:资源包已被用于HRLV场景和新护士的停机时间。它很容易实施,并且可以针对许多单位和患者群体进行个性化。它可以作为一个桥梁,轻松地将最佳实践信息带到床边。
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引用次数: 0
AACN Practice Alert: Implementing Effective Oral Care Practices for Acutely and Critically Ill Patients. AACN实践提示:实施有效的口腔护理实践急危病人。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026463
Chet McCauley, Amanda Szatala, Tracy Thomas, Oscar Navarro, Cyndee Stull
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引用次数: 0
Bedside Nurses as Advocates for Change. 床边护士作为变革的倡导者。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026806
Annette M Bourgault
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引用次数: 0
Enteral Feeding Intolerance in Adult Patients Receiving Mechanical Ventilation: A Comprehensive Review. 接受机械通气的成人患者肠内喂养不耐受:一项综合综述。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026884
Annette M Bourgault, Jennifer Carroll Simmons, Jan Powers, Lillian Aguirre, Mary Lou Sole

Background: Enteral feeding intolerance, a type of gastrointestinal dysfunction, is common in adults receiving mechanical ventilation, yet its definition and clinical assessment remain variable. If untreated, this syndrome may lead to underfeeding, which is associated with worse patient outcomes.

Objective: To describe what is known about enteral feeding intolerance, including who is at risk, clinical symptoms, identifying measures used, treatment, and clinical implications for nursing practice.

Results: Enteral feeding intolerance is identified by (1) changes in gastrointestinal function, (2) high gastric residual volume, and/or (3) inadequate delivery of enteral nutrition. A combination of gastrointestinal symptoms and high gastric residual volume is generally used to diagnose the condition. The most common symptoms are vomiting, abdominal distention, absence of bowel sounds or flatus, and diarrhea. Administration of promotility agents and reduction of the enteral formula rate are most often used to reduce the effects of enteral feeding intolerance until it resolves.

Discussion: Many gastrointestinal assessment findings are subjective and lack precision. Although the routine measurement of gastric residual volume is no longer standard practice, it is indicated in patients at risk for enteral feeding intolerance.

Conclusion: Nurses should become familiar with how to assess for and treat enteral feeding intolerance, as well as rule out other common gastrointestinal complications. Clinical biomarkers are needed to objectively identify enteral feeding intolerance in critically ill patients.

背景:肠内喂养不耐受是一种胃肠道功能障碍,在接受机械通气的成人中很常见,但其定义和临床评估仍存在差异。如果不及时治疗,这种综合征可能导致进食不足,这与患者预后较差有关。目的:描述肠内喂养不耐受的已知情况,包括高危人群、临床症状、确定使用的措施、治疗方法以及护理实践的临床意义。结果:肠内喂养不耐受表现为:(1)胃肠功能改变,(2)胃残量高,和/或(3)肠内营养输送不足。胃肠道症状和高胃残余量的结合通常被用来诊断这种疾病。最常见的症状是呕吐、腹胀、没有肠音或肠胃胀气以及腹泻。最常用的方法是使用促进剂和降低肠内配方奶粉率,以减轻肠内喂养不耐受的影响,直至其消除。讨论:许多胃肠道评估结果是主观的,缺乏准确性。虽然常规测量胃残余容量不再是标准做法,但它适用于有肠内喂养不耐受风险的患者。结论:护士应熟悉肠内喂养不耐受的评估和治疗,并排除其他常见的胃肠道并发症。需要临床生物标志物来客观识别危重患者的肠内喂养不耐受。
{"title":"Enteral Feeding Intolerance in Adult Patients Receiving Mechanical Ventilation: A Comprehensive Review.","authors":"Annette M Bourgault, Jennifer Carroll Simmons, Jan Powers, Lillian Aguirre, Mary Lou Sole","doi":"10.4037/ccn2026884","DOIUrl":"https://doi.org/10.4037/ccn2026884","url":null,"abstract":"<p><strong>Background: </strong>Enteral feeding intolerance, a type of gastrointestinal dysfunction, is common in adults receiving mechanical ventilation, yet its definition and clinical assessment remain variable. If untreated, this syndrome may lead to underfeeding, which is associated with worse patient outcomes.</p><p><strong>Objective: </strong>To describe what is known about enteral feeding intolerance, including who is at risk, clinical symptoms, identifying measures used, treatment, and clinical implications for nursing practice.</p><p><strong>Results: </strong>Enteral feeding intolerance is identified by (1) changes in gastrointestinal function, (2) high gastric residual volume, and/or (3) inadequate delivery of enteral nutrition. A combination of gastrointestinal symptoms and high gastric residual volume is generally used to diagnose the condition. The most common symptoms are vomiting, abdominal distention, absence of bowel sounds or flatus, and diarrhea. Administration of promotility agents and reduction of the enteral formula rate are most often used to reduce the effects of enteral feeding intolerance until it resolves.</p><p><strong>Discussion: </strong>Many gastrointestinal assessment findings are subjective and lack precision. Although the routine measurement of gastric residual volume is no longer standard practice, it is indicated in patients at risk for enteral feeding intolerance.</p><p><strong>Conclusion: </strong>Nurses should become familiar with how to assess for and treat enteral feeding intolerance, as well as rule out other common gastrointestinal complications. Clinical biomarkers are needed to objectively identify enteral feeding intolerance in critically ill patients.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 1","pages":"23-31"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethical Analysis of Extracorporeal Membrane Oxygenation Using the Values Balancing Framework: A Case Study. 基于价值平衡框架的体外膜氧合伦理分析:个案研究。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026812
Rachael Alexis Jividen, Paul J Ford, Lauren Sankary, Georgina Morley

Introduction: Extracorporeal membrane oxygenation is a life-sustaining therapy that can produce complex ethical scenarios. Ethical challenges include patient selection and initiation, a frequently abbreviated informed consent process, ambiguity related to ongoing benefit and withdrawal of extracorporeal membrane oxygenation, resource intensity, and moral distress.

Clinical findings and diagnosis: A 50-year-old man with mucinous colorectal carcinoma was admitted to the hospital. He encountered treatment complications and received cannulation for extracorporeal membrane oxygenation twice during his stay. Ethical issues included the potentially limited physiological benefits of extracorporeal membrane oxygenation, fluctuations in his decision-making capacity, and need to ensure that decisions honored his preferences.

Interventions: A novel Values Balancing framework is used to identify and address ethical issues, possible courses of action, applicable values, open questions, other perspectives, and ethically supportable courses of action. With this framework, an action plan is established and the team is encouraged to review, reassess, and reflect on outcomes. The framework is applied to the case study.

Outcomes: The patient was transitioned to comfort care according to his wishes and died in the intensive care unit.

Conclusion: Using a structured framework to approach ethical challenges may facilitate decision-making and collaborative discussions that optimize ethical approaches to extracorporeal membrane oxygenation. Critical care nurses can assist with goals-of-care discussions, support families, and advocate for early involvement of bioethics and palliative support personnel to navigate ethical challenges.

体外膜氧合是一种维持生命的治疗方法,可能会产生复杂的伦理问题。伦理挑战包括患者的选择和启动、经常缩短的知情同意过程、与体外膜氧合持续获益和退出相关的模糊性、资源强度和道德困境。临床表现和诊断:一个50岁的男性粘液性结直肠癌住进医院。他遇到了治疗并发症,并在住院期间接受了两次体外膜氧合插管。伦理问题包括体外膜氧合的潜在有限的生理益处,他的决策能力的波动,以及需要确保决策尊重他的偏好。干预措施:一个新的价值平衡框架被用来识别和解决伦理问题、可能的行动方案、适用的价值、开放的问题、其他观点和伦理上支持的行动方案。有了这个框架,就可以制定行动计划,并鼓励团队审查、重新评估和反思结果。将该框架应用于案例研究。结果:患者根据自己的意愿转入舒适护理,在重症监护病房死亡。结论:使用结构化框架来处理伦理挑战可以促进决策和协作讨论,从而优化体外膜氧合的伦理方法。重症护理护士可以协助讨论护理目标,支持家庭,并倡导早期参与生物伦理学和姑息治疗支持人员,以应对伦理挑战。
{"title":"Ethical Analysis of Extracorporeal Membrane Oxygenation Using the Values Balancing Framework: A Case Study.","authors":"Rachael Alexis Jividen, Paul J Ford, Lauren Sankary, Georgina Morley","doi":"10.4037/ccn2026812","DOIUrl":"https://doi.org/10.4037/ccn2026812","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation is a life-sustaining therapy that can produce complex ethical scenarios. Ethical challenges include patient selection and initiation, a frequently abbreviated informed consent process, ambiguity related to ongoing benefit and withdrawal of extracorporeal membrane oxygenation, resource intensity, and moral distress.</p><p><strong>Clinical findings and diagnosis: </strong>A 50-year-old man with mucinous colorectal carcinoma was admitted to the hospital. He encountered treatment complications and received cannulation for extracorporeal membrane oxygenation twice during his stay. Ethical issues included the potentially limited physiological benefits of extracorporeal membrane oxygenation, fluctuations in his decision-making capacity, and need to ensure that decisions honored his preferences.</p><p><strong>Interventions: </strong>A novel Values Balancing framework is used to identify and address ethical issues, possible courses of action, applicable values, open questions, other perspectives, and ethically supportable courses of action. With this framework, an action plan is established and the team is encouraged to review, reassess, and reflect on outcomes. The framework is applied to the case study.</p><p><strong>Outcomes: </strong>The patient was transitioned to comfort care according to his wishes and died in the intensive care unit.</p><p><strong>Conclusion: </strong>Using a structured framework to approach ethical challenges may facilitate decision-making and collaborative discussions that optimize ethical approaches to extracorporeal membrane oxygenation. Critical care nurses can assist with goals-of-care discussions, support families, and advocate for early involvement of bioethics and palliative support personnel to navigate ethical challenges.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 1","pages":"50-58"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bed Rest After Removing Central Arterial and Venous Access Devices. 移除中心动脉和静脉通路装置后卧床休息。
IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-02-01 DOI: 10.4037/ccn2026789
Julie Miller
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引用次数: 0
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Critical care nurse
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