Critical Care Nursing Quarterly最新文献

This article describes the staged restructure of the rapid response program into a dedicated 24/7 proactive rapid response system in a quaternary academic medical center in the southern United States. Rapid response nurses (RRNs) completed clinical leadership training on artificial intelligence, electronic risk stratification alerts, expert nurse rounding, emergency response, teamwork, closed-loop communication, and outcome measurement. The program goal was to reduce preventable deaths and resuscitation events outside the intensive care unit (ICU). Program outcomes between 2017 and 2019 included a 65% decrease in cardiac arrests outside the ICU, a 27% decrease of cardiac arrests inside the ICU, a 4.7% decrease in patients admitted to the ICU from inpatient beds, and a 27% reduction in the risk-adjusted mortality index for patients with expert proactive rounding encounters. Hospital peer group ranking on the Hospital Survey of Patient Safety improved in the areas of events reported, actions promoting patient safety, and continuous improvement suggesting a positive cultural shift. Implementation of a dedicated 24/7 RRN model of care integrating proactive rounding, technology, and ART can improve outcomes for patients and staff.

Social media has changed the way individuals communicate and recently multiple articles have been published highlighting the utilization of social media for education. To our knowledge, cross-discipline education utilizing these platforms has not been evaluated. The purpose of this study was to implement a pharmacist-led, social media-based nursing education program and evaluate the perceived value. A curriculum of pharmacy-related issues was developed and topics were posted to the neurocritical care unit (NCCU) Facebook group or emailed to non-Facebook users weekly. A pre- and posteducation survey was sent out evaluating the program's effectiveness. Thirty-seven nurses were members of the NCCU Facebook group and 33 received the education via email. A total of 29% and 19% of nurses completed the pre- and posteducation survey, respectively. Of those who completed the survey, 36% received education via Facebook. As compared with the preeducation survey, there were no statistically significant differences in nursing performance on fact-based questions (P value > .05 on all assessment questions); however, 100% of respondents wanted to continue this education delivery. Utilizing social media as a means of cross-discipline education was well-received; however, the solitary utilization should be used cautiously, as performance did not improve on assessment questions.

Determining the treatment plan and how to successfully manage a patient suffering from an acute ischemic stroke can be challenging for a registered nurse (RN) in the emergency department. Using a mnemonic in the treatment process assists in reducing medical errors and increases the likelihood of making positive clinical outcomes. Mnemonics sum up complex strategies into relevant information that can be comprehensible for users. The authors have created a mnemonic strategy to provide RNs in the emergency department with a structured approach to the pharmacotherapeutic strategies used in treating patients with an acute ischemic stroke. All guidelines used throughout the article are in concurrence.

Delirium is an indicator of morbidity and mortality in intensive care unit (ICU) patients. It can lead to negative outcomes and longer hospital stays, thus increasing hospital costs. Despite national recommendations for daily assessment of delirium, it remains underdiagnosed. Many studies point to a lack of knowledge among health care professionals to accurately detect and manage ICU delirium. The aim of our study was to assess the knowledge, attitudes, and practices of Palestinian health care professionals regarding ICU delirium. The results of a cross-section observational study revealed that delirium appears to be often underrecognized or misdiagnosed in ICUs in Palestine. Therefore, it is critical to further educate the medical and nursing teams and to promote the use of validated tools that can aid in the assessment of this condition. In this way, the length of hospital stays and related health care costs can be reduced.

Adequate safety precautions and proper use of personal protective equipment (PPE) in hospitalized patients with health care-associated infections (HAIs) are the most effective preventions in their spread. Observational study was conducted in one inpatient facility in the Czech Republic before the COVID-19 pandemic (April 2019 to February 2020). Data were analyzed using Minitab at a significance level of .05. The execution of preventative measures in patients hospitalized with a HAI (n = 44) and the use of PPE by health care workers (n = 514) have been observed. The presence of defined PPE items usage differs on the basis of the department type (P = .0004). The correctness of PPE use differs on the basis of profession (P < .001), hand disinfection before PPE use (P < .001), use of all PPE (P < .001), and hand hygiene after PPE use (P < .001). General nurses had a higher observed frequency of hand hygiene (53.3%) than physicians (42.4%). The correct order of operations when using PPE differs on the basis of the department type (P < .001) and their architecture arrangement (open, semiopen, box) (P < .001). Critical preventative measures shortage was found at all units. Insufficient execution of the correct procedure of actions in the use of PPE was observed among health care workers. The best results have been observed among nurses.

The objective of this study was to determine the experience of the nurses who provide health care in the final stages of life in the intensive care unit for adults. The authors report the results of their study, which used a qualitative design with a phenomenological approach. Eighteen adults participated by being interviewed using semistructured questions. The nurses expressed that health care at the end of life represents an emotional and psychological burden for them. They also recognized that health care was given based on the empiricism achieved through clinical experience. In this regard, they emphasize the importance of having the proper education in this area to provide comprehensive care to the patient, the family, and the nurse.

The cost of a prolonged critical care admission is often the driver of the high cost of care. At a time when the health care system in the United States is absorbing an increasing percentage of the gross domestic product, an understanding of the value equation is essential. The pressure to provide high-quality care at a cost that the nation can shoulder unifies the bedside nurse and the C-suite to a common goal. The president, chief operating officer, and chief financial officer of a large urban teaching hospital were interviewed to provide some insight into how C-suite members view the value equation and the role of critical care nurses in achieving success.

Recognizing delays in patient transfers from the intensive care unit (ICU) to its designated telemetry unit impeded patient flow, a group of nurses from both units came together to identify barriers for the transfer process and worked on a solution that benefited the patient, staff, and hospital. Nurses changed the process of patient handoff by means of telephone to bedside handoff, creating a culture change and eliminated approximately 60 minutes from the average time to transfer patient from the ICU to the telemetry unit. The bedside handoff included a neurological assessment, which helped facilitate continuity of care and decreased anxiety for the patient during transition to the telemetry unit.

Benefits of the use of social media platforms in health care are significant and far-reaching. There are also times when these platforms place health care professionals at risk. This article assists health care professionals to understand the overall uses of social media while providing descriptions of events that result in unplanned consequences. Simple tips are provided that all health care professionals should consider to ensure their privacy and that of their patients.

Organizational structures have been shifting in health care over the past decade. Although hierarchal structures exist in many hospitals and health care entities, matrix approaches have been implemented to complement the traditional reporting configuration. The institute model is a hybrid structure implemented within medical and surgical service lines to promote patient-centered care within a hospital network. Physician administrators lead the institutes with collaboration by key liaisons such as nursing and quality leaders. In order to be successful, the concepts must extend from the boardroom to the front line. Teams focused specifically on quality metrics were developed within the service lines using an interdisciplinary approach to promote engagement and achieve desired outcomes. A key strategy was the implementation of a nurse manager/attending physician dyad model. This partnership is the linkage from the front line to the institute chair. The focus on collegiality and collaboration has led to improved engagement and problem-solving within the service lines.