Journal of critical care最新文献

Background: Transfer of medication information from intensive care units (ICUs) to general wards is error prone. Additional challenges emerge in hospitals where a different electronic medical record (eMR) is used in ICU and wards. Digital transfer systems, that support information transfer between different eMRs, could minimise errors, but limited research has evaluated these. We aimed to 1) determine the impact of eTOC, a medication transfer system, on medication errors and potential patient harms that occur during ICU-to-ward transfers, 2) to determine frequency of eTOC use post-implementation, and 3) explore how eTOC is used and viewed by clinicians.

Methods: A mixed methods approach was used at one metropolitan and one regional hospital in NSW, Australia. Part 1 comprised a pragmatic pre-post chart-review study (n = 200 patient transfers) and Part 2 used a qualitative approach, including usability testing (n = 4) and semi-structured interviews with clinicians (n = 11).

Results: Implementation of the eTOC system did not significantly reduce the number of transfers containing an error (51 % vs 46 %, pre-post). Although the use of eTOC more than halved the odds of a medication error occurring (OR: 0.44, 95 %CI: 0.27-0.71), the system was inconsistently used. Interviews and usability testing revealed that barriers related both to system design/configuration and to the context of use and organisation (e.g., time pressure) impacted uptake of eTOC.

Conclusions: There is significant potential for technology to support transfer of medication information from ICU to the ward and improve safety if technology is designed well and aligns with how work is done in practice.

Background: Intensive care unit (ICU) admission of obstetric patients during pregnancy or postpartum is not uncommon. The long-term physical and emotional implications of such admissions require elucidation.

Aim: To describe obstetric patients' long-term perspectives on ICU admission and recovery.

Methods: A phenomenological approach was undertaken. All consecutive obstetric patients admitted to the ICU during 2016-2021 were invited to participate in a semi-structured interview after hospital discharge. Interviews were conducted from 12/2020 to 06/2022, and the transcripts were analyzed using Braun and Clarke's six-phase approach to reflexive thematic analysis.

Results: A total of 59 women aged 20-34 years admitted to an ICU during pregnancy or postpartum were interviewed. Qualitative inductive analysis of the interview transcripts generated three themes: the illness experience, an atypical patient, and recovery. Repetitive topics were a sense of disorientation, feeling distressed and scared, the importance of remaining in contact with and informed on the neonate, the importance of partner and family support, the challenges of being an atypical ICU patient, the difficulties in returning to normal life, and coping strategies.

Conclusions: This study sheds new light on the experiences of obstetric patients admitted to an ICU. It highlights missed opportunities for maternal‑neonatal bonding, the importance of family support, unique needs that often remain unmet, the need for effective communication with the ICU staff, and the physical and emotional long-term adverse effects of the experience. The patient's narrative can contribute to our understanding of the ICU experience as a whole and its outcomes.