Safety, An Issue of Critical Care Nursing Clinics

Debora Simmons

Description

This issue of Critical Care Nursing Clinics, Guest Edited by Debora Simmons, RN, MSN, CCRN, CCNS, will feature such article topics as: Cause Mapping Critical Events; Blood Bank Safety in the ICU; Patient Safety in Perinatal Care; High Risk Drugs in Critical Areas; Enteral Feeding Tubing Misconnections; Safe Practices for Enteral Nutrition; Negotiating Safety; Device Complexity and Human Factors; Decreasing Risk; Delirium in ICU; and Voice of the Patient.

Sujets

• Critical Care
• Medical
• Médecine
• Nursing
• Intensive Care

Informations

• Publié par: Saunders
• Date de parution: 29 juin 2010
• Nombre de lectures: 0
• EAN13: 9781455700226
• Langue: English

Extrait

Table of Contents

Cover image
Preface
Intensive Care Unit Delirium
Incidence
Pathophysiology and risk factors
Clinical relevance: morbidity and mortality
ICU Delirium assessment
Treatment
Practice implications
Summary
Blood Transfusions in Critical Care: Improving Safety Through Technology & Process Analysis
Transfusion safety—a focus on the process
Acute hemolytic transfusion reaction
A case of transfusing mismatched blood
Analyzing the systems and human performance factors
Lapses in transfusion administration
Technological advances for transfusion safety
The hospital's initiatives for transfusion safety
Transforming practice in transfusion verification
Summary
Medication Errors from an Emergency Room Setting: Safety Solutions for Nurses
A guide to understanding medication errors from an emergency department setting: safety solutions for nurses
Discussion
Recommendations
Summary
Safe Practices for Enteral Nutrition in Critically Ill Patients
Indications and use of enteral nutrition in critically ill patients
Enteral nutrition areas of concern and safety recommendations
Monitoring GI function and tolerance
Nursing campaign for safety
State of the Science: β-Blockers and Reduction of Perioperative Cardiac Events
Background and significance
Integrated literature review
Perioperative β-blockade guidelines: past and present
β-Blockade: the scientific evidence
β-Blockade in high-risk patients
Examining alternative findings
Significant findings
Recommendations
Summary
Strategies for Safe Care of Critical Care Perinatal Patients
System design
Key elements for risk reduction
Voice of the Patient: The Essence of Patient-Centered Care
Human Factors: Should Your Medical Devices Require Intensive Care?
Examples
Human factors
The proper perspective
Cause-and-effect Mapping of Critical Events
Systems thinking
Error analysis
Analysis tools
Process maps
RCA
Ishikawa diagram
CauseMapping
Sample CauseMap
Summary
Neonatal Intensive Care Unit and Emergency Department Nurses' Descriptions of Working Together: Building Team Relationships to Improve Safety
Background
Study design
Results
Implications
Summary
Acknowledgments
Negotiating Safety when Staffing Falls Short
Background and significance
Safety strategies
Summary
Defragmenting Care: Testing an Intervention to Increase the Effectiveness of Interdisciplinary Health Care Teams
Literature review
Conceptual model
Methodology
Results
Discussion
Registered Nurses Select Multiple Factors Associated with their Errors
Problems with medical errors
Survey of registered nurses involved in medical errors
RNs respond
Summary
CNC Volume 22, Issue 2, June 2010 Copyright © 2010 Elsevier Inc.. ISSN 0899-5885 Published by Elsevier Inc. DOI 10.1016/j.ccell.2010.04.001


Preface
Safe Process, Safe Practice, Safe Patients: The Pivotal Role of Nurses in the Safety of Patients

Debora Simmons, RN, MSN, CCRN, CCNS (email: [e-mail] )

Texas Woman's University, College of Nursing, Houston, TX, USA
Rural and Community Health Institute, Texas A & M University, Bryan, TX, USA
Buehler Center on Aging, Health & Society, Northwestern University, Chicago, IL, USA

Debora Simmons, RN, MSN, CCRN, CCNS, Guest Editor

It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm
Florence Nightingale, 1863
This year marks the 100th anniversary of Florence Nightingale's death and also the 10th-year anniversary of the Institute of Medicine's (IOM) report, To Err Is Human: Building a Safer Health System . The work of Nightingale and of the IOM share common aspects that span the past 100 years and remind us of the vital role nurses play in delivering safe care. A later IOM report, Keeping Patients Safe: Transforming the Work Environment of Nurses , reminds us that in every health care delivery setting there is a nurse present and accountable for the patient's journey. Nightingale spent her life improving health care and preventing harm caused by health care; the IOM reminds us the mission continues.
The work of Nightingale and the IOM points to using evidence for our actions, to improving those actions through the use of evidence, and to having continuous focus on patients. The authors in this issue are working within this structure in a diversity of settings, in critical functions, and with multiple disciplines. Key to each article is the focus on action in order to effect change—the actions may be gathering evidence, applying tools, or using assessment skills to improve care. The key is action—each on the patient's behalf. Every article in this issue began with an idea and resulted in an action focused on patients' well being. These written accounts of action are shared with you, the readers, in hopes that you will find a call to action for yourselves.
You ask me why I do not write something….I think one's feelings waste themselves in words; they ought all to be distilled into actions and into actions which bring results
Florence Nightingale (cited by Cook, 1913)
Resources
1. E.T. Cook, The life of Florence Nightingale . ( 1913 ) Macmillan , London .
2. In: (Editors: L.T. Kohn, J.M. Corrigan, M.S. Donaldson) To err is human: building a safer health system ( 2000 ) National Academies Press , Washington, DC .
3. F. Nightingale, Notes on hospitals . 3rd edition ( 1863 ) Savill and Edwards, Printers , London .
4. In: (Editor: A. Page) Keeping patients safe: transforming the work environment of nurses ( 2004 ) National Academies Press , Washington, DC .
CNC Volume 22, Issue 2, June 2010 Copyright © 2010 Elsevier Inc.. ISSN 0899-5885 Published by Elsevier Inc. DOI 10.1016/j.ccell.2010.03.003



Intensive Care Unit Delirium
The authors have no conflicts of interest regarding this publication.

Jeffrey J. Bruno, PharmD, BCNSP, BCPS a , ∗ (email: [e-mail] ) and Mary Lou Warren, MSN, RN, CNS-CC, CCNS, CCRN b

a Critical Care/Nutrition Support, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 377, Houston 77030-4009, TX, USA
b Intensive Care Unit, Division of Nursing, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston 77030-4009, TX, USA
∗ Corresponding author.


Once considered a benign iatrogenic consequence of intensive care unit (ICU) admission, ICU delirium is now recognized as a prominent disorder that negatively affects patient morbidity and mortality. The primary goal in the detection and treatment of ICU delirium is to ensure the safety of the patient and caregiver(s). Most critically ill patients possess 1 or more risk factors for the development of delirium; therefore, interventions that target delirium assessment and prevention are essential. This article highlights some of the recent data that have emerged regarding ICU delirium, including its definition, incidence, risk factors, diagnostic tools, and treatment.
Keywords: Delirium; Critical illness; Critical care; Diagnosis; Antipsychotic agents; Screening
The Diagnostic and Statistical Manual of Mental Disorders , fourth edition (DSM-IV), defines delirium as a disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that develops in a short period (hours to days) and fluctuates over time. This definition highlights the 4 key characteristics of delirium: altered level of consciousness, inattention, disorganized thinking, and acute onset with a fluctuating course. Critically ill patients are prone to the development of delirium during their stay in the intensive care unit (ICU). More than 25 terms have been used in the literature to describe ICU delirium, including ICU psychosis, ICU syndrome, acute confusional state, septic encephalopathy, and acute brain failure. By consensus, the proper terminology is ICU delirium. 1 Although delirium is commonly associated with restlessness and agitation, there are 3 distinct subtypes of ICU delirium: hyperactive, hypoactive, and mixed ( Fig. 1 ). 2

Fig. 1
ICU delirium subtypes.
Data from Truman B, Ely EW. Monitoring delirium in critically ill patients. Crit Care Nurse 2003;23:25–37.

Incidence
The incidence of ICU delirium varies widely from 16% to 89%. 3 , 4 , 5 , 6 , 7 , 8 , 9 , and 10 The variation is primarily attributable to differences in study population, use and choice of screening instrument, diagnostic criteria, and risk factors, such as sedative agents administered. Fig. 2 illustrates the varying incidence of ICU delirium in various subpopulations using the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC), 2 validated delirium assessment tools that are discussed in detail later. In regards to delirium subtypes, the most prevalent are the hypoactive and mixed; despite popular belief, hyperactive delirium is relatively uncommon. Studies have shown that hypoactive delirium encompasses up to 64% and mixed delirium up to 55% of delirium cases in critically ill patients. Hyperactive delirium has been identi