Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time.

BACKGROUNDS AND OBJECTIVE: The true role of the age in the prognosis of patients admitted in the ICU is not known. This work analyzes the influence of age on the duration of the stay and mortality of patients who remain in an Intensive Care Unit (ICU) for a long period of time. PATIENTS AND METHOD: A retrospective, observational study was performed with patients hospitalized ≥14 days in the ICU. Three age groups were established: <50, 50-70 and >70 years. The influence of different factors on the relationship existing between stay and age was studied. In addition, stay and survival in the ICU, hospital and at one year were analyzed based on the groups. RESULTS: A total of 707 patients were included. Significant differences in hospital stay (P=.183) were not found among the three groups. The older group, which showed greater severity on admission, was the group undergoing the most tracheostomies (74.7%) and extrarenal purification (HDF) (10.8%). When the influence of factors such as APACHE II, pre-ICU stay, origin, tracheostomy or hemodiafiltration (HDF) were analyzed, no relation was found between stay and age of patient. Survival decreased as age increased. CONCLUSIONS: No differences were found in stay based on age, although a difference was found in mortality.

[Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard]. / Gestión de la calidad en una unidad de cuidados intensivos: implementación de la norma ISO 9001:2008.

The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel.

[Perception of ethical attitudes of intensive care nurses on treatment limitation]. / Percepción de las actitudes éticas de la enfermería de cuidados intensivos ante la limitación del tratamiento.

OBJECTIVE: Analyze the perception of intensive care nurses regarding the limitation of therapeutic efforts (LET). METHOD: A 2-month cross-sectional, descriptive study carried out among Intensive Care nursing staff of our Hospital. An anonymous survey was used to assess the attitudes of intensive care nurses on LET. RESULTS: Fifty-two nurses (86.6%), 57.7% women, with a working experience of 8.8±4.8 years and 17.7%, had some additional training in ethics. The decision not to hospitalize a patient whose short term quality of life is very poor changes when the patient's opinion is considered (36.5% vs 61.5%, p=0.008), a difference that is greater in male nurses without prior training in ethics. A total of 23.1% were not aware of the existence of agreed on guidelines on LET in the Service. A total of 17.3% consider that limiting treatment, either by not providing it or by withdrawing it, is a form of passive euthanasia, which would be an acceptable practice as opposed to euthanasia and 84.6% consider that administering a treatment is not the same as withdrawing it. Of those surveyed, 36.5% felt that the neither the nursing staff should not participate in the decision to limit treatment nor the patients (34.6%) nor family (23.1%). CONCLUSIONS: Nursing is not aware of the importance it can have, along with the family and patient, in decision making in relationship to the limitation of the treatment of the critical patient, providing a humanizing and ethical view of the care.

[Evacuation plan of an intensive care unit: a new quality indicator?]. / Plan de evacuación de la unidad de cuidados intensivos: ¿un nuevo indicador de calidad?

The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.