The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital.

BACKGROUND: Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses' use of the system, and the impact of system use on critical care nursing processes and outcomes. METHODS: This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. RESULTS: A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. CONCLUSIONS: Nurses in this ICU unit in China actively participated in the ICIS development and fully used the system to document care. Introduction of the ICIS led to significant improvement in quality and efficiency in nursing documentation, medication order transcription and administration. It allowed nurses to spend more time with patients to improve quality of care. These led to improvement in overall nursing performance. Further study should investigate how the ICIS system contributes to the improvement in decision making of ICU nurses and intensivists.

Fatal adverse effects of injected ceftriaxone sodium in China.

PURPOSE: The incidence of adverse reactions to ceftriaxone, which is widely used in China, has gradually increased, with an associated increase in patient fatality. An analysis of the reported data from articles published in China highlights the importance and extent of this growing public health problem. METHODS: We identified previously reported cases of adverse effects to ceftriaxone sodium by searching the Chinese Medical Text Database System for reports published between January 2002 and December 2009. The references cited in the articles were examined for additional reports. RESULTS: A total of 17 articles were identified that cited fatal adverse reactions in 22 cases. Most patients had been treated for upper respiratory tract infection and bronchitis and had no reported history of ceftriaxone allergy. Of the patients, 77% were treated with ceftriaxone without undergoing intradermal testing, and 36% were not offered any information on intradermal testing. Concomitant intravenous medications were prescribed in 7 cases, and an overdose of ceftriaxone sodium was prescribed for two patients. The delay between drug administration and the onset of adverse drug reactions occurred within 30 min in 72.7% of the patients. Of the deaths, 73% occurred on the first day of treatment. CONCLUSIONS: The fatal adverse events associated with ceftriaxone occurred because of inappropriate drug usage, drug overdoses, careless medical personnel, poor medical conditions, and possibly poor drug quality. Although some deaths may be unavoidable, the risks can be minimized by the appropriate administration of ceftriaxone and further consultation with the Chinese medical profession and research.