Non-pharmacological interventions to reduce physical restraints in critical care units.

Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimising the use of physical restraints in adult critically ill patients. Interventions are classified into two groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programmes and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organisations towards making restraints visible might be the most effective. The implementation of these programmes should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.

Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. / Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD.

AIMS: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).

[Prevention of ventilator-associated pneumonia: a comparison of level of knowledge in three critical care units]. / Prevención de neumonía asociada a ventilación mecánica, comparación de conocimientos entre tres unidades de críticos.

OBJECTIVE: To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. METHOD: A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. RESULTS: Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. CONCLUSION: The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention.

[An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period]. / Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005).

INTRODUCTION: The research on critical care nursing is generally presented in the annual national congresses of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC). This study has aimed to analyze the main features of the papers presented in the above-mentioned congresses in order to get a deeper knowledge of the research capacity of our professional group. MATERIALS AND METHODOLOGY: A descriptive, observational and retrospective study. SAMPLE: all the papers. Dimension studied: structure and process. Time: 8 years. DATA SOURCE: a collection of the papers presented in congresses. DEVELOPMENT: collected variables: number of authors, type of paper, city and region, type of study, timing, nursing role, dimension analyzed, topic, hospital, department, type of statistics, relevance, financing, structural quality and others. Statistical processing: descriptive statistics for quantitative variables with means and standard deviation (SD); qualitative variables are written in percentages. We have contrasted hypotheses with chi(2) accepting if p < 0.05 as a statistical significance. RESULTS: Papers 736 (65-119), oral papers 270 (40.4%), mean of authors 4.87 (1-16), SD 1.97; per provinces: Barcelona 146 (19.8%); per autonomous communities: Catalonia 166 (22.6%); hospitals: University Hospital from Bellvitge 27 (4.2%); research studies 426 (65.3%); prospective studies 333 (51%), quantitative 345 (53%); with descriptive statistics 305 (46.9%); with a health perception and health management pattern 76 (10.3%); analyzed quality area: structure 379 (51.5%); with the presence of an autonomous role 380 (51.6%); most mentioned theme: respiratory care 100 (13.6%), with relevance and/or applicability 450 (69%); financed 23 (3.5%). Fulfillment of scientific structure: 97%. CONCLUSIONS: Intensive Nursing Care shows an important amount of oral papers. Research studies stand out among these papers, the former having high structural quality and relevance and/or applicability.

[Acute ICU syndrome. Contributing factors and attitude of the nursing staff]. / Síndrome confusional agudo en UCI: factores que influyen y actitud de enfermería.

It is not uncommon for patients in intensive care units (ICUs) to suddenly and unexpectedly present what is known as acute ICU syndrome. This syndrome appears independently of the patient's situation and diagnosis. The aim of the present study was to determine the incidence of this nursing diagnosis in our department, to identify the possible environmental factors that could contribute to its appearance and to evaluate nursing interventions to resolve this syndrome in the ICU.Data were collected from a register of 62 items containing information on the health status of the patient on presenting the syndrome (vital signs, laboratory investigations, etc.), data on the environment, drugs used and other factors that could, a priori, play a role. The statistical analysis was performed using the SPSS program. This prospective study was carried out in a general ICU with ten beds: six beds in an open ward and four individual rooms. Two hundred forty-three patients were admitted during the 6-month study period. The incidence of ICU syndrome was 8.1 % (20 cases). Factors influencing its appearance were the timing of the shifts, the temperature, and whether patients were in individual rooms or open wards. The frequency of the syndrome was much higher in open wards and in the afternoon (from 15:00 to 22:00). In conclusion, the attitude of the nursing staff should be alert to identify the syndrome early and initiate appropriate measures, such as orienting the patient in time and space, achieving an appropriate temperature, using relaxation techniques, facilitating access to the family, etc., since in 35 % of cases these measures are sufficient to stabilize and/or resolve the problem, without the need of drugs.

Síndrome confusional agudo en uci: factores que influyen y actitud de enfermería / Acute ICU syndrome. Contributing factors and attitude of the nursing staff

En la UCI se observa con cierta frecuencia que los enfermos, independientemente de su situación y enfermedad, presentan de forma brusca e inesperada lo que denominamos síndrome confusional agudo (SCA) como diagnóstico de enfermería. Los objetivos del estudio son: determinar la incidencia de este diagnóstico enfermero en nuestro servicio, conocer las posibles causas del entorno que pueden incidir de forma más importante sobre su aparición, y evaluar la intervención de enfermería para resolver el cuadro confusional agudo del paciente en UCI. Para la recogida de datos, se utilizó un registro con 62 ítems en el que quedan reflejadas las variables sobre el estado del paciente cuando se presentaba el cuadro (constantes vitales, parámetros analíticos, etc.), datos del entorno, fármacos utilizados, y otros factores que a priori podían incidir. Se realizó procesamiento estadístico con el programa estadístico SPSS. El estudio se desarrolló de forma prospectiva, en una UCI polivalente de 10 camas, con 6 camas abiertas y 4 en boxes cerrados. Durante el período de estudio (6 meses), ingresaron 243 enfermos. La incidencia del SCA fue del 8,1 por ciento (20 casos). Como factores que inciden en su aparición se detectaron: el turno horario, el ambiente, y la situación de boxes individuales o camas abiertas, siendo destacable la aparición del cuadro con mucha mayor frecuencia en estas últimas, y en horario de tardes (15 a 22 h). Como conclusión, es importante destacar "la actitud de enfermería" que debe estar alerta para identificar el cuadro precozmente e iniciar las medidas oportunas, como orientar en tiempo y espacio, procurar un ambiente adecuado, emplear técnicas de relajación, facilitar el acceso a la familia, etc., ya que en el 35 por ciento de los casos ha resultado "eficaz" para estabilizar y/o resolver este problema, sin necesidad de fármacos (AU)

[Measurement of care time in patients with acute myocardial infarction admitted to a general ICU: evaluation and improvement]. / Medición de tiempos en la atención al paciente con infarto agudo de miocardio en una UCI polivalente: estudio de evaluación y mejora.

Acute myocardial infarction (AMI) requires early and safe nursing care, particularly with respect to initiating and following up thrombolytic treatment, the most effective therapy according to the literature. Time is decisive. Recommended door-to-needle time should not exceed 35 minutes (from patient's arrival to injection of the thrombolytic agent in the ICU). This quality of care study centered on the measurement of four partial times and their sum. These times corresponded to different phases a patient with AMI undergoes from arrival at the hospital emergency room center to thrombolysis in the ICU. The intrahospital delay in patient care was examined. Times were recorded on a specific register of all patients with priority I AMI (clear criteria for fibrinolysis) who were seen at our center. Total time to fibrinolysis in the ICU was 60 minutes (excessive intrahospital delay). A corrective intervention plan was designed and implemented, which reduced the delay to an acceptable 30 minutes. This improved the quality of care of AMI patients at our center.

[A new candidate for intensive care: patients undergoing rapid opiate withdrawal, and their care]. / Un nuevo candidato para cuidados intensivos: "el paciente que se va a someter a desintoxicación ultracorta por opiáceos, y sus cuidados".

Withdrawal from drugs currently is and interesting topic because of the repercussions it has on different aspects of life, particularly: health, work, family and social relationships, etc. In this article we report a new system for minimizing the adverse effects of withdrawal from opiates (which usually are prolonged), and for carrying out withdrawal as quickly and effectively as possible. A protocol is described in detail, as well as special nursing care. This protocol is called ultrashort withdrawal (24 hours) and it has been developed and used in the intensive care department of the General University Hospital of Murcia (Spain), in collaboration with the center's hospital detoxification unit.

[Prevention of infections caused by venous catheters in intensive care units]. / Prevención de las infecciones relacionadas con catéteres venosos en cuidados intensivos.

The importance of the prevention of infections related to venous catheters comes from the frequent morbility which derives from these devices in ICU and the foresecable increase of infections which are secondary to them with the consequent increase in the load of Nursing work and costs in Spain, bacteriemias related to central catheters are 8%, under 5% for Swan-Ganz and almost inexistent for peripherals. Germs responsible for infectious incidences caused by catheters are basically Staphylococcus coagulase-negative and Staphylococcus aureus. The most affected veins are the jugular, followed by femoral, antecubital, subclavian and peripheral. The colonization of the patient's skin and the connections of catheters are the most frequent origin of infections and, since certain germs create defensive structures which make them more resistant to treatment, it is very important to carry out protocols of prevention and care which should encompass hand washing efficiency, daily care of the wound, use of suitable disinfectants and, very especially, the protection of catheter connections.