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1.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artículo en Noruego | MEDLINE | ID: mdl-31502798

RESUMEN

BACKGROUND: The purpose of introducing the 'cancer patient pathway for breast cancer' was to ensure a coherent treatment pathway without unnecessary delays. Radiologists and pathologists who work with breast diagnostics are involved in both cancer patient pathways and BreastScreen Norway. The extent to which this policy may have affected waiting times has not been analysed previously. This study presents waiting times in BreastScreen Norway before and after introduction of cancer patient pathway. MATERIAL AND METHOD: We analysed waiting times associated with 1 485 240 screening examinations undertaken as part of BreastScreen Norway in the period 01.7.2011-30.6.2018, stratified by breast diagnostic centre. Waiting times were defined as the number of calendar days from the a) screening examination to the dispatch of the negative results letter (dispatch time), b) screening examination to the date on which the follow-up examination was performed (follow-up examination time) and c) follow-up examination to diagnosis (diagnosis time). Data were retrieved from the Cancer Registry of Norway's databases. Use of these is set out in the Cancer Registry Regulations. We calculated median waiting times in addition to 90th percentiles. RESULTS: The median dispatch time was 13 days before the cancer patient pathway was introduced, and 12 days after. The median follow-up examination time increased from 23 to 27 days, while the median diagnosis time was 3 days both before and after introduction of the cancer patient pathway. INTERPRETATION: Dispatch and diagnosis times were unchanged, or slightly changed after introduction of the cancer patient pathway, while follow-up examination time increased somewhat. Introduction of the cancer patient pathway may have led to differential adjustments in priorities, workflows and access to resources between the breast diagnostic centres.


Asunto(s)
Neoplasias de la Mama , Mamografía/normas , Paquetes de Atención al Paciente/normas , Listas de Espera , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico por imagen , Diagnóstico Tardío , Detección Precóz del Cáncer , Femenino , Humanos , Persona de Mediana Edad , Noruega , Sistema de Registros , Factores de Tiempo
2.
Orthop Nurs ; 38(4): 262-269, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31343631

RESUMEN

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.


Asunto(s)
/normas , Paquetes de Atención al Paciente/normas , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/normas , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/normas , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Distribución de Chi-Cuadrado , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paquetes de Atención al Paciente/instrumentación , Paquetes de Atención al Paciente/métodos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Sudeste de Estados Unidos/epidemiología
4.
Pediatr Clin North Am ; 66(4): 751-773, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31230621

RESUMEN

Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.


Asunto(s)
Comunicación Interdisciplinaria , Pase de Guardia/normas , Pediatría/normas , Medicina Basada en la Evidencia , Humanos , Errores Médicos/prevención & control , Cultura Organizacional , Paquetes de Atención al Paciente/normas , Seguridad del Paciente/normas , Mejoramiento de la Calidad
5.
Crit Care Nurs Clin North Am ; 31(2): 177-193, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31047092

RESUMEN

The quality of maternal care in the United States is receiving increased attention due to rising rates of severe maternal morbidity and maternal mortality when compared with other developed countries. Many of these events are considered preventable. The lack of adoption of evidence-based maternal patient safety bundles and tool kits requires immediate attention. Maternal levels of care described by the American Congress of Obstetricians and Gynecologists requires increased focus so that women are in the appropriate facility to receive care. Perinatal care management, integrated behavioral health, and preconception care should be considered a preferred methodology to achieve optimal maternal outcomes.


Asunto(s)
Mortalidad Materna/tendencias , Atención Perinatal/normas , Mejoramiento de la Calidad/economía , Parto Obstétrico/economía , Femenino , Humanos , Hipertensión Inducida en el Embarazo/prevención & control , Recién Nacido , Paquetes de Atención al Paciente/economía , Paquetes de Atención al Paciente/normas , Seguridad del Paciente/normas , Atención Perinatal/métodos , Hemorragia Posparto/prevención & control , Embarazo , Atención Prenatal/métodos , Sepsis/prevención & control
6.
Intensive Crit Care Nurs ; 53: 68-72, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31036423

RESUMEN

OBJECTIVE: Determine the incidence and risk factors for pressure ulcers in a paediatric intensive care unit. Use the information gathered to develop preventive pressure ulcer care bundles. RESEARCH METHODOLOGY: Prospective cohort study using Braden Q Scale for Predicting Pressure Sore Risk and European Pressure Ulcer Advisory Panel Pressure Ulcer Staging tool. SETTING: General paediatric intensive care unit in a tertiary level hospital between May and October 2017. RESULTS: Seventy-seven children were recruited. Most children were male (n = 42, 54.5%) and all nine children (11.7%) that developed a pressure ulcer were male. The main risk factor for developing a pressure ulcer was lack of physical activity. None of the children assessed as high or severe risk developed a pressure ulcer. Eight (89%) pressure ulcers were assessed as grade one. Seven pressure ulcers (77.8%) were on the facial and scalp area and all seven children were receiving airway support at the time the pressure ulcers developed. CONCLUSION: Incidence of pressure ulcers was 11.7%, with the facial and scalp area the most common anatomical areas affected. Medical devices appeared to be the prime causative factor. Based on our data we have modified and launched the SSKIN care bundle for the paediatric intensive care unit setting.


Asunto(s)
Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Paquetes de Atención al Paciente/normas , Úlcera por Presión/diagnóstico , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Unidades de Cuidado Intensivo Pediátrico/normas , Irlanda/epidemiología , Masculino , Paquetes de Atención al Paciente/métodos , Paquetes de Atención al Paciente/estadística & datos numéricos , Úlcera por Presión/epidemiología , Úlcera por Presión/prevención & control , Estudios Prospectivos , Factores de Riesgo
7.
Implement Sci ; 14(1): 47, 2019 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-31060625

RESUMEN

BACKGROUND: Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. METHODS: A scoping review was carried out using the Arksey and O'Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. RESULTS: Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman's rho = - 0.47, non-parallel cohort and - 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies. CONCLUSION: Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity. TRIAL REGISTRATION: This review was registered on the PROSPERO database: CRD 42015029963 in December 2015.


Asunto(s)
Ciencia de la Implementación , Paquetes de Atención al Paciente/normas , Medicina Basada en la Evidencia , Humanos
8.
Rev Bras Enferm ; 72(1): 50-56, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30916267

RESUMEN

OBJECTIVE: To investigate the factors that influence the knowledge and behavior of professionals of neonatal and pediatric units about bundled strategies of insertion of central venous catheter. METHOD: This is a cross-sectional study, conducted in one neonatal and one pediatric intensive care units in a public hospital in Belo Horizonte, Brazil, from April to July, 2016. The sample consisted of 255 professionals who answered a structured instrument. Descriptive and comparative analyses were made using the SPSS software. RESULTS: The category nursing professional (p = 0.010), working hours of 12×36 scale (p < 0.001), training as a form of acquiring knowledge (p < 0.001) and participation in training programs (p < 0.001) are associated to greater knowledge about the bundle. Regarding behavior, no significant associations were observed. CONCLUSION: The study showed that there are factors that influence the knowledge about bundled strategies of insertion of central venous catheter, reflecting the need to consider these practices for making more effective educational practices in health care.


Asunto(s)
Cateterismo Venoso Central/métodos , Conocimientos, Actitudes y Práctica en Salud , Paquetes de Atención al Paciente/normas , Adulto , Anciano , Brasil , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/tendencias , Competencia Clínica/normas , Estudios Transversales , Femenino , Humanos , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Unidades de Cuidado Intensivo Pediátrico/tendencias , Masculino , Persona de Mediana Edad , Paquetes de Atención al Paciente/métodos , Encuestas y Cuestionarios
9.
Dimens Crit Care Nurs ; 38(2): 70-82, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30702476

RESUMEN

Increased mortality has been identified as the sepsis cascade progresses from sepsis to severe sepsis to septic shock. Estimates reflect sepsis death rates ranging from 10% to 20%, severe sepsis death rates of 20% to 50%, and septic shock fatality rates of 40% to 80%. The high rates of morbidity, mortality, and Medicare costs prompted the Centers for Medicare and Medicaid Services to implement bundled care and public reporting of the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) quality measure in 2015. Sepsis care bundles were identified to be beneficial since the 1990s as the bundle facilitates efficient, effective, and timely delivery of care to support quality improvement. The SEP-1 measure can be challenging and requires the nurse's active participation. Nurses need increased knowledge of the sepsis cascade and treatments as defined in the SEP-1 quality measure. Increased knowledge and application of bundle elements are lifesaving and can influence postdischarge outcomes. This article discusses the nurse's role in meeting the specific elements of each bundle and strategies to improve bundle compliance.


Asunto(s)
Manejo de la Enfermedad , Adhesión a Directriz , Rol de la Enfermera , Paquetes de Atención al Paciente/normas , Garantía de la Calidad de Atención de Salud , Choque Séptico/enfermería , Enfermería Basada en la Evidencia , Mortalidad Hospitalaria , Humanos , Choque Séptico/mortalidad , Estados Unidos
10.
Crit Care Nurse ; 39(1): 36-45, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30710035

RESUMEN

The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.


Asunto(s)
Cuidados Críticos/normas , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos/normas , Paquetes de Atención al Paciente/normas , Mejoramiento de la Calidad , Conducta Cooperativa , Práctica Clínica Basada en la Evidencia/normas , Humanos
11.
Crit Care Nurse ; 39(1): 46-60, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30710036

RESUMEN

Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.


Asunto(s)
Cuidados Críticos/normas , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos/normas , Paquetes de Atención al Paciente/normas , Mejoramiento de la Calidad , Conducta Cooperativa , Práctica Clínica Basada en la Evidencia/normas , Humanos
12.
Ann Vasc Surg ; 57: 174-176, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30684619

RESUMEN

The etiology of surgical site infection (SSI) is multifactorial, with efforts to combat it employing "bundled" initiatives. Preoperative antiseptic wash was classified by the Centers for Disease Control and Prevention as a Category IB strongly recommended and accepted practice. Its inclusion, in a best-practice bundle, may contribute to reduction in SSIs. We describe our quality improvement initiative to increase adherence to this critical bundle element.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Baños/normas , Clorhexidina/análogos & derivados , Higiene , Pacientes Internos , Cuidados Intraoperatorios/normas , Paquetes de Atención al Paciente/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Infección de la Herida Quirúrgica/prevención & control , Procedimientos Quirúrgicos Vasculares/normas , Antiinfecciosos Locales/efectos adversos , Baños/efectos adversos , Clorhexidina/efectos adversos , Clorhexidina/uso terapéutico , Humanos , Cuidados Intraoperatorios/efectos adversos , Cooperación del Paciente , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos
14.
J Arthroplasty ; 34(2): 206-210, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30448324

RESUMEN

BACKGROUND: Revision total joint arthroplasty (TJA) is associated with increased readmissions, complications, and expense compared to primary TJA. Bundled payment methods have been used to improve value of care in primary TJA, but little is known of their impact in revision TJA patients. The purpose of this study is to evaluate the impact of a care redesign for a bundled payment model for primary TJA on quality metrics for revision patients, despite absence of a targeted intervention for revisions. METHODS: We compared quality metrics for all revision TJA patients including readmission rate, use of post-acute care facility after discharge, length of stay, and cost, between the year leading up to the redesign and the 2 years following its implementation. Changes in the primary TJA group over the same time period were also assessed for comparison. RESULTS: Despite a volume increase of 37% over the study period, readmissions declined from 8.9% to 5.8%. Use of post-acute care facilities decreased from 42% to 24%. Length of stay went from 4.84 to 3.92 days. Cost of the hospital episode declined by 5%. CONCLUSION: Our health system experienced a halo effect from our bundled payment-influenced care redesign, with revision TJA patients experiencing notable improvements in several quality metrics, though not as pronounced as in the primary TJA population. These changes benefitted the patients, the health system, and the payers. We attribute these positive changes to an altered institutional mindset, resulting from an invested and aligned care team, with active physician oversight over the care episode.


Asunto(s)
Artroplastia de Reemplazo de Cadera/normas , Artroplastia de Reemplazo de Rodilla/normas , Vías Clínicas/normas , Paquetes de Atención al Paciente/normas , Reoperación/normas , Anciano , Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Vías Clínicas/economía , Vías Clínicas/estadística & datos numéricos , Episodio de Atención , Gastos en Salud , Hospitales , Humanos , Persona de Mediana Edad , Paquetes de Atención al Paciente/economía , Paquetes de Atención al Paciente/estadística & datos numéricos , Alta del Paciente , Reoperación/economía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos
15.
Int Emerg Nurs ; 43: 56-60, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30381143

RESUMEN

INTRODUCTION: Pain management in children is often poorly executed in Emergency Departments and Minor Injury Units. The aim of this study was to assess the impact of a care bundle comprising targeted education on pain score documentation and provision of appropriately dosed analgesia for the paediatric population attending Emergency Departments (EDs) and Minor Injury Units (MIUs). METHODS: A total of 29 centres - 5 EDs and 24 MIUs - participated in an intervention study initiated by Emergency Nurse Practitioners to improve paediatric pain management. In Phase 1, up to 50 consecutive records of children under 18 presenting at each MIU and ED were examined (n = 1201 records); Pain Score (PS), age, whether the child was weighed, and provision of analgesia was recorded. A care bundle consisting of an education programme, paediatric dosage chart and flyers, was then introduced across the 29 centres. Nine months following introduction of the care bundle, the same data set was collected from units (Phase 2, n = 1090 records). RESULTS: The likelihood of children having a pain score documented increased significantly in Phase 2 (OR 6.90, 95% CI 5.72-8.32), The likelihood of children receiving analgesia also increased (OR1.82, 95% CI 1.51-2.19), although there was no increase in the proportion of children with moderate or severe pain receiving analgesia. More children were weighed following the care bundle (OR 2.58 95% CI 1.86-3.57). Infants and children who were not weighed were more likely to receive an incorrect analgesia dose (p < 0.01). CONCLUSIONS: Rates of PS documentation improved and there was greater provision of analgesia overall following introduction of the care bundle. Although weighing of children did improve, the levels remain disappointingly low. EDs generally performed better than MIUs. The results show there were some improvements with this care bundle, but future work is needed to determine why pain management continues to fall below expected standards and how to further improve and sustain the impact of the care bundle.


Asunto(s)
Dolor/enfermería , Paquetes de Atención al Paciente/normas , Pediatría/normas , Adolescente , Niño , Preescolar , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Inglaterra , Femenino , Humanos , Lactante , Masculino , Manejo del Dolor/métodos , Manejo del Dolor/normas , Dimensión del Dolor/métodos , Paquetes de Atención al Paciente/métodos , Pediatría/métodos , Factores de Tiempo
17.
Eur J Emerg Med ; 26(2): 94-99, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28906260

RESUMEN

OBJECTIVE: We evaluated the effectiveness of the Subacute Ambulatory care for the Functionally challenged and Elderly (SAFE) programme, a post-emergency department (ED) discharge intervention for elderly and functionally challenged patients, in reducing acute hospital admissions. METHODS: This study was a 32-month retrospective quasi-experimental study comparing patients with at least one of six diagnostic classifications who underwent SAFE intervention with those who were eligible but declined and received usual ED care (control). The primary outcomes were rates of first acute hospital admission at 30 and 60 days post-ED discharge. Secondary outcomes were 20-day withdrawal rate and 60-day mortality. The difference in primary outcome between the two groups was compared using a Cox proportional hazards model. We reported adjusted hazard ratios (HRs) with their 95% confidence intervals (CIs) adjusting for predefined factors of age, sex, triage risk assessment tool scores and baseline ED utilization and acute hospital admission rates in the past year. RESULTS: There were 438 and 209 patients in the intervention and control groups, respectively. The intervention group had reduced risk of first acute hospital admission at 30 days (10 vs. 27%, HR=0.34, 95% CI: 0.22-0.52) and 60 days (18 vs. 33%, HR=0.48, 95% CI: 0.34-0.69) compared with the control. The 20-day withdrawal rate was 3.2%. Both groups did not differ in 60-day mortality rates. CONCLUSION: The SAFE programme was effective in reducing first acute hospital admissions in selected elderly and functionally challenged patients after ED discharge at 30 and 60 days compared with usual ED discharge care.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Paquetes de Atención al Paciente/normas , Grupo de Atención al Paciente/organización & administración , Alta del Paciente/normas , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Triaje/organización & administración
18.
J Am Heart Assoc ; 7(24): e009860, 2018 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-30561251

RESUMEN

Background Over 6000 children have an in-hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives. Methods and Results A prospective observational study of quality of chest compressions ( CC ) during pediatric in-hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality CC , 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association ( AHA ) Pediatric Advanced Life Support CC guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had CC data captured via defibrillator-based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123], P<0.001). There were 2135 1-minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061, P<0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES2). The adjusted marginal probability of a CC epoch meeting the criteria for excellent CPR (compliant for rate, depth, and chest compression fraction) in 2015, after CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3-53.3) versus 19.9%(6.9-32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3-8.1], P=0.01). Conclusions CODE ACES2 was associated with progressively increased compliance with AHA CPR guidelines during in-hospital cardiac arrest.


Asunto(s)
Reanimación Cardiopulmonar/normas , Paro Cardíaco/terapia , Paquetes de Atención al Paciente/normas , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Adhesión a Directriz/normas , Paro Cardíaco/diagnóstico , Paro Cardíaco/mortalidad , Paro Cardíaco/fisiopatología , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Pacientes Internos , Masculino , Guías de Práctica Clínica como Asunto/normas , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Recuperación de la Función , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Flujo de Trabajo , Adulto Joven
19.
J Trauma Nurs ; 25(6): 348-355, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30395033

RESUMEN

Delirium is a frequent complication of intensive care unit (ICU) admissions, manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long-term disability and mortality. The Society of Critical Care Medicine published guidelines for the management of pain, agitation, and delirium (PAD) in the ICU in 2013. Based on these PAD guidelines, the ABCDEF bundle was created. Research is lacking on how adherence to the ABCDEF bundle elements impacts specific populations such as trauma patients. This represents a significant gap for patients whose multisystem injuries and comorbidities add a higher level of complexity to their care and outcomes. The medical ICU at a large community hospital participated in a 2-year quality improvement project as part of the Society of Critical Care Medicine's ICU Liberation Collaborative. However the organization's trauma ICU (TICU) was excluded from the study. The purpose of this study was to conduct a baseline assessment of trauma patient records to determine which bundle elements were already being applied in the TICU, and if the resources required for implementing the full ABCDEF bundle would be beneficial to the TICU patient outcomes. Benchmark data from the organization's participation in the ICU Liberation Collaborative quality improvement project served as the primary source of evidence. Analysis revealed strengths and opportunities for improvement. Incidence of delirium remained unchanged and far below national averages, indicating the need for further investigation into practices to verify this finding. An opportunity was identified to expand implementation of certain elements of the ABCDEF bundle in the trauma ICU. There is an opportunity for nurses to take the lead in improving patient outcomes. With improved education, evidence-based assessment tools, and best practice guidelines, nurses can help decrease the incidence of delirium by as much as 30%.


Asunto(s)
Cuidados Críticos/organización & administración , Delirio/etiología , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Paquetes de Atención al Paciente/normas , Mejoramiento de la Calidad , Benchmarking , Delirio/fisiopatología , Femenino , Hospitales Comunitarios/organización & administración , Humanos , Masculino , Paquetes de Atención al Paciente/métodos , Guías de Práctica Clínica como Asunto , Análisis de Supervivencia , Centros Traumatológicos/organización & administración , Estados Unidos
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