Optimization of pre-emptive isolations in a polyvalent ICU through implementation of an intervention strategy.

BACKGROUND: Pre-emptive isolation refers to the application of contact precaution measures in patients with strongly suspected colonization by multiresistant bacteria. OBJECTIVE: To assess the impact of an intervention program involving the implementation of a consensus-based protocol of pre-emptive isolation (CPPI) on admission to a polyvalent ICU of a general hospital. METHODS: A comparative analysis of 2 patient cohorts was made: a historical cohort including patients in which pre-emptive isolation was established according to physician criterion prior to starting CPPI (from January 2010 to February 2011), and a prospective cohort including patients in which CPPI was implemented (from March to November 2011). CPPI included the identification and diffusion of pre-emptive isolation criteria, the definition of sampling methodology, the evaluation of results, and the development of criteria for discontinuation of pre-emptive isolation. Pre-emptive isolation was indicated by the medical staff, and follow-up was conducted by the nursing staff. Pre-emptive isolation was defined as "adequate" when at least one multiresistant bacteria was identified in any of the samples. Comparison of data between the 2 periods was made with the chi-square test for categorical variables and the Student t-test for quantitative variables. Statistical significance was set at P<.05. RESULTS: Among the 1,740 patients admitted to the ICU (1,055 during the first period and 685 during the second period), pre-emptive isolation was indicated in 199 (11.4%); 111 (10.5%) of these subjects corresponded to the historical cohort (control group) and 88 (12.8%) to the posterior phase after the implementation of CPPI (intervention group). No differences were found in age, APACHE II score or patient characteristics between the 2 periods. The implementation of CPPI was related to decreases in non-indicated pre-emptive isolations (29.7 vs. 6.8%, P<.001), time of requesting surveillance cultures (1.56 vs. 0.37 days, P<.001), and days of duration of treatment (4.77 vs. 3.58 days, P<.001). In 44 patients (22.1%) in which pre-emptive isolation was indicated, more than one multiresistant bacteria was identified, with an "adequate pre-emptive isolation rate" of 19.8% in the first period and 25.0% in the second period (P<.382). CONCLUSIONS: The implementation of CPPI resulted in a significant decrease in pre-emptive isolations which were not indicated correctly, a decrease in the time elapsed between isolation and collection of samples, and a decrease in the duration of isolation measures in cases in which isolation was unnecessary, without increasing the rate of "adequate pre-emptive isolation".

[Joint clinical rounds in the ICU and satisfaction of the professionals]. / Sesiones clínicas conjuntas en UCI y satisfacción de los profesionales.

It is unknown if multidisciplinary clinical rounds provide a greater degree of satisfaction among the professionals than the traditional work methods.The objective was to compare the satisfaction of the physicians and nurses who evaluate the patients jointly with those of the professionals who do so separately and transmit the information «at bedside¼ (traditional method). An anonymous survey that examined eleven dimensions of expectations, motivation and satisfaction on the common work method was used. Greater global satisfaction was observed in regards to the joint work method both with the substitute nurses (8.3 ± 0.8 versus 3.1 ± 2.8; p < 0.001) as well as those of the staff (7.2 ± 1.3 versus 2.1 ± 1.3; p = 0.01). In the remaining dimensions examined, the scores of the professionals who participated in the joint clinical rounds were also significantly better. Among the physicians, there were no significant differences in the different dimensions or in the global satisfaction.As a conclusion, it can be stated that the joint and consensual work method for the assessment of the patients produces an improvement in all the dimensions of satisfaction, expectations, and professional performance in the nursing area that is not detected among the physicians.

Sesiones clínicas conjuntas en UCI y satisfacción de los profesionales / Joint clinical rounds in the ICU and satisfaction of the professionals

Se desconoce si las sesiones clínicas multidisciplinarias (clinical rounds) comportan mayor grado de satisfacción, entre los profesionales que los métodos tradicionales de trabajo. El objetivo fue comparar la satisfacción de médicos y enfermeras que valoran los pacientes conjuntamente con la de aquellos profesionales que lo realizan por separado y transmiten la información «a pie de cama» (método tradicional). Se empleó una encuesta anónima donde se exploraron once dimensiones de expectativas, motivación y satisfacción sobre el método de trabajo habitual. Se observó una mayor satisfacción global respecto al método de trabajo conjunto tanto en las enfermeras suplentes (8,3 ± 0,8 versus 3,1 ± 2,8; p < 0,001) como en las de plantilla (7,2 ± 1,3 versus 2,1 ± 1,3; p = 0,01). En el resto de dimensiones exploradas también fueron significativamente mejores las puntuaciones de las profesionales que participaban en sesiones conjuntas. Entre los médicos no existieron diferencias significativas en las diferentes dimensiones ni en la satisfacción global. Como conclusión puede afirmarse que el método de trabajo conjunto y consensuado para la valoración de los enfermos produce, en enfermería, una mejora en todas las dimensiones de satisfacción, expectativas y desempeño profesional que no se detecta entre los médicos (AU)

It is unknown if multidisciplinary clinical rounds provide a greater degree of satisfaction among the professionals than the traditional work methods. The objective was to compare the satisfaction of the physicians and nurses who evaluate the patients jointly with those of the professionals who do so separately and transmit the information «at bedside» (traditional method). An anonymous survey that examined eleven dimensions of expectations, motivation and satisfaction on the common work method was used. Greater global satisfaction was observed in regards to the joint work method both with the substitute nurses (8.3± 0.8 versus 3.1 ± 2.8; p < 0.001) as well as those of the staff (7.2 ± 1.3 versus 2.1 ± 1.3; p = 0.01). In the remaining dimensions examined, the scores of the professionals who participated in the joint clinical rounds were also significantly better. Among the physicians, there were no significant differences in the different dimensions or in the global satisfaction. As a conclusion, it can be stated that the joint and consensual work method for the assessment of the patients produces an improvement in all the dimensions of satisfaction, expectations, and professional performance in the nursing area that is not detected among the physicians (AU)

El circuito de estupefacientes en el servicio de medicina intensiva. ¿Es suficientemente riguroso su control? / Narcotics monitoring in the intensive care unit

Objetivo. Se propone una reevaluación y la posible introducción de controles adicionales en el actual circuito de estupefacientes. Métodos. Estudio descriptivo transversal, sin intención de tratar, basado en la obtención y cuantificación por espectrofotometría de la concentración de muestras de morfina, extraídas de pacientes ingresados en un servicio de medicina intensiva (SMI). Se propone como un control de calidad adicional y eficiente. Se realizó un muestreo no probabilístico según criterios de inclusión (estar registrados en el SMI, recibir morfina como parte de su tratamiento), obteniendo muestras de morfina. Resultados. La media de las concentraciones de las muestras de morfina fue de 1 mg/ml y la media de las obtenidas de los pacientes (n = 26) fue de 0,9700 (IC del 95 por ciento, 0,81-1,16; CV, 7,91 por ciento).La media de la muestra de la dilución teórica fue de 0,8586 (IC del 95 por ciento, 0,93-0,73; CV, 8,00 por ciento).Posteriormente se realizó un sondeo de opinión entre los profesionales sanitarios y más de un 60 por ciento estaba de acuerdo con la ampliación del circuito con los "controles sorpresa". Conclusiones. Consideramos que la monitorización de mórficos mediante controles sorpresa es una media eficiente que mejora la calidad del sistema y responde a una demanda social. (AU)