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1.
Heart Lung ; 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31918974

RESUMO

Professional networks support health care providers in implementing evidence based knowledge. The German Network for Early Mobilization in Intensive Care Units (ICU) was founded in 2011 and serves for more than 300 critical care team members today. The mobilization network is connected to other professional networks and contributed to the development of national guidelines and quality indicators. Several research projects were conducted. Members of the mobilization network perceived benefits for themselves and their workplace. The network increased participants' knowledge and contributed to quality improvement projects on ICUs. Without having significant resources, this network development may serve as an example for other networks.

2.
Med Klin Intensivmed Notfmed ; 115(1): 59-66, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31712834

RESUMO

In Germany, there are currently many voices calling for a reform of hospital planning and reimbursement to correct some aberrations of the last decades and to enable the system to cope with future challenges. Some recent political decisions to change the structures of emergency medical services as well as the introduction of mandatory nurse-to-patient ratios and the exclusion of the cost for nursing from the case-based hospital reimbursement represent first steps of a reform, which also affects intensive care and emergency medicine. In this discussion paper a group of intensivists, emergency physicians, medical controllers, and representatives of nurses suggest more far-reaching changes, which can be summarized in 5 points: (1) General hospitals with intensive care units (ICU) and emergency departments (ED) which are part of the emergency medical system should be considered as an element of public service and be planned accordingly. (2) The planning of the intensive care infrastructure should be based on the three levels of emergency medical services to identify hospitals that are system relevant and to define appropriate criteria for structure and quality measures. (3) Hospital reimbursement should consist of a base amount (covering costs for hospital staff, infrastructure plus investments) and case-based fees (covering material costs). (4) To determine the requirements for nurses, physicians, and other medical staff, adequate tools for ICU and ED should be applied. (5) For these purposes as well as for quality management and optimal medical care, hospitals should be provided with a substantially improved IT-infrastructure.


Assuntos
Cuidados Críticos , Administração Financeira de Hospitais , Unidades de Terapia Intensiva , Custos e Análise de Custo , Serviço Hospitalar de Emergência , Alemanha , Humanos
3.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 669-683, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805586

RESUMO

Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with increased morbidity and mortality as well as neurocognitive disorder and associated loss of autonomy and increased need for care. As professionals, it is our duty to treat our patients in a holistic individual concept with the aim to reintegrate our patients into their home and social environment afterwards. In addition to preoperative and intraoperative interventions, postoperative prevention is of particular importance. This article focuses on non-pharmacological prevention strategies to avoid postoperative delirium and neurocognitive disorder in postoperative inpatient care. It is based on the "Evidence-based and consensus-based guideline on postoperative delirium". Thus, risk factors are addressed and non-pharmacological strategies are presented, which include reorientation, mobilization and nutritional support. Interprofessional cooperation plays just as important a role as the implementation of the listed preventive measures. Finally, the modified Hospital Elder Life Program is presented, which presents and applies preventive measures as a system-oriented and interdisciplinary concept, which "prevents functional decline and allows older adults to return home at the maximal level of independence". From our point of view, the training of a professional delirium team is a future-oriented complementary measure in the treatment concept of Perioperative Neurocognitive Disorders (PND), which finds its justification as an interface in the treatment of high-risk patients.


Assuntos
Delírio , Complicações Pós-Operatórias , Idoso , Delírio/prevenção & controle , Humanos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
4.
Clin Nutr ; 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31732289

RESUMO

OBJECTIVE: To evaluate a) the magnitude of the increase in caloric consumption due to early mobilisation of patients with mechanical ventilation (MV) in Intensive Care Units (ICU) as part of routine care, b) whether there are differences in caloric consumption due to active or passive mobilisation, and c) whether early mobilisation in routine care would lead to additional nutritional requirements. DESIGN: Prospective, observational, multi-centre study. SETTING: Medical, surgical and neurological ICUs from three centres. PATIENTS: Patients on MV in ICU who were mobilised out of bed as part of routine care. MEASUREMENTS AND MAIN RESULTS: Caloric consumption was assessed in 66 patients by indirect calorimetry at six time points: (1) lying in bed 5-10 min prior to mobilisation, (2) sitting on the edge of the bed, (3) standing beside the bed, (4) sitting in a chair, (5) lying in bed 5-10 min after mobilisation, and (6) 2 h after mobilisation. Differences in caloric consumption in every mobilisation level vs. the baseline of lying in bed were measured for 5 min and found to have increased significantly by: +0.4 (Standard Deviation (SD) 0.59) kcal while sitting on the edge of the bed, +1.5 (SD 1.26) kcal while standing in front of the bed, +0.7 (SD 0.63) kcal while sitting in a chair (all p < 0.001). Active vs. passive transfers showed a higher, but non-significant consumption. A typical sequence of mobilisation including sitting on edge of the bed, standing beside the bed, sitting in a chair (20 min) and transfer back into bed, would require an additional 4.56 kcal compared to caloric consumption without mobilisation. CONCLUSIONS: Based on this data, routine mobilisation of MV patients in ICU increases caloric consumption, especially in active mobilisation. Nevertheless, an additional caloric intake because of routine mobilisation does not seem to be necessary.

5.
Intensive Crit Care Nurs ; 48: 52-60, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29776706

RESUMO

Significant improvements in our understanding of pain, agitation, and delirium management within the Intensive Care Unit have been made in recent years. International guidelines and implementation bundles have become more evidence-based, patient-centred, and provide clear recommendations on the best-practice management of critically ill patients. However, the intensive care community has highlighted the need for higher-order evidence in several areas of pain, agitation and delirium research and studies suggest that a significant number of intensive care patients still receive outdated treatment as a consequence of inadequate guideline implementation. Where do the gaps exist in pain, agitation and delirium management, what are the barriers to guideline implementation and how can these problems be addressed to ensure patients receive optimised care? As an international professional consensus exercise, a panel of seven European intensive care nurses convened to discuss how to address these questions and establish how the provision of pain, agitation and delirium management can be improved in the intensive care unit.


Assuntos
Conferências de Consenso como Assunto , Enfermagem de Cuidados Críticos , Estado Terminal/enfermagem , Delírio/prevenção & controle , Unidades de Terapia Intensiva/normas , Dor/prevenção & controle , Delírio/enfermagem , Europa (Continente) , Fidelidade a Diretrizes , Humanos , Dor/enfermagem , Melhoria de Qualidade
6.
Nurs Crit Care ; 23(1): 23-29, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28523698

RESUMO

BACKGROUND: Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines. AIM: To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians. DESIGN: The study used an open online survey with multiple-choice responses. METHODS: An invitation for participation was spread via journals and electronic resources using a snowball system. Apart from recording socio-demographical characteristics, the survey collected data on delirium assessment, delirium-related processes, non-pharmacological prevention and treatment and barriers for implementation. Differences between nurses and physicians were tested by Fisher's exact test with sequential Bonferroni correction. RESULTS: The survey was conducted in autumn 2016, and 559 clinicians participated. More nurses than physicians reported screening for delirium. The majority of clinicians reported screening for delirium when this was suspected; more than 50% used validated instruments. Half of the clinicians had delirium-related structures implemented, such as two thirds reporting delirium-related processes. Most cited barriers were lack of time and missing knowledge about delirium and its assessment. With significant difference, physicians recommended more than nurses early removal of catheters and daily interprofessional goals for patients. CONCLUSION: In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians. RELEVANCE TO CLINICAL PRACTICE: Nurses and physicians in this survey reported similar perceptions and attitudes towards management of delirium. Both professions need more knowledge and inter-professional training on when and how to use validated assessment instruments.


Assuntos
Enfermagem de Cuidados Críticos/estatística & dados numéricos , Delírio/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/métodos , Médicos/estatística & dados numéricos , Delírio/terapia , Alemanha , Humanos , Unidades de Terapia Intensiva , Inquéritos e Questionários
8.
Ann Am Thorac Soc ; 13(5): 724-30, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27144796

RESUMO

Early mobilization of patients in the intensive care unit (ICU) is safe, feasible, and beneficial. However, implementation of early mobility as part of routine clinical care can be challenging. The objective of this review is to identify barriers to early mobilization and discuss strategies to overcome such barriers. Based on a literature search, we synthesize data from 40 studies reporting 28 unique barriers to early mobility, of which 14 (50%) were patient-related, 5 (18%) structural, 5 (18%) ICU cultural, and 4 (14%) process-related barriers. These barriers varied across ICUs and within disciplines, depending on the ICU patient population, setting, attitude, and ICU culture. To overcome the identified barriers, over 70 strategies were reported and are synthesized in this review, including: implementation of safety guidelines; use of mobility protocols; interprofessional training, education, and rounds; and involvement of physician champions. Systematic efforts to change ICU culture to prioritize early mobilization using an interprofessional approach and multiple targeted strategies are important components of successfully implementing early mobility in clinical practice.


Assuntos
Cuidados Críticos/métodos , Deambulação Precoce/métodos , Unidades de Terapia Intensiva/organização & administração , Humanos
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