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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.
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
3.
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.

4.
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
6.
Ger Med Sci ; 15: Doc10, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28794694

RESUMO

Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilization which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the peer review in intensive care, a method endorsed by the DIVI. A validity period of three years is planned for the quality indicators.


Assuntos
Cuidados Críticos/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Analgesia/normas , Sedação Consciente/normas , Infecção Hospitalar/prevenção & controle , Deambulação Precoce/normas , Nutrição Enteral/normas , Previsões , Alemanha , Humanos , Hipotermia Induzida/normas , Indicadores de Qualidade em Assistência à Saúde/tendências , Respiração Artificial/normas , Desmame do Respirador/normas
7.
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
9.
Crit Care Med ; 42(5): 1178-86, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24351373

RESUMO

OBJECTIVES: There is growing evidence to support early mobilization of adult mechanically ventilated patients in ICUs. However, there is little knowledge regarding early mobilization in routine ICU practice. Hence, the interdisciplinary German ICU Network for Early Mobilization undertook a 1-day point-prevalence survey across Germany. DESIGN: One-day point-prevalence study. SETTING: One hundred sixteen ICUs in Germany in 2011. PATIENTS: All adult mechanically ventilated patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For a 24-hour period, data were abstracted on hospital and ICU characteristics, the level of patient mobilization and associated barriers, and complications occurring during mobilization. One hundred sixteen participating ICUs provided data for 783 patients. Overall, 185 patients (24%) were mobilized out of bed (i.e., sitting on the edge of the bed or higher level of mobilization). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 8%, 39%, and 53% were mobilized out of bed, respectively (p < 0.001 for difference between three groups). The most common perceived barriers to mobilizing patients out of bed were cardiovascular instability (17%) and deep sedation (15%). Mobilization out of bed versus remaining in bed was not associated with a higher frequency of complications, with no falls or extubations occurring in those mobilized out of bed. CONCLUSIONS: In this 1-day point-prevalence study conducted across Germany, only 24% of all mechanically ventilated patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of routine care. Addressing modifiable barriers for mobilization, such as deep sedation, will be important to increase mobilization in German ICUs.


Assuntos
Deambulação Precoce/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Respiração Artificial , Adulto , Estudos Transversais , Sedação Profunda , Feminino , Alemanha , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade
10.
Ger Med Sci ; 12: Doc17, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25587245

RESUMO

INTRODUCTION: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. METHODS: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs - representing over 300 patient beds - had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. RESULTS: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.


Assuntos
Unidades de Terapia Intensiva/normas , Revisão por Pares/métodos , Melhoria de Qualidade/organização & administração , Alemanha , Humanos , Unidades de Terapia Intensiva/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Programas Voluntários
11.
Ger Med Sci ; 11: Doc09, 2013.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-23904823

RESUMO

Quality indicators are key elements of quality management. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2010 were recently evaluated when their validity time expired after two years. Overall one indicator was replaced and further three were in part changed. The former indicator I "elevation of head of bed" was replaced by the indicator "Daily multi-professional ward rounds with the documentation of daily therapy goals" and added to the indicator IV "Weaning and other measures to prevent ventilator associated pneumonias (short: Weaning/VAP Bundle)" (VAP = ventilator-associated pneumonia) which aims at the reduction of VAP incidence. The indicator VIII "Documentation of structured relative-/next-of-kin communication" was refined. The indicator X "Direction of the ICU by a specially trained certified intensivist with no other clinical duties in a department" was also updated according to recent study results. These updated quality indicators are part of the Peer Review in intensive care medicine. The next update of the quality indicators is due in 2016.


Assuntos
Cuidados Críticos/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Gestão da Segurança/normas , Alemanha
12.
Nurs Crit Care ; 15(5): 241-50, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20712669

RESUMO

AIM: To explore German intensive care nurses' experiences and attitudes toward family witnessed resuscitation (FWR). BACKGROUND: The subject of FWR has fuelled much controversy among health professionals. Typically studies involving European critical and cardiac nurses' under-represent the perspective of individual countries. Arguably research exploring the experiences and attitudes of nurses by country may expand understanding and embrace cultural values. DESIGN: Descriptive survey. METHODS: Three hundred and ninety-four German intensive care nurses attending a conference were invited to complete a 36-item questionnaire on their experiences and attitudes towards FWR. Participants were also invited to share, in writing, other thoughts relevant to the study. Data was analysed using descriptive statistics. RESULTS: A total of 166 (42.1%) questionnaires were returned completed. Seventy participants had experiences with family members being present and for 46 (65.7%) these were negative. Participants (68%) did not agree that family members should have the option to be with loved ones during resuscitation. Over half (56.0%) were concerned that family presence may adversely influence staff performance during resuscitation procedures. There was a lack of certainty about the outcomes of the practice, although 61% agreed that family presence could facilitate better understanding among relatives. Qualitative responses where characterized by four broad themes relating to individualized decision-making, supporting families, threats of violence and family involvement. CONCLUSIONS: German intensive care nurses have guarded attitudes towards FWR because of their experiences and concerns for the well-being of relatives and staff. Introducing this topic within nursing curricula, as part of resuscitation training and by wider professional debate will help challenge and resolve practitioner concerns and objections. RELEVANCE TO CLINICAL PRACTICE: Health professionals have anxieties about possible consequences of FWR, strategies involving education and simulation training may improve attitudes.


Assuntos
Reanimação Cardiopulmonar/psicologia , Família/psicologia , Enfermeiras e Enfermeiros/psicologia , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Cuidados Críticos , Tomada de Decisões , Feminino , Alemanha , Humanos , Masculino , Inquéritos e Questionários , Visitas a Pacientes
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