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1.
Clin Nurse Spec ; 34(2): 50-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32068633

RESUMO

Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.


Assuntos
Alarmes Clínicos , Monitorização Fisiológica/enfermagem , Recursos Humanos de Enfermagem/educação , Gestão da Segurança/organização & administração , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem
2.
J Clin Nurs ; 29(13-14): 2053-2068, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32017272

RESUMO

AIMS AND OBJECTIVES: To synthesise evidence regarding the time nurses take to monitor and record vital signs observations and to calculate early warning scores. BACKGROUND: While the importance of vital signs' monitoring is increasingly highlighted as a fundamental means of maintaining patient safety and avoiding patient deterioration, the time and associated workload involved in vital signs activities for nurses are currently unknown. DESIGN: Systematic review. METHODS: A literature search was performed up to 17 December 2019 in CINAHL, Medline, EMBASE and the Cochrane Library using the following terms: vital signs; monitoring; surveillance; observation; recording; early warning scores; workload; time; and nursing. We included studies performed in secondary or tertiary ward settings, where vital signs activities were performed by nurses, and we excluded qualitative studies and any research conducted exclusively in paediatric or maternity settings. The study methods were compliant with the PRISMA checklist. RESULTS: Of 1,277 articles, we included 16 papers. Studies described taking vital signs observations as the time to measure/collect vital signs and time to record/document vital signs. As well as mean times being variable between studies, there was considerable variation in the time taken within some studies as standard deviations were high. Documenting vital signs observations electronically at the bedside was faster than documenting vital signs away from the bed. CONCLUSIONS: Variation in the method(s) of vital signs measurement, the timing of entry into the patient record, the method of recording and the calculation of early warning scores values across the literature make direct comparisons of their influence on total time taken difficult or impossible. RELEVANCE TO CLINICAL PRACTICE: There is a very limited body of research that might inform workload planning around vital signs observations. This uncertainty means the resource implications of any recommendation to change the frequency of observations associated with early warning scores are unknown.


Assuntos
Escore de Alerta Precoce , Monitorização Fisiológica/enfermagem , Sinais Vitais , Carga de Trabalho , Humanos , Padrões de Prática em Enfermagem , Fatores de Tempo
4.
J Nurs Care Qual ; 35(2): 115-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31513051

RESUMO

BACKGROUND: Nonactionable alarms comprise over 70% of alarms and contribute a threat to patient safety. Few studies have reported approaches to translate and sustain these interventions in clinical settings. PURPOSE: This study tested whether an interprofessional team-based approach can translate and implement effective alarm reduction interventions in the adult intensive care unit. METHODS: The study was a prospective, cohort, pre- and postdesign with repeated measures at baseline (preintervention) and post-phase I and II intervention periods. The settings for the most prevalent nonactionable arrhythmia and bedside parameter alarms were adjusted during phases I and II, respectively. RESULTS: The number of total alarms was reduced by 40% over a 14-day period after both intervention phases were implemented. The most prevalent nonactionable parameter alarms decreased by 47% and arrhythmia alarms decreased by 46%. CONCLUSIONS: It is feasible to translate and sustain system-level alarm management interventions addressing alarm fatigue using an interprofessional team-based approach.


Assuntos
Alarmes Clínicos , Unidades de Terapia Intensiva/organização & administração , Monitorização Fisiológica/enfermagem , Equipe de Assistência ao Paciente , Segurança do Paciente , Adulto , Alarmes Clínicos/efeitos adversos , Alarmes Clínicos/estatística & dados numéricos , Enfermagem de Cuidados Críticos , Feminino , Humanos , Monitorização Fisiológica/instrumentação , Estudos Prospectivos
5.
Br J Nurs ; 28(19): 1256-1259, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680572

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
6.
Br J Nurs ; 28(19): 1156-1159, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647734

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
7.
Issues Ment Health Nurs ; 40(10): 917-921, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490708

RESUMO

Safe prescribing for persons with severe mental illness requires laboratory monitoring for psychotropic drug levels and metabolic side effects. Barriers to appropriate and timely monitoring increase when clients must obtain phlebotomy services at a separate facility. This quality improvement project was conducted within a program for assertive community treatment (PACT). Specific aims were to increase access to laboratory testing, improve efficiency, and lower costs by implementing on-site specimen collection. Outcomes, measured three months post-implementation, indicate that over half of all labs were obtained on-site, clients and staff were pleased with increased efficiencies, and costs were reduced by 37%.


Assuntos
Biomarcadores , Serviços Comunitários de Saúde Mental/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/enfermagem , Monitorização Fisiológica/enfermagem , Melhoria de Qualidade/organização & administração , Idoso , Serviços Comunitários de Saúde Mental/economia , Comorbidade , Controle de Custos/economia , Controle de Custos/organização & administração , Eficiência , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Flebotomia/enfermagem , Melhoria de Qualidade/economia , Estados Unidos , Fluxo de Trabalho
8.
Rev Bras Enferm ; 72(3): 609-616, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269123

RESUMO

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


Assuntos
Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Idoso , Pressão Sanguínea/fisiologia , Alarmes Clínicos , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
9.
Crit Care Nurse ; 39(3): 20-32, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154328

RESUMO

BACKGROUND: Brain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized. OBJECTIVES: To standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed. METHODS: A quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented. RESULTS: Process metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities. CONCLUSIONS: Compliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.


Assuntos
Lesões Encefálicas/enfermagem , Enfermagem de Cuidados Críticos/métodos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Exame Neurológico/enfermagem , Avaliação em Enfermagem/normas , Melhoria de Qualidade , Lesões Encefálicas/diagnóstico , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Documentação/métodos , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica/enfermagem , Exame Neurológico/normas
10.
Rev. bras. enferm ; 72(3): 609-616, May.-Jun. 2019. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1013566

RESUMO

ABSTRACT Objective: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. Method: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. Results: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). Conclusion: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


RESUMEN Objetivo: Medir la magnitud del efecto de un protocolo de parametrización individualizada de alarmas hemodinámicas en pacientes con infarto agudo de miocardio. Método: Ensayo clínico pragmático, open label y single arm cuya intervención ocurrió por medio de un protocolo validado y testado en 32 pacientes, utilizándose monitores multiparamétricos. Las alarmas de frecuencia cardíaca, presión arterial, frecuencia respiratoria, saturación de oxígeno y segmento ST fueron valorados y clasificados según su consistencia clínica, una hora antes y después de la intervención, durante 64 horas. Resultados: El protocolo obtuvo un índice de Validez de Contenido de 0,92. De las 460 alarmas registradas, 261 fueron consideradas inconsistentes antes de la intervención y 47 después. El Riesgo Relativo de las alarmas incoherentes después del protocolo fue de 0,32 (IC 95% 0.23-0.43, p <0,0001). Conclusión: El protocolo se mostró un factor protector al surgimiento de alarmas clínicas inconsistentes de monitores multiparamétricos.


RESUMO Objetivo: Medir a magnitude do efeito de um protocolo de parametrização individualizada de alarmes hemodinâmicos em pacientes com infarto agudo do miocárdio. Método: Ensaio clínico pragmático, open label e single arm, cuja intervenção ocorreu por meio de um protocolo validado e testado em 32 pacientes usando monitores multiparamétricos. Os alarmes de frequência cardíaca, pressão arterial, frequência respiratória, saturação de oxigênio e segmento ST foram mensurados e classificados quanto à consistência clínica uma hora antes e após a intervenção, durante 64 horas. Resultados: O protocolo obteve Índice de Validade de Conteúdo de 0,92. Dos 460 alarmes registrados, 261 foram considerados inconsistentes antes da intervenção e 47 após. O Risco Relativo de alarmes inconsistentes após o protocolo foi de 0,32 (IC 95% 0.23-0.43, p<0,0001). Conclusão: O protocolo mostrou-se um fator protetor ao surgimento de alarmes clínicos inconsistentes de monitores multiparamétricos.


Assuntos
Humanos , Masculino , Feminino , Idoso , Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Pressão Sanguínea/fisiologia , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Alarmes Clínicos , Frequência Cardíaca/fisiologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
11.
Dimens Crit Care Nurs ; 38(3): 160-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946125

RESUMO

INTRODUCTION: The research literature is replete with evidence that alarm fatigue is a real phenomenon in the clinical practice environment and can lead to desensitization of the need to respond among nursing staff. A few studies attest to the effectiveness of incorporating parts of the American Association of Critical-Care Nurses recommended nursing practices for alarm management. No studies could be found measuring the effectiveness of the American Association of Critical-Care Nurses recommendations in their entirety or the effectiveness of a nursing-driven, evidence-based, patient-customized monitoring bundle. PURPOSE/RESEARCH QUESTION: The purpose of this study was to describe the effect of implementing CEASE, a nurse-driven, evidence-based, patient-customized monitoring bundle on alarm fatigue. CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (ongoing). RESEARCH QUESTIONS: (1) In a 36-bed intensive care unit/step-down unit (ICU/SDU) with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by the number of hemodynamic and respiratory monitoring alarms? (2) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by duration of alarms? and (3) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by nurse perception? METHODS: This was an institutional review board approved exploratory, nonrandomized, pretest and posttest, 1-group, quasi-experimental study, without-comparators design describing difference in pretest and posttest measures following CEASE Bundle implementation. The study was conducted over a 6-month period. Convenience sample of 74 registered nurses staffing a 36-bed ICU/SDU using the CEASE Bundle participated. Preimplementation/postimplementation number of alarms and alarm duration time for a 30-day period were downloaded from the monitoring system and compared. Nurses completed an electronic 36-item Clinical Alarms Survey provided by the Healthcare Technology Foundation: 35 before implementation and 18 after implementation. Researchers measured CEASE alarm bundle adherence. χ and t-tests determined statistical significance. RESULTS: Total number of monitoring alarms decreased 31% from 52 880 to 36 780 after CEASE Bundle implementation. Low-priority Level 1 alarms duration time significantly decreased 23 seconds (t = 1.994, P = .045). Level 2 duration time did not change. High-priority Level 3 alarms duration time significantly increased to 246 seconds (t = 4.432, P < .0001). CEASE alarm bundle adherence significantly improved to 22.4% (χ = 5.068, P = .0244). Nurses perceived a significant decrease in nuisance alarm occurrence (68% to 44%) postimplementation (χ = 3.243, P = .0417). No adverse patient events occurred. CONCLUSIONS: Decreased total number of monitoring alarms improved nurse perception of alarm fatigue. Continued monitoring of CEASE Bundle adherence by nursing staff is required. Longer high-priority Level 3 alarms duration suggests need for further research.


Assuntos
Alarmes Clínicos , Enfermagem de Cuidados Críticos/métodos , Unidades de Terapia Intensiva/organização & administração , Monitorização Fisiológica/enfermagem , Enfermagem Baseada em Evidências , Humanos , Segurança do Paciente
12.
J Adv Nurs ; 75(9): 1996-2005, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31012124

RESUMO

AIMS: To investigate the impact of the national early warning score on the frequency and the quality of vital sign registration and to study the association between protocol compliance and patient mortality. DESIGN: We conducted a post hoc data analysis of a stepped wedge cluster randomized controlled trial (RCT) in six hospitals. METHODS: All adult, non-pregnant patients admitted to 24 wards were included. The intervention comprised an observation protocol using the national early warning score combined with a pragmatic medical response strategy. Data collection lasted from October 2013-May 2015. Patient comorbidity scores and vital signs were sampled every 4 months on each ward. All vital signs in the 24 hr before a serious adverse event were collected. RESULTS: Patients (N = 60,956) were included of which 32,722 in the intervention group. Comorbidity scores were sampled in 3,600 patients and vital signs in 2,951 patients. In 668 patients, vital signs were collected before a serious adverse event. The mean number of vital signs per observation increased significantly in the intervention group. The observation frequency increased in patients with a serious adverse event and decreased in patients without a serious adverse event. Protocol compliance was negatively associated with patient mortality adjusted for comorbidity and age. CONCLUSION: Our intervention improved patient monitoring practice and reduced mortality. IMPACT: The impact of early warning scores on patient monitoring practice and patient outcomes remains unclear. Our intervention improved the observation of patients and reduced patient mortality. These results could support hospitals in their decision to implement rapid response systems. TRIAL REGISTRATION: We have registered this study in the clinicaltrials.gov database (identifier: NCT01949025).


Assuntos
Escore de Alerta Precoce , Fidelidade a Diretrizes , Mortalidade Hospitalar , Monitorização Fisiológica/enfermagem , Monitorização Fisiológica/normas , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Sinais Vitais/fisiologia
13.
Nurs Forum ; 54(3): 369-375, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30838672

RESUMO

BACKGROUND: Clinical alarms represent the top hazard listed in the "Top Ten Health Technology Hazards" report. Frequent false alarms can disrupt patient care and reduce trust in alarms. AIM: The aim of the present study was to investigate the perceptions and practices of critical and noncritical care nurses regarding clinical alarms. METHODOLOGY: This was a descriptive analytical study conducted from October 2016 to February 2017 at three hospitals on 197 nurses at Neyshabur University of Medical Sciences in Neyshabur, Northeastern Iran. Participants were selected through stratified random sampling. The perceptions were measured through the 2011 Health care Technology Foundation Clinical Alarms Survey. RESULTS: More than half of the nurses believed that frequent false alarms reduced trust in alarms, leading nurses to inappropriately disable alarms. The nurses ranked frequent false alarms as the most important issue in response to alarms. More than 60% of the nurses indicated that they needed more training on the use of bedside and central monitors. CONCLUSION: The result of this study suggested that frequent false alarms, as the most important issue related to alarms, should be taken into account by hospital administrators and researchers to decrease alarm fatigue and improve alarm system safety. More specialized clinical policies and procedures for alarm management should also be considered.


Assuntos
Alarmes Clínicos/normas , Enfermeiras e Enfermeiros/psicologia , Processo de Enfermagem/tendências , Percepção , Adulto , Atitude do Pessoal de Saúde , Alarmes Clínicos/efeitos adversos , Alarmes Clínicos/tendências , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/enfermagem , Monitorização Fisiológica/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Inquéritos e Questionários
14.
Sociol Health Illn ; 41(6): 1104-1119, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30874324

RESUMO

This paper analyses the 'failure' of a patient safety intervention. Our study was part of a randomised controlled trial (RCT) of bed and bedside chair pressure sensors linked to radio pagers to prevent bedside falls in older people admitted to hospital. We use agential realism within science and technology studies to examine the fall and its prevention as a situated phenomenon of knowledge that is made and unmade through intra-actions between environment, culture, humans and technologies. We show that neither the intervention (the pressure sensor system), nor the outcome (fall prevention) could be disentangled from the broader sociomaterial context of the ward, the patients, the nurses and (especially) their work through the RCT. We argue that the RCT design, by virtue of its unacknowledged assumptions, played a part in creating the negative findings. The study also raises wider questions about the kind of subjectivities, agencies and power relations these entanglements might effect and (re)produce in the hospital ward.


Assuntos
Acidentes por Quedas/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/enfermagem , Segurança do Paciente , Idoso , Idoso de 80 Anos ou mais , Hospitais , Humanos , Avaliação de Resultados em Cuidados de Saúde
15.
Hu Li Za Zhi ; 66(2): 85-92, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-30924518

RESUMO

BACKGROUND & PROBLEMS: According to the Emergency Care Research Institute, "not responding to alarms" is a top-ten health-technology hazard that ranked first between 2008 and 2014. The failure of clinical nurses to respond to alarms in time due to lack of awareness, fatigue, or other cause represents a great threat to patient safety. Between August 2014 and August 2015, two patients in this unit died because the red alert on the physiological alarm surveillance system was not answered and dealt with promptly. PURPOSE: To raise the 10-second response rate to red alerts from 22% to 100% in order to enhance inpatient safety. METHODS: Establish standard operating procedures for alarms and for the handling of physiologic monitor devices when alarms sound; form a gatekeeper system; and arrange on-the-job training. RESULTS: The 10-second response rate to red alerts increased from 22% to 100% between November 2016 and November 2017. CONCLUSIONS: By following standard operating procedures, personnel now have a guide to respond to and handle red alerts comprehensively. Implementing the gatekeeper system also increased the team spirit of the unit and helped personnel appreciate the importance of cooperation in handling alarms. In addition, the functions of the physiologic monitor devices and the 10-second response rate for red alerts will be included in the annual quality control checklist of the unit for follow up, review, and further improvement.


Assuntos
Alarmes Clínicos , Monitorização Fisiológica/enfermagem , Recursos Humanos de Enfermagem no Hospital/psicologia , Humanos , Capacitação em Serviço , Unidades de Terapia Intensiva , Medicina Interna , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Segurança do Paciente , Fatores de Tempo
16.
J Matern Fetal Neonatal Med ; 32(16): 2653-2656, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29463144

RESUMO

OBJECTIVE: The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g. DESIGN: This was a controlled prospective study. SETTING: This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India. METHODS: Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery. RESULTS: A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%. CONCLUSION: The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications.


Assuntos
Hipotermia/diagnóstico , Temperatura Cutânea , Feminino , Idade Gestacional , Humanos , Índia , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/enfermagem , Valor Preditivo dos Testes , Estudos Prospectivos
17.
Br J Nurs ; 27(21): 1237-1239, 2018 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-30457372

RESUMO

Jaden Allan, Senior Lecturer in Adult Nursing, Northumbria University ( jaden.allan@northumbria.ac.uk ) and Karen Sheppard, Sister, Critical Care, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, provide a how-to guide on taking a pulse in adult patients.


Assuntos
Monitorização Fisiológica/enfermagem , Pulso Arterial , Adulto , Humanos , Monitorização Fisiológica/métodos , Processo de Enfermagem
18.
Diabet Med ; 35(8): 1027-1036, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30152589

RESUMO

This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area.


Assuntos
Glicemia/metabolismo , Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Nutrição Enteral/normas , Hospitalização , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Complicações do Diabetes/sangue , Complicações do Diabetes/enfermagem , Diabetes Mellitus/sangue , Diabetes Mellitus/enfermagem , Nutrição Enteral/métodos , Nutrição Enteral/enfermagem , Humanos , Pacientes Internados , Monitorização Fisiológica/enfermagem , Monitorização Fisiológica/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Reino Unido
19.
Epilepsy Behav ; 86: 15-18, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30036764

RESUMO

Expert consensus statements recommend continuous observation for patients undergoing intracranial electroencephalography (EEG), but this practice is neither universal nor specific regarding the type of observation. We compared outcomes for patients who underwent intracranial stereotactic EEG (SEEG) before and after the adoption of continuous monitoring by a staff bedside sitter. We retrospectively studied 26 consecutive adult patients who underwent SEEG placement at our center over a three-year period. Thirteen patients were monitored with usual protocol (no-sitter group), and 13 patients had a full-time hospital-employed sitter at bedside (sitter group). We analyzed nursing responses for all electroclinical seizures and characterized seizure-related adverse events. More seizures went unrecognized without a sitter (33.3% versus 15.0% of all seizures; p = 0.03). Two unrecognized focal to bilateral tonic-clonic seizures occurred only in the no-sitter group. Nursing response was significantly faster in the sitter group in relation to both electrographic seizure onset (12.0 s, p = 0.04) and clinical seizure onset (13.5 s, p = 0.02). Two patients in the no-sitter group pulled their electrodes out periictally while none did so in the sitter group. The addition of a full-time staff bedside sitter improved nursing response times and lowered the rate of unrecognized seizures in patients with SEEG monitoring. Sitters also helped to eliminate inadvertent major electrode displacement.


Assuntos
Eletrocorticografia/enfermagem , Epilepsia/diagnóstico , Monitorização Fisiológica/enfermagem , Convulsões/diagnóstico , Técnicas Estereotáxicas , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Adulto Jovem
20.
Rev Gaucha Enferm ; 39(1): e2017-2, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29846477

RESUMO

OBJECTIVE To evaluate the nursing care regarding the intramuscular medication administration procedure in pediatrics. METHODS It was an observational and quantitative study performed in a pediatric hospital located in the city of Fortaleza, in Ceará, Brazil. The data collection was carried out through the observation of 327 intramuscular medication administration procedures. An observational checklist composed by 25 steps was used to collect data. The performance of the 25 steps of the checklist was divided as follows: (1) five steps were applied before the procedure of intramuscular medication administration; (2) fourteen steps during the procedure; (3) six steps after the procedure. RESULTS It was found that none of the five steps carried out before the intramuscular medication administration procedure were satisfactory performed. Regarding the fourteen steps applied during the procedure, six of them were satisfactory performed (42.8%). With regards to the six steps applied after the procedure, three of them were satisfactory performed (50%). CONCLUSIONS Fragilities that negatively impact the intramuscular medication administration procedures in pediatric patients were identified in this study.


Assuntos
Lista de Checagem , Injeções Intramusculares/enfermagem , Segurança do Paciente , Pré-Escolar , Família , Feminino , Hospitais Pediátricos , Humanos , Lactente , Injeções Intramusculares/métodos , Masculino , Monitorização Fisiológica/enfermagem , Relações Enfermeiro-Paciente , Equipe de Enfermagem , Pesquisa Qualitativa
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