[Nursing approaches to improve extracorporeal membrane oxygenation (ECMO) care in a pediatric intensive care unit].

BACKGROUND: Medical technology advances have led to the increasingly frequent use of extracorporeal membrane oxygenation (ECMO) in intensive care unit applications. Four of the 26 patients treated using ECMO in 2009 at our hospital were under 18 years of age. Limited nurse experience with ECMO and resultant nursing staff nervousness / pressure when using this technique encouraged us to establish an ad hoc group to explore ECMO care and related issues. PURPOSE: Improvement measures were implemented to (1) raise the pre- ECMO placement integrity of order sheets to 98%; (2) reduce materials preparation time to below 60 minutes; and (3) enhance nursing care ECMO cognitive accuracy to 99%. RESOLUTION: We implemented the following intervention measures: (1) A dedicated ECMO vehicle was deployed to enhance clinical work convenience and safety; (2) a ECMO technique preparation checklist was developed to improve tubing placement and reduce preparation time; (3) an ECMO care in-service education program was developed to enhance nurses' ECMO care awareness and skills; (4) an ECMO trainee system was established to increase nurses ECMO care experience and reduce negligence-related errors. RESULTS: Project results included: material preparation order sheet accuracy rose from 25% to 100%; average materials preparation time fell from 90 to 40 minutes, and nursing staff ECMO cognitive accuracy increased from 51.2% to 99.2%. The program achieved all stated objectives. CONCLUSIONS: This program enhanced the quality of ECMO care for pediatric patients, reduced materials preparation times, and improved the nursing approach to ECMO care.

[Reducing patient pressure sore incidence in the surgical intensive care unit].

BACKGROUND: Pressure ulcers were an increasingly significant problem among patients in the authors' ward. The eight patients diagnosed with pressure ulcers (0.42% of all inpatients) during the first half of 2009 represented a 140% increase over the first half of 2008 (0.28% of all inpatients). PURPOSE: This project was designed to reduce pressure ulcer incidence in the surgical intensive care unit (ICU) to 0.05%. METHODS: Intervention measures included: 1) holding professional training on preventing pressure ulcers; 2) specifying appropriate patient turnover tools; 3) creating and distributing to nurses a proper turnover technique and positioning manual; 4) creating and distributing to nurses a comprehensive patient skin inspection checklist; and 5) organizing a permanent pressure ulcer care quality and audit committee. RESULTS: Pressure ulcer incidence fell from 0.42% to 0.04% following implementation of the methods. CONCLUSION: Results demonstrate the effectiveness of using the proposed methods to reduce pressure ulcer incidence and enhance nursing care quality.