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Found 105 results
  1. Content Article
    Healthcare associated infections (HAI), such as ventilator-associated pneumonia (VAP), are the most common and most preventable complication of a patient’s hospital stay. Their frequency and potential adverse effects increase in critically ill patients because of impaired physiology, including a blunted immune response and multi-organ dysfunction. Traditionally, VAP rates have been measured as an indicator of quality of care. Despite recent initiatives to measure complications of mechanical ventilation and a decrease in incidence over the past few years, VAP remains an issue for critically ill adults, with mortality estimated as high as 10%. This article from Boltey et al. reviews the top five evidence-based nursing practices for reducing VAP risk in critically ill adults.
  2. Content Article
    Ventilator-associated pneumonia is an important healthcare-associated infection. Interventions for the prevention of ventilator-associated pneumonia are often used within bundles of care. Recent evidence has challenged widespread practices mandating a review of subject. This article outlines guidance for ventilator-associated pneumonia prevention.
  3. Content Article
    Hospitals across the US are grappling with nurse shortages as the pandemic continues to change the healthcare system as we know it. Two intensive care unit nurses who left their jobs shared their experiences in Becker's Hospital Review.
  4. Content Article
    The primary objective of this study, published in Intensive Care Medicine, was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Authors conclude: "The ICU-BSI risk was higher for COVID-19 than non-COVID-19 critically ill patients after seven days of ICU stay. Clinicians should be particularly careful on late ICU-BSIs in COVID-19 patients. Tocilizumab or anakinra may increase the ICU-BSI risk."
  5. Content Article
    A toolkit for healthcare staff has been published by the National Tracheostomy Safety Project (NTSP) in collaboration with the AHSN Network and the National Patient Safety Improvement Programmes in response to the COVID-19 pandemic, to support healthcare staff who are looking after patients with tracheostomies. The number of patients requiring relatively prolonged ventilatory support in intensive care units due to COVID-19 has led to increased numbers of patients requiring tracheostomies, which are used to help wean some patients from respiratory support. The toolkit provides information, practical resources and links to useful online training videos and websites. Primarily the toolkit is for hospital staff. However, much of the material is also applicable to primary and community care settings.
  6. Content Article
    This study, published in Occupational Medicine, aimed to identify the rates of probable mental health disorder in staff working in intensive care units in nine English hospitals during June and July 2020. Results showed: Almost half of intensive care unit staff who participated in this study report symptoms consistent with a probable diagnosis of post-traumatic stress disorder, severe depression or anxiety or problem drinking. Around one in seven intensive care unit staff in this study report recent thoughts of self-harm or of wanting to be better off dead. Nursing staff in this study were more likely to report higher levels of distress than doctors or other clinical staff.
  7. Content Article
    This study in Patient Education and Counseling aimed to systematically review parental perceptions of shared decision-making (SDM) in neonatology, and identify barriers and facilitators to implementing SDM. The study identified the following key barriers to SDM: Emotional crises experienced in the NICU setting Lack of medical information provided to parents to inform decision-making Inadequate communication of information Poor relationships with caregivers Lack of continuity in care Perceived power imbalances between HCPs and parents. It also identified the following key facilitators for SDM: Clear, honest and compassionate communication of medical information Caring and empathetic caregivers Continuity in care Tailored approaches that reflected parent’s desired level of involvement.
  8. Content Article
    The extent to which postintensive care unit (ICU) clinics may improve patient safety for those discharged after receiving intensive care remains unclear. This observational cohort study from Karlick et al., conducted at an academic, tertiary care medical centre, used qualitative survey data analysed via conventional content analysis to describe patient safety threats encountered in the post-ICU clinic. For 83 included patients, safety threats were identified for 60 patients resulting in 96 separate safety threats. These were categorised into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviours (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). Of the 96 safety threats, 41% were preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable. Nearly 3 out of 4 patients within a post-ICU clinic had an identifiable safety threat. Medication errors and delayed medical follow-up were the most common safety threats identified; most were either preventable or ameliorable.
  9. News Article
    Health Education England (HEE) has announced that its new £10 million training programme, intended to ‘boost’ the critical care workforce, will be rolled out this autumn. According to HEE, the funds it secured earlier this year will provide nurses and Allied Health Professionals with a ‘nationally recognised pathway’ to further their careers in Adult Intensive Care Units (ICUs). Specialist training, delivered through a ‘blended learning package’ could help to strengthen the ICU workforce across England and will offer around 10,500 nursing staff the chance to undertake courses and ‘further their careers’. There will be a focus on flexible training – enabling participants to balance family and caring commitments, as well as taking into account those who are unable to travel, when the roll-out of the programme begins. The learning will be delivered by higher education institutions, Critical Care Skills Networks and acute trusts, and it is expected to take participants up to 12 months to receive the standardised qualification. It’s hoped that the programme could lead staff to career opportunities such as becoming a shift leader or clinical educator, or to lead on research. Read full article here Original source: Leading Healthcare News
  10. News Article
    "There can be no debate: this is now much, much worse than the first wave", says a NHS consultant. "Truly, I never imagined it would be this bad. Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant. The patients are younger this time around too, and there are so many of them. They are sick. We are full." Read full story Source: The Guardian, 7 January 2020
  11. News Article
    For the first since April the UK has recorded more than 1,000 daily Covid-related deaths – one of the highest figures of the pandemic. Right now, London is at the epicentre of this crisis. Hospitals now have more Covid patients being admitted every day than they did at the peak in April. Many doctors and nurses say they're reaching breaking point. The BBC's medical editor Fergus Walsh filmed inside the intensive care unit at London's University College Hospital, which is one of the busiest in the capital. View video Source: BBC News, 6 January 2021
  12. News Article
    London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
  13. News Article
    London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned. The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity. More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice. On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen. Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%. Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running. A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.” Read full story Source: The Independent, 17 December 2020
  14. News Article
    Across Britain, intensive care nurses and doctors are being pushed to their limits as they try to save lives from coronavirus. During 12-hour shifts in sweltering conditions, they are faced with technical and emotional challenges that many have never faced as they tackle a virus that has swept across the globe in a matter of days, threatening to kill tens of thousands in the UK. Britain has yet to even hit the peak of infections, but intensive care specialists are already asking how long they can keep working relentlessly. “We are trained for and used to dealing with difficult and emotional scenarios, but this is like a major incident that never ends,” says critical care nurse Karin Gerber. As an advanced nurse practitioner in critical care outreach, the 47-year-old sees patients in hospital who are getting sicker and may need to be admitted to intensive care. She says she has never seen anything “at this intensity”. The Royal London Hospital is at the forefront of the capital’s fight against the virus and has created more than 200 extra beds at its Whitechapel site in east London. They are filled with COVID-19 patients. Simon Richards, senior charge nurse at the Royal London’s critical care unit, tells The Independent: “In 20 years as a nurse this situation is by far the worst I have ever seen and totally unexpected, but the team spirit that people have shown has been amazing. “It’s extremely difficult, we are working so hard. The whole team is being pushed to their limit and you do wonder how long can this be sustained for? I wish we could see light at the end of the tunnel.” Read full story Source: The Independent, 24 November 2020
  15. News Article
    A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say. Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care. The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year. “We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.” Read full story Source: The Guardian, 20 November 2020
  16. News Article
    Nurses will be allowed to look after two critically ill COVID-19 patients at the same time after NHS bosses relaxed the rule requiring one-to-one treatment in intensive care as hospitals come under intense strain. NHS England has decided to temporarily suspend the 1:1 rule as the number of people who are in hospital very sick with Covid has soared to 11,514, of whom 986 are on a ventilator. The move comes amid concern that intensive care units, which went into the pandemic already short of nurses, are being hit by staff being off sick or isolating as a result of Covid. It follows a warning last week by Prof Chris Whitty, England’s chief medical officer, that the Covid resurgence could overwhelm the NHS. Dr Alison Pittard, the dean of the Faculty of Intensive Care, which represents doctors in ICUs, welcomed the shift to a more “flexible” nurse/patient staffing ratio in critical care. But she said it must be used only for as long as the second wave is putting units under serious pressure. “Covid has placed the NHS, and critical care in particular, in an unenviable position and we must admit everyone for whom the benefits of critical care outweigh the burdens. This means relaxing the normal staffing ratios to meet this demand in such a way that delivers safe care, but also takes account of the impact this may have on staff health and wellbeing." “The 1:2 ratio is a maximum ratio, to be used only to support Covid activity, [and] not for planned care, and is not sustainable in the long term. This protects staff and patients”, she said. Read full story Source: The Guardian, 8 November 2020
  17. News Article
    Several hospitals in the north of England are already at full capacity and may have to start moving patients to other regions, doctors have warned. Consultants fear that if Covid infection rates do not begin to fall significantly the NHS will be overwhelmed in less than a month from now. Members of the British Medical Association have reported that Intensive Care Units (ICU) in a number of regions, including Manchester, Liverpool and Hull, are close to capacity as the number of people hospitalised with COVID-19 continues to grow. Dr Vishal Sharma, chairman of the BMA’s consultants committee, told The Telegraph: “Capacity in the north of England is at the limits and in some places above the limit. Our next concern is ICU capacity, which is always tight at this time of year, even without Covid.” Dr Sharma said some general ward beds could be adapted to provide intensive breathing support for Covid patients, and the re-opening of Manchester’s Nightingale Hospital may also take the pressure off ICU departments. But more radical steps may have to be taken if numbers of hospitalised patients continue to rise. “We may have to move patients around the country to create extra capacity, but if the whole country starts to struggle things will get very difficult." Read full story Source: The Telegraph,
  18. News Article
    As hospitalisations and intensive care admissions surge around the country, new figures indicate coronavirus patients in critical care have a better survival rate now than when the pandemic first began. The latest report from The Intensive Care National Audit and Research Centre (ICNARC) into critical care for England, Wales and Northern Ireland looks at patients admitted to intensive care up until 31 August and those admitted from 1 September. The data shows that on average, 39% of critical care coronavirus patients died up until the end of August while less than 12% have died since September. The proportion of patients who died after being admitted to critical care fell by almost a quarter from the peak and as much as half in hospitals overall. However, the Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard, told the BBC that the difference may be attributed to an insufficient amount of time having passed which impedes an accurate and longterm patient assessment, as some remain in hospital. Meanwhile, scientific advisors continue to warn that the next few weeks are critical for regulating hospital admissions. Read full story Source: The Independent, 18 October 2020
  19. News Article
    Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections. Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus. "Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme. "The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days." Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive." He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid." Read full story Source: The Independent, 14 October 2020
  20. News Article
    Covid survivor Tam McCue is one of the lucky ones. Earlier in the year he was in intensive care in the Royal Alexandra Hospital in Paisley where he had been on a ventilator for nearly two weeks. At one point Mr McCue, who could barely speak, didn't think he would live. Fast forward five months and Mr McCue, of Barrhead, East Renfrewshire, is back from the brink. He became desperately ill but, thankfully, it only went as far as his lungs. With coronavirus some patients have have suffered multiple organ failure which also affected their heart, kidneys, brain and gut. Mr McCue describes his recovery as a "rollercoaster". He added: "It's a slow process. You think you can do things then the tiredness and fatigue sets in." He said: "It lies in the back of your mind. As years go on, how are you going to be? Is it going to get you again? It does play on you. It definitely does." As part of his recovery Mr McCue is attending the Ins:pire clinic online. It is normally a face-to-face rehabilitation clinic which involves multiple specialties, including pharmacists, physiotherapists and psychologists. Mr McCue is one of the first Covid survivors to take part in the five-week programme, which started earlier this month. Read full story Source: BBC Scotland News, 29 September 2020
  21. News Article
    Hospitals have been warned hundreds of ventilators used to keep sedated patients alive are at risk of suddenly shutting down because of a fault, in some cases without warning. The Medicines and Healthcare products Regulatory Agency, which said there were approximately 303 Philips Respironics V60 ventilators used in the UK, has warned hospitals over a delay in replacement parts arriving in the UK to fix the problem. It has issued a safety alert to hospitals to make them aware of the increased risk. The regulator said it had received one report of a ventilator suddenly shutting down but said there was no report of any injury to patients. Read full story Source: The Independent, 23 September 2020
  22. News Article
    The NHS's "insufficient" critical care capacity has been laid bare by the pandemic, with the UK having one of the lowest number of beds per head in Europe, NHS Providers has said. The group, which represents trusts in England, is calling for a review of the health service's capacity. The UK has 7.3 critical care beds per 100,000 people, compared to Germany's 33.8 and the US's 34.3, analysis found. The government said it was investing £72bn in the next two years in the NHS. "The UK is towards the bottom of the European League table for critical care beds per head of population," NHS Providers said. The group added that the UK had comparatively fewer critical care beds than France, Italy, Australia and Spain. "It's neither safe nor sensible to rely on NHS hospital trusts being able to double or triple their capacity at the drop of a hat as they've had to over the last two months, with all the disruption to other care and impossible burdens on staff that involves." Seeking a review into critical care capacity in England, the organisation said it wanted the government to commit to providing additional finances in areas where it was needed. "There have been too many reviews of NHS capacity in the past where huge amounts of time have been wasted because the government has not been willing to fund the results of what's been found," the group said. Read full story Source: BBC News, 1 March 2021
  23. News Article
    The number of patients in critical care grew at one in four English hospital trusts in the past week, despite overall covid-19 occupancy falling, HSJ can reveal. It comes with adult critical care occupancy still very high in many areas — 10 trusts still have at least double the number of patients that they normally have space for. It highlights the ongoing pressure still on hospitals, with the prime minister due to decide in coming days on a timetable for loosening lockdown. HSJ analysis of NHS sitrep data shows that 31 trusts (of a total 125 general acute trusts) saw the number of critically ill adults climb between 2 and 9 February. Twenty-five of these trusts were either at or above their total capacity available last winter. The critical care units still seeing increasing pressure when compared to last year are spread nationally, but are predominantly in Yorkshire, Midlands and the North West, where the covid third wave peaked later. Read full story (paywalled) Source: HSJ, 11 February 2021
  24. News Article
    "Traumatised" and "exhausted" medical staff need time to recover before tackling an NHS backlog, says the group representing hospitals in England. Many staff could resign if their wellbeing is not factored into plans to cut waiting lists, NHS Providers said. The number of people waiting more than a year for surgery rose 1,613 to 192,000 during the Covid pandemic. NHS Providers said demand for hospital beds is easing, but the pressure on intensive care units is still intense. NHS Providers estimates that it is going to be at least a month before the NHS gets back to normal winter pressures, and trusts are concerned about the transition into the next phase of the pandemic. Critical work that has been postponed, including a small number of urgent cancer cases, will be a priority, but there remains a need to tackle a wider backlog of routine operations alongside the vaccination programme. NHS Providers said trusts will work as fast as possible to tackle the backlog, but leaders cannot do so at the expense of staff burnout. Last month, a study suggested that many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead". Read full story Source: BBC News, 1 February 2021
  25. News Article
    COVID-19 patients in England's busiest intensive care units (ICUs) in 2020 were 20% more likely to die, University College London research has found. The increased risk was equivalent to gaining a decade in age. By the end of 2020, one in three hospital trusts in England was running at higher than 85% capacity. Eleven trusts were completely full on 30 December, and the total number of people in intensive care with Covid has continued to rise since then. The link between full ICUs and higher death rates was already known, but this study is the first to measure its effect during the pandemic. Tighter lockdown restrictions are needed to prevent hospitals from being overwhelmed, says study author Dr Bilal Mateen. Researchers looked at more than 4,000 patients who were admitted to intensive care units in 114 hospital trusts in England between April and June last year. They found the risk of dying was almost a fifth higher in ICUs where more than 85% of beds were occupied, than in those running at between 45% and 85% capacity. That meant a 60-year-old being treated in one of these units had the same risk of dying as a 70-year-old on a quieter ward. The Royal College of Emergency Medicine sets 85% as the maximum safe level of bed occupancy. However, the team found there was no tipping point after which deaths rose - instead, survival rates fell consistently as bed-occupancy increased. This suggests "a lot of harm is occurring before you get to 85%". Read full story Source: BBC News, 14 January 2021
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