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Showing results for tags 'ICU/ ITU/ HDU'.
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Community PostDuring the COVID pandemic, it was clear that Emergency Departments across the UK needed to adapt and quickly, with my trust not exempt from this. We have increased capacity, increased our nursing and doctors on the shop floor, obviously with nurse in charge being responsible for all areas. We have different admission wards in terms of symptoms that the patient has, but also have a different type of flow, which i am getting my head around to be able to share I have seen departments split into 2 and various other ideas coming out from various trusts. Which got me thinking about patient safety and how well this is managed. So.... How is your department responding to the pandemic? Do you have any patient safety initiatives as a result of the response? Is there a long term plan? The reason why i am asking this, is so we can share practice and identify individual trust responses.
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News Article
Severe shortage of nurses in UK children’s intensive care units
Patient Safety Learning posted a news article in News
Britain’s sickest children are being treated in intensive care units that are struggling with severe shortages of the specialist nurses needed to look after them, a report says. The shortages in the UK’s 30 paediatric intensive care units (PICUs) are so severe that healthcare assistants are covering the work of nurses in an attempt to ensure that staffing levels are maintained. Only one of the PICUs – at the James Cook University hospital in Middlesbrough – was found to have enough nurses to guarantee the standards of care expected. About 15,000 children and young people a year, often with life-threatening conditions, are cared for in PICUs. Clinical standards that prevail in PICUs require them to ensure that seven nurses are on duty for each bed in a 24-hour cycle. However, the report by the Paediatric Intensive Care Audit Network (PICANet), a group of experts from Leicester and Leeds universities, found that 29 of the 30 had too few nurses to do that, and that all 30 had vacancies, sometimes large numbers of them. “Parents will find this extremely alarming”, said Patricia Marquis, the Royal College of Nursing’s England director. “Most people wouldn’t believe that only one paediatric intensive care unit across the whole UK has enough staff to function properly, but this is the reality of the workforce crisis. Key roles in specialist nursing teams are lying vacant for years.” Read full story Source: The Guardian, 23 January 2022 -
News Article
Intensive care units for children not meeting standards, says NHSE report
Patient Safety Learning posted a news article in News
Three intensive care units for children are not meeting standards for co-located services, a national report has found. Royal Stoke University Hospital, Royal Brompton Hospital in London and Freeman Hospital in Newcastle, which all have “level three” paediatric intensive care beds for the most seriously ill patients, do not offer specialised paediatric surgery, according to a report from NHS England’s Getting it Right First Time (GIRFT) programme. The report, released in April, said specialised paediatric surgery “should be co-located on the same site” as a paediatric intensive care unit with level three beds and be “immediately available” to meet quality standards set by the Paediatric Intensive Care Society. The report also found the units do not offer services such as trauma, neurosurgery and bone marrow transplantation, which it says is a reflection of the variability and “the poor alignment” of specialised paediatric services at PICUs. Read full story (paywalled) Source: HSJ, 23 May 2022 -
News Article
Families banned from Covid wards during lockdown ‘left with PTSD’
Patient Safety Learning posted a news article in News
Relatives of intensive care Covid patients were left traumatised by being banned from visiting their seriously ill loved ones during the pandemic, a study has found. Researchers found two-thirds of family members of patients in intensive care were still suffering high levels of symptoms of post traumatic stress disorder (PTSD) three months after their relative was admitted. Symptoms of PTSD include flashbacks, nightmares and physical sensations such as pain, sweating, feeling sick or trembling. Before the Covid pandemic, symptoms of PTSD in family members of intensive care patients were between 15 and 30 per cent, depending on the condition. The team from the University of Colorado School of Medicine said visitation restrictions may have inadvertently generated a secondary public health crisis of stress-related disorders in family members of Covid patients. At the height of the pandemic, hospitals across Britain restricted access to patients, with many people forced to say goodbye to dying loved ones over Skype, or behind screens or windows. Even as late as last winter, a Telegraph investigation showed that a quarter of trusts were still imposing restrictions on visitors. The findings suggest that the rates of PTSD may be higher in relatives than in patients. A previous study by Imperial College and the University of Southampton found that only one-third of patients on ventilators suffer symptoms. Read full story (paywalled) Source: The Telegraph, 25 April 2022 -
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Content ArticleAdult critical care provides specialised care for patients who are seriously ill, or who are at risk of becoming seriously ill. About 200,000 people per year in the UK require critical care for may different reasons including medical emergencies, major trauma or following complications after surgery. The GIRFT national report for adult critical care contains 19 recommendations for improving services in England, within the context of COVID-19. These recommendations aim to ensure equal access to critical care services. You will need a FutureNHS account to view this report, or you can watch a short video summarising the report's recommendations
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Content ArticleTools include: Assessment ICU assessment ICE assessment response guide Action plan template Implementing CUSP onboarding modules, laying a foundation to implement a program of preventing CLABSI and CAUTI CLABSI and CAUTI prevention modules, providing an introduction to the tiered interventions Playbook for preventing CLABSI and CAUTI in the ICU setting: connecting the dots between CUSP and the tiered interventions CLABSI and CAUTI learning tools APIC HAIs calculator tools Overcoming common challenges Team engagement tools Team functioning tools Overcoming clinical mindset tools Safety culture tools
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Content ArticleThe campaign poster can be downloaded below and can be printed and displayed at bedsides and on notice boards.
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Content ArticleLatest case studies: Urgent/emergency care Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Equipment falling onto critically ill patients during intrahospital transfers Misapplication of spinal collars resulting in harm from unsecured spinal injury Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring pregnant women with COVID-19 symptoms access appropriate care General medicine Harm from catheterisation in patients with implanted artificial urinary sphincters Confusion between different strength preparations of alfentanil Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Variation in use of cardiac telemetry Ceftazidime as a 24-hour infusion Tacrolimus – risk of overdose when converting from oral to intravenous route Haloperidol prescribing for confused/agitated/delirious patients Ensuring oxygen delivery when using two step humification systems Intensive care Ventilator left in standby mode Equipment falling onto critically ill patients during intrahospital transfers Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Sudden patient deterioration due to secretions blocking heat and moisture exchanger filters Anaesthetic machines used as ventilators: issues with circuit set up Importance of ‘tug test’ for checking oxygen hose when transferring a patient to a portable ventilator Ensuring oxygen delivery when using two step humification systems Obstetrics and gynaecology/midwifery Harm from prescribing and administering Syntometrine when contraindicated to woman with significantly raised BP Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Unnecessary caesarean section for breech presentation if not scanned on the day HIV prophylaxis in women and new-borns Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring the safe use of plastic cord clamps at caesarean section Warning on the use of ethyl chloride during fetal blood sampling Ensuring pregnant women with COVID-19 symptoms access appropriate care Risk of babies becoming unwell following move to virtual home midwifery visits Paediatrics and child health Ensuring compatibility between defibrillators and associated defibrillator pads Risk of babies becoming unwell following move to virtual home midwifery visits Unintentional perforation of oesophagus in neonates from invasive procedures Chemical burn to a neonate from use of chlorhexidine Other Ensuring compatibility between defibrillators and associated defibrillator pads Infrared temperature screening to detect COVID-19
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Content ArticleThe guidelines recommend a number of changes to training and preparation, including: Clinical staff of all grades should receive multidisciplinary training in their place of work as part of annual mandatory training, covering the management of a fire and evacuation of their work area. Nominated clinical staff should be trained to select and use fire extinguishers. Designing new and refurbished ICUs and operating theatres is an opportunity to incorporate mandatory fire safety features. New strategies covered in these guidelines include modern sprinkler systems, emergency low level lighting and oxygen pipelines designed so that the oxygen supply to an ICU area affected by a fire to be cut off without interrupting the oxygen supply to the whole ICU. Ventilation of ICUs and clinical areas where high-flow nasal oxygen and non-invasive respiratory support are in use should be good enough to prevent oxygen enrichment of the ambient atmosphere: the recommended minimum ventilation rate of these areas is 10 air changes per hour. Laminated fire and emergency evacuation action cards, specific for that clinical area, should be placed next to all manual fire call points so that they can be followed in the event of a fire or if an emergency evacuation is required for another reason.. Cylinders should be stored, handled and used according to the gas supplier’s instructions, using the correct sequence of actions when administering oxygen and using an oxygen cylinder bed bracket at all times. Major incident planning should include plans for internal incidents, where the staff themselves are victims and unable to work and where ICU and theatre suites become unusable for patient care. All staff involved in a fire or similar emergency should be supported following the event and assessed by their occupational health team before restarting work.
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News Article
Pilot scheme has 'changed critical care forever'
Patient Safety Learning posted a news article in News
A specialist service to transport critically ill and injured patients is being copied around England after the success of a trial in the South West. More than 700 patients have been transported since the pilot scheme began a year ago. Retrieve was set-up to transport the most seriously ill patients between intensive care units to take pressure off ambulance and hospital staff. Six other regions around England are now developing a similar service. "Everyone will have a service that looks similar to Retrieve by the end of next year which is amazing in the short period of time that we've been talking about it," said Dr Scott Grier, lead consultant for Retrieve. Dr Grier said critically unwell patients need to be transported between hospitals for various reasons, though frequently to be treated in a hospital specialising in the care they require. The service, which operates in Bristol, Gloucestershire, Wiltshire, Somerset, Devon and Cornwall, is funded by NHS England and Improvement South West and costs £3.2m a year. "It sounds expensive but it's an efficient service and every time we make a transfer we save the hospital and staff time and those hospitals can care for other people while we care for their patients on the move. "It's incredibly exciting because we have changed this area of critical care forever," added Dr Grier. Read full story Source: BBC News, 5 January 2021 -
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Trust in staffing crisis as eight ICU nurses quit in just two weeks
Patient Safety Learning posted a news article in News
Eight highly skilled intensive care (ICU) nurses have resigned from one trust in the past two weeks and more could follow, a leading nurse has warned. More resignations expected as working conditions remain unsustainable Belfast Health and Social Care Trust in Northern Ireland has confirmed it is redeploying non-specialist nursing staff to fill the gaps in staffing on ICU wards, with experienced ICU nurses expected to provide supervision. RCN Northern Ireland director Rita Devlin said the college has heard others at the trust are ‘considering their position’. "These are highly skilled nurses who are difficult to replace and this is a very worrying situation," she said. "Nursing staff are doing everything they can to keep services going, but it is not sustainable to work under such pressure for long periods of time without a break." The resignations come just months after it was revealed that 182 nurses and 50 healthcare assistants had quit their jobs at the trust between January and July. Read full story Source: Nursing Standard, 23 November 2021 -
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Children’s intensive care at near full national occupancy amid rising RSV
Patient Safety Learning posted a news article in News
A senior doctor has warned that paediatric intensive care units (PICUs) are ‘as pressured as I can ever recall’ – despite the absence of cold weather, which typically leads to higher demand levels. James Fraser, president of the Paediatric Critical Care Society, said national bed occupancy in PICUs has “often been greater than 95 per cent” over recent weeks, while several units have reported 100 per cent occupancy. He said some children have had to be transferred between regions in order to admit them to a bed. PICUs are often under more pressure during winter, due to seasonal RSV and other viral infections. But high demand levels have started earlier this year, which has meant severely ill children have occasionally waited longer in local hospitals before being admitted to PICUs, and have sometimes had to be transferred to another site. Mr Fraser told HSJ: “[PICUs] are really busy, as pressured as I can ever recall them. “Every winter PICUs are under huge pressure due to seasonal RSV bronchiolitis. This usually happens between November and February. This year we always anticipated it would be a much longer season. It’s putting a lot of pressure on our national bed base. “What is different is we have been under this pressure earlier in the year with RSV and other viral chest infections. We have been under this pressure for a month. The pressure is both the number of patients and there are a lot of staff off having to self-isolate." Read full story (paywalled) Source: HSJ, 29 October 2021 -
News ArticleOn Tuesday, there were 356 COVID-19 patients being treated in intensive care wards throughout Australia. Of those, 25 were fully vaccinated. While the data points to the extraordinary efficacy of COVID-19 vaccines in preventing people from becoming severely unwell, being hospitalised and dying, it does raise the question: why do a small number of people become seriously ill and, in rare cases, die, despite being fully vaccinated? An intensive care unit staff specialist at Nepean hospital in Sydney, Dr Nhi Nguyen, said those who are fully vaccinated and die tend to have significant underlying health conditions. Being treated in intensive care, where people may be on a ventilator and unable to move, added to any existing frailty, especially in elderly people, she said. “If we think about intensive care patients in general, whether they are there due to COVID-19, pneumonia or any other infection, we know that those who have underlying disorders, those who are frail, and those with co-morbidities will have a higher risk of dying from whatever the cause of being in intensive care is,” she said. “Being fully vaccinated against Covid protects you from getting severe disease, yes, but it doesn’t completely protect you from getting Covid. So if you are someone with chronic health conditions, what might be a mild disease or mild infection in a young person or a person who is in good health, will have a greater impact on you.” She said this was why the Australian Technical Advisory Group for Immunisation (Atagi) had recommended boosters for those people who are severely immunocompromised. On Wednesday the government said it intended booster shots to be rolled out to the aged care sector within weeks, and to be available to the whole population by the end of the year. Read full story Source: The Guardian, 20 October 2021
