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Showing results for tags 'ICU/ ITU/ HDU'.
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Content ArticleIn the UK, around 20,000 children are admitted to intensive care each year. Most will receive oxygen through a ventilator. Many hospitals aim to give almost as much oxygen as people’s blood can carry (more than 94% saturation). However, some studies suggest that this could be harmful for some children. Providing less oxygen (88 to 92% of the blood’s capacity) may be better. A groundbreaking nurse-led NIHR trial explored the oxygen levels of critically ill children in intensive care. The study found that with reduced oxygen targets children spent less time on life-saving machines and required fewer drugs. The researchers say that with reduced oxygen targets: 50 more children would survive in the UK each year the NHS could save £20 million per year. The findings suggest that, if oxygen targets for children in intensive care were reduced across the NHS, 50 more children would survive every year. In total, children would spend 6,000 fewer days in intensive care. Lower oxygen targets could be particularly beneficial in countries where resources are scarce, the researchers say, or at times of crisis (such as during a pandemic).
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Content ArticleHospital-acquired pressure injuries are a significant patient safety concern. The Centers for Medicare & Medicaid Services tracks hospital-acquired pressure injuries as a patient safety indicator. Healthcare organisations with higher-than-expected rates may incur penalties. The aim of this study was to reduce the prevalence and incidence of hospital-acquired pressure injuries in the cardiothoracic intensive care unit. Local problem The pressure injury prevalence rate in a cardiothoracic intensive care unit was above the National Database of Nursing Quality Indicators benchmark. The current standard of care—use of the Braden scale for pressure injury risk assessment and the SKIN (surface, keep turning, incontinence care, and nutrition) care bundle—may not adequately address the needs of the intensive care unit population. In addition, cardiac patients present a special challenge because of their disease process and the mechanical support devices used to treat patients in cardiogenic shock, which place them at risk for the development of hospital-acquired pressure injuries. Methods A performance improvement project was carried out in the cardiothoracic intensive care unit to reduce the prevalence and incidence of hospital-acquired pressure injuries. A preintervention convenience cohort was compared with a postintervention cohort. The intervention consisted of use of the Cubbin-Jackson scale, an intensive care unit–specific risk-assessment tool, with linked interventions to prevent pressure injuries. Results The preintervention and postintervention cohorts consisted of 102 patients each. The pressure injury prevalence and incidence rates decreased by 67.84% and 36.43%, respectively, from before to after the intervention. Conclusion The use of an intensive care unit–specific risk-assessment tool with linked interventions to prevent pressure injury can help reduce hospital-acquired pressure injuries in an intensive care unit.
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Content ArticleA new study by Toronto researchers evaluates the use of CHARTWatch, an artificial intelligence (AI) early warning system developed at Unity Health Toronto that monitors hospitalised patients in real-time, identifies those at high risk of unexpected death or transfer to an intensive care unit, and alerts doctors and nurses to intervene early. The study, published in the Canadian Medical Association Journal, shows a 26% reduction in unanticipated mortality after the tool was implemented in the general internal medicine ward of Unity Health Toronto’s St. Michael’s Hospital. “As AI tools are increasingly being used in medicine, it is important that they are evaluated carefully to ensure that they are safe and effective,” says lead author Amol Verma, general internist at Unity Health and professor in the department of medicine in the University of Toronto’s Temerty Faculty of Medicine who led the development and implementation of CHARTWatch. “Our findings suggest that AI-based early warning systems are promising for reducing unexpected deaths in hospitals.”
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Content Article
Martha Mills died from sepsis aged 13 after sustaining a pancreatic injury from a bike accident. The inquest into her death heard that she would likely have survived had consultants made a decision to move her to intensive care sooner. Her mother, Merope, has spoken about the failures in Martha’s care, and how she trusted the clinicians against her own instincts – they didn’t listen to her concerns and instead “managed” her. This report is a response to that call from Martha Mills’ parents to rebalance the power between patients and medics with one purpose only: to improve patient safety. It comes amidst significant evidence that shows that failing to properly listen to patients and their families contributes to safety problems in the NHS. Martha’s Rule would mean that in the event of a suspected deterioration or serious concern on the part of a patient on a hospital ward, or their family or carer, they would have the right easily to call for a rapid review or second opinion from an ICU/HDU doctor within the same hospital. Recommendation 1 NHS England should develop best practice guidance to allow hospitals to adopt this system as soon as possible. Recommendation 2 Hospitals should adopt Martha’s Rule as a matter of urgency and communicate it clearly to patients. Recommendation 3 The Care Quality Commission, that inspects hospitals, should consider Martha’s Rule standard practice in inspections and include their implementation in inspections. Further recommendations We considered three further recommendations, but have chosen to focus on Martha’s Rule as potentially the most immediately effective: The right to access patient notes. This could shift the power dynamic between patients and doctors, and put the onus on the doctors to communicate in an inclusive and more relational way with patients. To implement real time open notes in acute settings it would taketesting, and training, to make it achievable in practice. The right to a named consultant. This was already recommended by the Francis review but hospitals have not consistently adopted it. The government should now review the extent of the implementation in order to understand the barriers, and work with the CQC to consider its implementation in its inspections. It should be considered best practice. A review of medical training to improve non-technical skills. Non-technical skills in medical training are undervalued and inconsistently delivered. Training is largely on the job, delivered by people already steeped in the NHS culture that is, rather than the culture it aspires to have. In light of the safety consequences identified here, this should be reviewed. -
Content ArticleThis study in Intensive and Critical Care Nursing examined the association between safety attitudes, quality of care, missed care, nurse staffing levels and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs). The authors concluded that positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs. Key findings ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses’ perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units.
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Content ArticleNHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. While the covid-19 pandemic has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decades long and unless urgent action is taken, we may not yet have reached its nadir, writes Tim Cooksley and colleagues in this BMJ opinion article.
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Content ArticleThrough a data sharing agreement, the Faculty of Intensive Care Medicine can access a record of incidents reported to the National Reporting and Learning System (NRLS). Available information is limited and from a single source; all that is know about these incidents is presented in this report. The safety bulletin aims to highlight incidents that are rare or important, and those where the risk is perhaps something we just accept in our usual practice. It is hoped that the reader will approach these incidents by asking whether they could occur in their own practice or on their unit. If so, is there anything that can be done to reduce the risk? February 2024 Needlestick injuries A missed prescription Inevitable harm? Air emboli The patient, the machine and everything inbetween Harm from a safety measure Unknown patients Retained foreign body Serotonin syndrome October 2023 Central line misplacement. Missing vital information. Can risk be avoided? Vasopressors outside the ICU. Mediastinal drains. Failure to recognise July 2023 Imaging Central venous access Nasogastric trauma SGLT-2 inhibitor associated diabetic ketoacidosis Chest drain clamps Where's the drain?
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Content ArticleInconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. The Safer Tracheostomy Care in Adults bundle was a programme of 18 interventions implemented across 20 hospitals in England between August 2016 and January 2018. These interventions were designed to improve the quality and safety of care for patients who have had tracheostomies. This evaluation report outlines why the interventions were needed and assesses their impact, including an estimated reduction in total hospital length of stay per tracheostomy admission of 33.02 days, corresponding to a potential reduction of over £27,000 per admission. Hospitals that implemented the Safer Tracheostomy Care initiative interventions saw improvements across a number of quality, safety and efficiency for patients who had tracheostomies, these improvements included: reduced length of stay in hospital reduced incident severity reductions in anxiety and depression. The level of these improvements varied across hospitals, as did the type of interventions implemented. The hospitals also had different characteristics and populations which they served.
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News ArticleWhile most babies born more than two months prematurely now survive thanks to medical advances, little progress has been made in the past two decades in preventing associated developmental problems, an expert review has found. The review also found that very preterm babies can have their brain development disrupted by environmental factors in the neonatal intensive care unit (NICU), including nutrition, pain, stress and parenting behaviours. A review conducted by experts from the Children’s Hospital of Orange County in the US and the Turner Institute for Brain and Mental Health at Monash University in Australia found that while these neurodevelopmental problems can be related to brain injury during gestation or due to cardiac and respiratory issues in the first week of life, the environment of the NICU is also critical. To improve outcomes for very preterm babies, the review recommended family based interventions that reduce parental stress during gestation, more research into rehabilitation in intensive care and in the early months of life, and greater understanding of the role of environment and parenting after birth. Read full story Source: The Guardian, 3 August 2023
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News ArticleWhistleblower Dr Chris Day has won the right to appeal when a a Deputy High Court Judge Andrew Burns of the Employment Appeal Tribunal granted permission to appeal the November 2022 decision of the London South Employment Tribunal on six out of ten grounds at a hearing in London. The saga which has now being going on for almost ten years began when Dr Day raised patient safety issues in intensive care unit at Woolwich Hospital in London. The Judge said today this was of the “utmost seriousness” and were linked to two avoidable deaths but their status as reasonable beliefs were contested by the NHS for 4 years using public money. In a series of twists and turns at various tribunals investigating his claims Dr Day has been vilified by the trust not only in court but in a press release sent out by the trust and correspondence with four neighbouring trust chief executives and the head of NHS England, Dr Amanda Pritchard and local MPs. This specific hearing followed a judgement in favour of the trust by employment judge Anne Martin at a hearing which revealed that David Cocke, a director of communications at the trust, who was due to be a witness but never turned up, destroyed 90,000 emails overnight during the hearing. A huge amount of evidence and correspondence that should have been released to Dr Day was suddenly discovered. The new evidence showed that the trust’s chief executive, Ben Travis, had misled the tribunal when he said that a board meeting which discussed Dr Day’s case did not exist and that he had not informed any other chief executive about the case other than the documents that were eventually disclosed to the court. Read full story Source: Westminster Confidential, 26 February 2024
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EventuntilThe Safe Anaesthesia Liaison Group Patient Safety Conference will be held in collaboration with RA-UK. The first session will include engaging lectures around the current work of SALG, and the second session will focus on topical issues in relation to regional anaesthesia safety. There will be a prize session for accepted abstracts, with a poster section and oral presentations. This online conference is being organised by SALG co-chairs, Dr Peter Young from the Association of Anaesthetists, Dr Felicity Platt, Royal College of Anaesthetists and Nat Haslam, Regional Anaesthesia UK The day will provide valuable knowledge for doctors engaged in clinical anaesthesia, pain management and intensive care medicine, and who have an interest in improving patient safety. Register
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EventuntilThis Webinar hosted by Hamilton Medical, will focus on the clinical use of intelligent ventilation software. Agenda Intro from Chair Luigi Camporata Presentation from Prof. Giorgio A. Iotti : “ The birth and growth of the visionary idea” Presentation from Laura Buiteman-Kruizinga: “Lung protective ventilation in the time of COVID-19” Followed by a Q&A Register for the webinar
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News ArticleThe most comprehensive picture so far of how covid’s second wave has hit the NHS in the north of England is revealed in new figures obtained by HSJ. The latest data confirms that parts of the North West region now have more coronavirus patients in hospital beds than they did in the spring. It comes amid intense public debate about the best way to fight covid, and whether or not it is close to swamping the NHS. Collected from local NHS sources in a joint HSJ and Independent investigation, the information shows for example that: Lancashire and South Cumbria had 544 confirmed covid hospital patients yesterday (around 15-18% of the bed base), about 20 more than during the April peak. Liverpool University Hospitals – which remains the most severely affected trust – had 408 confirmed covid patients yesterday (20-25% of bed base), whereas it never topped 400 in the spring. The data is sent routinely by trusts to NHS England but most of it is not published – something some politicians are now calling for. As of yesterday, there were nearly 6,100 confirmed-covid patients across England, about 650 of whom were in critical care, and 560 receiving mechanical ventilation, according to information shared with HSJ. The number of “unoccupied” hospital beds is much lower now than in the spring, when they were cleared out in anticipation of a major hit. In the North West, up to 5,500 acute beds were reported as “unoccupied” in the spring, whereas the figure now is about 2,500 (around 14-18% of the bed base). However, critical care is the major pinch point in the most affected areas, with nearly half of the mechanical ventilation beds open at Liverpool’s hospitals (29 of 62) occupied by confirmed covid patients; and a third of those across the North West (178 of 556). However, hospitals in the area have opened very few extra critical care “surge” beds so far. The total numbers of mechanical ventilation (a subset of critical care) beds open in LUH and the rest of the region has not increased much in recent weeks, and falls well short of what they have declared they could open as potential surge capacity, if they cancelled large amounts of non-urgent care and reorganised staffing and wards. Read full story Source: HSJ, 23 October 2020
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News ArticleNew data has shown the number of coronavirus patients being admitted to hospital and intensive care units across the country has risen as lockdown rules are set to be eased further on Monday. The Public Health England (PHE) data, published on Friday, covers 134 NHS trusts across the country and shows the daily rate of new patients admitted to hospital and critical care with COVID-19 has risen compared to recent weeks, with London experiencing a sharp spike in new admissions in the past week. The south east region also saw an increase. The surveillance data on the spread of COVID-19 throughout England has also revealed an increase in the number of people testing positive at their GP. Read full story Source: Independent, 31 May 2020
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Content ArticleIn conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with patients, monitoring their condition 24 h, are particularly exposed to so-called alarm fatigue. The purpose of this study from Lewandowska et al. is to review the literature available on the perception of clinical alarms by nursing personnel and its impact on work in the ICU environment.
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Content Article
Guidance for: Prone positioning in adult critical care (2019)
Sam posted an article in Respiratory conditions
Guidance from the Faculty of Intensive Care Medicine and Intensive Care Society on prone positioning in adult critical care. It is hoped that the adoption of the guidance set out within this document will help improve safety and reduce complications associated with the prone positioning of mechanically ventilated patients. This document also hopes to standardise the approach to manging a cardiac arrest in the prone position, and has some guidance on prone ventilation in ECMO patients as well as considerations for performing bronchoscopy in the prone position. Assuming adequate staffing and equipment is available, the intervention of prone positioning involves very low costs and provided additional patient complications and long-term injuries to staff do not occur, would almost certainly be a cost-effective intervention. -
Content ArticleNewborn babies may need extra care in a neonatal intensive care unit or special care baby unit if they were born prematurely or if they need care for a particular health condition. Babies and infants that need long-term care can be transferred to a local unit or discharged to receive care at home. A baby with complex health needs may move between distinct areas of care or 'pathways'. This Care Quality Commission (CQC) review looked at how risks for newborn babies are identified and managed and at the care for infants in the community who need respiratory support. This review draws on one particular case that had a tragic outcome for a baby and her parents. Elizabeth Dixon was born prematurely but suffered brain damage as a result of missed high blood pressure. She died shortly before her first birthday in 2001, when there was a failure to correctly maintain her tracheostomy tube. While this review was not an investigation of the specific circumstances of Elizabeth's case, it drew on this to examine current practice, systems and guidance.
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Content Article
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This learning resource has been designed for frontline clinical staff who are caring for critically ill patients during the COVID-19 pandemic. This includes a wide range of healthcare professionals in acute care, from many different clinical speciality backgrounds. You may have some previous critical care experience or none. The information in this resource will support those refreshing critical care knowledge and skills, newly qualified doctors, those who are upskilling, and those returning to acute clinical services during the COVID-19 pandemic. By the end of the course, you‘ll be able to: Apply the current and evolving principles of personal protective equipment (PPE) in the care of COVID-19 patients. Apply evidence-based principles of advanced organ support and monitoring to the COVID-19 critically ill patient. Apply evidence-based daily practices to care of the critically ill patient. Develop a range of specialised self-caring practices Reflect critically on the complex elements required to achieve both self-awareness and self-compassion in a high-tension environment. -
News Article
Coronavirus: Delirium 'may be common' in Covid seriously ill
Patient Safety Learning posted a news article in News
Delirium and confusion may be common among some seriously-ill hospital patients with COVID-19, a study in The Lancet suggests. Long stays in intensive care and being ventilated are thought to increase the risk, the researchers say. Doctors should look out for depression, anxiety and post-traumatic stress disorder (PTSD) after recovery, although most patients, particularly those with mild symptoms, will not be affected by mental health problems. The evidence is based on studies of patients with severe acute respiratory syndrome (Sars) and Middle-East respiratory syndrome (Mers), as well early data on COVID-19 patients. Read full story Source: BBC News, 19 May 2020 -
News Article
Coronavirus: Restarting NHS services will be a major challenge, warn experts
Patient Safety Learning posted a news article in News
Restarting NHS services will be an even greater challenge than coping with the first coronavirus infections, health think tanks and hospital chiefs have warned. Since March, the NHS has freed up more than 33,000 beds to prepare for an influx of COVID-19 patients needing intensive care, but since the peak of infection health chiefs have worried that delays to care were harming patients. Around 46,000 so-called excess deaths have been recorded during the pandemic, as compared against a five-year average. Around a quarter of these are believed to be unrelated to COVID-19. In a joint statement, the Health Foundation, Nuffield Trust and King’s Fund think tanks have said it could take months before the NHS and social care are able to fully restart. All three bodies will be giving evidence to the Commons health committee on Thursday, where they will warn about the impact on the health service’s “exhausted staff” and demand action to help care homes – which are now at the frontline in the fight against coronavirus. The experts will stress the need for the NHS to begin planning for a second peak of infections, especially if it comes in winter – when the service is usually overwhelmed by seasonal flu. They will warn about concerns over how the NHS manages the risk of infection, with the need for more protective equipment, social distancing and increased testing. This will “severely limit capacity for many months”, they said. Read full story Soruce: The Independent, 14 May 2020 -
News Article
NHS staff given conflicting advice over resuscitation of coronavirus patients
Patient Safety Learning posted a news article in News
Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection. While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment. The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance. One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus. Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance. Read full story Source: The Independent, 6 April 2020 -
News Article
Frantic action to stop London ‘running out of beds in four days’
Patient Safety Learning posted a news article in News
Details of a massive ramp-up in intensive care beds have been circulated to NHS bosses in London, amid concerns from national leaders that they are four days away from full capacity. In a call with local leaders, the NHS’ national director for mental health, Claire Murdoch, spoke about the intense pressures facing the acute system due to the coronavirus outbreak. According to several people on the call, she said London “runs out of [ICU] beds in four days” if urgent action is not taken. She also warned the need for intensive care beds will now double every three days, the sources said. The capital’s hospitals are frantically planning to try to quadruple their “surge capacity” in intensive care over the next fortnight, from around 1,000 surge beds over the weekend just passed, to more than 4,000 in two weeks’ time. Read full story Source: HSJ, 24 March 2020 -
News ArticleNew guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic. The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators. The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment. They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”. Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”. Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care. Read full story Source: Independent, 22 March 2020
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Content ArticleThis case study looks at how implementing a daily emergency call safety huddle at Surrey and Sussex Healthcare NHS Trust has increased efficiency in team working and improved patient safety. A safety huddle is a short multidisciplinary briefing, held at a predictable time and place, and focused on the patients most at risk. By implementing the ten-minute daily safety huddle, the medical emergency and cardiac arrest teams improved patient outcomes and staff experience, and were able to make better use of resources.
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