Safety intensive care

LaPointe DR, Arnold AD, Eichelberger WJ, 2002. Quality improvement projects to enhance safety and efficacy of gentamicin in a neonatal intensive care unit. ASHP Midyear Clinical Meeting, Adanta, GA. 

Santell, J. P., Hicks, R. W., and Cousins, D. D. (2005), MEDMARXData Report A Chart-book of 2000-2004 Findings from Intensive Care Units and Radiological Services, USP Center for Advancement of Patient Safety, Rockville, MD. 

Rothschild JM, Landrigan CP, Cronin JW. The Critical Care Safety Study The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 2005 33 1694-1700. 

Zaloga GP, Teres D. The safety and efficacy of propofol containing EDTA a randomised clinical trial programme focusing on cation and trace metal homeostasis in critically ill patients. Intensive Care Med 2000 26(Suppl 4) S398-9. 

The intensive care nurse is preparing to administer trimetrexate (Neutrexin) to a client diagnosed with AIDS and Pneumocystis carinii pneumonia (PGP). Which intervention is the most important safety consideration for the nurse ... 

Injecting a gas into the circulation may seem potentially hazardous,but extensive clinical experience has shown that the tiny volume of the air or gas given (<200 jJ) is not dangerous, and the safety of microbubbles compares well with that of conventional agents in radiography and MRl (Nanda and Carstensen 1997). At the moment, the use of SonoVue is not permitted in mechanically ventilated intensive care unit patients and in patients with heart failure, right-to-left shunts of the heart, uncontrolled hypertension and adult respiratory distress syndrome. 

Holzmueller, C.G., Pronovost, P.J., Dickman, F. et al. (2005) Creating the web-based intensive care unit safety reporting system. Journal of the American Medical Informatics Association, 12(2), 130-139. 

Catchpole, K.R., de Leval, M.R., McEwan, A. etai. (2007) Patient handover from surgery to intensive care using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatric Anaesthesia, 17(5), 470-478. 

As the success of this and related programmes became apparent, a much wider intervention was launched led by the Michigan Health and Hospital Keystone Association for Patient Safety and Quality. 108 Michigan ICUs took part in an 18-month intervention programme aimed particularly at decreasing catheter related bloodstream infections, a common, costly and potentially lethal complication of ICU care. In the United States, 80 000 patients each year were affected, with up to 28 000 deaths in intensive care units from this cause. 

This programme has improved safety dramatically for patients and saved a great deal of money in reducing length of stay in intensive care. However, achieving change on this scale requires investment ... 

Huang, D.T., Clermont, G., Sexton, J.B., Karlo, C.A., Miller, R.G., Weissfeld, L.A., Rowan, K.M. and Angus, D.C. 2007. Perceptions of safety culture vary across the intensive care units of a single institution. Critical Care Medicine, 35(1), 165-76. 

Sexton, J.B., Berenholtz, S.M., Goeschel, C.A., Watson, S.R., Holzmueller, C.G., Thompson, D.A., Hyzy, R.C., Marsteller, J.A., Schumacher, K. and Pronovost, PJ. 2011. Assessing and improving safety chmate in a large cohort of intensive care imits. Critical Care Medicine, 39(5), 934-9. 

Ballangrud, R., Hedelin, B. and Hall-Lord, M L. 2012. Nurses perceptions of patient safety climate in intensive care units A cross-sectional study. Intensive and Critical Care Nursing, 28(6), 344-54. 

Snijders, C., Kollen, B.J., van Lingen, R.A., Fetter, W.P.F., Molendijk, H. and Neosafe, S.G. 2009. Which aspects of safety culture predict incident reporting behavior in neonatal intensive care units A multilevel analysis. Critical Care Medicine, 37(1), 61-7. 

Ludbrook, G. L., Webb, R. K., Fox, M. A., The Australian Incident Monitoring Study Physical Injuries and Environmental Safety in Anaesthesia An Analysis of 2000 Incident Reports, Anaesthesia and Intensive Care, Vol. 21, No. 5, 1993, pp. 659-663. 

Most patient safety research relies on review of medical records. This approach represents a concern in research because medical records are often incomplete, and events are likely not to be recorded. Experts agree that the number of events undocumented in medical records is substantial (Weingart, Wilson, Gibberd, and Harrison, 2000). This concern is validated by observational studies that demonstrate higher adverse event rates. For example, observational studies document that 17.7 percent of patients on an intensive care unit experience a medical event (Flyrm, Pearson, and Barker, 1997 Andrews and others, 1997 Donchin and others, 1995). By comparison, studies using medical records found injury in only 3.7 percent of patients in New York in 1991 (Brennan and others, 1991), 2.9 percent of patients... 

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