AACN advanced critical care
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Hospitals, especially their intensive care units, are not particularly safe for patients. Life-threatening mistakes and omissions in care can and do occur. To deter omissions and mistakes wherever possible, our medical intensive care team developed a checklist of care issues that must be addressed daily for every patient in our intensive care unit. ⋯ It is too soon to tell whether the checklist has had an impact on our survival rate or length of stay, but we have documented clear improvement in our attention to these core intensive care issues. In addition, our team's collegiality and team bonding are enhanced by using an evidence-based tool to achieve our care goals. We share our checklist, so that others can use and/or adapt it in their pursuit of optimal care for their critically ill patients.
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The use of rapid response teams is a relatively new approach for decreasing or eliminating codes in acute care hospitals. Based on the principles of a code team for cardiac and/or respiratory arrest in non-critical care units, the rapid response teams have specially trained nursing, respiratory, and medical personnel to respond to calls from general care units to assess and manage decompensating or rapidly changing patients before their conditions escalate to a full code situation. This article describes the processes used to develop a rapid response team, clinical indicators for triggering a rapid response team call, topics addressed in an educational program for the rapid response team members, and methods for evaluating effectiveness of the rapid response team.
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There is growing evidence that control of hyperglycemia in the critically ill patient improves outcome. Normalizing blood glucose levels decreases the risk of developing sepsis, end-organ damage, and hospital mortality. ⋯ This article describes the effects of hyperglycemia and discusses the evidence supporting tight glycemic control in such patients. The necessary steps to implement an intensive insulin therapy protocol for control of acute hyperglycemia are detailed.
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Review
Recombinant factor VIIa: review of current "off license" indications and implications for practice.
Uncontrolled bleeding and coagulopathy are associated with trauma, liver failure, obstetric conditions, and a variety of surgical circumstances, resulting in increased morbidity and mortality in the critically ill. Recently, the role of recombinant factor VIIa (rFVIIa) in the management of uncontrolled bleeding has attracted interest. rFVIIa was initially developed (and licensed) for the treatment of hemophilia. ⋯ Recently, the first randomized controlled trial of rFVIIa in trauma patients reported a significant reduction in red blood cell transfusion, and a trend toward reduced mortality and critical complications. As evidence builds to support the use of rFVIIa, nurses need to be aware of the administration and safety issues of this treatment.
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Gastric ulcers have been known to develop in critically ill patients secondary to physiological stress since the 19th century. It is only relatively recently that stress ulcer prophylaxis has become an established routine practice in the intensive care unit. Numerous terms have been used to describe stress ulcers, but stress-related mucosal disease (SRMD) is commonly used. ⋯ Critically ill patients are at an increased risk for developing SRMD and subsequent bleeding secondary to several risk factors. To minimize stress-related mucosal bleeding, several regimens have been used. This article presents an update on the incidence, pathophysiology, risk factors, and prophylaxis of SRMD.