Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2012
Review[Delirium in the intensive care unit : Overview for nurses and physicians].
Delirium is a severe but frequent organ dysfunction in intensive care units (ICU) affecting nearly 80% of mechanically ventilated patients and up to 50% of non-ventilated patients. Although guidelines for diagnosis and treatment of delirium exist it often remains underdiagnosed due to the lack of implementation of these guidelines. ⋯ Delirium results in longer mechanical ventilation, extended hospital stay, more nosocomial infections and an increased mortality. Measures which improve the frequency of diagnosis and increase the quality of treatment will only be successful if physicians, nursing staff and other medical staff on ICUs realize strategies together and raise their awareness on delirium.
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Med Klin Intensivmed Notfmed · May 2012
Case Reports[The palliative care team in the intensive care unit].
The aim of palliative care is to relieve suffering and stabilize or improve quality of life. Prolongation of life and focus on quality of life seem to be at first glance mutually exclusive. However, in daily clinical routine they occasionally do simultaneously occur, when further medical treatment to prolong life is not successful, not appropriate, or simply refused by the patient. ⋯ They also facilitate referral of seriously ill patients to a hospice or home. Palliative care consultation is recommended, if distressing symptoms can not be alleviated sufficiently or support for referral of terminally ill patients is sought. In addition, a PCT can provide support in discussions about withdrawal of life-prolonging treatments and the aims of therapy.
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Med Klin Intensivmed Notfmed · May 2012
[Occurrence and prevention of errors in intensive care units].
Recognition and analysis of error constitutes an essential tool for quality improvement in intensive care units (ICUs). The potential for the occurrence of error is considerably high in ICUs. ⋯ A system approach needs to consider human limitations and to design working conditions, workplace, and processes in ICUs in a way that promotes reduction of error. The development of a preventive safety culture must be seen as an essential task for ICUs.
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Communication plays a crucial role in the intensive care unit. Posttraumatic stress syndromes develop in a significant number of patients and their relatives after being in an intensive care unit. The syndromes may persist for several years. ⋯ Rounds of discussions among the work groups are the basis for a healthy team structure. Inadequate communication, e.g., during emergencies or shift change, endangers the safety of patients and in the worst case, results in treatment mistakes. Measures for improved communication in the intensive care unit should always be implemented.
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Med Klin Intensivmed Notfmed · May 2012
[Quality management in intensive care medicine. Indispensable for daily routine].
In areas requiring maximum safety like intensive care units or operating room departments, modern quality management and risk management are essential. Treatment of critically ill patients is associated with high risk and, therefore, demands risk management and quality management. ⋯ In addition, regional networks of intensive care physicians result in improved local networking. In intensive care medicine, this innovative modular system of quality management and risk management is pursued more consequently than in any other specialty.