Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Sep 2015
Implementation of an Intensive Care Unit Delirium Protocol: An Interdisciplinary Quality Improvement Project.
Delirium is a commonly observed problem for adult patients in the intensive care unit (ICU) that is associated with increased mortality, increased hospital length of stay, and long-term disability of ICU survivors. This makes prevention and prompt treatment of delirium imperative goals for critical-care providers. Bedside critical-care nurses are uniquely poised to champion efforts to prevent, detect, and treat delirium but oftentimes are not aware of the most recent evidence-based guidelines or the potential long-term implications for the ICU survivor. Nurses have reported higher levels of confidence in detecting delirium, increased knowledge of delirium, and enhancement of patient care skills after receiving formal didactic educational training. ⋯ This quality improvement project demonstrates that a formal didactic training program for ICU nurses can result in increased awareness and knowledge of ICU delirium and adequately prepare them for how to properly screen and treat patients. Although overall compliance with implementing daily ICU delirium screenings and care bundle interventions was relatively low, those patients who did receive screening and interventions demonstrated that the incidence of positive delirium screenings at this facility is low compared with reported figures. In addition, patients who did receive the appropriate care bundle interventions did so in a uniform manner, regardless of the presence or absence of clinical delirium.
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Critically ill intensive care unit (ICU) patients often experience pain, anxiety, panic, fear, dyspnea, and distress related to mechanical ventilation. Patients' recollections vary from having little or no memory of actual events to having total recall. Few studies have examined family members' memories and congruence with patients' symptom report and nurse observation. ⋯ Further inquiry of the patient's experience with mechanical ventilation, the use of a ventilation sedation management protocol, and the evaluation of effective communication tools such as the use of bedside reporting or patient communication boards is warranted.
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Dimens Crit Care Nurs · Sep 2015
Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital.
The ABCDE bundle is an evidence-based, multidisciplinary approach to optimizing patient outcomes in the adult intensive care unit (ICU). The ABCDE bundle incorporates awakening, breathing, coordination, delirium monitoring and management, and early mobility to minimize potentially deleterious effects of prolonged hospitalization, including the development of delirium. ⋯ Implementation of the bundle decreased average patient hospital length of stay by 1.8 days, reduced length of mechanical ventilation by an average of 1 day, and established a baseline delirium prevalence of 19% over a 3-month time period. The results of this project indicate that the ABCDE bundle can be implemented in rural, community-based hospitals and provides a safe, cost-effective method for enhancing ICU patient outcomes.
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Dimens Crit Care Nurs · Sep 2015
Delirium and Dementia in the Intensive Care Unit: Increasing Awareness for Decreasing Risk, Improving Outcomes, and Family Engagement.
: Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. ⋯ It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.