Critical care nursing clinics of North America
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POCT is rapidly expanding in today's critical care areas. Nurses need to be involved in the implementation and evaluation process of POCT at every step. Each institution must determine which bedside tests are indicated based on an in-depth analysis of test accuracy, positive clinical impact, and cost-benefit ratio. ⋯ In addition, clinicians should examine the cost to patients regarding comfort and quicker discharge. These are quality indicators from the patient's perspective. POCT offers many advantages, but surrounding the implementation of this technology is a multitude of questions that each institution must answer prior to undertaking a POCT program.
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Crit Care Nurs Clin North Am · Dec 1998
Review Comparative StudySelecting and managing fluid therapy. Colloids versus crystalloids.
The critical care nurse is responsible for monitoring the effects of parenteral therapy. If the nurse is to collaborate with the physician on the type of solution appropriate for the patient, it is imperative that the nurse understand how the solution will impact the patient. Only through comprehending the effects and properties of each solution can the nurse provide quality care and ensure desirable patient outcomes.
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Crit Care Nurs Clin North Am · Dec 1998
Review Case ReportsFluid balance assessment. The total perspective.
Fluid balance assessment is a fundamental aspect of caring for critically ill patients who often have volume disturbances. Since the introduction of hemodynamic monitoring in the critical care setting decades ago, we have become more dependent on technology to assist us in evaluating a patient's fluid status and less skilled in basic physical examination and interpretation of common blood and urine values. Information obtained from these basic clinical skills is equally as, if not more, important as numbers derived by invasive means.
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Crit Care Nurs Clin North Am · Mar 1998
ReviewHistorical development of outcomes-based care delivery.
Outcomes-based care delivery is both a subtle and profound change in practice. It is proactive, patient-centered, data-generating, and establishes clear accountability. Most importantly, outcomes defined and managed at the patient-provider level will be the quality conscience as health care enters a new millennium.
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Crit Care Nurs Clin North Am · Mar 1998
ReviewThe long-term mechanically ventilated patient. An outcomes management approach.
As noted previously, prior to permanently instituting an outcomes approach, we compared the effects of such a model to a nonoutcomes-managed approach. The positive trend noted during the study interval has been sustained 2 years later, and the variables of cost, LOS, and ventilator duration (median = 9 days for DRG 475, 483 combined) for these patients continue to be favorably affected (see Figure 2). In addition, the outcomes-management model has been well accepted by all members of the health care team. ⋯ Provision of quality, cost-effective care for patients requiring prolonged ventilation is a true clinical challenge. Outcomes management is a multidisciplinary method of care delivery that is systematic and comprehensive in approach. Although little science exists related to the application of the model for patients requiring prolonged ventilation, preliminary reports are promising and warrant future applications and evaluation of the same.