American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. ⋯ Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.
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Critically ill adults often cannot self-report pain. ⋯ Implementation of the tool increased frequency of pain assessment and appeared to influence administration of analgesics in both units.
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Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit. ⋯ Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium.