American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Checklists have been recognized by multiple industries as a valuable tool to reduce errors of omission. In the busy environment of a pediatric intensive care unit, adverse events are common and can have severe consequences. Researchers have focused on developing evidence-based practice guidelines; however, the nature of human error means that consistent application of this evidence in practice is challenging. ⋯ Prevention of adverse events is better than cure. Use of the KIDS SAFE checklist has the potential to reduce errors of omission in pediatric intensive care units.
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Comparative Study
Dedicated multidisciplinary ventilator bundle team and compliance with sedation vacation.
How compliance with a ventilator bundle is monitored varies from institution to institution. Some institutions rely on the primary intensive care unit team to review the bundle during their rounds; others rely on a separate team of health care personnel that may include representatives from disciplines such as nursing, respiratory therapy, and pharmacy. ⋯ A dedicated ventilator bundle rounding team improves compliance with sedation vacation, but not with spontaneous breathing trials and prophylaxis of peptic ulcer disease. In a large-volume tertiary center, a dedicated ventilator bundle rounding team may be more effective than the primary rounding team in achieving compliance with some bundle components.
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Case Reports
Repeated scenario simulation to improve competency in critical care: a new approach for nursing education.
In Japan, nursing education is being reformed to improve nurses' competency. Interest in use of simulation-based education to increase nurses' competency is increasing. ⋯ Our new educational approach of using repeated scenario simulations and TAINS seemed not only to enhance individual nurses' technical skills in critical care nursing but also to improve their nontechnical skills somewhat.
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Critically ill patients with circulatory shock sometimes need rescue treatment with high doses of norepinephrine, a treatment that may be associated with a poor outcome because of excessive vasoconstriction. ⋯ Although the cause of shock and treatment with norepinephrine were not predictive of death when high doses of the drug were deemed necessary, rescue treatment with high-dose norepinephrine is futile in patients with severe disease and metabolic acidemia.