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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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.
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High-quality communication is a key determinant and facilitator of patient-centered care. Nurses engage in most of the communication with patients and patients' families in the intensive care unit. ⋯ Critical care, including communication, is a collaborative effort. Understanding how nurses engage in patient-centered communication in the intensive care unit can guide future interventions to improve patient-centered care.