Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2007
ReviewEffect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit.
Pediatric intensive care unit patient care occurs in an unpredictable, technology-rich environment that is dependent on highly skilled providers who need constant communication-all features providing the setting for potential error. This review examines basic principles of human error and sleep physiology and evaluates the evidence for potential effects of fatigued healthcare workers and workload on medical error. BODY: The pediatric intensive care unit setting, examined from a human factors engineering standpoint, is a highly complex environment in which fatigue and excessive workload can provide potential "holes" that may allow errors to occur. A large body of evidence is examined that suggests sleep deprivation can impair medical and surgical performance and can be improved with scheduling intervention. Nursing fatigue and workload have documented effects on increasing intensive care unit error, infections, and cost. Specific environmental factors such as distractions and communication barriers are also associated with greater error. ⋯ Fatigue, excessive workload, and the pediatric intensive care unit environment can adversely affect the performance of physicians and nurses working in the pediatric intensive care unit. The weight of the evidence suggests that these factors have the potential to contribute to medical error in the pediatric intensive care unit.
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Pediatr Crit Care Me · Mar 2007
Direct observation approach for detecting medication errors and adverse drug events in a pediatric intensive care unit.
To determine the incidence, type, and stage of occurrence of medication errors and potential and actual adverse drug events (ADEs) in a pediatric intensive care unit (ICU) using trained observers. The preventability and severity of ADEs and the system failures leading to medication error occurrence were also investigated. ⋯ Our medication error rate was similar to that of previous pediatric ICU studies that used the direct observation method for reporting but higher than the rates in previous studies using other detection techniques such as voluntary incident reporting. Periodic direct observation and other ongoing data collection methods such as voluntary incident reporting have the potential to be complementary approaches to medication error and ADE detection.
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Pediatr Crit Care Me · Mar 2007
CommentDo pediatric patients with septic shock benefit from steroid therapy? A critical appraisal of "Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock" by Oppert et al. (Crit Care Med 2005; 33:2457-2464).
To review the findings and discuss the implications of studies on the use of low-dose corticosteroids in septic shock. ⋯ There is some, albeit limited, evidence for the benefit of low-dose steroids in adults with sepsis. No supporting data are available for the pediatric population; therefore, a randomized controlled trial in septic children is needed.
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Pediatr Crit Care Me · Mar 2007
Comparative StudyEndotracheal intubation and pediatric status asthmaticus: site of original care affects treatment.
Status asthmaticus is a common cause of admission to a pediatric intensive care unit (PICU). Children unresponsive to medical therapies may require endotracheal intubation; however, this treatment carries significant risk, and thresholds for intubation vary. Our hypothesis was that children who sought care at community hospitals received less aggressive treatment and more frequent intubation than children who sought care at a children's hospital. ⋯ Children with status asthmaticus are more likely to be intubated, and intubated sooner, at a community hospital. The shorter duration of intubation suggests that some children may not have been intubated had they presented to a children's hospital or received more aggressive therapy at their community hospital.
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Pediatr Crit Care Me · Mar 2007
Case ReportsOral and nasal enteral tube placement errors and complications in a pediatric intensive care unit.
To report five cases of errors in the placement of oral/nasal enteral tubes in a pediatric intensive care unit, and to review literature on placement techniques and complication rates. ⋯ Patients in the pediatric intensive care unit may have characteristics that place them at an increased risk for misplacement of oral or nasal enteral tubes into the respiratory tract. Placement of enteral tubes into the respiratory tract may cause serious morbidity and possibly mortality. Checking the placement of enteral tubes with traditional methods does not prevent misplacement in the respiratory tree, and new techniques should be considered.