Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2010
Health care providers' perceptions of family presence during pediatric resuscitation.
The Pediatric Intensive Care Unit (PICU) team strives to achieve the family-centred care philosophy consistent with the organization's vision and mission. In 2006, a team of nurses began exploration of the evidence on family presence during pediatric resuscitation with the primary goal to integrate this knowledge into practice. From the literature search, it was apparent there was limited published research, especially in a Canadian pediatric setting. This led to a staged research project to explore and, subsequently, integrate family presence during resuscitation into the culture. ⋯ In 2007, data demonstrated sufficient support to move this project forward. In addition, the survey indentified facilitators and barriers to assist in both the development of an evidence-based guideline and the successful integration into practice. In 2010, the post-implementation survey supported the evidenced-based practice guideline had achieved its goal of integration into practice.
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Dynamics (Pembroke, Ont.) · Jan 2010
Case ReportsHospital-acquired acute hyponatremia and reports of pediatric deaths.
Information from four voluntary reports of hospital-acquired acute hyponatremia leading to the death of otherwise healthy children is highlighted. In this column, we present two cases and information from a recent ISMP Canada Safety Bulletin, as well as two cases reported to ISMP United States. Information is shared to enhance health care practitioners' awareness of the potential for acute hyponatremia and to provide an overview of some of the potential underlying factors.
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Dynamics (Pembroke, Ont.) · Jan 2010
Where is end expiration? Measuring PAWP when the patient is on pressure support ventilation.
The hemodynamic information obtained from the pulmonary artery catheter provides physiologic rationale for a selected therapy and allows rapid determination of patients' response to the therapy. A wide range of pressure support levels have been used in pressure support ventilation (PSV), and patients' breathing patterns change from a spontaneous breathing pattern with low levels of PSV to a pressure control pattern with high levels of PSV. Different levels of pressure support have different effects on intrathoracic pressure. Changes in intrathoracic pressure may change the respiratory pattern and affect the timing for measuring the pulmonary artery wedge pressure. ⋯ Different levels of pressure support have various impacts on the intrathoracic pressure and alter the respiratory pattern. Using the proximal airway pressure, nurses can identify the location of end-expiration and measure the PAWP accurately.
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Dynamics (Pembroke, Ont.) · Jan 2010
Development, dissemination and implementation of a sedation and analgesic guideline in a pediatric intensive care unit...it takes creativity and collaboration.
Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children. ⋯ The quality of patient care initiative focused on consistent use of (a) validated sedation and analgesia assessment tools, (b) a goal-directed approach by identifying daily therapeutic target scores and titrating interventions accordingly, and (c) non-pharmacologic, pharmacologic and adjunctive measures. The authors describe their experience in the development, dissemination and implementation of an interprofessional guideline directed at improving sedation and analgesia and patient safety in the PICU. Tools developed to support the practice change, challenges and lessons learned are shared.