Dynamics (Pembroke, Ont.)
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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.
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Dynamics (Pembroke, Ont.) · Jan 2009
National collaborative: Top five drugs reported as causing harm through medication error in pediatrics.
The Canadian Association of Paediatric Health Centres (CAPHC) and the Institute for Safe Medication Practices Canada (ISMP Canada) are working collaboratively to enhance the safety of pediatric medication use. Eleven CAPHC member organizations submitted data on more than 4,000 medication incidents to ISMP Canada for the period October 2005 to June 2008, 305 of which were reported as resulting in harm. From this, the top five drugs causing harm through medication error and contributing factors to the incidents were identified. In this article, we intend to inform critical care practitioners of the medication incident analyses and the collaborative pediatric patient safety initiatives underway.
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Dynamics (Pembroke, Ont.) · Jan 2009
Comparative StudyTotal spinal anesthesia for cardiac surgery: does it make a difference in patient outcomes?
Heart disease is a major cause of morbidity and mortality. While cardiac surgery is a viable treatment option, it is a potent physiological stressor. The surgical stress response may result in patient decompensation and negative patient outcomes. The goal of a novel anesthetic approach, which combines high spinal anesthesia with intrathecal morphine and general anesthesia (TSA), is to attenuate this stress response. ⋯ This evidence highlights the clinical nursing relevance of the type of anesthesia on postoperative care and outcomes. The knowledge gained from these findings will help to enable the multidisciplinary critical care team to anticipate TSA patient outcomes and to facilitate the development of appropriate and effective evidence-based, patient-focused plans of care. This pilot study establishes sound rationale for subsequent larger prospective cohort research of the TSA patient population.