Articles: intensive-care-units.
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The proliferation of alarms on equipment in ICUs contributes to a level of noise that can disturb both patient and staff. To determine whether these alarms are identifiable by sound alone to our ICU staff, we recorded 33 audio signals commonly heard on the ward, 10 of which we defined as critical alarms. One hundred subjects (25 physicians, 41 nurses, and 34 respiratory therapists) listened individually in a quiet room to the tape recording that consisted of 10 s of audible followed by a 10-s pause for a written response. ⋯ Those with > 1 year ICU work experience scored higher than those with less than 1 year. We conclude that the myriad of alarms that regularly occur in the ICU are too much for even experienced ICU staff to quickly discern. Patient and caregiver alike could benefit by a graded system in which only urgent problems have audible alarms, and these should be covered by regular in-service training.
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Patient exposure to ionising radiation in the intensive care unit due to portable chest radiography.
The chest X-ray is the most commonly performed radiological examination in the intensive care unit. We used TLDs to measure the radiation exposure in 30 ICU patients due to portable chest radiography. The mean number of CXR was 3 (range 1-11). ⋯ Very small amounts of radiation were detected at the symphysis pubis and in more than half of the patients no radiation was detected at this site. These values are well above accepted norms. Patient exposure may be reduced by ordering fewer X-rays or by changing to a faster screen-film combination.
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The authors performed a study to document the impact of a clinical pharmacist on cost saving and cost avoidance in an intensive care unit, and to evaluate the cost saving and avoidance to justify additional clinical pharmacist positions. Over 13 consecutive 5-day weeks, a clinical pharmacist with 50% teaching responsibility documented time spent and all interventions that impacted the cost of drug therapy. Both cost avoidance and cost saving were documented on change in route, change in dosage, change to another drug, discontinuation of therapy, discontinuation of therapeutic duplication, discontinuation of inappropriate therapy, notification of pharmacy of discrepancy, and improper drug-level monitoring avoidance. ⋯ Although 31.3% of interventions involved change of dosage, interventions involving change to another drug (13.9%) had the largest economic impact ($62,527). The majority (85.4%) of the savings involved costs of medications saved (actual dollars saved rather than avoided). The authors concluded that the clinical pharmacist had a significant impact on the cost of drug therapy in the intensive care unit and that the cost of additional clinical pharmacist positions should be justified.
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To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. ⋯ The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.