BathMat: development and early evaluation of an inflatable prone repositioning device to enhance efficiency and patient safety on intensive care units

Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine. The demand for cardiovascular critical care is increasing with the aging of the population and is reflected by trends in the use of critical care in general.1 Between 2000 and 2005, although the total number of hospital beds in the United States declined by 4.2%, the number of critical care beds increased by 6.5% and the annual costs attributed to critical care increased by 44%, representing 13.4% of hospital costs.2 Projections for the next 15 years suggest that the need for critical care will increase markedly in the United States and globally.1,3–5 For example, in Canada, a 57% increase in the need for critical care beds is anticipated during that period.5 Concurrent with increases in demand, the medical demographics of general and cardiac critical care have evolved toward a patient population with an increasing number of comorbid medical conditions who require more prolonged and more technologically sophisticated invasive support. As a result, the delivery of critical care is advancing substantially in its complexity. Moreover, accumulating evidence has indicated that outcomes are better when critical care is provided by specially trained providers in a dedicated intensive care unit (ICU).6–9 In the context of this evolution, provision of optimal care in the contemporary cardiac ICU (CICU) presents a different set of challenges and requires an expanded set of skills compared with 10 years ago. Cardiovascular medicine has lagged behind other medical disciplines that have met the “critical care crisis”4 with ICU-focused innovations in organization, training, and quality improvement. Therefore, the American Heart Association Council on Cardiopulmonary, Critical …

Keeping Patients Safe During Intrahospital Transport

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

BackgroundPatient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture.ObjectiveOur aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture.MethodsHealth care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User’s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents.ResultsWe distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions.ConclusionsOur study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture.

Medication Errors in the Intensive Care Unit

The future of intensive care

Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses

Supplemental Digital Content is available in the text.

BackgroundProviding optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The “ICU Support” team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of “ICU Support” for patient- and staff-centered outcomes.MethodsICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors.DiscussionThe need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff.Trial registrationGerman Clinical Trials Register DRKS00028642. Registered on 4 April 2022.

Purpose: Intensive care units (ICUs) are departments that use high-risk drugs and medical devices. Therefore, patient safety is especially important in ICUs. However, new nurses in ICUs often lack patient safety competencies. Thus, it is necessary to improve patient safety competencies for new nurses working in ICUs.Methods: This methodological study was designed to develop a simulation program to improve patient-safety competencies among new nurses working in ICUs. To develop a patient-safety simulation program, we conducted a survey on educational needs and reviewed the core competencies of patient safety applicable to healthcare providers. Additionally, we conducted an expert validation process and a pilot test.Results: A simulation-based patient safety program was developed that spanned 4 weeks (240 minutes).Conclusion: The patient safety simulation program, which considered the characteristics and competence levels of new nurses working in ICUs, was found to be appropriate. This program is expected to improve the patient safety competencies of new intensive care nurses, thereby contributing to the creation of a safer ICU environment.

Patient safety is stated as the fundamental principle of good patient care (Summary of the evidence on patient safety: implications for research, WHO, Geneva, 2008). Nearly half (45%) of the adverse events in the Critical Care Safety Study were deemed preventable (Shostek, J Ambul Care Manage 30: 105–113, 2007). Patient safety incidents lead to unnecessary suffering and are a major cause of prolonged hospital stays. Human error is stated as the most common cause of patient safety incidents. Ensuring patient safety is becoming increasingly important for cardiac surgery intensive care unit practitioners. The cardiac surgery intensive care unit is particularly prone to medical errors because of the complexity of the patients, interdependence of the practitioners, and dependence on team functioning. Approaches related to high-reliability organizations (HRO) such as aviation have been applied in health care to prevent incidents and to ensure the delivery of proper care (Riley, J Nurs Manag 17: 238–246, 2009). Measurements of patient safety culture, teamwork, and continuous improvement and organizational learning, including team training with the use of simulation (Wilson et al., Qual Saf Health Care 14: 303–309, 2005), are all HRO approaches (Evidence scan: high reliability organizations, The Health Foundation, London, 2011) recommended as initiatives to improve quality and patient safety in health care. A culture of safety is created through changes in health personnel’s safety perspective and work behaviors, and human resource professionals are an essential contributor to this development. Human patient simulation-based training is a recommended method to make health-care professionals aware of the importance of teamwork and the aspects of team performance (Crossing the Quality Chasm: A New Health System for the Twenty-First Century, National Academy Press, Washington, DC, 2001). Team training program based on crew resource management can be used to improve efficiency, morale, and patient safety in health care (West et al., J Nurs Adm 42: 15–20, 2012). Several important factors play a role in fostering patient safety in the postoperative adult cardiac surgery intensive care unit environments, such as a patient safety culture, better communication, team performance, and team training strategies as initiatives for building patient safety within the adult cardiac surgery intensive care unit.

The role of safety leadership in nursing management during the pandemic

The intensive care unit (ICU) is considered a high- risk area in the hospital because of the severity of injuries and the high liability of occurrences associated with ICU. Critically ill patients are at high risk for actual or potential life-threating health problems. Moreover, critical care nurses must develop their knowledge, skills, and safe practice in acute areas where patients require more detailed observation or intervention to deliver safe and effective care. Objectives: This study aimed to assess the effect of an educational program on nurses’ practices regarding the implementation of patient care and safety measures during enteral feeding. Design: The quasi-experimental design was used in this study. Methods: The study was conducted from June to September 2020. All registered nurses who were working in the intensive care units during the period of data collection comprised the sample. Based on the nurses’ needs regarding the condition of their competencies during the initial assessment, we developed and designed the educational program. This program consists of two parts: theory and practical. The program contains workshop (8 hours) per day and educational pamphlet handout. The workshop consists of PowerPoint presentations, group discussions, and training scenarios. Results: This study was carried out with 48 nurses working in the previous intensive care units. The nurses’ score were improved after the program regarding to nurses’ age, qualification, and experience. The overall study found a statistically significant relationship of this procedure before and after the implementation of the educational program (p&lt;0.001). Conclusion: There has been remarkable and variation improvement of nurses performance after they received the education program. The results show that a statistically significant difference was found before and after implementing the program regarding the nurses’ age, qualification, and experience. It is recommended to pay more attention to these nurses by helping them to improve their knowledge and practices in all nursing interventions. Furthermore, it is necessary to improve nurses’ awareness regarding the quality of care and patient safety. It was also found that the poor knowledge and practice and its complications have a negative impact on the quality of care and patient safety.

Statement of the problem: Critically ill patients in Intensive Care Units (ICUs) are faced with the challenge of surviving in a high-risk area and rely on healthcare professionals to ensure their safety and provide complex care. One way of measuring safety attitudes in the ICU is through self-reporting questionnaires. Aim: To examine attitudes to patient safety in ICU from the perspective of healthcare professionals in the Kingdom of Saudi Arabia (KSA). Method: A descriptive cross-sectional design was employed. The survey instrument - Safety Attitude Questionnaire (SAQ-ICU version) – comprised items regarding attitudes to patient safety, rating of communication and collaboration with colleagues, as well demographic questions. Results: Sixty per cent (n= 144) of the healthcare professionals from two hospitals in Taif in KSA responded. Six safety domains were scored and showed that all participants had a negative attitude towards patient safety in the two ICUs, with one ICU scoring lower in all domains. Mean scores across domains ranged from 47.14 to 70.36 on a 100-point scale, with lowest scores for the ‘perceptions of management’ domain. Leaders and bedside nurses shared similar attitudes across domains. There was a significant difference in attitudes between respiratory therapists (RTs) and nurses (F (2, 131) = 4.18, p= 0.017); there were no other significant differences between groups. Whilst communication was mostly scored as adequate, physicians rated communication high with each other and with nurses (t= 4.35, p= 0.000). Conclusion: The findings indicate that all domains need further attention. Differences between the two ICUs indicate that hospital safety culture may be an important issue for exploration in further studies.

Counterpoint: Should an Anesthesiologist Be the Specialist of Choice in Managing the Difficult Airway in the ICU? Not Necessarily