ICU Department Research Articles

Evaluation of antibiotic consumption using WHO -antimicrobial consumption tool and AWaRe classification

ABSTRACT Introduction: Antimicrobial resistance is a public health concern with global ramifications. Antibiotic misuse and overuse, are rampant in our country but more alarming is the data on the use of antibiotics primarily because of lack of access is another threat. A majority of the data on drug sales and consumption in India comes from the private sector and is typically gathered from private commercial organization. Because data on antibiotic usage in India is rarely reported, the study’s objectives were to estimate antibiotic consumption in ICU patients and also to assess antibiotic usage trends using the WHO AWaRE classification. Materials and Methods: A prospective observational study was carried out in the ICU department for six months after obtaining institutional ethics committee approval (P14/2021/14). In-patient records and details on antibiotic prescriptions were collected from the day of admission until they were discharged from the intensive care unit. Data on antibiotic consumption were retrieved from the hospital pharmacy. Descriptive statistics such as frequency, percentages, and means were used to summarize the data. Microsoft Excel 2016 was used for all statistical analyses. Results: The results of the study showed that female patients (54%), made up a significant majority of those receiving antimicrobial treatment. The age group between 40–49 years (21.68%) was the most common for those receiving antimicrobial treatment. Surgical prophylaxis (37.34%) emerged as the most common indication. Among the different antimicrobials studied, ceftriaxone 1 gm (108.5 DDD) emerged as the most prescribed antimicrobial. The access group of antibiotics accounted for 55% of the total usage. Conclusion: Appropriate use of antibiotics is important to minimize the risk of adverse events and antimicrobial resistance.

PREVALENCE OF MISSED NURSING CARE AMONG SENIOR NURSING STAFF

Missed nursing care (MNC) refers to the partial, delayed, or omitted delivery of essential patient care. It is a critical issue in healthcare systems worldwide, directly impacting patient safety, satisfaction, and outcomes. While extensively studied in developed nations, evidence from low- and middle-income countries, particularly Pakistan, remains limited. Objective: To evaluate the prevalence of MNC among senior nursing staff and identify contributing factors in a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 245 registered nurses working in the ICU, ER, and other departments of Sir Ganga Ram Hospital, Lahore. Data were collected using an adapted questionnaire assessing MNC frequency and analyzed using SPSS. Descriptive statistics were calculated, and the reliability and validity of the tool were confirmed through Cronbach’s Alpha and Kaiser-Meyer-Olkin (KMO) measures. Results: The study found a high prevalence of MNC, with discharge planning (Mean = 2.77, SD = 1.14), patient ambulation (Mean = 1.79, SD = 0.99), and mouth care (Mean = 2.26, SD = 1.23) identified as the most frequently missed tasks. Contributing factors included excessive workload, resource shortages, and insufficient staffing. Nurses with less experience were more likely to report missed tasks, highlighting the importance of clinical exposure and training in reducing care omissions. Conclusion: Missed nursing care poses a significant challenge to healthcare quality and patient safety in Pakistan. Addressing these issues requires systemic reforms, including improved staffing ratios, resource allocation, and professional development programs. These findings provide valuable insights for policymakers and healthcare administrators to implement effective interventions aimed at mitigating MNC and enhancing nursing care quality.

A Comparison of Sodium Citrate and Sodium Bicarbonate's Safety and Effectiveness in Treating Metabolic Acidosis in Patients with Chronic Renal Disease

Background: Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD) that accelerates disease progression and worsens overall health outcomes. Objective: This study compares the safety and effectiveness of sodium citrate and sodium bicarbonate in treating metabolic acidosis in CKD patients to determine the optimal therapeutic approach. Method: A prospective randomized clinical trial was conducted at the Department of Anesthesiology and ICU, Shaheed Monsur Ali Medical College and Hospital, Dhaka, Bangladesh, from October 2023 to September 2024. A total of 132 CKD patients with metabolic acidosis were randomly assigned to two groups: Group A (66 patients) received sodium citrate, and Group B (66 patients) received sodium bicarbonate. Safety, efficacy, and acid-base balance were monitored over 12 months. Results: Both sodium citrate and sodium bicarbonate significantly improved serum bicarbonate levels and reduced blood acidity. In Group A, 85% of patients showed a 50% reduction in acidemia, compared to 78% in Group B. However, Group A demonstrated superior gastrointestinal tolerance (10% side effects) compared to Group B (25% side effects). Sodium citrate also improved bone health markers, with a 15% improvement in calcium levels, while sodium bicarbonate patients had a 10% increase. However, sodium bicarbonate was more cost-effective. Conclusions: Sodium citrate appears to be more effective and better tolerated than sodium bicarbonate in treating metabolic acidosis in CKD patients, though cost considerations may influence therapeutic choices.

Hypophosphatemia as a Prognostic Value in Acute Exacerbation of COPD: Prospective Study

Abstract Background Acute exacerbation of chronic obstructive disease leads to repeated hospital admissions and is associated with a high mortality rate, making it a leading cause of disability and morbidity. Phosphorus is an important and essential electrolyte that plays a significant role in various physiological and cellular biochemical processes, including adenosine triphosphate high energy bonds, which affect muscle contractility, cellular integrity, and other biological functions. Aim of the Work to evaluate the prognostic effects of hypophosphatemia in acute exacerbation of COPD patients and evaluate the correlation between phosphorus levels and the severity of acute exacerbation of COPD. Patients and Methods a prospective comparative study that was conducted on patients admitted to ER previously diagnosed as COPD with Gold score (moderate IIA to very severe IV) suffering from acute exacerbation of COPD at Ain Shams University Hospital throughout 6 months. Results The study found a male predominance (85%) among the included COPD patients with acute exacerbation. COPD patients with hypophosphatemia were significantly associated with a need for mechanical ventilation and failed weaning. Blood gas analysis is an important method in ICU departments which can evaluate the condition and progress of patients with acute exacerbation of COPD. Conclusion Hypophosphatemia was found to be a predictor of failure in weaning from mechanical ventilation among patients with acute exacerbation of COPD. Treatment with phosphorus improves outcomes and reduces the duration of mechanical ventilation.

The Effect of Intrathecal Anesthesia during Emergency Caesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

Background: Severe preeclampsia and eclampsia are common in Bangladesh and are one of the leading cause of perinatal morbidity and mortality. The aim of the study is to observe the effect and hazards of intrathecal anesthesia for the mangement of caesarean section for severe pre-eclampsia and eclampsia patients. Management of these patients is very much important for the strenuous obstetrician and anesthesiologist both. Materials and Methods: This retrospective observational study was conducted in the Department of Anesthesiology and ICU of the IAHS (Institute of Applied Health Sciences) Chattogram from January 2022 to December 2022. Total 50 ASA grade 1 or 11, aged between 18-40 years, need urgent LSCS of 1-2 hours duration cases were selected purposively for intrathecal anesthesia. Patients with known cardiovascular and pulmonary diseases, fetal distress, severe maternal distress, uncontrolled DM, presence of any contraindication, patient’s refusal for SAB, septicemia, BP>170/120 mmhg, altered coagulation profile, APH, IUD were excluded from this study. Results: Among the study subjects, 30(59.68%) cases were primigravida patients- out of which five had severe pre eclampsia and 25 had eclampsia. Intraoperative shivering was observed in 18(29.03%) cases, postoperative shivering was observed in 16(25.80%) cases. Acute renal failure was found in 3(6%) cases, HELLP syndrome 10%, DIC 8%, abruption placentae 14%, pulmonary edema 4%, septicemia 16%, PPH 12% and postpartum eclampsia 22% cases. Apgar score <7 at 5 minutes in severe PET was observed in 04(6.45%) cases and eclampsia in 07 (14.51%) cases. Among them 10(20.96%) were eclamptic and 02(4.83%) had PET. p value was found 0.000 which is very highly significant. Conclusion: The outcome results of intrathecal anesthesia is better than general anesthesia. IAHS Medical Journal Volume 6(2) December 2023; 58-63

Significance of acupuncture treatment for medical staff with low back pain: A case report.

A 24-year-old female nurse with a 4-month history of low back pain (LBP) was treated with acupuncture because of difficulty to her working. At the first presentation, the numerical rating scale (NRS) value was 7. After 2 weeks, the NRS value improved to 2-3, and she could bend over better, including when working night shifts. After 4 months, the NRS value remained at 1-2 so her relocating or leaving of absence from the ICU department was avoided. Acupuncture treatment for medical staff with LBP could relieve their pain and improve decreased clinical performance in hospitals or clinics.

Epidemiological study on non-drug-resistant Acinetobacter

Objective. To explore the prevalence of non-drug-resistant Acinetobacter, in order to provide a theoretical basis for clinical anti-infection treatment of non-drug-resistant Acinetobacter. Methods. The medical records of inpatients in various departments of the hospital were retrospectively sorted out, and the data covered many aspects of human body such as blood, saliva, sputum and tissue. Immediately after collection, samples were labeled and stored in a refrigerator at 8°C to investigate clinical distribution and prevalence. Results. Among the 158 strains of non-drug-resistant A. baumannii, 30 strains were obtained from sputum samples (18.98%). The second most common type was 11 strains in urine (6.96%); 44 blood samples, accounting for 27.85%. The age distribution was as follows: 8 strains (11.39%) were minors under 18 years of age; There were 20 plants (12.66%) aged from 18 to 30 years old; 75 strains (47.47%) were over 60 years old. Nine of the 158 non-resistant strains were included, accounting for the highest proportion of A. Boumani, followed by A. Boumani Hospital and A. Boumani Pittsburgh. At present, the bacterial strain is mostly detected in blood samples, and is mainly distributed in middle-aged and old patients over 50 years old, and is relatively popular in ICU and FMW departments. Conclusion. The drug-resistant A. baumannii in hospital specimens tends to accumulate in ICU, and the nosocomial infection caused by this disease is mainly concentrated in the elderly and patients with various basic diseases, with a high detection rate. Acinetobacter strains are generally resistant, and polymyxin B and minocycline are often the first choice of therapy.

Constipation and related factors among patients in ICU of Department of Neurology and Neuro Intensive Care, Viet Duc University Hospital

Constipation and related factors among patients in ICU of Department of Neurology and Neuro Intensive Care, Viet Duc University Hospital

MRSA and VRSA isolated from patients hospitalized in the ICU, NICU and surgical departments of hospitals

MRSA and VRSA isolated from patients hospitalized in the ICU, NICU and surgical departments of hospitals

Survey of immunological and bacteriological parameters of septicemia in patients hospitalized in ICU departments of Mosul hospitals

Survey of immunological and bacteriological parameters of septicemia in patients hospitalized in ICU departments of Mosul hospitals

Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients

Objective: To determine the comparison of homodynamic effect of propofol and ketofol duringinduction in general surgery patients.Study design: Randomized control trialSetting: Department of Anesthesia, Surgical ICU and Pain management, Civil Hospital Karachi.Duration: Seven months from June 2019 to January 2020.Methods: Patients scheduled for elective general surgery procedures, aged 20 to 60 years, bothmale and female patients were included. Patients were randomly allocated into two groups.Group A received a combination of ketofol while Group B received propofol as the inductionagent. After recording of the base line values of mean arterial pressure patient was induced usingpropofol or ketofol. Mean arterial pressure readings were noted at 30 seconds after druginjection, as well as at 1 minute, 5 minutes, and 10 minutes after intubation, to capture theimmediate hemodynamic effects of the drugs and to observe any potential changes over timefollowing intubation.Results: The average age of the patients was 37.38±13.78 years. Out of 64 patients, 30(46.9%)were male and 34(53.1%) were female. Homodynamic effect was significantly high in thosepatients who received ketofol than those who received propofol (100% vs. 59.4% p=0.0005).The findings observed also with significant differences in hemodynamic effects between the twogroups, even after controlling for age, gender, and ASA classification (p-<0.05).Conclusion: Combination of Ketofol with ketofol was observed to be the betterhemodynamically as compared to Propofol. Additionally, the use of ketofol reduces the cost ofinduction and decreasing the economic burden on the patient.

Thrombosis in severely ill patients admitted in ICU due to COVID-19 pneumonia. Data from a Greek Hospital

Background: SARS-CoV-2 can lead to a prothrombotic state and the activation of the body's coagulation mechanism, resulting in thrombotic episodes, especially in critically ill patients. The rates of thromboembolic disease in patients with COVID-19 vary and range from 10-40%, while in Greece the existing epidemiological data on the incidence of thromboembolic disease in the ICU are limited. Aim This study aimed to determine the proportion of hospitalized COVID-19 patients who developed thromboembolic disease (pulmonary embolism, deep vein thrombosis, or arterial embolism). It was also crucial to investigate at the relationship between the incidence of VTE (venothrombosis-VTE) and Covid infection in ICU patients. After 28 days from ICU admission, the survival rate of patients with Covid infection admitted to ICUs within the specified time frame was also noted. Method and Material: The study included 85 patients with Covid-19 infection who were hospitalized in two ICU departments in a large adult hospital in Athens between June and September 2021. The occurrence of VTE was diagnosed by computed tomography angiography, regarding the pulmonary embolism and with triplex veins of the lower extremities. Various epidemiological factors, laboratory findings and characteristics of the patients' hospitalization in the Intensive Care Unit were recorded. Results: The incidence of VTE in patients with Covid-19 infection admitted to the Intensive Care Unit was 14% (12/85 patients). Patients who experienced VTE during their hospitalization in the Intensive Care Unit had more days on mechanical ventilation support, more days on vasoconstrictor drugs, and had been transfused more times with blood plasma. In the multivariate analysis that followed, it was found that total days of mechanical ventilation (p=0.02), total days of vasoconstrictor administration (p=0.03) and plasma transfusion (p=0.03) were still statistically significant. Conclusion: In patients with Covid-19 infection and hospitalization in the Intensive Care Unit, longer stay on mechanical respiratory support, more days of vasoconstrictor drug administration and plasma administration are independent predisposing factors for the occurrence of VTE.

Evaluation of preoperative melatonin on emergence agitation after herniorrhaphy surgeries in pediatrics

Background and objective Emergence agitation is a common phenomenon in children recovering from general anesthesia. An emergence agitation reaction increases the risk of injuring the surgical repair, the patient, and the caregivers. Thus, we aim to explore the efficacy of melatonin premedication on emergence agitation in children undergoing herniorrhaphy surgeries. Patients and methods A randomized prospective triple-blinded trial was conducted on 117 children with herniorrhaphy surgeries conducted at the Anesthesia, ICU, and Pain Management Department, Menoufia University hospitals from April 2022 to July 2023. Results Yale preoperative scale at the start did not significantly differ among the studied groups (P>0.05). However, the Yale preoperative scale at 1 was significantly higher in group 1 with a mean of 10.2±1.9 than in group 2 (9.5±1.4) and group 3 (5.9±1.4) (P<0.001). The agitation score at 5 h was significantly higher among group 1 with a mean of 2.77±0.67 than group 2 (2.56±0.64) and group 3 (2.03±0.96) (P<0.001). Also, agitation scores at 10 and 15 h were significantly higher in group 1 (3.36±0.63, 4.2±0.66) than in group 2 (3.2±0.66, 3.79±0.73) and group 3 (1.74±0.88, 2.03±1.04), respectively (P<0.001). Conclusion Melatonin premedication decreased the agitation scale postoperatively. The decrease was significantly higher in high doses in preventing emergence agitation in children. High-dose melatonin compared with low dose might have a significant effect in preventing emergence agitation.

Cybersecurity and critical care staff: A mixed methods study

IntroductionCyberattacks on healthcare organisations are becoming increasingly common and represent a growing threat to patient safety. The majority of breaches in cybersecurity have been attributed to human error. Intensive care departments are particularly vulnerable to cyberattacks. The aim of this study was to investigate cybersecurity awareness, knowledge and behaviours among critical care staff. MethodsThis was a multi-site cross-sectional survey study administered to critical care staff. Cybersecurity awareness was evaluated using the validated HAIS-Q instrument. Knowledge and behaviours were evaluated by direct questioning and scenario-based multiple-choice questions. Free text options were also offered to respondents. Thematic analysis was performed on free text sections. ResultsMedian scores of 12–15 in each of the HAIS-Q focus areas were achieved, indicating high levels of cybersecurity awareness among critical care staff. However, self-reported confidence in cybersecurity practices, especially identifying signs of cybersecurity breaches and reporting cybersecurity incidents, were relatively low. Participants responses to the scenarios demonstrated a lack of knowledge and awareness of some of the mechanisms of cyberattacks. Barriers to safe cybersecurity practices among staff that emerged from the qualitative analysis included: a lack of training and education; heavy workloads and staff fatigue; perceived lack of IT support and poor IT infrastructure. ConclusionCritical care staff appear to have a high-level cybersecurity awareness. However, in practice safe cybersecurity practices are not always followed. ICU departments and hospitals must invest in the human aspect of cybersecurity to strength their cyber-defences and to protect patients.

Characteristics of acute kidney injury and mortality in patients with sepsis and septic shock

Background and Objective: Acute kidney injury (AKI) is a life-threatening disease and a global health burden, with an increasing incidence in both developed and developing countries. 40 - 50% of AKI cases are caused by sepsis and septic shock. Mortality increases respectively with disease severity. Therefore, we conduct this research with the objective of determining the incidence of sepsis-associated and septic shock-associated AKI and mortality in these patients. Methods: This cross sectional study was conducted on 65 patients with sepsis or septic shock in the Department of ICU - Hue Central Hospital - Vietnam, from February 2022 to March 2023. Results: Of the 65 patients admitted with sepsis and septic shock, 38 (58.5%) developed AKI, the rates of KDIGO stage 1, 2, 3 were 44.7%, 38.8%, and 18.5%, respectively. The rate of patients receiving RRT was 39.5%. The rate of patients with positive blood cultures was 12.6%. The average SOFA score, APACHE II score at admission were respectively 7.63 ± 5.8; 19.18 ± 9.2. The average serum levels of lactate and PCT in patients with sepsis and septic shock were respectively 3.9 ± 3.23 mmol/l; 33.13 ± 38.49 ng/ml. The average ICU length of stay was 9.03 ± 5.23 days, the rate of requiring mechanical ventilation was 36.9%, in-28-day mortality was 32.3%. Mortality was statistically significantly higher in the AKI groups compared to non-AKI group (p < 0.05). Conclusion: Patients with sepsis and septic shock have high rates of AKI and mortality, increased length of hospital stay. Key words: acute kidney injury, sepsis, septic shock.

Investigating the relationship between the increase in color doppler ultrasound indices of the ophthalmic artery and the serum lactate level and the severity of the disease in patients with sepsis.

Background: The objective of this study was to investigate the relationship between the increase in color Doppler ultrasound indices of the ophthalmic artery and the serum lactate level and the severity of the disease in patients with sepsis.
 Methods: This was a cross-sectional study conducted on 24 patients diagnosed with sepsis, who were admitted to the intensive care unit of Shariati Hospital. The patients were more than 18 years old, hospitalized in the first 42 hours, and selected by the portable color Doppler ultrasound available in the ICU department. The ESI probe was placed on the patient’s eye with the eyelid closed, and the ophthalmic artery was located. The indices including RI, PSV, PI were measured along with their serum lactate levels. The correlation of these indices with the severity of sepsis was checked.
 Results: In this study, 24 patients who were less than 81 years old were diagnosed with sepsis and had a sofa score above 3. It was observed that there is a significant relationship between the dose of increased lactate levels and PSV1, and this parameter can be considered a predictive factor. It was also observed that there is a significant relationship between the dose of increased lactate levels and PSV2, and this parameter can be considered as a predictive factor. Additionally, there is a significant relationship between the dose of increased levels of lactate and PI, and this parameter can be considered as a predictive factor.
 Conclusions: The study found a significant relationship between increased levels of lactate and decreased blood supply in the optic artery. It is suggested that due to the lack of numbers in this study, more samples should be investigated in future studies. In a scientific article, the use of “we” and “our” should be avoided. If necessary, the third person should be used.

The Effect of Concept Map Training on the Process of Study approach in Nursing Students

Introduction: It is very important to choose the appropriate teaching method that can cause meaningful, effective and usable learning for learners. The present study was conducted with the aim of investigating the effect of conceptual map on the study approaches of nursing students in intensive care unit internship. Methods: This is a semi-experimental study, 36 nursing students of Bandar Gaz Azad University, who were doing ICU internship at Hakim Jurjani Hospital in Gorgan in 2023, participated. The students were included in the study by census method and were assigned to two groups of intervention (18 people) and control (18 people) by random number table. The students of the test groups were trained in the ICU department for 40 hours using a concept map. Questionnaires, including demographic information and revised two-factor study approach questionnaire, were completed before the start of the internship and on the last day of the internship by the students of the experimental and control groups. Data were analyzed using Descriptive and analytical statistics (Shapiro-Wilk, U-Man-Whitney and T. Welch tests through SPSS. Results: The results showed that the average score of the study approach process before the intervention was 65.05 ± 8.18 in the test group and 60.55 ± 2.91 in the control group. Also, the average score of the study approach process in the test group after the intervention (68.83 ± 6.38) was significantly higher than the control group (60.05 ± 2.99) (p=0.02 , t=2.43). Conclusion: The score of the study approach process increased in the people who received training with concept map, so the concept map method promotes the meaningful learning of students and can be used in basic lessons that require high-level learning.

Incidence of effort-reward imbalance among nurses: a systematic review and meta-analysis.

To systematically evaluate the incidence of effort-reward imbalance among nurses. PubMed, Web of Science, Embase, CNKI, WanFang Data, and VIP databases were searched to collect studies on the incidence of effort-reward imbalance among nurses. The search timeframe was from database construction to December 2023. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. The meta-analysis was performed using Stata 17.1 software. A total of 60 studies, including 79,644 participants, were included. The prevalence of effort-reward imbalance among nurses was 52.3% (95% CI: 44.9-59.7%). In terms of time, the incidence of effort-reward imbalance among nurses before 2010 (26.6, 95%CI: 6.8-46.4%) and in 2010-2015 (42.4, 95%CI: 32.1-52.8%), 2016-2020 (60.2, 95%CI: 49.6-70.7%), and 2021-2023 (65.0, 95%CI: 51.5-78.4%) continued to increase. Geographically, Asia (57.4, 95%CI: 51.8-63.1%) nurses had a relatively higher prevalence of effort-reward imbalance. In terms of department, the incidence of effort-reward imbalance among nurses was relatively higher in operating rooms (71.8, 95%CI: 64.5-79.0%), ICU (64.6, 95%CI: 27.7-100.0%), emergency (68.7, 95%CI: 62.9-74.5%), and pediatrics (65.8, 95%CI: 32.2-99.3%). The prevalence of nurse effort-reward imbalance is high, and there are differences in its prevalence across time, geography, department. Hospital administrators should actively take measures to effectively prevent and reduce the effort-reward imbalance for nurses, especially for nurses in Asia, operating rooms, emergency pediatrics and ICU departments. PROSPERO (CRD42023452428).

Nurses’ engagement in antimicrobial stewardship and its influencing factors: A cross-sectional study

ObjectiveThis study aimed to investigate the level and influencing factors of nurses’ antimicrobial stewardship (AMS) engagement in China based on the capability, opportunity, motivation, and behavior (COM-B) theory, providing valuable insights for developing effective strategies to improve nursing quality in AMS. MethodsThis cross-sectional study was conducted in 17 tertiary hospitals in Hunan, China, from November 2021 to January 2022. A total of 4,514 nurses were selected. The Nurse AMS Engagement Questionnaire (NAEQ), developed using the COM-B theory, was used for evaluation. The questionnaire included capability (14 items), opportunity (7 items), motivation (6 items), and behavior (12 items) four dimensions, 39 items. ResultsThe total NAEQ score was 155.08 ± 27.12, indicating a moderate level. The score of the capability, opportunity, motivation, and behavior dimensions were 52.33 ± 13.48, 28.64 ± 5.76, 24.57 ± 4.57 and 49.53 ± 8.83, respectively. Significant differences in nurses’ AMS engagement were based on professional titles, whether working as a part-time infection control nurse, whether knowing the AMS teams and the defined daily doses of antibiotics, department type, the deployment of clinical pharmacists, and frequency of antimicrobial training and physician-nurse joint rounds (P < 0.05). Nurses with junior titles had higher scores on the NAEQ than nurses with intermediate titles (P < 0.05). Nurses who worked as part-time infection control nurses, knew the AMS team, and the defined daily doses of antibiotics had higher NAEQ scores than those who didn’t (P < 0.01). Nurses working in the ICU and infectious disease department had lower NAEQ scores than those in other departments, such as the ear, nose, and throat (ENT) department (P < 0.01). Nurses who had clinical pharmacists deployed in their department had higher NAEQ scores than those without or unclear deployment (P < 0.01). Furthermore, nurses who received more frequent antimicrobial training and participated in physician-nurse joint rounds had higher NAEQ scores (P < 0.01). ConclusionMultiple strategies, including enhanced education and training and improved multidisciplinary communication and collaboration, are expected to improve nurse AMS engagement. It is important to give more attention to nurses with intermediate professional titles, less experience, and those working in specific departments.

Critical illness among patients experiencing homelessness: a retrospective cohort study

PurposeTo understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing.MethodsThis retrospective population-based cohort study included adults admitted to any ICU in Alberta, Canada, for a 3-year period. Administrative and clinical data from the hospital, ICU and emergency department were used to examine healthcare resource use (processes of care, ICU and hospital length of stay, hospital readmission and emergency room visits). Regression was used to quantify differences in healthcare use by housing status.Results2.3% (n = 1086) of patients admitted to the ICU were experiencing homelessness; these patients were younger, more commonly admitted for medical reasons and had fewer comorbidities compared to those with stable housing. Processes of care in the ICU were mostly similar, but healthcare use after ICU was different; patients experiencing homelessness who survived their index hospitalization were more than twice as likely to have a visit to the emergency department (OR = 2.3 times, 95% CI 2.0–2.6, < 0.001) or be readmitted to hospital (OR = 2.1, 95% CI 1.8–2.4, p < 0.001) within 30 days, and stayed 10.1 days longer in hospital (95% CI 8.6–11.6, p < 0.001), compared with those who have stable housing.ConclusionsPatients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.