Implementation In Intensive Care Unit Research Articles

ICU nurses' practice and intention to implement early mobilization: A multi-centre cross-sectional survey.

Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood. The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting. A cross-sectional, multi-centre, survey-based study. The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings. Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings. This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes.

Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis

BackgroundThe Family in Intensive Care UnitS (FICUS) trial investigates the clinical effectiveness of a multicomponent, nurse-led interprofessional family support intervention (FSI) and explores its implementation in intensive care units (ICUs). The local context of each ICU strongly influences intervention performance in practice. To promote FSI uptake and to reduce variation in intervention delivery, we aimed to develop tailored implementation strategies.MethodsA mixed method contextual analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed from March to June 2022 on eight ICUs assigned to the intervention group. ICU key clinical partners were asked to complete a questionnaire on CFIR inner setting measures (i.e., organizational culture, resources, learning climate and leadership engagement) and the Organizational Readiness for Implementing Change (ORIC) scale prior to group interviews, which were held to discuss barriers and facilitators to FSI implementation. Descriptive analysis and pragmatic rapid thematic analysis were used. Then, tailored implementation strategies were developed for each ICU.ResultsIn total, 33 key clinical partners returned the questionnaire and 40 attended eight group interviews. Results showed a supportive environment, with CFIR inner setting and ORIC measures each rated above 3 (scale: 1 low—5 high value), with leadership engagement scoring highest (median 4.00, IQR 0.38). Interview data showed that the ICU teams were highly motivated and committed to implementing the FSI. They reported limited resources, new interprofessional information exchange, and role adoption of nurses as challenging.ConclusionWe found that important pre-conditions for FSI implementation, such as leadership support, a supportive team culture, and a good learning climate were present. Some aspects, such as available resources, interprofessional collaboration and family nurses’ role adoption were of concern and needed attention. An initial set of implementation strategies were relevant to all ICUs, but some additions and adaptation to local needs were required. Multi-component interventions are challenging to implement within complex systems, such as ICUs. This pragmatic, theory-guided, mixed methods contextual analysis demonstrated high readiness and commitment to FSI implementation in the context of a clinical trial and enabled the specification of a tailored, multifaceted implementation strategy.

Assessment of the implementation of safe medication practices in Intensive Medicine Units.

To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. A descriptive multicenter study was carried out. Intensive Care Units. A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.

Psychosocial care for relatives in the ICU: framework concept

Family-centered care is an important aspect of care in intensive care medicine. But currently there is no agreement about the implementation in intensive care units (ICUs). Specific concepts of palliative medicine and pediatrics offer agood basis, but contents have to be adapted for the field of intensive care medicine. ICUs should formulate and implement aminimum standard based on the goals of shared decision-making, support for relatives in accompanying the patient, and support for the potentially burdened relatives themselves. Related protocols, reportings, and evaluation should be developed. Staff training in family-centered care and liability of provision is of great relevance for the implementation.

Assessment of the implementation of safe medication practices in Intensive Medicine Units

ObjectiveTo assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DesignA descriptive multicenter study was carried out. SettingIntensive Care Units. Participants/ProcedureA total of 40 ICUs voluntarily completed the “Medication use-system safety self-assessment for Intensive Care Units” between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. Main variablesCalculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, referred to the key elements and to each individual item for evaluation. ResultsThe mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these Units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages <50%. ConclusionsNumerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.

Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding: A retrospective cohort study.

Esophagogastroduodenoscopy (EGD) is a useful procedure performed for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD implementation in intensive care unit (ICU) patients with suspected GI bleeding. The objective of this study was to compare the clinical effectiveness of EGD in critically ill patients who are using high-dose proton pump inhibitor (PPI) for suspected GI bleeding.We retrospectively analyzed ICU patients using high-dose PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 1:1 propensity score matching was performed. The change in hemoglobin level, requirement of red blood cell transfusion, re-suspected bleeding event, length of ICU stay, and ICU mortality were compared between the EGD and non-EGD groups.Of the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI administration. In the EGD group, 22 (42.3%) patients showed normal findings, while esophagitis and gastritis were most common abnormal finding (n = 11, 21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing the 2 groups, the EGD group required a higher amount of red blood cell transfusion (packs) than the non-EGD group for a week (3.04 ± 0.44 vs 2.07 ± 0.25, P = .01). There was no significant difference in the change in hemoglobin level after 1 week (P = .15). After propensity score matching, the EGD group showed similar the requirement of red blood cell transfusion and change in hemoglobin level for a week (P = .52, P = .97, respectively). In analyses for all patients and propensity score matched patients, there was no statistically significant difference in term of re-suspected bleeding event rate, duration of ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU mortality were lower trend in the EGD group than the non-EGD group.This study showed that EGD had no definite clinical benefit in ICU patients using high-dose PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. However, it is necessary to consider EGD in patients who are tolerant.

User evaluation of the APP NAS software in intensive care unit

PurposeThe Nursing Activities Score (NAS) is a management tool that measures nursing workload, quantifying the care and the degree of complexity involved in the assistance, and can subsidize the managers for an adequate dimensioning of the team.ObjectiveThe objective of this study is to evaluate impressions of users who work in the intensive care unit (ICU) of APP NAS in the APP and WEB modules, comparing them with classical methods of score evaluation: printed paper (PP) and/or spreadsheet (SS).MethodsThis was a longitudinal, quantitative-descriptive study with professional nurses working in the intensive care of a University Hospital in Brazil. For the assessment test, the quality assessment process model was used, according to the NBR ISO / IEC 9126-1 standard employing the Questionnaire for User Interaction Satisfaction (QUIS). The research participants were nurses and nursing residents (n = 9) working in an ICU for at least 3 months in the institution. QUIS allows the evaluation of the following domains by grouping questions for each study group: general impressions, functionality, reliability, usability, efficiency, and maintainability.ResultsStatistically significant satisfaction scores (p < 0.05) were observed in APP NAS when comparing to the classical methods (PP and SS) in the evaluated characteristics except for reliability.ConclusionOur data showed broad approval of the APP NAS when comparing to classical methods making the software viable for implementation in ICUs of hospitals.

The impact of multidisciplinary team care on decreasing intensive care unit mortality

Patients with critical illness and high mortality risk are frequently admitted to intensive care units (ICUs). Therefore, improving the quality of healthcare for these patients is essential. Improving overall health and following best practices for patient safety are important goals in the health-care sector; especially in critically ill patients. To achieve these goals, many researches have been conducted to develop procedures, protocols and improve ICU structure and design. To discuss the effectiveness of multidisciplinary team (MDT) implementation in ICUs in the Saudi Arabian hospitals and how would this approach significantly reduce ICU mortality rates and improves the quality of healthcare. This review search of electronic search engines was conducted, including ProQuest, Medline, and Google Scholar. The search was narrowed to a total of 21 articles between 2010 and 2020 articles were included, which were found to match the inclusion criteria. Findings indicated a positive effect of the MDT care on decreasing the ICU's mortality rates. The studies reviewed have documented the necessity of successful MDT care implementation for improved survival rates. A collaborative approach by the various health-care providers-nurses, physicians, intensivists, respiratory therapists, and pharmacists–enhances patient care, improves clinical outcomes, and reduces the mortality rate.

How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study.

Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%-17.1%, averted 1,090-2,795 new carriers, 273-722 infections and 37-87 deaths over 3 years and saved $30.5-$69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved $47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.

Implementing Prone Positioning in Your Unit: What Do You Need to Know?

Prone positioning for patients with acute respiratory distress syndrome (ARDS) has been occurring for over 30 years. A recent randomized control trial showing significant impact on 30- and 90-day mortality has placed it into international guidelines as a strongly recommended therapy. The current coronavirus pandemic shined a light on prone positioning as a lifesaving technique to improve oxygenation. This has resulted in worldwide implementation in intensive care units (ICUs). To incorporate prone positioning into moderate and severe ARDS patients' routine practice, the multiprofessional team must address many factors. They include: Understanding why prone positioning works and the evidence to supports its use with moderate to severe ARDS patients.Identify screening strategies to determine which patients the position should be initiated early in the course of their disease.Multiprofessional development of a protocol is required to address indications for use, methods, frequency of prone positioning, contraindications, equipment needed, preparation of the patient to prevent injury, and care of the patient while in the prone position as indications for stopping the procedure.Development of education and implementation plans to ensure the successful integration of the new practice.

Re: Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study.

Re: Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study.

Measuring Family-centered Care in Intensive Care Units: Developing and Testing Psychometric Properties

Background: The availability of a valid scale to measure family-centered care (FCC) in intensive care units (ICUs) is of utmost importance. Purpose: the present study aimed to develop and test the psychometric properties of a new tool for measuring FCC in ICUs from the perspectives of patients’ family members. Method: This methodological study was conducted from May 2018 to November 2019 at two Iranian universities of medical sciences. The scale items were thus designed based on the integration of the findings of a qualitative study and the results of a literature review. Then, face validity and content validity of the given scale were assessed. A total number of 204 and 203 family members of patients admitted to ICUs were recruited through convenience sampling method to examine construct validity via exploratory factor analysis and confirmatory factor analysis. The data were also analyzed using the IBM SPSS Statistics (Version 25) and AMOS software. The reliability of this scale was ultimately tested using Cronbach’s alpha and test-retest correlation. Results: In the initial design, a 35-item scale was obtained. As face validity and content validity were determined, the number of items reduced to 26 cases. Following exploratory factor analysis, a 20 item scale containing 5 components (factors) including dignity, receiving information, support, family empowerment, and access to the physician, accounting for 63.4% of the total variance of the scale was developed. The reliability of this research tool was found acceptable based on Cronbach’s alpha and intraclass correlation coefficient by 0.89 and 0.93; respectively. Conclusions/Implications for Practice: This study concluded with the development of a new scale for measuring FCC in ICUs entitled “FCCS-ICU”. Accordingly, administrators and nurses are suggested to practice it to measure the extent and the manner of FCC implementation in ICUs from the perspectives of patients’ family members.

Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study.

Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers toward applying physiotherapy in ICUs. A 54-item survey for determining the characteristics of physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23-52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapist (low level of employment and practice, lack of shift); patient (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. The most common interventions were positioning, active, passive, and breathing exercises and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, team, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil.

Background Central venous catheter-associated bloodstream infections (CVC-BSIs) have been associated with increased length of hospital stay, mortality, and healthcare costs, especially in intensive care units (ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before and after implementation of the bundle in a hospital of infectious and dermatological diseases in Central Brazil. Methods A retrospective cohort study was conducted in two ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to assess the effect of the intervention in incidence density of CVC-BSIs: before and after intervention, related to the stages before and after the implementation of the bundle, respectively. Results No significant reduction was observed in the incidence density of CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-value = 0.469), despite the high bundle application rate in the postintervention period. Similarly, significant reduction in the incidence density in pediatric ICU has not been verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-value = 0.834). Conclusion Not significant reduction in the incidence density of CVC-BSIs was observed after bundle implementation in ICUs, suggesting the need to review the use of process, as well as continuing education for staffs in compliance and correct application of the bundle. Further studies are needed to evaluate the effect of bundle in the reduction of incidence density of CVC-BSIs in Brazil.

Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.

As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI). The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS. Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences. Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.

Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

Program Pengendalian Resistensi Antibiotik (PPRA) merupakan program wajib rumah sakit Indonesia sesuai Permenkes No. 8 tahun 2015. Rumkital dr. Ramelan Surabaya termasuk salah satu rumah sakit yang telah menerapkan PPRA. Tujuan penelitian ini adalah untuk mengetahui deskripsi kuantitatif-kualitatif pemakaian antibiotik, serta luaran klinis dan mikrobiologis yang teramati pascapencanangan penerapan PPRA di ICU Rumkital dr. Ramelan Surabaya. Desain penelitian adalah studi observasi cross-sectional yang dilakukan selama 3 bulan (Februari–Mei 2016) di ICU Rumkital dr. Ramelan. Deskripsi kuantitatif diamati menggunakan Days of Therapy (DOT/100 hari-pasien), deskripsi kualitatif menggunakan alur Gyssens. Pengamatan luaran klinis dilakukan terhadap infeksi nosokomial, mortalitas terkait infeksi, dan lama tinggal di ICU ( Length of Stay /LOS). Pengamatan luaran mikrobiologis dilakukan terhadap pola penyebaran bakteri multiresisten. Hasil perhitungan jumlah konsumsi antibiotik didapatkan 151,63 DOT/100 hari-pasien. Penilaian kualitas antibiotik menunjukkan hasil 52,73% terapi tepat; 8,18% tidak tepat; 7,27% tanpa indikasi; 31,82% tidak tercapai kesepakatan antar penilai (κ=0,59; p<0,05). Infeksi nosokomial terbanyak yaitu Hospital Acquired Pneumonia (HAP)/ Ventilator Associated Pneumonia (VAP), mortalitas terkait infeksi 44,68%; dan LOS rata-rata 7,17±1,9 hari (p<0,05). Belum ditemukan adanya insiden Methicillin-resistant Staphylococcus aureus (MRSA) ataupun Extended Spectrum Beta-Lactamase (ESBL), namun ditemukan dua kasus Multi Drug Resistant (MDR) Acinetobacter baumannii . Kata kunci: Alur Gyssens, DOT, ICU, PPRA, resistensi antibiotik Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya Antibiotic Stewardship Program (ASP) is mandatory to all Indonesian hospitals, in accordance to the 2015 Minister of Health Decree No. 8. Dr. Ramelan Naval Hospital Surabaya is one among the many hospitals in Indonesia that has implemented the ASP. The study objective was to describe quantitative-qualitatively the use of antibiotics, along with clinical and microbiological outcomes observed in an Intensive Care Unit (ICU) after ASP implementation in dr. Ramelan Naval Hospital Surabaya. The design was a 3-month (February–May 2016) cross-sectional observational study. Quantitative description was reported using Days of Therapy (DOT)/100 patient-days, the qualitative description was reviewed using Gyssens’ flowchart. Clinical outcomes observed include nosocomial infection, infection-related mortality, and average length of stay (LOS). Microbiological outcome was observed through the occurences of multi-drug resistant organism. The results showed overall antibiotic use was 151.63 DOT/100 patient-days. Quality of antibiotic use were 52.73% definitely appropriate; 8.18% inappropriate regarding dose, intervals, durations, and timing; 7.27% no indication; and no mutual agreement in 31.82% (κ=0.59; p<0.05). Hospital Acquired Pneumonias (HAPs)/Ventilator Associated Pneumonias (VAPs) were the most observed nosocomial infection, infection-related mortality rate was 44.68%; and average LOS were 7.17±1.9 days (p<0.05). No incidents of Methicillin-resistant Staphylococcus aureus (MRSA) or Extended Spectrum Beta-Lactamase (ESBL) have been found, but there were two cases of Multi Drug Resistant (MDR) Acinetobacter baumannii. Keywords: Antibiotic resistance, ASP, DOT, Gyssens’ flowchart, ICU

In-bed cycling in the ICU; patient safety and recollections with motivational effects.

In-bed cycling (IBC) is gaining interest for implementation in intensive care units. Our main objective was to explore patient recollections and experiences of early mobilization, including IBC. Secondly, we aimed to examine if IBC was safe and feasible. Eleven participants were interviewed about their experiences during their critical illnesses and active mobilization in the intensive care unit. The interviews were analyzed thematically. Six participants were also monitored for physiological reactions and adverse events during IBC while mechanically ventilated. From the interviews, one main theme with three subthemes was identified. The main theme was: Early mobilization gave a direction toward normalization. The three subthemes were: (1) IBC gave a feeling of control over recovery early on during the critical illness (2) Early mobilization, including IBC, with continuous support from health care professionals gave a feeling of safety and hope for recovery for the patient; and (3) Unpleasant experiences and disorientation were felt during the critical illness and IBC. Furthermore, IBC did not induce large physiological changes or major adverse events in the participants who were monitored for feasibility and safety. Patient interviews indicated that the patients' participation in early mobilization with emphasis on IBC motivated them to be active in their recovery to regain a good level of health after their earlier critical illness during their intensive care stay. IBC was, in this small study, safe and feasible in the two participating intensive care units.

Development and validation of an eye care educational programme for intensive care unit nurses.

To develop and validate an eye care educational programme for intensive care unit nurses. Eye care guidelines and protocols have been developed for increasing eye care implementation in intensive care units. However, the guidelines lack consistency in assessment or intervention methodology. This was a one-sample pre/postprogramme evaluation study design for testing the effects of the eye care educational programme, developed for and applied to intensive care unit nurses, on their levels of knowledge and awareness. The eye care educational programme was developed based on literature review and survey of educational needs. Thirty intensive care unit nurses served as subjects for the study. The levels of eye care-related knowledge, awareness and practice were enhanced following the implementation of the educational programme. Moreover, satisfaction with the educational programme was high. It is necessary to intensify eye care education aimed at new nurses who are inexperienced in intensive care unit nursing and provide continuing education on the latest eye care methods and information to experienced nurses. The eye care educational programme developed in this study can be used as a strategy to periodically assess the eye status of patients and facilitate the appropriate eye care.

Central line bundle implementation in intensive care units and its impact on Central Line Associated Blood Stream Infection (CLABSI) in a tertiary care centre

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases. Search strategy: “Personal Satisfaction” and (patients or caregivers) and “Intensive Care Units”. Inclusion criteria: studies published between 2013-2018, population aged between 19-64 years, English and Spanish language.760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n = 5), the quality of care (n = 4), and the cleanliness and environment of the units (n = 2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n = 5), inadequate communication (n = 4), and the involvement of families and patients in decision-making (n = 4). Training of professionals (n = 5), inclusion of the family during the process of hospitalization (n = 2) and redesigning the waiting room (n = 2) are some of the suggestions for improvement.Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.Las unidades de cuidados intensivos son lugares hostiles que se deben acondicionar a las necesidades de los pacientes y familiares, para esto se deben conocer los factores que influyen en la satisfacción de estos.Actualizar el conocimiento sobre la satisfacción de los pacientes ingresados en una Unidad de Cuidados Intensivos (UCI) de adultos y la de sus cuidadores familiares descritos en la literatura científica.Se realizó una revisión bibliográfica sistematizada en las bases de datos PubMed, Scopus, Cinahl y WOS. Estrategia de búsqueda: «Personal Satisfaction» and (patients or caregivers) and «Intensive Care Units». Criterios de inclusión: Estudios publicados entre 2013-2018, población entre 19-64 años, idioma inglés y castellano.Se localizaron 760 estudios y se seleccionaron 15. Los factores que generan satisfacción son: Buena comunicación con los profesionales (n = 5), calidad de cuidados (n = 4) y limpieza y ambiente de la unidad (n = 2). Los factores que producen insatisfacción son: Infraestructura de las salas de espera (n = 5), inadecuada comunicación (n = 4) y la implicación de familiares y pacientes en la toma de decisiones (n = 4). Como estrategias de mejora encontramos el entrenamiento de los profesionales (n = 5), inclusión familiar durante el proceso (n = 2) y rediseño de las salas de espera (n = 2).Entre los factores generadores de satisfacción hallamos los relacionados con los profesionales y con el ambiente y limpieza. Los que causan insatisfacción se relacionan con una mala infraestructura, falta de implicación en la toma de decisiones de pacientes y familiares y mala comunicación con los profesionales. Las estrategias para mejorar la satisfacción de los pacientes y familiares están relacionadas con la organización, los profesionales, los familiares y con la infraestructura y ambiente.

Implementation of therapeutic hypothermia after cardiac arrest in intensive care units in Poland

Therapeutic hypothermia (TH) is one of few interventions that improve survival after a cardiac arrest with good neurological outcome. Current guidelines for cardiopulmonary resuscitation recommend TH in comatose adult patients after return of spontaneous circulation (ROSC) regardless of cardiac arrest location and cardiac rhythm during the event. To evaluate level of TH implementation in intensive care units (ICUs) in Poland and identify barriers to the implementation process. A telephone survey was carried out to determine how many Polish ICUs were using TH in the management of comatose patients after a cardiac arrest. The survey was conducted from October to December 2010. The survey also included questions on the number of patients cooled, method of TH induction and maintenance, target temperature, duration of cooling, and cardiac arrest rhythm in patients treated with TH. We have also collected data on pre-hospital use of TH and potential barriers to implementation of TH. We obtained information from 263 of 464 ICUs (56.8%) in Poland. At the time of the survey, 57 ICUs (21.7%) were using TH in comatose patients after ROSC. There was a significant increase in the number of ICUs using TH as compared with the 2005 survey. Most ICUs did not use any sophisticated equipment to induce and maintain TH. Ninety six percent of ICUs were using TH regardless of the cardiac arrest rhythm. In 65% of ICUs (37 units), target temperature was 32-34°C and 63% of ICUs (36 units) maintained TH for 12-24 hours. An increase in ICU experience in TH can be noted: 61% of ICUs (35 units) declared TH use in more than 10 patients during the last year. We found the following barriers to implementation of TH: lack of knowledge, lack of local protocols, lack of equipment, and economic issues. The number of ICUs using TH in Poland increased threefold in the 5 year period of 2005-2010. However, the proportion of ICUs using TH is still low (21.7%) compared to other European countries. Further efforts should be undertaken to reduce barriers to implementation of current resuscitation guidelines.