Patient Safety In Intensive Care Research Articles

COVID-19 and patient safety in intensive care: What can we learn?

COVID-19 and patient safety in intensive care: What can we learn?

Validation of a training model of professional competence management of patient safety in intensive care in the Bachelor of Nursing degree

Introduction: the pedagogical model as a scientific result of educational research, understood as a representation of essential elements of the training process or some of its parts. Objective: to validate a model for the formation of the professional competence "Management of patient safety in intensive care" in the Bachelor's degree in Nursing. Method: A study was carried out at the Baracoa Medical Sciences Branch, belonging to the Guantánamo University of Medical Sciences from 2016-2018, methods such as methodological triangulation were used through the criteria of 20 experts by the Green method. Results: The consensus general of the experts was "strongly in agreement" for the foundations that support the training model of professional competence "Management of patient safety in intensive care" in the Nursing Bachelor's degree and its quality. Conclusions: the training model of professional competence "Management of patient safety in intensive care" is accepted as valid and feasible for its implementation in practice, it constitutes a novel and relevant contribution for the transformation of the training process in the career of Nursing, from the Emergency Nursing subject in the fourth year, which promotes the relationship between the systematization of skills and the development of innovation capacity in students to guarantee patient safety.

'Doing the best we can': Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19.

AimsTo explore registered nurses' experiences of patient safety in intensive care during COVID‐19.DesignA qualitative interview study informed by constructivism.MethodSemi‐structured interviews were conducted and audio‐recorded with 19 registered nurses who worked in intensive care during COVID‐19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework.ResultsTwo key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short‐ and long‐term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well‐being and Peer Support.ConclusionNurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long‐term impacts on patient safety and recovery from critical illness.ImpactThis study explored the perceived impact of COVID‐19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long‐term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.

The organisation of nurse staffing in intensive care units: A qualitative study

To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates. Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence. Focus groups with intensive care health care professionals (n = 52 participants) and individual interviews with critical care network leads and policy leads (n = 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis. Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes. Whilst nurse:patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff well-being, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies. In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket 'ratio' approach to nurse staffing, intended to apply uniformly across health services.

Nursing technologies for patient safety in intensive care: a systematic review

This article aims to demonstrate the evidence that nursing care technologies ensure the safety of patients admitted to Intensive Care Units. Systematic review with search in six databases. Two researchers selected the texts independently in the first stage; and, in the second stage, in a conciliation meeting, the conflicts were analyzed by a third researcher. In order to evaluate the level of agreement, the Kappa coefficient was applied; in order to evaluate the risk of bias and classify the levels of evidence, the Grading of Recommendations, Assessment, Development and Evaluation was adopted. Observational studies were also evaluated with the risk of bias in non-randomized studies of interventions. The 23 included studies were evaluated regarding their quality of evidence, with very low evidence ranking determined for most studies (16/69.6%), moderate evidence for five studies (21.7%), one study with low evidence (4.3%) and one study as high evidence (4.3%). Patient safety is essential, but, despite this commitment, only one study (4.3%), about thermometry assessment, showed high level of evidence that nursing care technologies ensure patient safety in the Intensive Care Unit setting.

Multiprofessional round with checklist: association with the improvement in patient safety in intensive care

RESUMO Objetivo Verificar a associação entre round multiprofissional com uso de checklist e práticas de segurança do paciente por profissionais de saúde de uma unidade de terapia intensiva. Método Estudo de método misto, delineado pela abordagem sequencial explanatória, realizado em um hospital do sul do Brasil. Os dados quantitativos foram analisados por meio de regressão de Poisson e os dados qualitativos, pela análise de conteúdo. Fez-se a análise integrada por meio da combinação explicada/conectada. Resultados No período pós-implementação dos rounds com uso sistemático de checklist houve melhora significativa da profilaxia de tromboembolia venosa, sedação leve, redução dos dias de uso de ventilação mecânica, cateter venoso central e de sonda vesical de demora. Conclusão O round multiprofissional com uso sistemático de checklist, associado com a melhoria nas práticas de segurança do paciente, foi considerado como uma estratégia que assegura melhores cuidados em terapia intensiva e favorece a satisfação no trabalho.

Conceptions of patient safety through the prism of social representations of intensive care nurses

Objective.To analyze the concepts of patient safety from the perspective of the social representations of intensive care nurses.Methods.An exploratory, qualitative and quantitative study, based on the Theory of Social Representations, was conducted in a large hospital in northeastern Brazil, with 20 intensive care nurses. Data collection took place in 2019, using the techniques of free word association test and semi-structured interview. The lexicons apprehended in the test were processed by the OpenEvoc software, by prototypical analysis of the evocations, and for the interview data, thematic content analysis was used.Results.In the composition of the central nucleus, the elements of surveillance, knowledge, identification, communication, and quality stood out, and in the constitution of the peripheral system of the social representations of intensive care nurses permeate care, attention, attitudes, and normative aspects. The triangulation of the findings outlined three thematic categories: Central dimensions of critical patient safety; Attitudinal dimensions for patient safety in intensive care; Normative dimensions linked to the safe handling of the patient in the ICU.Conclusion.The social representations of intensive care nurses reveal that the critical patient's conceptions of security involve effective surveillance and communication, promotion of a safe environment based on risk prevention, use of guides and protocols, teamwork, and the sense of responsibility and commitment to individuality of being cared for, elements that for this social group, are the differential for assertive and safe care.

The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study.

BackgroundPatient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring.ObjectiveWe aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring.MethodsIn this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies.ResultsParticipants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=−3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=−1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001).ConclusionsThis eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

ELDERLY PATIENT SAFETY IN INTENSIVE CARE UNIT: BIBLIOMETRIC ANALYSIS OF INTERNATIONAL PRODUCTION

Objective: to analyze the international scientific production on elderly patient safety in Intensive Care Unit. Method: bibliometric study carried out on ISI Web of Knowledge / Web of ScienceTM database, with the search terms: “Patient Safety”, “Elderly”, “Intensive Care Units”, performed from exporting these data for the bibliometric analysis software HistCiteTM. Results: 103 publication records were identified, in 85 different journals, written by 679 authors that are associated with 224 institutions, located in 30 countries. In analysis of number of citations count, the h-index value is equal to 24. Conclusion: the theme is presented in a broad and diverse way, without demonstrating the existence of a good articulation among the studies, authors and institutions around the world. There is a need to construct knowledge networks in the field that make possible further studies able to contribute to improve elderly patient safety in intensive care.

Percepções da equipe de enfermagem acerca da humanização em terapia intensiva

Objetivo: Conhecer as percepções da equipe de Enfermagem acerca da humanização da assistência em Unidade de Terapia Intensiva. Métodos: Estudo com abordagem qualitativa realizado em 2017, em uma instituição hospitalar cujos participantes foram quatro enfermeiros e oito técnicos de enfermagem atuantes na Unidade de Terapia Intensiva Adulto de um hospital do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu por meio de entrevista semiestruturada. Os dados foram analisados pela análise temática, a partir da qual emergiu uma categoria temática, qual seja: O cotidiano de trabalho na Unidade de Terapia Intensiva no contexto da humanização da assistência. Resultados: Os achados revelam que os profissionais percebem a importância da assistência qualificada, embasada numa prática acolhedora e humanizada. Apontam a importância de atender não somente às necessidades biológicas dos pacientes por eles assistidos, mas o uso da comunicação como prática intimamente relacionada com a humanização do cuidado. No entanto, pode-se identificar, por vezes, a falta de conhecimento em relação à política nacional de humanização. Conclusão: O estudo traz subsídios para que os profissionais de Enfermagem possam re(pensar) a sua prática assistencial, tendo em vista aliar a alta densidade tecnológica com a humanização e a segurança do paciente em terapia intensiva.

Principles of Automation for Patient Safety in Intensive Care: Learning From Aviation

The transition away from written documentation and analog methods has opened up the possibility of leveraging data science and analytic techniques to improve health care. In the implementation of data science techniques and methodologies, high-acuity patients in the ICU can particularly benefit. The Principles of Automation for Patient Safety in Intensive Care (PASPIC) framework draws on Billings's principles of human-centered aviation (HCA) automation and helps in identifying the advantages, pitfalls, and unintended consequences of automation in health care. Billings's HCA principles are based on the premise that human operators must remain "in command," so that they are continuously informed and actively involved in all aspects of system operations. In addition, automated systems need to be predictable, simple to train, to learn, and to operate, and must be able to monitor the human operators, and every intelligent system element must know the intent of other intelligent system elements. In applying Billings's HCA principles to the ICU setting, PAPSIC has three key characteristics: (1) integration and better interoperability, (2) multidimensional analysis, and (3) enhanced situation awareness. PAPSIC suggests that health care professionals reduce overreliance on automation and implement "cooperative automation" and that vendors reduce mode errors and embrace interoperability. Much can be learned from the aviation industry in automating the ICU. Because it combines "smart" technology with the necessary controls to withstand unintended consequences, PAPSIC could help ensure more informed decision making in the ICU and better patient care.

Establishing Patient Safety in Intensive Care— A Grounded Theory

Background: The modern intensive care unit (ICU) is a complex and high-risk environment, and even small adverse events and changes may deteriorate the patient’s conditions and eventually cause harm. Many factors can potentially be associated within an increased amount of errors, leading to adverse events. Nurses, nurse managers, and other leaders all play important roles in establishing patient safety. Aim: This study aimed to obtain a deeper understanding of leaders’ and nurses’ main concerns in establishing patient safety in Swedish intensive care units. Method: A grounded theory methodology was used. Data from 15 interviews with leaders and nurses involved in critical care in Sweden were collected, analysed and constant compared. Findings: The main concern in establishing patient safety was promoting quality of care, work engagement, and staffs well-being in strained ICUs. The core category building trust explained how the leaders’ and nurses’ strove for quality of care and wished a healthy, safe work environment. This is further explained in the categories “Being an accessible and able leader”, “Creating knowledge and understanding”, and “Establishing collaborative practice”. Conclusion: Establishing patient safety in the ICU requires that staffs enjoy going to work, have good work relations, are committed and want to stay at the unit. A healthy, salutogenetic unit with a work environment marked by trust provides a better opportunity to establish patient safety, and various leaders have potential to achieve this.

Contributions of healthcare staff to promote patient safety in intensive care

Objective: Presenting the recommendations of health professionals from an Intensive Care Unit for the improvement of patient safety culture. Methods: Descriptive-exploratory study, with a quantitative approach, resulting from the application of the Survey about Patient Safety in Hospitals, 59 professional staff participated between November 2013 and January 2014. Results: Were obtained 124 recommendations, which were categorized according to aspects of the instrument. Highlighting recommendations related to the support of the hospital management to patient safety, in particular, the supply of material resources; and also to organizational learning and continuous improvement, with suggestions for training and implementation of protocols aimed at standardizing the assistance. Conclusion: The study permitted to list significant recommendations for improvements in patient safety, and made it possible to identify the dimensions of safety culture that have more vulnerabilities.

Intensive care nurses’ perceptions of simulation-based team training for building patient safety in intensive care: A descriptive qualitative study

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety.

Intensive care unit nurses' evaluation of simulation used for team training

To implement a simulation-based team training programme and to investigate intensive care nurses' evaluations of simulation used for team training. Simulation-based training is recommended to make health care professionals aware of and understand the importance of teamwork related to patient safety. The study was based on a questionnaire evaluation design. A total of 63 registered nurses were recruited: 53 from seven intensive care units in four hospitals in one hospital trust and 10 from an intensive care postgraduate education programme. After conducting a simulation-based team training programme with two scenarios related to emergency situations in the intensive care, the participants evaluated each simulation activity with regard to: (i) outcome of satisfaction and self-confidence in learning, (ii) implementation of educational practice and (iii) simulation design/development. Intensive care nurses were highly satisfied with their simulation-based learning, and they were mostly in agreement with the statements about self-confidence in learning. They were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Significant differences were found with regard to scenario roles, prior simulation experience and area of intensive care practice. The study indicates a positive reception of a simulation-based programme with regard to team training in emergency situations in an intensive care unit. The findings may motivate and facilitate the use of simulation for team training to promote patient safety in intensive care and provide educators with support to develop and improve simulation-based training programmes.

Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study

To assess on a multinational level the prevalence and corresponding factors of selected unintended events that compromise patient safety (sentinel events) in intensive care units (ICUs). An observational, 24-h cross-sectional study of incidents in five representative categories. 205 ICUs worldwide Events were reported by intensive care unit staff members with the use of a structured questionnaire. Both ICU- and patient-related factors were assessed. In 1,913 adult patients a total of 584 events affecting 391 patients were reported. During 24 h multiple errors related to medication occurred in 136 patients; unplanned dislodgement or inappropriate disconnection of lines, catheters, and drains in 158; equipment failure in 112; loss, obstruction or leakage of artificial airway in 47; and inappropriate turn-off of alarms in 17. Per 100 patient days, 38.8 (95% confidence interval 34.7-42.9) events were observed. In a multiple logistic regression with ICU as a random component, the following were associated with elevated odds for experiencing a sentinel event: any organ failure (odds ratio 1.13, 95% confidence interval 1.00-1.28), a higher intensity in level of care (odds ratio 1.62, 95% confidence interval 1.18-2.22), and time of exposure (odds ratio 1.06, 95% confidence interval 1.04-1.08). Sentinel events related to medication, indwelling lines, airway, and equipment failure in ICUs occur with considerable frequency. Although patient safety is recognised as a serious issue in many ICUs, there is an urgent need for development and implementation of strategies for prevention and early detection of errors.

The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care.

Intensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.

Adverse Incident Reporting in Intensive Care

This prospective, observational, anonymous incident reporting study aimed to identify and correct factors leading to reduced patient safety in intensive care. An incident was any event which caused or had the potential to cause harm to the patient, but included problems in policy or procedure. Reports were discussed at monthly meetings. Of 390 incidents, 106 occasioned "actual" harm and 284 "potential" harm. There was one death, 86 severe complications and 88 complications of minor severity. Most were transient but the effects of 24 lasted up to a week. Most incidents affected cardiovascular and respiratory systems. Incident categories involved drugs, equipment, management or procedures. Incident causes were knowledge-based, rule-based, technical, slip/lapse, no error or unclassifiable. The study has identified some human and equipment performance problems in our intensive care unit. Correction of these should lead to a reduction in the future incidence of those events and hence an increased level of patient safety.