Intensive Care Unit Safety Research Articles

Vitamin D for very preterm infants-determining the how, when, and why.

A recent survey study found that 400 IU/day vitamin D is the most common dose in United States neonatal intensive care units. Results of clinical trials are inconsistent, and, therefore, have not determined the optimal vitamin D dose for efficacy and safety in the neonatal intensive care unit. Future studies must consider the unique attributes of perinatal vitamin D metabolism and the potential role of vitamin D in immune function and organ development. IMPACT: Preterm infant vitamin D metabolism is a complex yet important area of research.

Let's Talk Safety - Data from the Neonatal Intensive Care Unit Safety and Bed Capacity Huddles.

Huddles are brief team meetings designed to communicate essential information. Safety huddles provide a forum to identify and review patient safety events. In a just culture, everyone is accountable for patient safety. The purpose of this project is to discuss safety issues/events at the twice daily bed capacity huddles in a Level IV Neonatal Intensive Care Unit (NICU) utilizing a just culture model. Having daily discussions of patient safety and the escalation process for follow-up promotes a just culture. The aims are to improve the unit's culture of safety and learn from patient safety issues. A just culture model was adopted to promote discussion of safety events during the huddles. A structured checklist of safety events was utilized along with a script of ground rules. Twice a day, a multidisciplinary group gathers to huddle. Nurse leaders facilitate the discussion, track the results, and provide follow-up. The structured safety huddle began in May of 2020 and continues twice daily. All required staff attend. The escalation process is defined and has prevented recurrence of some safety issues. The NICU experienced a 14% increase in favorable results on the Agency for Healthcare Research and Quality (AHRQ) culture of safety survey since the inception of the structured safety huddles. Safety huddle discussions have impacted the culture of safety on this unit. Tracking of discussions can help to identify trends, improve processes, and impact patient safety.

Patient safety culture and medication safety in European intensive care units: a focus group study

BackgroundPatients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its...

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

ObjectivesMedication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to...

Building a NICU quality & safety infrastructure

The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care, published in 2023, highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP). A comprehensive Neonatal Intensive Care Unit (NICU) quality and safety infrastructure (QSI) is based on four foundational domains: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational guide for NICU clinical leaders and quality champions to navigate these domains and develop their local QSI to include the AAP NPSQIP standards.

Nurses' attitudes towards factors determining the safety of patients treated in intensive care units: A cross-sectional study.

The goal of health care systems is to ensure high quality of medical services provided, including patient safety. The intensive care unit (ICU) is an environment conducive to the occurrence of adverse events and medical errors because of the complexity of the care provided, the severity of the conditions of patients treated in these units and work often performed under stressful conditions. Assessment of attitudes of nurses working in ICUs towards patient safety. A cross-sectional, descriptive study was conducted in a group of 214 nurses employed in ICUs in hospitals located in the southern part of Poland. The study used the Polish version of the Attitudes towards safety: (SAQ-SF PL) questionnaire and an original questionnaire consisting of questions on socio-demographic and professional data. The overall SAQ score for the whole group was 61.89, 57.29 for adult ICU nurses and 68.20 for children's ICU. The surveyed nurses in general obtained the highest average results in terms of teamwork climate (TC)-66.92, while the lowest scores were given to the management-hospital management (PM)-45.08 and working conditions (WC)-57.56. job satisfaction (JS) positively correlated with the assessment of the TC, the assessment of the safety climate (SC), the assessment of the management staff (Head of Department) (PM), the assessment of the management staff (hospital management) (PM) and the assessment of work conditions (WC). A statistically significant, negative correlation was found between the assessment of JS and the assessment of stress recognition (SR) (r = -.20; p < .01). In the surveyed ICU branches, there is a low SC, and it is related, among others, to the perception of WC and the role of the management staff. The level of JS among nursing staff mainly depends on the SC, the TC, WC and the support of the management staff. The results of the research presented here provide valuable assistance in identifying areas related to patient safety in ICUs. Managers' awareness of the importance of coping with occupational stress, WC or effective teamwork can help to improve staff attitudes and attitudes towards patient safety. When shaping a safe culture in a health care organization, it is important to remember that ensuring safe patient care is not only about programmes, standards or procedures, but safety is primarily about human resources-the staff involved in the treatment process-doctors, nurses, paramedics and physiotherapists. High awareness of safety at work, cooperation in an interdisciplinary team, assessment of safety culture at work and analysis and drawing conclusions may result in a real increase in quality and safety, and the patient will feel safer in 'XX' hospitals.

ERRATUM: Organizational culture and climate for patient safety in Intensive Care Units

ERRATUM: Organizational culture and climate for patient safety in Intensive Care Units

Clinical impact of pharmacists’ interventions in intensive care units in a tertiary institution in Singapore – A retrospective cohort study

Background and aim Previous studies have deemed pharmacists essential in the intensive care units (ICU) to provide quality healthcare and ensure medication safety. As the impact of pharmacists in ICU varies according to different factors, our study aims to characterise and evaluate the impact of pharmacists’ interventions in ICUs in Singapore, to enable the identification of areas of improvement in our critical care pharmacy practice. Methods We retrospectively evaluated 7 months of pharmacists’ interventions in five ICUs at Singapore General Hospital. Interventions were classified based on the medication-related problems (MRPs) addressed. The impact of pharmacists’ interventions was assessed by rating the severity of error in medication order, the clinical relevance of intervention, and the probability of adverse drug events (pADE) that would have occurred without pharmacists’ interventions. Results There were 619 interventions addressing 775 MRPs, of which 91.1% were accepted. The main MRP identified was inappropriate drug regimen (49.2%) and the medication class most frequently involved in MRPs was anti-infectives (56.9%). Majority of the interventions were rated as significant for both the severity of error (76.9%) and clinical relevance (72.4%). However, the pADE was deemed to be low (61.2%). The rating of pADE may be affected by the lack of information in patient profiles. Conclusion This study demonstrated the crucial role of pharmacists in ensuring medication safety in ICUs. Possible areas of service improvement include educating medical residents on common medication errors and empowering pharmacists towards collaborative prescribing.

Evaluation of off-label medication use and drug safety in a pediatric intensive care unit

Safety and efficacy are essential in the process of disease treatment. However, off-label medication use is inevitable because various medications do not contain regulatory labels for pediatric use. We aimed to examine off-label medication use and analyze the risk factors correlated with adverse drug reactions (ADRs). This study was performed retrospectively using electronic medical data from a pediatric intensive care unit (PICU) of a tertiary hospital in Korea from July 2019 to June 2020. A total 6,183 prescribed medications from 502 PICU patients were examined in the present study. A total of 80% were infants or children, and 96.0% of them were treated with off-label medications. It was discovered that 4,778 off-label cases (77.2%) of the top 100 drugs had prescriptions with dosage (67.8%). Drugs prescribed to patients admitted to the cardiothoracic department (odds ratio [OR], 3.248; p = 0.019), total number of medications (OR, 1.116; p = 0.001), and length of PICU stay of ≥ 7 days (OR, 4.981; p = 0.008) were significantly associated with ADRs. ADRs were noted to be more severe in off-label use (p = 0.0426). For appropriate medication use, evidence regarding the safety of off-label medications is required and ultimately reflected in the official regulation.

Identifying the barriers and facilitators to implementation of ventilator bundle in the nepalese intensive care unit: A descriptive qualitative study

BackgroundA ventilator bundle is an effective preventive strategy against the development of ventilator-associated pneumonia (VAP). However, in clinical practice ventilator bundle implementation is poor. Understanding the barriers to ventilator bundle implementation in low- and middle-income countries can inform the development of effective implementation strategies to reduce the burden of VAP. ObjectivesThe primary objective of this study was to explore the barriers and facilitators of ventilator bundle implementation perceived by healthcare professionals (HCPs) working in intensive care units (ICU) in Nepal. The secondary objective was to prioritise the barriers when developing implementation strategies. MethodsThis study used a pragmatic approach comprising a series of methods to identify the implementation strategies: (i) Barriers and facilitators were explored using a qualitative study design. Twenty-one HCPs selected using the maximum variation sampling technique from a large tertiary hospital, completed semistructured interviews. All the interviews were recorded, transcribed word-by-word, and uploaded into NVivo for analysis using the thematic analysis approach. (ii) After analysis, nine participants were selecteded to determine the priority order of the barriers using a barrier identification and mitigation tool. ResultsThe data analysis revealed five main themes and 19 subthemes that affected ventilator bundle implementation. The main themes were provider-related factors, organisational and practice-related factors, performances of work, environmental conditions, and patient-related factors. The common barriers were job insecurity, poor knowledge, negative attitude, insufficient equipment, and severity of patient disease. Common facilitators were educational training, equipment functioning, adequate staff, strong leadership, and organisational support. Finally, eight main barriers were prioritised to target the change. ConclusionThe barriers to implementing ventilator bundles in ICUs were identified. Focussing on addressing the prioritised barriers may aid in improving patient care and safety in ICUs. Results may guide HCPs in the development of implementation strategies to reduce the burden of VAP.

Impact of Interprofessional Communication on Safety in the Neonatal Intensive Care Unit.

In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers. This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ). Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU. The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.

Understanding the co-construction of safety in the paediatric intensive care unit: A meta-ethnography of parents' experiences.

Children experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research. A systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results. We identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference. This synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study

BackgroundThe unprecedented increase in the nurses’ workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU.MethodThis is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA).ResultsThe results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001).ConclusionThe use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

Factors Affecting Quality of Nursing Handover among Staff Nurses and Its Relation to Patients’ Safety in Intensive Care Units

Factors Affecting Quality of Nursing Handover among Staff Nurses and Its Relation to Patients’ Safety in Intensive Care Units

Patient Safety in Intensive Care Unit: What can We Do Better?

Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med 2023;27(3):163-165.

Critical Care Nurse’s Practice Regarding Medication Administration Safety in Intensive Care Units at Governmental Hospitals in Gaza Strip

Background: Administration of medications is primarily the nurse’s responsibility. This study aimed to assess intensive care nurses’ practice of safe medication administration in governmental hospitals in the Gaza Strip. Methods: This study utilized descriptive, cross-sectional, analytical design. The sample of the study consisted of 116 ICU nurses from five governmental hospitals (Al Shifa Hospital, Indonesy Hospital, Shohada Al Aqsa hospital, European Gaza Hospital, and Nasser Hospital). For data collection, the researcher used Patient Safety Assessment in Medication Administration Questionnaire and Observation Checklist. A pilot study was conducted on 20 nurses, and reliability of the Patient Safety Assessment in the Medication Administration Questionnaire was 0.908. Results: The results showed that 66.4% of study participants were male nurses and 33.6% were female nurses, mean age was 28.97 years, 85.4% have bachelor degree, mean experience was 4.18 years, mean income was 1431.64 New Shekel, and 67.2% are working mixed shifts (morning, evening, and night). The practice of safety medication administration indicated that the highest score was in right route (93.8%), the right time (91.8%), right patient (90.7%), right way (89.5%), right recording of administered medication (88.9%), right answer (86.7%), right guidance (86.5%), right dose (86%), right medication (85.3%), and the overall score was 88.6%. Also, observation of nurses indicated high practice of safe medication administration with an average score of 83.6%. There were statistically insignificant differences in the practice of safe medication administration related to the hospital, gender, qualification, age, experience, and income. Conclusion: The study concluded that intensive care nurses handling medication safely at a moderate level and more. The authors demonstrated the need to provide adequate number of qualified nurses in Intensive Care Units, and encouraged nurses to participate in training programs about safe medication preparation and administration.

A pharmacogenetic precision medicine approach to analgesia and sedation optimization in critically ill adults.

Precision medicine is a growing field in critical care. Research increasingly demonstrated pharmacogenomic variability to be an important determinant of analgesic and sedative drug response in the intensive care unit (ICU). Genome-wide association and candidate gene finding studies suggest analgesic and sedatives tailored to an individual's genetic makeup, environmental adaptations, in addition to several other patient- and drug-related factors, will maximize effectiveness and help mitigate harm. However, the number of pharmacogenetic studies in ICU patients remains small and no prospective studies have been published using pharmacogenomic data to optimize analgesic or sedative therapy in critically ill patients. Current recommendations for treating ICU pain and agitation are based on controlled studies having low external validity, including the failure to consider pharmacogenomic factors affecting response. Use of a precision medicine approach to individualize pharmacotherapy focused on optimizing ICU patient comfort and safety may improve the outcomes of critically ill adults. Additionally, benefits and risks of analgesic and/or sedative therapy in an individual may be informed with large, standardized datasets. The purpose of this review was to describe a precision medicine approach focused on optimizing analgesic and sedative therapy in individual ICU patients to optimize clinical outcomes and reduce safety concerns.

In Situ Simulation: A Strategy to Restore Patient Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review.

Patient safety is a public health problem worldwide. In situ simulation (ISS) arises as a learning strategy that allows health professionals to immerse themselves in a real environment without endangering the patients until they have learned the skills needed, thus increasing the quality of care. This systematic review aimed to verify the efficacy of the use of "in situ simulation" as a method that will allow health professionals to increase patient safety in Intensive Care Units after the situation experienced during the pandemic caused by the COVID-19 virus. Seven studies were reviewed using the PRISMA methodology for systematic reviews. The CASPe guide was used to assess the quality of the manuscripts. The main topics that emerged from this review in relation to in situ simulation were as follows: looking at aspects such as patient self-perception of safety, adverse events, interprofessional communication and health system organization in relation to in situ simulation. The adequate implementation of in situ simulation after the COVID-19 pandemic in ICU services is shown to be an efficient and effective strategy to promote improvement in the attitudes on a culture of safety and teamwork of professionals.

A study of drug utilization pattern, safety, and drug interactions in pediatric intensive care unit at tertiary care hospital

Background: Conducting drug utilization studies are crucial, particularly for pediatric patients, as it helps improve the prescribing patterns and usage of medications in the health-care system. However, there is a scarcity of research on the utilization of drugs in children, making this study an invaluable resource for understanding prescription patterns. Aims and Objectives: Main objectives behind our study were to examine and evaluate such prescription pattern in detail including antibiotics usage and prescription analysis using core drug prescribing indicators given by the World Health Organization (WHO), to evaluate adverse drug reactions that are observed during study and to evaluate drug-drug interactions (DDIs). Materials and Methods: This is an observational cross-sectional study of 12-month duration started after intuitional ethical committee approval. Total 450 prescriptions were studied. The study included all patients, regardless of gender, who were admitted to the pediatric intensive care unit (PICU). Results: Our study found that the average number of drugs per prescription was 4.87. In addition, a high percentage of drugs, specifically 97.39%, were prescribed using their generic names, while 94.84% of drugs prescribed were from the WHO essential drug list for children. Moreover, we observed that in 88.88% of encounters, antibiotics were prescribed and percentage of prescriptions, in which drugs were prescribed through injectable route, was 98.22%. Very minimal amount of adverse drug reaction was seen in patients. In our study, in 75.77% of the prescriptions, DDIs were not found. Conclusion: The study found that generic names of drugs were frequently used, and a high percentage of drugs prescribed were from the WHO essential drug list. However, the study also revealed a high percentage of encounters with antibiotics and injections prescribed. The occurrence of adverse drug reactions was minimal in the study. Moreover, most prescriptions did not exhibit DDIs, indicating appropriate therapeutic management in the PICU.

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.