Dissertations / Theses: 'Intensive care units - Evaluation'

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Lone, Nazir Iftikhar. "Evaluation of five year survival and major health care resource use following admission to Scottish intensive care units." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/8826.

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Long-term outcomes for patients admitted to intensive care units (ICUs) are recognised to be of increasing importance. Published studies indicate that ICU survivors have significant physical impairment, impaired quality of life, and excess mortality during the post-ICU period. The period of excess mortality has been variously estimated as lasting from one to 16 years after ICU discharge. Remarkably little information about long-term mortality and healthcare resource use exists for critical care populations, and outcomes relative to a non-ICU control population are unknown. The aims of the studies presented in the thesis were (i) to describe long-term (five year) mortality and identify factors associated with mortality for patients admitted to ICUs in Scotland (ICU admission cohort) and those surviving to be discharged from hospital alive (ICU survivor cohort); (ii) to compare mortality rates with control populations after adjustment for relevant confounders; (iii) to evaluate the extent of, and factors associated with, long-term (five year) major healthcare resource use of survivors of critical illness (ICU survivor cohort); and (iv)to compare major healthcare resource use with a control hospital inpatient population. I undertook a detailed systematic review of the international literature relating to healthcare resource use in ICU survivors to inform the design of the part of the study relating to resource use. This revealed a paucity of high quality studies but led to recommendations for improving the conduct and reporting of future research in this field. Using both retrospective cohort and matched cohort study designs, I analysed data relating to all patients admitted to Scottish ICUs in 2005 from the Scottish Intensive Care Society Audit Group (SICSAG) database. Two cohorts were defined: an ICU admission cohort, representing all ICU admissions, and a subcohort of those who survived to hospital discharge (ICU survivor cohort). Matched control cohorts of non-ICU hospital inpatients were selected from national datasets. The main outcomes were five-year mortality and major healthcare resource use obtained from linkage to national datasets. Major healthcare use was measured by number of hospital readmissions, number of days spent in hospital and hospital costs during the five years after hospital discharge. Five year mortality was 53% in the ICU cohort compared with 27% for the matched control hospital cohort and 16% for an age/sex-standardised general population. Among hospital survivors, ICU patients had higher five year mortality after adjustment for confounders (HR 1.3, 95%CI 1.2 to 1.4, p<0.001). Age, comorbidity, ICU admission diagnosis and deprivation quintile were independently associated with five-year mortality. The ICU diagnosis with greatest five year mortality (relative to self-poisoning) was variceal bleeding (HR 3.9, 95%CI 2.2 to 6.7, p<0.001). The readmission rate for the 5259 ICU patients surviving to hospital discharge declined from 1.7 readmissions per person in the first year to 0.9 in the fifth year of follow-up. Overall, ICU survivors spent a mean of 29 days in hospital over the five year follow up period, at a cost of £14593 per person. Previous number of admissions was the factor most strongly associated with resource use. ICU patients had a significant increased rate of hospital admission compared with the control cohort throughout the five year follow up period (admission rate ratio 1.21 (95%CI 1.14 to 1.29, p<0.001)). In the programme of work presented in this thesis, I have systematically reviewed evidence for resource use following critical illness, and have demonstrated that ICU patients are more likely to die compared with other hospital inpatients over a five-year horizon, even when only hospital survivor cohorts are considered. Furthermore, I have demonstrated that ICU survivors utilise a significant amount of excess acute hospital resource, which is relevant to health service planning and economic evaluations.

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Cretikos, Michelle School of Anaesthetics Intensive Care &amp Emergency Medicine UNSW. "An evaluation of activation and implementation of the medical emergency team system." Awarded by:University of New South Wales. School of Anaesthetics, Intensive Care and Emergency Medicine, 2006. http://handle.unsw.edu.au/1959.4/25720.

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Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

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Alamu, Josiah Olusegun Herwaldt Loreen A. "Evaluation of antimicrobial use in a pediatric intensive care unit." Iowa City : University of Iowa, 2009. http://ir.uiowa.edu/etd/277.

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Alamu, Josiah Olusegun. "Evaluation of antimicrobial use in a pediatric intensive care unit." Diss., University of Iowa, 2009. https://ir.uiowa.edu/etd/277.

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A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

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Tridente, Ascanio. "Evaluating outcome in patients with faecal peritonitis admitted to European Intensive Care Units." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/19160/.

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Hanekom, Susan. "The implementation and evaluation of a best practice physiotherapy protocol in a surgical ICU." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5328.

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Bibliography
Thesis (PhD ( Interdisciplinary Health))--University of Stellenbosch, 2010.
Bibliography
ENGLISH ABSTRACT: Introduction: It is increasingly being recognized that how intensive care services are delivered may have a greater impact on patient outcome than the individual therapies. Uncertainty regarding the optimal physiotherapy service provision model in a surgical intensive care unit (ICU) exists. Methodology: The aims of this study were to 1) develop an evidence-based physiotherapy protocol; 2) validate the content of the protocol; and 3) conduct an explorative intervention trial to compare usual care to the estimated effects of providing a physiotherapy service guided by an evidence-based physiotherapy protocol by a dedicated physiotherapist. A systematic review process was used to synthesize the evidence in eight subject areas. The GRADE system was used to formulate best practice recommendations and algorithm statements. Forty-two experts from a variety of disciplines were invited to participate in a Delphi process. Finally, the evidence-based physiotherapy protocol was implemented in a surgical ICU over four three-week intervention periods by a group of research therapists. The outcomes measured included ventilator time, ventilation proportions, failed extubation proportions, length of ICU and hospital stay, mortality, functional capacity, functional ability and cost (using nursing workload as proxy). Results: Fifty-three research reports in eight subject areas were identified, 23 draft best-practice recommendations and 198 algorithm statements were formulated. The draft protocol consisted of five clinical management algorithms. Fifteen international research experts and twelve national academics in the field of critical care agreed to participate in the Delphi process. Consensus was reached on the formulation of 87% (20/23) recommendations and the rating of 66% (130/198) statements. The risk of an adverse event during the protocol care intervention period was 6:1000 treatment sessions (p=0.34). Patients admitted to the unit during the protocol care intervention period were less likely to be intubated (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail extubation (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the daily unit TISS-28 score between the two condition periods was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patients managed by the protocol tended to remain in the hospital for a shorter time after unit discharge (p=0.05). There was no difference in the time spent on the ventilator (p=0.50), mortality (p=0.52) or in the six minute walk distance (p=0.65). In addition there was no difference in the proportion of patients who reached independence in any of the Barthel Index activities measured within 48 hours of discharge from the unit. Conclusions: The use of an evidence-based physiotherapy protocol for the comprehensive physiotherapeutic management of patients in a surgical ICU was feasible and safe. The preliminary results of this study suggest that a physiotherapy service, which is guided by an evidence-based protocol and offered by a dedicated unit therapist, has the potential to lower the cost of ICU care and facilitate the functional recovery of patients after unit discharge. This information can now be considered by administrators to optimize the physiotherapy service provided in ICU.
AFRIKAANSE OPSOMMING: Inleiding: Daar word toenemend erken dat die wyse waarop dienste gelewer word, ‘n groter impak mag hê op die uitkoms van pasiënte as die spesifieke modaliteite in gebruik. Onsekerheid heers tans oor die optimale fisioterapie diens model om te volg in ‘n chirurgiese intensiewe sorg eenheid (ISE). Metodologie: The doel van hierdie projek was om 1) ‘n bewysgesteunde protokol te ontwikkel; 2) die geldigheid van die protokol te bevestig; en 3) om deur middel van ‘n eksploratiewe studie die uitkoms van pasiënte te vergelyk wanneer die fisioterapie diens gelewer word aan die hand van die bewysgesteunde protokol deur ‘n toegewyde fisioterapeut, teenoor wanneer die gewone fisioterapie diens gelewer word. Die empiriese bewyse in agt onderwerp areas is gesintetiseer na afloop van ‘n sistematiese literatuur oorsig proses. Die GRADE sisteem is gebruik om beste praktyk aanbevelings en algoritme stellings te formuleer. Twee en veertig kundige persone van verskeie disiplines is genooi om deel te neem aan die Delphi proses om die geldigheid van die protokol te bevestig. Uiteindelik is die geldige bewysgesteunde protokol oor ‘n tydperk van vier drie weke intervensie periodes deur ‘n groep navorsings terapeute in ‘n chirurgiese ISE geïmplementeer. Die tyd wat pasiënte geventileer is, die proporsie pasiënte wat geïntubeer en geherintubeer is in die tydperk, die lengte van ISE en hospitaal verblyf, mortaliteit, funksionele kapasiteit asook funksionele vaardigheid en koste (deur die verpleeg werkslading te gebruik as ‘n indikasie van koste) is gemeet. Resultate: Drie en vyftig navorsings verslae in agt onderwerp areas is geïdentifiseer, 23 konsep aanbevelings en 198 algoritme stellings is geformuleer. Die konsep protokol het uit vyf algoritmes bestaan. Vyftien internasionale en twaalf nasionale kundiges het die uitnodiging aanvaar om aan die delphi proses deel te neem. Konsensus is bereik vir die formulering van 87% (20/23) van die aanbevelings en die gradering van 66% (130/198) van die algoritme stellings. Die risiko vir ‘n ongunstige episode tydens die protokol intervensie periode was 6:1000 sessies (p=0.34). Pasiënte wat tydens die protokol intervensie periode tot die eenheid toegelaat is was minder geneig om geïntubeer te word (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) of om ‘n ekstubasie te faal (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). Die gemiddelde verskil in die daaglikse eenheid TISS-28 telling tussen die twee intervensie periodes was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patiente wat tydens die protokol intervensie periode behandel is was geneig om vinniger uit die hospitaal ontslaan te word nadat hul uit die eenheid ontslaan is (p=0.05). Daar was geen verskil in die ventilasie tyd, (p=0.50) die mortaliteit (p=0.52) of die afstand wat pasiente in ses minute kon aflê binne 48 uur na ontslag uit die eenheid (p=0.65) nie. Daar was ook geen verskil in die proporsie pasiente wat onafhanklikheid bereik het in enige van die kategorieë van die Barthell Index instrument nie. Gevolgtrekking: Die gebruik van die protokol vir die omvattende hantering van pasiënte in ‘n chirurgiese eenheid is haalbaar en veilig. Die voorlopige resultate van hierdie studie dui daarop dat wanneer ‘n fisioterapie diens in ‘n chirurgiese ISE gelewer word aan die hand van ‘n bewysgesteunde protokol deur ‘n toegewyde fisioterapeut dit die potensiaal het om ISE koste te verminder en die funksionele herstel van pasiente na ontslag uit die eenheid te fasiliteer. Hierdie inligting kan nou deur administrateurs oorweeg word om ‘n optimale fisioterapie diens in ‘n chirurgiese ISE te verseker.

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Bennett-Baird, Penny. "Development and psychometric evaluation of an instrument : neonatal infection control and compliance index to measure infection control compliance in the neonatal intensive care unit environment : a dissertation /." San Antonio : UTHSC, 2006. http://proquest.umi.com/pqdweb?did=1221711861&sid=1&Fmt=2&clientId=70986&RQT=309&VName=PQD.

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Gilson, Sheryl L. "Promoting Early Mobility of Patients in the Intensive Care Unit." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6433.

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Deconditioning occurs in critically ill patients as early as 4 days after entering the intensive care unit (ICU) resulting in a loss of up to 25% peripheral muscle tone and 18% body weight by the time the patient is discharged. Early mobility (EM) has been shown to reduce complications such as neuromuscular weakness, muscle wasting, pneumonia, and the effects of prolonged periods of time on the ventilator. No formal education on EM had been provided to nurses at the clinical site. The purpose of this project was to develop an educational program on EM to promote early ambulation of critically ill ICU patients. The theory of knowledge to action was used to guide the development of the educational program. The practice-focused question addressed whether an educational program would improve nurses' perceptions of their knowledge of EM and if they would promote the use of EM among ICU patients. After a literature review to identify evidence-based practices and a protocol on EM, an educational program was developed that included a 25-item Likert-style pretest and posttest to measure percent agreement with perceptions of knowledge gained and likelihood of behavior change related to the practice of EM. Participants included 60 ICU nurses. Results demonstrated improvement in perceptions of knowledge of EM (from 74% before education to 88% after) and in likelihood of behavior change related to EM (from 69% before education to 91% after). Findings may be used to integrate EM into the ICU setting to reduce complications such as neuromuscular weakness, muscle wasting, and pneumonia. Results may also include improved patient outcomes, reduced length of stay, and increased quality of life for patients and their families, and thereby promote positive social change.

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Magalhães, Bárbara Gomes. "Evaluation of a new molecular typing strategy of Pseudomonas aeruginosa." Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/13861.

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Mestrado em Microbiologia
Pseudomonas aeruginosa is the third leading cause of hospital acquired infection in intensive care unit (ICU) patients. This microorganism holds responsibility in a high number of nosocomial infections and their severity. Because it is ubiquitous in the environment and also constitutes the endogenous microbiota of hospitalized patients, there is a need to use powerful molecular typing methods to establish clonal relationships between individual isolates. Double Locus Sequence Typing (DLST) has recently been used in the analysis of P. aeruginosa strains relatedness, proving to be efficient, easy, and also reducing the working time and costs of analysis. Another typing technique called Double Digest Sequence Label (DDSL) had also been reported in the molecular study of this microorganism. A higher discriminatory power makes DDSL a putative typing complement to resolve DLST clusters in specific situations. From 2010 to 2012, an increase in P. aeruginosa infections incidence was observed in the ICUs of the Lausanne University Hospital, Switzerland. During this period, 689 isolates were retrieved from 254 patients. All isolates were analyzed with DLST and grouped in 46 DLST clusters, from which 4 clusters were further investigated in this study (cluster 1_18, 1_21, 6_7 and 28_77). These 4 clusters were retrospectively typed with the DDSL method to verify if an improved discrimination of isolates could be achieved. To do so, a first DDSL optimization step was performed, which resulted in good quality fingerprinting profiles. However, a quantitative analysis of the results using BioNumerics software was not possible. Visual comparison of DDSL fingerprinting patterns within each cluster allowed the formation of different DDSL types, but not the determination of bands differences between them. Epidemiological data showed that contamination of humid environments probably played an important role in the dissemination of P. aeruginosa strains in this outbreak. Comparison of epidemiological and molecular information showed that most of undistinguishable DDSL types were epidemiologically linked, leading to the assumption that patient-to-patient transmission should be highly suspected, as seen for cluster 1_18. Nevertheless, strain evolution should be considered when studying a long period outbreak. In conclusion, this new typing strategy of P. aeruginosa allowed the acquisition of a general picture about this outbreak’s epidemiology. Nevertheless, the DDSL is a technically complex, time consuming and subjective technique, not efficient to be use for epidemiological investigation purposes.
Pseudomonas aeruginosa é a terceira causa de infeção adquirida em hospitais, em pacientes hospitalizados em unidades de cuidado intensivo (UCIs). Este microrganismo é responsável por um elevado número de doenças nosocomiais, e pelo sua gravidade. Uma vez que é ubíquo no ambiente e também constitiu a microbita endógena de pacientes hospitalizados, existe a necessidade de utilizar métodos de tipagem molecular eficientes no estabelecimento de relações clonais entre isolados. Double Locus Sequence Typing (DLST) tem sido usado recentemente na análise de relações clonais entre estirpes de P. aeruginosa, provando ser eficaz, fácil, e reduzindo também o tempo de manipulação e custos de análise. Outra técnica de tipagem chamada Double Digest Sequence Label (DDSL) foi também descrita no estudo molecular deste microrganismo. Um elevado poder discriminatório torna DDSL num complemento putativo à tipagem para resolver clusters de DLST em situações específicas. De 2010 a 2012 observou-se um aumento da incidência de infeções por P. aeruginosa nas UCIs do Hospital Universitário de Lausana, na Suíça. Durante este período, 689 isolados foram recolhidos de 254 pacientes. Todos os isolados foram analisados com DLST e agrupados em 46 DLST clusters, dos quais 4 clusters foram posteriormente investigados neste estudo (cluster 1_18, 1_21, 6_7 e 28_77). Estes 4 clusters foram retrospectivamente tipados com o método DDSL para verificar se se poderia alcançar uma melhor discriminação dos isolados. Para isso, um primeiro passo de optimização de DDSL foi realizado, o qual resultou em perfis de fingerprinting de boa qualidade. Contudo, a análise quantitativa dos resultados usando o software BioNumerics não foi possível. A comparação visual dos perfis de fingerprinting de DDSL para cada cluster permitiu a formação de diferentes tipos de DDSL, mas não a determinação de bandas diferentes entre os mesmos. Os dados epidemiológicos mostraram que a contaminação de ambientes húmidos provavelmente desempenhou um papel importante na disseminação de estirpes de P. aeruginosa neste surto. Comparação de informação epidemiológica e molecular mostrou que a maioria dos tipos de DDSL não distinguíveis estavam epidemiologicamente ligados, levando à suposição de que a transmissão paciente-para-paciente deveria ser altamente considerada, como visto para o cluster 1_18. No entanto, a evolução da estirpe deve ser considerada aquando do estudo de um surto de longa duração. Concluindo, esta nova estratégia de tipagem de P. aeruginosa permitiu obter uma imagem geral acerca da epidemiologia deste surto. Todavia, DDSL é um método tecnicamente complexo, demorado e subjectivo, não eficiente para ser usado para fins de investigação epidemiológica.

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Johnson, Randall. "Evaluation of an Education Intervention for the Staff on the Head of the Bed Elevation in the Pediatric Intensive Care Unit." Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3036.

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Elevating the head of bed (HOB) reduces risks for aspiration and ventilator associated pneumonia (VAP) in the adult population. Educational interventions have resulted in improvements in achieving a target HOB elevation of 30[degrees] in adults. Limited research has addressed this intervention in the pediatric intensive care unit (PICU). The aim of this study was to determine if an educational intervention for the PICU staff would result in improvement in the HOB elevation in the PICU. Four research questions were studied: 1) What is the common practice related to the elevation of the HOB in the PICU? 2) Is there a difference in the mean HOB elevation before and after an education intervention? 3) Is there a difference in the percent of time the HOB is at or above 30[degrees] after the intervention? and 4) What factors influence HOB elevation in the PICU? A quasi-experimental, pre, and post measurement, with nonequivalent comparison group design was used. The angle of the HOB elevation was measured with the "Pitch and Angle Locator" (PAL) (Johnson, Mequon, WI). Baseline measurements (n = 99) were obtained for patients admitted to a PICU at various days and times over a 2-week period. An educational intervention was done for the staff members in the PICU, with a focus on the importance of keeping the HOB up and strategies for measuring the HOB elevation. Posters to reinforce the information were placed on the unit. Post-intervention, measurements (n = 98) were obtained for another 2-week period. At the time of data collection, staff members caring for the PICU patients were asked to provide responses for what influenced them to place the patient at the documented HOB elevation. Children were older in the post-intervention group than in the pre-intervention (8.8 yrs, vs. 3.7, yrs, respectively, t = -6.67, df = 195, p= .000). The children also weighed more in the post-intervention group than in the pre-intervention (32.0 kg vs. 19.7 kg, respectively, t = -4.19, df= 195, p = .000). The mean HOB elevation was 23.5[degrees] before the intervention. After the intervention, the mean HOB increased to 26.5[degrees] (t = -1.19, df 195, p = .033). For ventilated patients, the mean HOB elevation went from 23.6[degrees] to 29.1[degrees] (t = -3.25, df 95, p= .001), and for patients mechanically ventilated and in an adult bed, the mean increased from 26[degrees] [plus or minus] 7.89[degrees], pre- intervention to 30[degrees] [plus or minus] 8.59[degrees] post-intervention (t = -1.80, df 63, p = .038). The percent of the time the measures were greater than 30[degrees] increased from 26% to 44% pre- and post-intervention respectively (X2 6.71, df 1, p= .005). Responses (n = 230) related to the factors that influenced positioning were categorized as follows: physician order (3%), safety (7%), found this way (11%), therapeutic intervention (16%), comfort (24%), and patient condition (39%). An educational intervention can impact the practice of elevation of the HOB in a PICU, thus decreasing the risks of developing aspiration and VAP. Although the mean HOB increased statistically, the HOB was less than 30[degrees] in more than half of the post intervention measurements, indicating the need for ongoing reinforcement of the education. The PAL device was a new, reliable method for recording HOB elevation in both adult beds and cribs. Follow-up research is needed to determine if these gains in HOB elevation have been sustained over time and their impact on VAP.
Ph.D.
School of Nursing
Health and Public Affairs
Nursing PhD

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Souza, Daniela Carla de. ""Avaliação da estrutura das unidades de terapia intensiva pediátrica neonatal do município de São Paulo"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-19102005-121204/.

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Apesar da importância das unidades de terapia intensiva pediátricas e neonatais (UTIP/UTIN) na assistência à criança criticamente enferma, pouco se conhece da estrutura destas unidades no município de São Paulo (SP). No período de agosto/00 a julho/02 foi realizado estudo descritivo da estrutura das UTIP/UTIN do município de SP. Das 107 unidades identificadas, 85 (79,4%) concordaram em participar através do preenchimento de questionário. Observou-se uma distribuição desproporcional das UTIs e dos leitos (1 leito/604 crianças - 1 leito/6.812 crianças; média: 1 leito/2.085 crianças). As 85 unidades totalizaram 1067 leitos, dos quais 969 estavam em atividade. A média do número de leitos por unidade foi 11,7 (4-60). Em relação a recursos materiais, equipamentos essenciais para o funcionamento de uma UTI estavam indisponíveis. Quanto aos recursos humanos, mais de 70% dos critérios mínimos foram cumpridos. Observou-se diversidade na distribuição dos leitos de UTIP/UTIN no município de SP
Despite the importance of pediatric and neonatal intensive care units (PICU/NICU) to the care of severally ill children, the knowledge of the structure of these units is scarce in Sao Paulo. From Aug/00 to July/02 it was conducted a descriptive study about structure of PICU/NIUC in the city of Sao Paulo. We identified 107 PICU/NICU and 85 (79.4%) agreed to participate. We noticed an irregular distribution of the ICU in relation to the pediatric population in each district (1bed/604 children - 1 bed/6.812 children, mean 1 bed/2.085 children). The 85 units made a total of 1067 beds of which 969 were considered active. The mean number of beds per ICU was 11.7 (4-60). Some basic requirements for a PICU were found to be unavailable in quite a number of units. Regarding human resources, more than 70% of standards were accomplished. We concluded that exists a substantial diversity in PICU/NICU structure in Sao Paulo

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Lobo, Renata Desordi. "Avaliação do impacto de dois diferentes modelos de intervenção na redução das taxas de infecção de corrente sanguínea relacionada a cateter venoso central em unidades de terapia intensiva." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-15042009-161344/.

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As infecções de corrente sanguíneas relacionadas a cateter venoso central (ICS-CVC) são as causas mais freqüentes de morbidade e mortalidade em unidade de terapia intensiva (UTI). Muitos estudos mostram que educação e treinamento dos profissionais da área da saúde (PAS) sobre as práticas do cuidado com o CVC é uma importante ferramenta na prevenção e redução das ICS-CVC, entretanto o melhor modelo de educação ainda não está bem estabelecido. O objetivo desse estudo foi avaliar o impacto de dois modelos de intervenção educacional na redução das taxas de ICS-CVC, avaliar o conhecimento de boas práticas do cuidado com o CVC pelos profissionais da área da saúde (PAS) e avaliar a aderência às recomendações do cuidado com o CVC pelos PAS após aplicação dos diferentes modelos de intervenção. Realizou-se um estudo observacional, prospectivo, no período de Janeiro de 2005 a Junho de 2007 em duas unidades médicas de terapia intensiva (UTI A e UTI B) em um grande hospital escola (976 leitos sendo 120 leitos de UTI). O estudo foi dividido em três períodos: basal (somente as taxas de ICS-CVC e densidade de utilização do CVC foram avaliadas), diagnóstico (aplicação de questionário para avaliar o conhecimento dos PAS, seguido de observação das práticas realizado pelos PAS de cuidado durante a inserção, manipulação e curativo do CVC em ambas UTIs) e período de intervenção. Na UTI A, baseado nos problemas encontrados na observação, foram aplicadas aulas, dinâmicas, divulgação mensal das taxas de ICS-CVC, cartazes e etiquetas nos CVCs com lembretes sobre práticas de cuidado com esses dispositivos. Essa intervenção ocorreu para todos os PAS da unidade além de novos funcionários e residentes de medicina. Na UTI B uma única aula foi aplicada. Essa aula continha informações sobre cuidados durante a inserção, manipulação e curativo do CVC. Uma tabela foi criada e os dados foram armazenados no programa Epidata-2.1. Qui-quadrado foi calculado comparando o período de diagnóstico e de intervenção. Durante esses dois períodos, 940 e 843 CVCdias foram avaliados respectivamente na UTI A e 2175 e 1694 na UTI B. Questões sobre inserção CVC, desinfecção da conexão e curativo com solução alcoólica foi respondido corretamente por 70% a 100% dos PAS, entretanto a aderência as praticas de cuidados com o CVC durante a observação foi baixa, especialmente para a higiene das mãos (6%-35%) e desinfecção da conexão do CVC (45-68%). Após a intervenção das taxas de ICS-CVC caíram nas duas UTIs, entretanto na UTI A que ocorreu intervenção contínua, o decréscimo das taxas foi progressivo e sustentado. Na UTI B, onde uma única intervenção foi aplicada (aula) as taxas de ICS-CVC caíram inicialmente e voltaram a subir ao longo do tempo. Na UTI A, foram identificados 12 ICS-CVC por 1000 cateteresdias no período basal e nove meses após o início da intervenção contínua, não foi identificado nenhuma ICS-CVC. Na UTI B, 16,2 ICS por 1000 cateteres-dias no período basal caiu para 6,7 ICS por 1000 cateteres-dias. Em conclusão, programa educacional contínuo e personalizado parece desenvolver uma cultura de prevenção e é mais efetivo que uma única intervenção, com sustentação dos índices baixos de ICS-CVC
Central venous catheter-related bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care unit (ICU). Many studies have shown that education and training of health-care workers (HCW) on practices concerning CVCs are important tools to decrease and prevent CVC-BSI but the best educational model has yet to be established. The aim of this study was to evaluate the impact of two models of educational intervention on the rates of CVC-BSI in the intensive care units (ICUs), to evaluate the knowledge of HCWs regarding the recommendations of CVC care and to evaluate the adherence to practices concerning CVC for each ICU, comparing the preintervention and interventions periods. This prospective observational study was conducted from January 2005 to June 2007 in two medical intensive care units (ICU A and ICU B) in a large teaching hospital. The study was divided in 3 periods: Baseline (only CVC-BSI rates and DU were evaluated) Pre-intervention (questionnaire to evaluate the knowledge of HCWs and observation phase of CVC insertion, handling and dressing practices by the HCWs in both ICUs) and Intervention periods (in ICU A, the tailored and continuous intervention was started, in ICU B a single intervention lecture was given. A database was created using the program Epi info. Chi-square was calculated comparing the pre-intervention and intervention periods. During the pre-intervention and intervention periods 940 and 843 CVC-days were evaluated respectively in ICU A and 2175 and 1694 CVC-day in ICU B. Questions regarding CVC insertion, disinfection during manipulation and the use of an alcohol-based product during dressing were answered correctly by 70- 100% of the HCWs. Notwithstanding the compliance of HCWs to these practices in the pre-intervention period was low, especially to hand hygiene (6%-35%) and disinfection of hub (45-68%). After the intervention CVC-BSI rates declined in both units, however in the ICU in which continuous intervention was used, this decrease was progressive and sustained. In the ICU B in which a single lecture was given, the rates dropped initially and increased over time. In ICU A, 12 CVC-BSI per 1000 catheters-days in baseline period to zero after 9 months intervention. In ICU B 16.2 CVC-BSI per 1000 catheters -days in baseline period dropped to 6.7 CVC-BSI per 1000 catheters-day. In conclusion, personal customized continuous education seems to develop a culture of prevention and is more effective than single intervention, it leading to a sustained reduction of infection rates

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Nazir, Souha. "Evaluation d’un système de détection surfacique ‘Kinect V2’ dans différentes applications médicales." Thesis, Brest, 2018. http://www.theses.fr/2018BRES0101.

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Une des innovations technologiques majeures de ces dernières années a été le lancement des caméras de profondeur qui peuvent être utilisées dans un large spectre d’applications, notamment pour la robotique, la vision par ordinateur, l’automatisation, etc. Ces dispositifs ont ouvert de nouvelles opportunités pour la recherche scientifique appliquée au domaine médical. Dans le cadre de cette thèse, nous évaluerons l’apport potentiel de l’utilisation du capteur de profondeur grand public « Kinect V2 » dans l’optique de répondre à des problématiques cliniques actuelles en radiothérapie ainsi qu’en réanimation. Le traitement par radiothérapie étant administré sur plusieurs séances, l'un des objectifs clés de ce traitement est le positionnement quotidien du patient dont la précision est impactée par les mouvements respiratoires. D’autre part, les mouvements de la machine ainsi que les éventuels mouvements du patient peuvent entraîner des collisions machine/machine ou machine/patient. Nous proposons un système de détection surfacique pour la gestion des mouvements inter- et intrafractions en radiothérapie externe. Celui-ci est basé sur un algorithme rigide de recalage surfacique pour estimer la position de traitement et un système de détection de collisions en temps réel pour satisfaire les conditions de sécurité durant le traitement. Les résultats obtenus sont encourageants et montrent un bon accord avec les systèmes cliniques. Coté réanimation médicale, la recherche de nouveaux dispositifs non invasifs et sans contact tend à optimiser la prise en charge des patients. La surveillance non invasive de la respiration des patients sous ventilation spontanée est capitale pour les patients instables mais aucun système de suivi à distance n’existe à ce jour. Dans ce contexte, nous proposons un système de mesure sans contact capable de calculer les paramètres ventilatoires en observant les changements morphologiques de la zone thoracique des patients. La méthode développée donne une précision de mesures cliniquement acceptable
In recent years, one of the major technological innovations has been the introduction of depth cameras that can be used in a wide range of applications, including robotics, computer vision, automation, etc. These devices have opened up new opportunities for scientific research applied to the medical field. In this thesis, we will evaluate the potential use of the "Kinect V2" depth camera in order to respond to current clinical issues in radiotherapy and resuscitation in intensive care unit.Given that radiotherapy treatment is administered over several sessions, one of the key task is to daily reposition the patient in the same way as during the planning session.The precision of such repositioning is impacted by the respiratory motion. On the other hand, the movements of the machine as well as the possible movements of the patient can lead to machine / machine or machine /patient collisions. We propose a surface detection system for the management of inter and intra-fraction motion in external radiotherapy. This system is based on a rigid surface registration algorithm to estimate the treatment position and a real-time collision detection system to ensure patient safety during the treatment.Obtained results are encouraging and show a good agreement with available clinical systems.Concerning medical resuscitation, there is a need for new non-invasive and non-contact devices in order to optimize patient care. Non-invasive monitoring of spontaneous breathing for unstable patients is crucial in the intensive care unit. In this context, we propose a non-contact measurement system capable of calculating the parameters of patient's ventilation by observing thoracic morphological movements. The developed method gives a clinically acceptable precision. Such system is the first to solve previously described issue

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Camacho, Eduardo Fernandes. "Avaliação do impacto da implantação de rotina de cuidados com cateter de drenagem ventricular externa em uma unidade de terapia intensiva neurológica." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-26052011-115512/.

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Introdução: a derivação ventricular externa (DVE) envolve um cateter colocado no espaço ventricular cerebral para drenar o liquor (LCR) excessivo. As complicações mais comuns dessa prática incluem hemorragia em sítio de inserção, obstrução do cateter, desconexão do sistema e infecção com indicadores que variam de 1% a mais de 27%. Objetivo: analisar os indicadores de infecção relacionada à DVE e avaliar o impacto da intervenção na rotina de cuidados com cateter de DVE. Casuística e Método: estudo quase-experimental realizado na UTI Neurológica do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram avaliados os dados de infecção em pacientes submetidos à DVE em duas etapas: pré-intervenção que ocorreu de abril de 2007 a julho de 2008 e intervenção que ocorreu de agosto de 2008 a julho de 2010. Na primeira etapa, foram realizadas observações do cuidado com DVE e aplicado questionário para avaliar o conhecimento dos profissionais. Na segunda etapa, foram realizados treinamentos da rotina de cuidados, higiene das mãos e biossegurança com intervalos de cinco, seis e sete meses e após um ano de intervenção foi realizado uma observação da higiene das mãos. Foram excluídos todos os pacientes que apresentaram traumatismo cranioencefálico com fratura exposta, presença de fístula liquórica, hidrocefalia congênita e presença de infecção ativa no sistema nervoso central. Os pacientes foram acompanhados por 30 dias após a retirada da DVE e considerou-se infecção relacionada à DVE os agentes microbiologicamente identificados em LCR de acordo com o critério do CDC. Foram realizadas cinco observações do cuidado com DVE, uma observação da higiene das mãos, uma elaboração da rotina de cuidados, três treinamentos com aulas expositivas e uma intervenção na redução do tempo de permanência do cateter de DVE, totalizando cinco intervenções. Resultados: Durante o estudo, 178 pacientes foram submetidos a 194 procedimentos correspondendo a 1217 cateteres-dia. A média de idade dos pacientes foi de 48 anos, sendo 62,4% do gênero feminino. A mortalidade global entre os pacientes foi de 34,8%. Antibioticoprofilaxia foi administrada em 80,4% dos procedimentos. Os agentes Gram-negativos foram identificados em 71,4% no período pré-intervenção e de 60% no período de intervenção. Os agentes Gram-positivos foram identificados em 14,3% no período pré-intervenção, de 20% no período de intervenção e infecção polimicrobiana foi identificada em 14,3% no período pré-intervenção e de 20% no período de intervenção. Os indicadores de infecção relacionada à DVE durante o estudo foram reduzidos de 9,5% para 4,8% por paciente (redução de 50,5%), de 8,8% para 4,4% por procedimento (redução de 50%) e a densidade de incidência de 14,0 para 6,9 infecções por 1.000 cateteresdia (redução de 49,2%) (p=0,027). Após a quarta intervenção, não foi identificada nenhuma infecção microbiologicamente confirmada durante doze meses consecutivos. Conclusão: Observou-se redução sustentada dos indicadores de infecção relacionada à DVE e diante desses resultados, a intervenção educacional continuada mostrou ser uma ferramenta útil na redução desses indicadores.
Introduction: an external ventricular drain (EVD) involves the placement of a catheter into the cerebral ventricular space in order to drain excessive cerebrospinal fluid (CSF). The most common complications of this practice include hemorrhage at the insertion site, obstruction of the catheter, disconnection of the system, and infection with indicator values that vary from 1% to more than 27%. Objective: to analyze the indicators of EVD-related infection and assess the impact of intervention on the routine of care of the EVD catheter. Cases and Method: the quasi-experimental study was carried out at the Neurological Intensive Care Unit of the Central Institute at the Clinics Hospital of the University of São Paulo School of Medicine. Data regarding infection from patients submitted to EVD were analyzed in two phases: pre-intervention, which occurred from April 2007 to July 2008, and intervention, which occurred from August 2008 to July 2010. During the first stage, observations were made as to the care given to the EVD and a questionnaire was applied to evaluate the level of knowledge of the healthcare professionals. During the second stage, training was given as to a routine of care, hand hygiene, and biosafety, with intervals of five, six, and seven months; one year after the intervention, observation of hand hygiene was performed. Excluded were all patients presenting with cranioencephalic trauma with exposed fractures, presence of CSF leakage, congenital hydrocephalus, and presence of active infection of the central nervous system. Patients were followed for 30 days after EVD removal and EVDrelated infections were considered those caused by agents microbiologically identified in the CSF according to CDC criteria. We conducted five observations of the care taken with the EVD, one observation of hand hygiene, one preparation of a routine of care, three training sessions with expository classes, and one intervention to reduce the time the EVD catheter remained in place, with a total of five interventions. Results: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 catheters-day. The mean age of the patients was 48 years, and 62.4% of them were females. Global mortality among the patients was 34.8%. Prophylaxis with antibiotics was given in 80.4% of the procedures. Gramnegative agents were identified in 71.4% of the cases during the preintervention period, and 60% during the intervention period. Gram-positive agents were identified in 14.3% of the cases during the pre-intervention period, and 20% during the intervention period, and 14.3% of them were polymicrobial infection in the pre-intervention period, and 20% during the intervention period. The values of EVD-related infection indicators during the study fell from 9.5% to 4.8% per patient (a 50.5% reduction), from 8.8% to 4.4% per procedure (a 50% reduction), and the density of incidence dropped from 14.0 to 6.9 infections per 1,000 catheters-day (a 49.2% reduction) (p=0.027). After the fourth intervention, no microbiologically confirmed infection was identified throughout twelve consecutive months. Conclusion: we observed a sustained reduction in EVD-related infection and in light of these results, continued educational intervention proved to be a useful tool in reducing these indicators.

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Dunbar, Pervell Velethia. "Nursing Care of Terminal patients in Intensive Care Units." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1379.

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Nursing Care for Terminal Patients in Intensive Care Units by Pervell Dunbar Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2015 Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A literature review revealed a poster previously used by a major health organization as a conversation starter to facilitate decision-making among ICU nurses, EOL patients, and their families related to EOL issues. The purpose of this quality improvement initiative was to introduce and implement an educational EOL tool that would engage patients and family members in meaningful and useful conversations with ICU nurses. Twenty seven ICU nurses were selected by the unit's director to attend a PowerPoint presentation on the use of the EOL educational poster. Four ICU nurses were chosen by the director to be champions for this project. After the presentation, there was a period for questions and answers, and the ICU nurses were requested to give feedback on the presentation. The result from the feedback revealed that EOL care is outside previous practice and may require extra education and support. These comments substantiated similar conclusions from other researchers as described in this paper. With an increase in EOL training for ICU nurses and the implementation of EOL teaching tools like the poster used in this study, ICU nurses may be better able to have conversations with EOL patients and families, thus improving patient care.

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BASTOS, LEONARDO DOS SANTOS LOURENCO. "ANALYSIS OF PERFORMANCE IN INTENSIVE CARE UNITS." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2018. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=35727@1.

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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO
COORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
A Unidade de Terapia Intensiva (UTI) é um departamento importante dentro do Hospital visto que lida majoritariamente com casos de alta complexidade e gera elevados custos administrativos, o que requer um controle adequado de seus processos. Inconformidades tais como erros em atividades de tratamento e falta de comunicação entre os funcionários são comumente responsáveis pelo baixo desempenho de UTIs e devem ser ajustados para reduzir possíveis danos ao tratamento do paciente. Para avaliar a eficiência de uma UTI, a literatura propõe que sejam estabelecidas métricas que considerem quatro perspectivas - médica ou clínica, econômica, social e institucional – que oferecem uma visão abrangente das atividades (administrativas ou de tratamento) dentro da unidade e seus impactos no pós-tratamento. Entretanto, a avaliação de desempenho em uma UTI não é uma tarefa simples, pois há diversas variáveis a serem consideradas e que podem ser potenciais causas de um mau desempenho. Além disso, não há uma métrica ou indicador padrão-ouro que consegue reter de forma adequadas as informações, sendo que diversas perspectivas devem ser consideradas. Os indicadores mais comuns são A Taxa de Mortalidade Padronizada (Standardized Mortality Ratio, SMR) e o Taxa de Uso de Rescursos Padronizada (Standardized Resource Use, SRU), que contabilizam desfechos de mortalidade (clínicos) e de uso de recursos (econômicos), junto de metodologias propostas para viabilizar a comparação entre diferentes UTIs, identificar de grupos de desempenho e analisar os riscos de mortalidade dos pacientes dentro da unidade, tais como os conceitos de Rankability e Perfis de Risco (Risk Profiles). Além disso, é necessário definir corretamente os desfechos a serem contabilizados em indicadores. Nesse contexto, recomenda-se a combinação de diferentes indicadores e metodologias de forma a complementar e elevar a confiabilidade da análise de desempenho e benchmarking. Com isso, este estudo tem como objetivo analisar um conjunto de UTIs em termos de desempenho quanto à mortalidade e uso de recursos, associando-os com as características das unidades e seus fatores institucionais, para identificar possíveis correlações. A análise foi feita em uma amostra composta por 12.100 pacientes que foram hospitalizados em 116 UTIs, considerando um desfecho em até 60 dias de interação. Este estudo teve como contribuição a combinação de diferentes técnicas e indicadores, e uma discussão a respeito da variabilidade do SMR em comparação à metodologia tradicional. Para este propósito, combinou-se as técnicas da Matriz de Eficiência, Rankability – índice de confiabilidade de um indicador de desfecho, e Perfis de Risco, de forma a obter e avaliar o desempenho de grupos de UTIs. Como resultados, verificou-se que UTIs cuja administração é de domínio Público e que destinam a maioria dos seus leitos ao Sistema Único de Saúde (SUS) brasileiro tiveram mortalidade significativamente alta em relação àquelas de dominínio privado (p-valor menor que 0.05). Além disso, realizou-se um agrupamento das UTIs utilizando quatro diferentes técnicas de clusterização de forma a garantir a máxima confiabilidade do indicador para comparação (Rankability), o que resultou na presença de clusters extremos contendo uma UTI cada, sendo elas a de maior e a de menor SMR, apesar de ambas apresentarem o mesmo conjunto de severidades. Para cada grupo, estimou-se o seu perfil de risco, e verificou-se que pacientes com menor gravidade apresentaram maior variabilidade nos riscos de morte, sendo estes maiores nos grupos com alto SMR e menores em grupos de menor mortalidade, sendo que a dispersão tendeu a ser menor quanto menor for o risco, o que poderia influenciar diretamente no cálculo do SMR. Com isso, por meio de equações matemáticas e simulação por meio de reamostragem, verificou-se que o SMR possui uma limitação em sua escala, que depende diretamente do espectro de gravidade dos pacientes em cada UTI ou grupo de desempenho analisado. O S
Intensive Care Unit (ICU) is an important department within a hospital since it deals mostly with complex cases and it generates the highest amount of costs, thus requiring adequate control on its care treatments. Nonconformities such as poor communication and treatment errors are commonly responsible for a bad performance in ICUs. However, evaluating the performance of an ICU is not an easy task and there are no gold-standard indicators. The most common metrics are the Standardized Mortality Ratio (SMR) and the Standardized Resource Use (SRU), which measure mortality and resource utilization, respectively. Hence, this study aims to analyze different ICUs in terms of mortality, resource use, and institutional factors, combining the methods Efficiency Chart, Rankability and Risk Profile. The analysis was performed considering a total of 12,100 patients in 116 ICUs provided by a clinical trial study. As results, it was verified that most ICUs were from hospitals with public administration (47.41 per cent), which had significantly high lethality rate compared to private hospitals. Four different clustering approaches were tested, which identified similar case-mixes between the best and lower performance groups of ICUs, and a high variability in expected risks for low severity patients. Using a resampling approach, it was evidenced that the mortality indicator varies strongly on low-risk groups of patients, while high-risk patients had a smaller range of SMR values, which may lead to biased conclusions when comparing ICUs with similar mortality and different case-mixes.

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Leighton, P. H. "Monitoring blood stream infection in neonatal intensive care units." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1302069/.

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Comparisons of the incidence of blood stream infection (BSI) between neonatal intensive care units (NICUs) can promote sharing of potentially better practices for infection control. Comparisons should take into account differences in babies’ vulnerability and the invasive procedures which can introduce infection. I carried out a systematic review of methods reported in the literature, or used by regional monitoring systems, for comparing the incidence of BSI among NICUs. I found substantial variation, especially in the risk factors used to adjust incidence estimates. The use of routinely recorded administrative data would minimize and accelerate staff workload for BSI monitoring. I investigated which risk factors recorded in routine data should be adjusted for when comparing BSI incidence between NICUs. I linked microbiology laboratory records with administrative records collected over four years for three London NICUs. I analysed rates of BSI using various methods, including Poisson regression and logistic regression assuming a matched case control design. With both approaches, National Health Service level of care was the strongest predictor for BSI incidence. Using Poisson regression models, the rate ratio for BSI, adjusted for birth weight, inborn/outborn status and postnatal age, was 3.15 (95% confidence interval (CI) 2.01, 4.94) for intensive care and 6.58 (95% CI 4.18, 10.36) for high dependency care, relative to special care. The case control study gave slightly larger estimates of effect than the Poisson regression models. Total parenteral nutrition was significantly associated with BSI incidence but explained less of the variance among babies than level of care. Using the results from the risk adjustment model, I demonstrated how routine data can be integrated into a method for prospective, risk adjusted monitoring. This method involved standardised infection ratios and a sequential probability ratio test. The method can evaluate changes in BSI rates over time and between NICUs. It could also be used to quantify improvements following infection control interventions.

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Kilinc, Derya, and Mattias Ghattas. "Implementing an Intelligent Alarm System in Intensive Care Units." Thesis, KTH, Skolan för teknik och hälsa (STH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-189536.

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Today’s intensive care units monitor patients through the use of various medical devices, which generate a high ratio of false positive alarms due to a low alarm speciﬁcity. The false alarms have resulted in a stressful working environment for healthcare professionals that are getting more desensitized to triggered alarms and causing alarm fatigue. The patient safety is also compromised by having high noise levels in the patient room, which disturbs their sleep. This thesis has developed an intelligent alarm system with an improved alarm management and the use of 23 intelligent algorithms to minimize the number of false positive alarms. The suggested system is capable of improving the alarm situation and increasing the patient safety in critical care. The algorithms were modeled with fuzzy logics consisting of delays and multi parameter validation. The results were iteratively developed by having focus groups with various experts.

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Schneider, Rosemary Roberta. "Treatment-withdrawal decisions in intensive care units : effects on nurses." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285861.

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Fernández, Méndez Rocío. "GlyCon : glycaemic control of stress hyperglycaemia in intensive care units." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/42920/.

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Background and aims Untreated stress-induced hyperglycaemia in critically ill patients has been associated with harmful effects, which can even be fatal. Current evidence about the optimal glycaemic targets, and the most effective and safest methods of glycaemic control (GC) in intensive care units (ICU), is contradictory. GlyCon study aimed to investigate the effectiveness, efficiency and safety of the monitoring and insulin treatment methods for GC implemented in the seven ICUs of an NHS ICU network in the UK. In addition, GlyCon study also aimed to explore the contents of the local protocols for GC of these ICUs, as well as the views of ICU professionals about several aspects of GC. Methodology A multi-method study was undertaken, comprising three sub‑studies: (1) a document review of the protocols for GC designed by and implemented at each of the participating ICUs, using techniques of inductive content analysis and descriptive statistics; (2) an online survey to ICU medical and nursing staff, on their opinion about effective GC, and deviations from protocol instructions, which was analysed using descriptive statistics and logistic regression; (3) A retrospective study about the methods and outcomes of GC, based on a review of electronic and manual medical records of a stratified random sample of 146 patients admitted to the seven participating ICUs during 2012 and 2013. The main analyses of association between the exposures and the primary outcome measure (percentage of time with glycaemic levels of 4‑10mmol/L, or TIR, which was transformed into the odds of being within that range at any time, or odds of IR), were mainly based on generalised estimating equations using the logit link, and autoregressive correlation structure. Secondary outcome measures of time‑efficiency and safety were also investigated, and analysed using univariate statistics and multiple log‑linear regression. Results The protocols for GC implemented in the seven ICUs differed greatly in their target patients, target glycaemic levels, recommended methods for monitoring, and insulin titration algorithms, among others. Most of the 40 respondents to the survey agreed that TIR≥75% constitutes good GC and TIR < 50% constitutes poor GC. Opinions were divided on intermediate levels of TIR, with professionals having more experience in intensive care tending to rate such intermediate TIR as poor GC more often than their less experienced colleagues. Most of the proposed protocol deviations were considered as major by at least two thirds of the respondents. Professionals’ role (nurse vs. physician) and their number of years of experience were significantly associated with different views. The blood glucose (BG) monitoring frequencies and insulin hourly dosages, at each glycaemic status, differed by ICU, and between patients with and without diabetes. Non‑adherence to protocol instructions regarding BG monitoring and insulin infusion rates occurred more often than not. The median (IQR) TIR was 91% (81‑96%) and 56% (34‑71%) among patients without and with diabetes, respectively. A number of time-dependent and time-constant factors were associated with higher odds of IR at any time. Time-constant protective factors included: having spent more than 20% of admission time receiving insulin during hyperglycaemia, certain ICU protocols, and lower levels of severity on admission. Time-dependent protective factors were: the number of hours from admission, and the dobutamine and insulin hourly dosages. Time-dependent detrimental factors were: non‑adherence to protocol insulin instructions, the hourly nutritional energy administered, and the hourly dosage of certain drugs, including adrenaline and hydrocortisone. Conclusions Protocols for GC, practice of GC, and outcomes of GC, all differed significantly across hospitals. Some protocols seemed more effective, time‑efficient or safe than others, but there was a high incidence of non‑adherence to protocol instructions in all ICUs. This contrasts with professionals rating deviations from protocols as major, more often than not. Certain monitoring and insulin treatment methods for GC were more effective, and some were more time‑efficient than others, particularly among patients without diabetes. There is a clear need for protocols to include different recommendations for patients with diabetes, as well as to formally emphasise the importance of GC also in patients without diabetes. ICU multidisciplinary teams should be involved in the development of these protocols, and their views should be accounted for in research studies about the effectiveness of GC in the ICU.

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Chaiwanon, Wongsakorn. "Capacity planning and admission control policies for intensive care units." Thesis, Massachusetts Institute of Technology, 2010. http://hdl.handle.net/1721.1/62406.

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Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2010.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 135-143).
Poor management of the patient flow in intensive care units (ICUs) causes service rejections and presents significant challenges from the standpoint of capacity planning and management in ICUs. This thesis reports on the development of a simulation framework to study admission control polices that aim to decrease the rejection rate in the ICU at Children's Hospital Boston (CHB), and to provide predictions for the future state of the ICU system. To understand the patient flow process, we extensively analyze the arrival and length of stay (LOS) data from the ICU census. The simulation model for the ICU is developed based on the results from this statistical analysis as well as the currently-practiced scheduling and admission policies of the ICU at CHB. The model is validated to provide accurate estimates for important performance metrics such as rejection rates in the ICU. The simulation model is used to study the performance of many admission control policies. The policies of our interest exploit "caps" to control the number of scheduled patients who are allowed to enter the ICU on a single day. In particular, we consider two cap-based policies: the uniform cap policy (UCP), which is the existing policy in CHB, and the service-specific cap policy (SSCP), which is originally proposed in this thesis. While the UCP implements caps on the total census of surgical patients, the SSCP utilizes the service-oriented heterogeneity of surgical patients' LOS and enforces caps on separate groups of surgical patients based on their average LOS. We show that the UCP can reduce the rejection rate in the ICU at the expense of extra waiting time of scheduled patients. The SSCP is shown to further decrease the rejection rate while increasing the waiting time compared to the UCP. We also demonstrate that the performance of both policies depends on the level of system utilization. In order to validate our results theoretically, a discrete-time queueing model for the ICU is developed and verified to provide estimates for performance measures that are consistent with the results from simulation. Finally, we introduce the notion of state-dependent prediction, which aims to identify the likelihood of the future state of the ICU conditional on the information of a current state. Several experiments are conducted by simulation to study the impact of a current state on a state in the future. According to our results, current state information can be useful in predicting the state of the ICU in the near future, but its impact gradually diminishes as the time difference between the present and future grows. Our major finding is that the probability of unit saturation at a certain future time can be determined almost entirely by the number of current patients who will leave the ICU after that time, regardless of the total number of patients who are currently staying in the unit. These results imply the potential development of adaptive cap-based policies that dynamically adjust caps according to the outcomes of state-dependent predictions.
by Wongsakorn Chaiwanon.
S.M.

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Watson, J'ai. "Impact of Noise on Nurses in Pediatric Intensive Care Units." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1378393887.

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Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.

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Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.
School of Nursing

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Amorim, Ângelo Mário Vieira. "Avaliação da qualidade assistencial de uma UTI adulto em um hospital público da cidade de São Paulo por meio dos domínios: segurança, efetividade, eficiência e centralidade no paciente." Universidade Nove de Julho, 2017. http://bibliotecatede.uninove.br/handle/tede/1613.

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Made available in DSpace on 2017-04-18T18:10:40Z (GMT). No. of bitstreams: 1 Angelo Mario Vieira Amorim.pdf: 2335865 bytes, checksum: df9aabae9bafbeac8b01885ccf1ccf83 (MD5) Previous issue date: 2017-01-06
Health is a complex system of service rendering, which has among its basic premises the search for quality and the guarantee of safety to users and patients. However, some hospital institutions have difficulty in diagnosing what should be implemented to meet these requirements. As a result, evaluate the level of health care provided in an ICU in public hospitals - through the domains of quality: safety, effectiveness, efficiency and centrality in the patients. The purpose of the present study was to analyze the quality and safety of patients in an adult intensive care unit (ICU) of a public hospital located in the city of São Paulo, and provides subsidies for the evaluation of their performance, enabling the institution to question its own results for decision making. As a methodological procedure, quality indicators related to the dimensions of safety, effectiveness, efficiency and centrality in the patient were surveyed, as well as the application of a questionnaire using sub-dimensions of patient safety assurance in 52 workers from different professional categories, who work on the unit searched. As results, it was possible to observe high rates of bloodstream infection associated with central venous catheters. In addition, with the use of analysis of variance (ANOVA), it was possible to identify that the variables associated with dimensions - management support and non-punitive responses - were the most relevant from the point of view of statistical significance (p> 0.05) as conditioners for a safe care to patient.
Saúde constitui um sistema complexo de prestação de serviços, que tem entre suas premissas básicas a busca pela qualidade e a garantia da segurança aos usuários e pacientes. No entanto, algumas instituições hospitalares têm dificuldade em diagnosticar o que deve ser implementado para o atendimento destes requisitos. Em decorrência, avaliar o nível da assistência à saúde prestada em uma UTI em hospitais públicos – por meio dos domínios da qualidade: segurança, efetividade, eficiência e centralidade no paciente. O propósito do presente estudo foi analisar a qualidade e a segurança de pacientes em uma Unidade de Terapia Intensiva (UTI) de adultos de um hospital público localizado na cidade de São Paulo e oferecer subsídios para a avaliação de seu desempenho, possibilitando à instituição questionar seus próprios resultados para tomadas de decisão. Como procedimento metodológico, houve o levantamento de indicadores de qualidade relacionados às dimensões de segurança, efetividade, eficiência e centralidade no paciente, bem como a aplicação de um questionário utilizando subdimensões da garantia da segurança do paciente em 52 trabalhadores de diversas categorias profissionais, atuantes na unidade pesquisada. Como resultados, foi possível a observação de altos índices de infecção de corrente sanguínea associada a cateteres venosos centrais. Ademais, com a utilização de análise de variância (ANOVA), foi possível identificar que as variáveis associadas às dimensões – apoio à gestão e respostas não punitivas – foram as mais relevantes do ponto de vista de significância estatística (p>0,05) como condicionantes de uma cultura para a assistência segura aos pacientes.

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Lai, Chi-keung Peter. "Protocol-led weaning of mechanical ventilation in adult intensive care Unit." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720895.

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Lau, Yuk-yin. "Effect of treatment interference protocol (TIP) on the use of physical restraints in ICU." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4072170X.

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Dshkhunyan, Narek. "Telemedicine systems at intensive care units : identifying patients that benefit most." Thesis, Massachusetts Institute of Technology, 2017. https://hdl.handle.net/1721.1/122867.

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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2017
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 63-64).
Telemedicine is an exciting development at the intersection of technology and medicine, which promises to improve health care systems and alleviate the workload on doctors and nurses alike at hospital intensive care units. While much work has been done on assessing the benefits of telemedicine compared to traditional approaches, we do not know which are the characteristics of patients that will benefit most from the introduction of tele-ICU systems in hospitals. In this thesis, we analyzed two large databases that contain plethora of deidentified health records about patients treated in traditional and tele-ICU hospitals, named MIMIC and eICU-CRD, respectively. By comparing key patient outcomes such as length of stay and mortality, and running sophisticated statistical methods, we identified certain traits of admitted patients that constantly benefit more from the presence of eICU than other patients. We hope that this work will help hospitals around the country and the world as they are preparing their facilites for the new generation of technologies.
by Narek Dshkhunyan.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science

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Lau, Chun-ling, and 劉俊玲. "Factors affecting hand hygiene compliance in intensive care units: a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48423890.

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Hospital-acquired, or nosocomial infections (HAIs) are the major source of mortality and morbidity for hospitalized patients. It is estimated that 7-10% patients developed HAIs during their hospital stays, with most patients got infected from intensive care units (ICU) [1,2]. Hand hygiene (HH) is recognized as the most easy and effective way to prevent HAIs. However, the observed hand hygiene compliance rates among healthcare workers (HCWs) have been regarded as unacceptably low, especially in ICU [3]. This literature review is to discuss the factors influencing the hand hygiene compliance among HCWs in ICU, in both the individual and institutional level, and suggest which factor was important in both levels. Recommendations in comprehensive approach on hand hygiene practices will also be included.
published_or_final_version
Public Health
Master
Master of Public Health

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Fontela, Patricia. "Surveillance of central line-associated bloodstream infections in Quebec intensive care units." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106376.

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Central line-associated bloodstream infections (CLABSI) figure as one of the most important healthcare-associated infections (HAI), particularly in intensive care units (ICU). Despite their clinical and public health importance, little is known about CLABSI in Canadian ICUs. Thus, the first objective of this thesis was to describe the epidemiology of CLABSI in Quebec ICUs, using data from the Surveillance Provinciale des Infections Nosocomiales – Bactériémies Associées aux Cathéters Centraux (SPIN-BACC) program. We showed that CLABSIs are an important problem in Quebec ICUs, but CLABSI incidence rates have decreased since 2007. Moreover, the proportion of methicillin-resistant Staphylococcus aureus has declined to <40% since 2006 (chapter 6). Surveillance programs are essential to establish benchmarks. In the last years, several regional and national CLABSI surveillance programs have decided to eliminate continuous participation requirements from hospitals. This might have jeopardized the validity of these programs' results because the minimal number of months hospitals should participate in such programs to generate valid annual benchmarks for CLABSI incidence rates have yet to be determined. Our second objective was to determine, through simulation, the impact of different participation requirements on the ability of national and provincial/regional surveillance programs to yield valid estimates of the true annual ICU CLABSI pooled incidence rates. We demonstrated that shortening participation requirements might be suitable for national ICU CLABSI surveillance programs if data are randomly collected. Nevertheless, regional/provincial programs should opt for continuous participation to avoid biased benchmarks (chapter 7). Furthermore, surveillance programs can also be used as a tool to reduce CLABSI incidence rates in ICUs. However, the magnitude of this effect has not been definitely determined as earlier studies presented a wide range of effect estimates. We hypothesized that the effect of surveillance on CLABSI rates differs depending on the characteristics of participating ICUs. Our third objective was to determine the effect of SPIN-BACC on the CLABSI incidence rates in Quebec ICUs, and identify ICU-level variables associated with higher CLABSI incidence rates. There were important reductions in the CLABSI incidence rates of "surveillance-naïve" (31%) and of non-university affiliated ICUs (27%) that participated in SPIN-BACC for 3 years. However, due to our small sample size, these results were not statistically significant. Neonatal and "surveillance-naïve" units were associated with higher CLABSI incidence rates (chapter 8). In conclusion, our first study described the CLABSI burden on ICU patients in Quebec. Our simulation study suggested that small and medium sizes surveillance programs should perform continuous surveillance to avoid biased benchmarks. Finally, we suggested that reductions in ICU CLABSI incidence rates associated with targeted surveillance may be more pronounced among "surveillance-naïve" and non-university affiliated ICUs. All the different applications of CLABSI surveillance data demonstrated in this thesis have the ultimate goal of improving patient care and safety.
Parmi les infections associées aux soins de santé, les bactériémies associées aux cathéters centraux (BACC) occupent une place prédominante, particulièrement dans les unités de soins intensifs. Toutefois, l'épidémiologie des BACC au niveau canadien est peu connue. Dès lors, le premier objectif de cette thèse était de décrire l'épidémiologie des BACC dans les unités de soins intensifs du Québec en utilisant les données du programme de Surveillance Provinciale des Infections Nosocomiales – Bactériémies Associées aux Cathéters Centraux (SPIN-BACC). Nous démontrons que les BACC sont un problème majeur dans les unités de soins intensifs du Québec. Néanmoins, les taux d'incidence de BACC ont progressivement baissé depuis 2007 et la proportion de Staphylococcus aureus résistants à la méthicilline se maintient <40% depuis 2006 (chapitre 6). Les programmes de surveillance sont essentiels pour générer des étalons externes. Toutefois, au cours des dernières années, plusieurs programmes régionaux et nationaux ont aboli la participation continue comme préalable. Cette décision pourrait avoir compromis la validité de leurs résultats car le nombre minimal de mois lesquels les établissements doivent soumettre des données à ces programmes afin d'obtenir des taux d'incidence régionaux/provinciaux ou nationaux valides est inconnu. Notre deuxième objectif était de déterminer, à l'aide de simulations, l'impact de différents seuils minimum de participation sur la capacité des programmes de surveillance régionaux/provinciaux et nationaux à fournir des estimations valides du vrai taux d'incidence des BACC dans les unités de soins intensifs. Nous démontrons que la réduction des seuils de participation peut être appropriée pour les programmes nationaux si les données sont soumises de façon aléatoire. Toutefois, les programmes régionaux/provinciaux, ainsi que les petits sous-ensembles des unités de soins intensifs, devraient opter pour une participation continue afin d'éviter le risque de générer des étalons externes biaisés (chapitre 7). Par ailleurs, les programmes de surveillance peuvent aussi être utilisés comme outils pour réduire le taux d'incidence des BACC dans les unités de soins intensifs. Toutefois, l'importance de cet effet n'a pas encore été déterminée de façon définitive, car les études antérieures ont presenté une vaste gamme d'effets de tailles différentes. Dès lors, notre troisième objectif était de déterminer l'effet de SPIN-BACC sur les BACC dans les unités de soins intensifs du Québec et d'identifier les variables associées à un taux d'incidence des BACC plus élevé. Nous observons des réductions importantes des taux d'incidence des BACC parmi les unités de soins intensifs qui n'avaient jamais été exposées à la surveillance (31%), ainsi que parmi les unités de soins intensifs non-universitaires (27%) qui ont participé à SPIN-BACC pendant 3 années. Toutefois, ces résultats n'étaient pas statistiquement significatifs à cause de notre petite taille d'échantillon. Les unités de soins intensifs néonatales et les unités qui n'avaient jamais été exposées à la surveillance étaient associées à un taux d'incidence des BACC plus élevé (chapitre 8). En bref, nous avons démontré que les BACC constituent un lourd fardeau au sein de la population de patients admis aux unités de soins intensifs dans la province de Québec. Notre deuxième étude a suggéré que les programmes de surveillance de petite et moyenne tailles devraient effectuer leur surveillance de façon continue. Enfin, l'effet d'un programme de surveillance ciblé sur les taux d'incidence des BACC semble être plus prononcé au sein des unités de soins intensifs n'ayant jamais exposées à la surveillance et les unités de soins intensifs qui ne sont pas affiliées à des universités.

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Erlandsson, Marcus. "Surveillance of Antibiotic Consumption and Antibiotic Resistance in Swedish Intensive Care Units." Doctoral thesis, Linköping : Univ, 2007. http://www.bibl.liu.se/liupubl/disp/disp2007/med1019s.pdf.

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Chard, Jennifer Clarissa 1963. "Professional nursing practice in medical-surgical and intensive care units: Baseline comparisons." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/278593.

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This study had three purposes: (1) to examine the differences and similarities between intensive care and medical-surgical RNs' self-reports of professional nursing practice and job satisfaction. (2 & 3) to explore the influence of professional nursing practice on nurse satisfaction in intensive care RNs and medical-surgical RNs, respectively. A two-group, cross-sectional descriptive design with a sample of 340 RNs was utilized to perform a secondary analysis of baseline data from the Differentiated Group Professional Practice project. Self-reports of RNs evidenced significantly higher levels of autonomy and control over nursing practice among intensive care subjects as opposed to medical-surgical subjects. The concepts of organizational commitment, autonomy, control over nursing practice, and group cohesion had a positive influence on total job satisfaction for the medical-surgical subjects. The above concepts with the exception of autonomy had a positive influence on total job satisfaction for the intensive care subjects.

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Wang, Ang. "Hybrid modelling and decision support for ventilator management in intensive care units." Thesis, University of Sheffield, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489681.

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Mechanical ventilation is a life-saving therapy for patient treatments in Intensive Care Units (ICUs). The management of mechanical ventilation is a very challenging task. It has long been recognised that a computer-based bedside decision support system is r desirable for optimal ventilator management in ICUs. In this thesis, a closed-loop adaptive model-based ventilator management decision support system is developed. A previously developed ventilated patient mathematical model is further improved and extended with respect to the model parameter estimation and the simulation of the patients as their clinical states evolve. A hybrid modelling strategy is implemented by combining mathematical modelling and data-driven modelling techniques. With the availability of rich data in ICU and the improvements made in the model parameter estimation, the model is able to represent patient state evolution and provide accurate blood gas and tidal volume predictions. An adaptive decision support system is, thereafter developed based on the patient model using an optimisation approach and the system is evaluated via a series of closed-loop simulations. Results show that the srstem can generate good ventilator setting advice subject to the patient state changes and competing ventilator management targets. In addition, a future ventilator management tool, named Electrical Impedance Tomography CElT), is investigated in this thesis in relation to its data processing and feature extraction. The integration of EIT into the current decision support system represents a very promising research direction for the optimal ventilator management decision support.

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Cruz, M. D., A. M. Fernandes, and CR Oliveira. "CO75 - Epidemiology of procedural pain in neonatal intensive care units of Portugal." Bachelor's thesis, Secção de Neonatologia da Sociedade Portuguesa de Pediatria, 2015. http://hdl.handle.net/10174/17193.

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A neonatologia é uma subespecialidade da pediatria relativamente nova iniciando-se como uma área altamente tecnológica e que tende a ser cada vez menos invasiva. Foram vários os avanços que permitiram uma redução da mortalidade do recém-nascido prematuro: o transporte in utero, os corticóides prenatais, o "milagre" do surfactante, cuidados regionalizados (de que Portugal é um bom exemplo), ... Com a evolução dos tempos a preocupação dos neonatologistas "transferiu-se" da mortalidade para a morbilidade, os cuidados passaram de centrados no doente a centrados na família, a ventilação tornou-se não invasiva, a maior importância da nutrição, sono, redução da infecção, luz, ruído e dor, variáveis conjuntas influenciando o neurodesenvolvimento.

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Rodriguez, Rene Merced. "Implementation of an Early Progressive Mobility Program in the Intensive Care Units." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3318.

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In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk for complications such as ventilator associated pneumonia, thromboembolisms, and pressure ulcers. The purpose of this evidence-based practice (EBP) quality improvement project was to evaluate an EPM program based to improve interdisciplinary collaboration and care coordination. The introduction, development, and evaluation of this project were guided by the Iowa Model and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) bundle. The EPM program was implemented in a 20-bed ICU in a 400-bed hospital as the Mobilization Criteria / Algorithm for Critical Care Patients (MCACCP). Retrospective data was collected for six months from the electronic health record and evaluated with a web-based analytics tool. The project resulted in a 1.2-day decrease in ICU LOS and a 6.7% reduction in ventilator days. The average daily census decreased from 16.2 in 2015 to 14.7 through 2016. EBP research supports the benefit of early mobility of ICU patients to reduce complications, ventilator days, LOS, and the overall cost for care. This project demonstrates standardizing clinical practice based on EBP guidelines and protocols translates into improved teamwork, patient outcomes, and organization metrics.

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Clifford, Ilzé. "The lived experiences of professional nurses with regards to end-of-life issues in the Intensive Care Unit." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1018572.

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Professional nurses working in an intensive care unit (ICU) are faced with the death of critically ill patients frequently. Modern day medicine and technology have made it possible for advanced life-sustaining measures to be implemented on patients who, without medical intervention, would otherwise not have survived. The question is raised: is modern technology preserving life and prolonging the dying process, or is it in the best interest of the patient for treatment to be withdrawn? Nurses, caring for these patients and their families, are practicing at the bedside of these dying patients and are thus often faced with end-of-life issues, particularly withdrawal of treatment. The primary functions of critical care nurses are toward their patients. Physicians are responsible for making decisions regarding withdrawal of treatment. However, the nurses in the ICU are responsible for implementing the decisions made; sometimes contradicting what they believe in. The experience of end-of-life issues, namely withdrawal of treatment, is a cause of distress for the professional nurse. Little research has been done on how the ICU nurses deal with end-of-life issues and what support structures are required to assist nurses in dealing with end-of-life issues (Hov, Hedelin & Athlin, 2006:204) The objectives of the study were to explore and describe the professional nurses‟ lived experiences of end-of-life issues in the intensive care unit. The study aimed to make recommendations regarding support strategies to assist professional nurses in dealing with end-of-life issues in the intensive care unit. The researcher has selected a qualitative research approach with an explorative, descriptive and contextual design in order to conduct the study. Data was collected by means of semi-structured interviews. Data was analysed using the steps as illustrated by Tesch‟s method. Ethical principles were maintained throughout the research study. The findings of this study are to be presented in a journal publication.

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Lawhon, Gretchen. "Facilitation of parenting within the newborn intensive care unit /." Thesis, Connect to this title online; UW restricted, 1994. http://hdl.handle.net/1773/7195.

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Thernström, Blomqvist Ylva. "Kangaroo Mother Care : Parents’ experiences and patterns of application in two Swedish neonatal intensive care units." Doctoral thesis, Uppsala universitet, Pediatrik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-180047.

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Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

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Van, der Heever Mariana. "An ideal leadership style for unit managers in intensive care units of private health care institutions." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4058.

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Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: The work environment in critical care units in South Africa is hampered by a profound shortage of nurses, heavy workloads, conflict, high levels of stress, lack of motivation and dissatisfaction among the staff. The task of managing a C.C.U. has therefore become a challenge. It is important that unit managers apply a leadership style that matches these challenges. The aim of this study was to investigate the ideal style of leadership. The objectives set for the study were to identify the ideal leadership style required in the following areas:  administrative functions  education functions  patient care  research An explorative, descriptive research design was applied, with a quantitative approach to determine the ideal leadership style for unit managers in critical care units of private health care institutions. The research sample consisted of all nurses working permanently in eleven private hospitals in the Cape Metropolitan area. A questionnaire consisting of predominantly closed questions was used for the collection of data, which was collected by the researcher in person. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University. Permission to conduct the research was obtained from the institutions and informed consent from the participants. A pilot study was conducted to test the questionnaire at a private hospital which did not form part of the study. A 10% sample of the relevant staff, namely 27 participants were involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician as well as experts in nursing and a research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi-square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings of the study show that participatory leadership style and transformational leadership approach were valued in all four (4) of the objectives. Emphasis was placed on consultation prior to any decisions. Nurses requested an opportunity to give feedback on a regular basis regarding the unit managers conduct (Chi-square test p = 0.025). They also agreed that unit managers should apply the necessary rules and procedures (Chi-square test p = 0.016). A huge request was made for integrity, trust, impartiality, openness, approachability and particularly honesty. The nurses also maintained that the nurse manager’s behaviour should be congruent. Furthermore, the results indicate that nurses would like to be empowered by:  being involved in the scheduling of off-duties  taking the lead in climate meetings  being granted opportunities (to all categories of nurses) to attend managerial meetings. N = 41 (48.2%) of nurses admitted that unit managers would instruct them to cope with insufficient staffing pertaining to ventilated patients, putting them under severe strain and at risk legally. N = 39 (47%) of nurses admitted that unit managers only consider qualifications and experience in the delegation of tasks if the workload in the unit justifies it. Safe patient care is not always a priority. N = 99 (96%) of nurses agreed that autocratic behaviour relating to task delegation exists. Recommendations included the application of transformational leadership and participatory management. The aim to create a healthier, more favourable work environment for critical care nurses will hopefully be attained through applying the ideal leadership style and leadership approach.
AFRIKAANSE OPSOMMING: Die werksverrigtinge in kritieke sorgeenhede in Suid-Afrika word deur ‘n ernstige tekort aan verpleegsters, hoë werklading, konflik, spanning, min motivering en baie ontevredenheid onder verpleeglui gekortwiek. Die leiding en bestuur van ‘n kritieke sorgeenheid is dus nie ‘n maklike taak nie. Dit is dus belangrik dat eenheidsbestuurders ‘n leierskapstyl aan die dag lê wat dié uitdagings doeltreffend aanspreek. Die doel van die studie is dus om ondersoek in te stel na die wenslike leierskapstyl vir kritieke sorgeenhede. Die doelwitte daargestel is dus om die ideale leierskapstyl in elk van die volgende funksies te bepaal:  administrasie  opleiding  pasiënte-sorg  navorsing Die ideale leierskapstyl vir eenheidbestuurders in kritieke sorgeenhede in privaathospitale is bepaal deur ‘n kwantitatiewe benadering met ‘n beskrywende ontwerp toe te pas. Die populasie het alle kritieke sorg verpleeglui ( permanent werksaam by een van elf privaathospitale in die Kaapse Metropool) ingesluit. Instrumentasie het ‘n vraelys behels (met oorwegend geslote vrae) en data is persoonlik deur die navorser ingevorder. Etiese toestemming is vanaf die Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die hoofde van die verskillende privaathospitale waar navorsing plaasgevind het. Ingeligte toestemming is ook van elkeen van die deelnemers verkry. Ten einde die vraelys te toets, is ‘n loodstudie by ‘n privaathospitaal ( wat nie by die studie ingesluit was nie) gedoen. Die loodstudie het N = 27 (10%) van die totale populasie behels. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Ten einde sterkte van verhoudings tussen twee opeenvolgende veranderlikes te bepaal, is die Spearman rangordekorrelasie (rho) aangewend. Die bevindings van die studie het getoon dat ‘n deelnemende bestuurstyl en transformasie-leierskapbenadering die mees aangewese keuse vir al vier doelwitte is. Die toepassing van veral ‘n deelnemende besluitnemingsproses het groot voorrang geniet, Verpleegkundiges wil daarbenewens ook op ‘n gereelde basis geleentheid hê om terugvoering oor die leierskapgedrag van die eenheidsbestuurder te gee (Chi-square toets p = 0.025). Ook verlang die deelnemers dat eenheidsbestuurders nie reëls en regulasies moet verontagsaam nie (Chi-square toets p = 0.016). ‘n Ernstige versoek is gerig ten opsigte van integriteit met pertinente verwysing na eerlikheid, vertroue, onpartydigheid, deursigtigheid, toeganklikheid en dat die leier se woorde en dade moet ooreenstem. Die resultate het verder getoon dat verpleegsters graag bemagtig wil word deur:  betrokkenheid in die skedulering van afdienste,  leiding in klimaatsvergaderings te wil neem,  geleentheid te hê om bestuurvergaderings by te woon (alle kategorieë van verpleegkundiges).. N = 39 (48.2%) van verpleegkundiges het erken dat hulle gedwonge personeeltekorte ten opsigte van geventileerde pasiënte ervaar en dus aan mediese geregtelike risiko’s en onnodige druk blootgestel word. N 39 (47%) van verpleegkundiges het erken dat eenheidsbestuuders kwalifikasies en ondervinding slegs in ag neem indien die werklading in die eenheid dit toelaat..Veilige pasiëntesorg kry dus nie altyd voorkeur nie. N = 99 (96%) van verpleegkundiges het erken dat outokratiese gedrag ( wat met werkstoewysing verband hou) wel voorkom. ‘n Transformasie leierskapsbenadering en deelnemende bestuurstyl is dus aanbeveel. Die hoop word dus uitgespreek dat deur aan die verpleegkundiges se versoeke ten opsigte van die ideale bestuursbenadering en bestuurstyl te voldoen, die werksatmosfeer binne kritieke sorgeenhede toenemend gesonder en dus aangenamer sal word.

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Moon, Mikyung. "Relationship of nursing diagnoses, nursing outcomes, and nursing interventions for patient care in intensive care units." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3356.

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The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type. The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.

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Lammers, Joyce. "Physical Therapists’ Beliefs about Preparation to Work in Special Care Nurseries and Neonatal Intensive Care Units." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/hpd_pt_stuetd/65.

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BACKGROUND: Physical therapists (PTs) may care for full-term or premature newborns in all levels of hospital nurseries. There is some endorsement in the published physical therapy literature for restricting practice in the nursery setting to only those PTs with specialized training.1-4 PURPOSE: The purpose of this study was to understand the experiences of becoming and being a physical therapist in a special care nursery (SCN) or neonatal intensive care unit (NICU) from the therapists’ perspective. METHODS: The participants were physical therapists who have practiced in a SCN or NICU in the United States. A phenomenological approach was used and data was collected through interviews. The constant comparative method was used to analyze the data and identify common themes to describe therapists’ beliefs about becoming and being a physical therapist in a hospital nursery. RESULTS: These four themes include: 1) Never Alone, which reflects the unique collaborative culture of the NICU; 2) Families First, which speaks to the need to focus on the family, avoid judgment, and facilitate their involvement in the care of their child; 3) Take a Deep Breath, which reflects the need to be mindful and cautious because of the potential to do harm due to the extreme fragility of the infant; and 4) Know What You Don’t Know, which reflects the depth and breadth of knowledge necessary to work in the NICU/SCN. CONCLUSIONS: This project was the first to systematically research practicing therapist’s beliefs and perspectives regarding PT practice in the SCN and NICU. It is evident that current practice does not align with the adopted statements from APTA and APPT, as well as other professional associations. Much evidence draws attention to the fragility of premature neonates, yet our PT practice and education does not appropriately address these concerns.

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Agvald-Öhman, Christina. "Colonization, infection and dissemination in intensive care patients /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-075-6/.

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黎自強 and Chi-keung Peter Lai. "Protocol-led weaning of mechanical ventilation in adult intensive careUnit." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720895.

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Benedetti, Paolo. "A multicentre study on antibiotic resistance in North-East Italian intensive care units." Thesis, Queen Mary, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.568962.

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BACKGROUND. Intensive care units (ICUs) are "hot" areas for antibiotic consumption, infection and antibiotic resistance. Resistance affects patient outcomes, resource utilization and determines whether treatments are adequate. Within Europe, Italy has among the highest rates of antibiotic consumption but resistances - particularly in ICUs - are largely unexplored, both nationally and regionally. OBJECTIVES. To assess variation in antibiotic prescribing, consumption, resistance, and treatment outcomes and to identify critical points for improvement in antimicrobial practice across 5 ICUs in the Veneto region, North-east Italy. RESULTS. From 2002 to 2010, 911 patients were reviewed. Median K'U stay (17 days; IQR, 8-29) and ICU mortality (mean, 24.9%) were similar across sites. Empirical antibiotics were given to 853 patients (83.1%), with penicillin/β-lactamase inhibitor combinations (26%), cephalosporins (20.7%), fluoroquinolones (10.9%), and carbapenems (9.8%) frequently used. Laboratory investigation was often long delayed (median 7 days IQR = 3-14) after treatment initiation, and there were few (37.2%) microbiological-based shifts; 30.9% of empirical regimens were inadequate. Treatment inadequacy (AOR=13.99) and septic shock (AOR=3.29) were the main independent predictors for hospital mortality. Amongst 1908 isolates tested - predominantly, Pseudomonas aeruginosa (22%) and MRSA (14.8%) - 53.7% were multiresistant, with significant inter-hospital differences in resistance rates of Enterobacteriaceae to fluoroquinolones, and for P. aeruginosa to fluoroquinolones and carbapenems) (p < 0.001). The relationship between resistance and use of fluoroquinolones and 3rd_ generation cephalosporins was clear for Enterobacteriaceae (p < 0.001), but weaker for P. aeruginosa. The susceptibility of Escherichia coli to fluoroquinolones decreased over time (X2 = 0.009). Antibiotic use was inflated, especially at one ICU with excess of fluoroquinolone (94.4 DDD/100 bed-days vs. 26.1-35.9 elsewhere) use. CONCLUSIONS. Considerable inter-hospital variation III prescribing affected antibiotic consumption and resistance prevalence. Poor and delayed use of laboratory microbiology was prominent, as was the uncontrolled use of antibiotics. Urgent interventions are needed and improvement strategies are discussed.

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de, Roiste Eilis Aine Mhaire. "Aspects of tactile stimulation with infants in intensive and special care baby units." Thesis, University of Glasgow, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.320595.

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Traina, J. Adam (Jeffrey Adam). "Diagnosing intensive care units and hyperplane cutting for design of optimal production systems." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/100090.

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Thesis: S.M., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 101-107).
This thesis provides a new framework for understanding how conditions, people, and environments of the Intensive Care Unit (ICU) effect the likelihood the preventable harm will happen to a patient in the ICU. Two years of electronic medical records from seven adult ICUs totalling 77 beds at Beth Israel Deaconess Medical Center (BIDMC) were analysed. Our approach is based on several new ideas. First, instead of measuring safety through frequency measurement of a few relatively rare harms, we leverage electronic databases in the hospital to measure Total Burden of Harm, which is an aggregated measure of a broad range of harms. We believe that this measure better reflects the true level of harm occurring in Intensive Care Units and also provides hope for more statistical power to understand underlying contributors to harm. Second, instead of analysing root causes of specific harms or risk factors of individual patients, we focus on what we call Risk Drivers, which are conditions of the ICU system, people (staff, patients, families) and environments that affect the likelihood of harms to occur, and potentially their outcomes. The underlying premise is that there is a relatively small number of risk drivers which are common to many harms. Moreover, our hope is that the analysis will lead to system level interventions that are not necessarily aiming at a specific harm, but change the quality and safety of the system. Third, using two years of data that includes measurements of harms and drivers values of each shift and each of seven ICUs at BIDMC, we develop an innovative statistical approach that identifies important drivers and High and Low Risky States. Risky States are defined through specific combinations of values of Risk Drivers. They define environmental characteristics of ICUs and shifts that are correlated with higher or lower risk level of harms. To develop a measurable set of Risk Drivers, a survey of current ICU quality metrics was conducted and augmented with the clinical experience of senior critical care providers at BIDMC. A robust machine learning algorithm with a series of validation techniques was developed to determine the importance of and interactions between multiple quality metrics. We believe that the method is adaptable to different hospital environments. Sixteen statistically significant Risky States (p < .02) where identified at BIDMC. The harm rates in the Risky States range over a factor of 10, with high risk states comprising more that 13.9% of the total operational time in the ICU, and low risk states comprise 38% of total operating shifts. The new methodology and validation technique was developed with the goal of providing a basic tools which are adaptable to different hospitals. The algorithm described within serves as the foundation for software under development by Aptima Human Engineering and the VA Hospital network with the goal of validation and implementation in over 150 hospitals. In the second part of this thesis, a new heuristic is developed to facilitate the optimal design of stochastic manufacturing systems. The heuristic converges to optimal, or near optimal results in all test cases in a reasonable length of time. The heuristic allows production system designers to better understand the balance between operating costs, inventory costs, and reliability.
by J Adam Traina.
S.M.
M.B.A.

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Underwood-Mobley, Olivett D. "Inclusion of Social Workers in End-of-Life Discussions in Intensive Care Units." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6142.

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Clinical social workers have roles in providing end-of-life care in the United States. Although clinical social workers are present in the intensive care unit (ICU) setting and have expertise to address end-of-life care dynamics, social workers are not consistently included in end-of-life discussions in the ICU setting. The purpose of this action research study was to explore the barriers that prevent clinical social workers from being included in end-of-life discussions in the ICU and how clinical social workers perceive their roles in end-of-life discussions in the adult ICU setting. Open-ended questions were used to gather data by facilitating 4 focus groups with 17 clinical social workers employed at a Florida hospital. This study was guided by complexity theory, which is concerned with complex systems and how systems can produce order while simultaneously creating unpredictable system behavior. A thematic analysis coding technique was used to analyze the data collected. Three themes emerged from data analysis: the ICU setting as chaotic, complex, and unpredictable; role ambiguity; and lack of confidence of social workers to perform expected roles in end-of-life discussions. The implications of this study for social work practice and social change relate to closing the gap between the patient, family members, social workers, and the medical team by developing protocols that consistently include social workers in end-of-life discussions, including education for the multidisciplinary team in the ICU on the skill set and role of clinical social workers in end-of-life discussions and formal training and education for clinical social workers regarding end-of-life care.

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Silva-Cruz, Aracely Lizet, Karina Velarde-Jacay, Nilton Yhuri Carreazo, and Raffo Escalante-Kanashiro. "Risk factors for extubation failure in the intensive care unit." Associacao de Medicina Intensiva Brasileira - AMIB, 2018. http://hdl.handle.net/10757/624625.

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Objective: To determine the risk factors for extubation failure in the intensive care unit. Methods: The present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation. Results: Out of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02). Conclusion: Pediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.
Revisión por pares
Revisión por pares

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Mpasa, Ferestas. "Management of endotracheal tube cuff pressure in mechanically ventilated adult patients in intensive care units in Malawi." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/19673.

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Patients who are critically ill get often admitted to intensive care units (ICUs). The majority of these patients require support with their breathing and are thus connected to a mechanical ventilator. One aspect to consider in the mechanically ventilated patient is endotracheal tube cuff pressure (ETT) management. The management of ETT cuff pressure entails that nurses working in ICUs have the responsibility of ensuring that ETT cuff pressure is kept within normal range of 20-30 cmH20 for the safety of the patients in order to avoid complication of over and under inflation. Poor management of ETT cuff pressure places the mechanically ventilated patients under risk of tracheal injury. Tracheal injury may also be caused by over or under inflation of the ETT cuff. Over inflation of the ETT cuff can lead to the occlusion of capillaries lining the trachea at the cuff site, tracheal stenosis, and can also lead to the death of mucus membranes around the area, just to mention a few. On the other hand, under inflation of the ETT cuff, can lead to air leaks as well as aspiration of gastric contents into the tracheal tree. Therefore, in order to maintain ETT cuff pressure within normal ranges, evidence-based guidelines related to the management of ETT cuff pressure should be used. However, in Malawi the management of endotracheal tube cuff pressure in mechanically ventilated adult patients by nurses in ICUs is not well explored and it is not clear whether this practice is based on evidence-based guidelines. Furthermore, strategies on how to implement evidence-based guidelines in the ICU might not be known and poorly defined because of the complexity of the context. The study is therefore aimed at implementing and evaluating the effect of an evidence-based guideline on the management of ETT cuff pressure in mechanically ventilated adult patients by nurses in ICUs in Malawi using active (printed educational materials and monitoring visits) and passive (printed educational materials only) implementation strategies. The research study used a quantitative approach with multi-designs. Four phases were used in order to achieve the four objectives that were set. Phase one was the pre-test and used a survey design, two was the expert panel review of the evidence-based guideline, three was the implementation of the reviewed evidence-based guideline using a randomised controlled trial design and phase four was the post-test which used a survey design. The RCT included 25 participants from the control and 27 from the intervention group. Each group had three ICUs of which one in each group was from a private hospital and the other were government. Data collection in phases one and four was by a hand delivered pre-and post-questionnaire. In phase two the expert panel members with experience in critical care used the AGREE II Instrument to review the evidence-based guideline that was implemented. In order to gather data during the monitoring visits, the researcher recorded field notes. The applications that were developed by the University statistician consultant using visual basic applications in excel were used to analyse data. Two different implementation strategies were used to implement the evidence-based guideline. The control group used passive implementation strategy which was printed educational materials thus the evidence-based guideline and algorithm. The intervention group used both active and passive implementation strategies which was the printed educational materials thus the evidence-based guideline and algorithm plus monitoring visits by the researcher. In order to establish the effect of the implemented evidence-based guideline on the nursing care practice for the management of endotracheal tube cuff pressure an evaluative posttest survey was conducted in phase four of the research study. The results revealed that the majority of participants had gaps in both groups regarding nursing care practice for the management of endotracheal tube cuff pressure for the mechanically ventilated adult patients in the pretest but improved in the posttest. In the control group 52% had very low knowledge score, 16% had low score, 28% average, and 4% high score while in the category of very high score there was nobody. However, in the posttest those in the very low score were only 44% while the percentage in the low score remained 16%. There was an improvement in the average scores in the posttest such that only 44% were in this category. There was no one in the high and very high score in the pretest. On the other hand, in the intervention group, 78% had a very low score, 9% low score, and 13% were in the category of average score, while in the high and very high score category there was zero percent in the pretest. However, there was also an improvement in the posttest such that only 44% a very low knowledge score. But 19% had a low score, there were 37% in the average category and no one was in the high and very high score. Statistical analysis revealed that the results were not significantly different between and within groups. Improvements were observed in the two groups regarding the scientific knowledge scores for the nursing care practices in the posttest. Upon qualitative analysis of the data from the open-ended question, two main themes emerged thus the need for documentation of endotracheal tube cuff and the process of implementation the evidence-based guidelines. Sub themes such as lack of documentation; no part of routine care and monitoring not done at all were identified under the main theme of the need for documentation of ETT cuff pressure. The Guideline itself need to be clear; implementation strategies; follow up; incentives; supervision; incentives; time factor; resources or equipment required for successful implementation; nurses buy-in critical for the implementation; training detrimental to EBP implementation; nurses attitude crucial to implementation of EBGs and knowledge of nurses for guideline essential for the implementation were the sub themes identified under the main theme of the process of implementing the evidence-based guideline. All appropriate ethical considerations such as principles of autonomy and self-determination, confidentiality and anonymity, voluntary participation, right to receive treatment, informed consent, were adhered to throughout the research study. The research study was unique in nature because it was the first of its kind in Malawi and it contributed to the awareness of the recommended practice for management of endotracheal tube cuff pressure in the ICUs in the country by implementing an evidence-based guideline. The unique contribution of the study is that it is a challenge to implement evidence-based guideline in poor and resource constraint countries like Malawi.

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Cronqvist, Agneta. "The moral enterprise in intensive care nursing." Doctoral thesis, Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-942-0/.

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Kindness, Karen. "Evaluation of a protocol to control methicillin resistant staphylococcus aureus (MRSA) in a surgical cardiac intensive care unit." Thesis, 2008. http://hdl.handle.net/10413/9055.

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Introduction. MRSA is a major healthcare problem with particular relevance to morbidity and mortality in ICU (Byers & Decker 2008). Due to the increased infection risks associated with cardiac surgery, MRSA screening and surveillance is widely used as a standard preoperative Investigation In many settings (Teoh, Tsim & Yap, 2008). The results, in conjunction with appropriate hygiene precautions, are used to control and prevent infection with MRSA. Following an outbreak of MRSA in cardiac patients an MRSA protocol (MRSAP) was implemented In the cardiac intensive care unit in this study. Purpose. To evaluate how nurses implement the MRSAP in the surgical cardiac intensive care unit in this study, and to evaluate the change in MRSA infection rates following implementation of the MRSAP. From the results obtained, to identify any areas for improvement in nursing practice with respect to the MRSAP. Methods. Nursing staff knowledge with respect to the MRSAP was assessed using a survey questionnaire. Their compliance with required Infection control practice for control of MRSA was assessed through periods of observation on the unit. Screening compliance and reduction in infection rates were investigated using a retrospective records review. Results. The survey revealed good awareness of the MRSAP (88%, n=23), but knowledge of the detailed content was variable. Most staff were apparently satisfied with the existing standards of infection control in CICU (84.6%, n=22). Observation revealed that, compliance with routine hygiene measures was good (66% correct contacts, n=144) by the standard of other studies, but, given the high risk of postoperative infection for these patients improvements are required. Inadequate data in sampled records prevented meaningful analysis of screening compliance, and hence the systems for handling screening swabs and results need to be reviewed. The change in infection rates between the pre and post MRSAP periods, which incorporated use of infection risk stratification data to demonstrate comparability of the two groups of patients, revealed that despite the high MRSA infection rate in 2005 (1.18%), and subsequent drop post MRSAP (0.35%), the actual number of cases found was too small to test statistically for significant difference. An incidental finding was that female cardiac surgery patients were getting significantly younger (p<0.01). There was a significant decrease in hospital MRSA infection rates for matched periods (p<0.0001 ). Conclusions. Evidence was found to support the efficacy of the MRSAP in the reduction of MRSA infections. Deficits in staff knowledge and infection control practice were identified and feedback has been implemented in order to improve compliance with the MRSAP and maintain the improved infection rates. Further research with respect to implementation of, and compliance with, infection control measures could both improve quality of patient care and decrease the burden of preventable infectious disease such as health care associated infections (HAls) in South Africa.
Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

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