Potential sources of conflict in intensive care units - a questionnaire study.

BACKGROUND: Conflicts occur in intensive care units (ICUs), and an international multicentre study conducted in 2008, including 323 ICUs from 24 European countries, confirmed the occurrence of this phenomenon. There are no data in Poland. The aim of the study was to analyse the frequency of the occurrence of conflicts in ICUs in Polish hospitals, and their most frequent sources. METHODS: The study was based on an original questionnaire performed in 12 ICUs in the Pomeranian Voivodship. The respondents were asked questions regarding the frequency, type, and lines of conflicts between employees, as well as potential causes of conflicts. RESULTS: Completed surveys were received from 232 employees, including 79 doctors and 153 nurses. The phenomenon of occurrence of conflicts was confirmed by about 30% of the staff, providing answer that conflicts occur "often". About 43% of staff estimated that conflicts "sometimes" occur and 25% chose the answer "rarely". Analysis of the answers made it possible to identify the most common potential causes of conflict. CONCLUSIONS: The main sources of conflicts in ICUs appear to be external factors such a financial issues and physical overload. The hospital policy and the health policy of the state are also important. The perceived conflicts require careful and constant monitoring. The frequency of hidden conflicts requires thorough assessment of their impact on the quality of work.

Labour epidural analgesia in Poland in 2009 - a survey.

BACKGROUND: Labour analgesia in most developed countries is funded by the state, available to every woman in labour, and plays an important role in the everyday activities of most anaesthetists. This paper presents the second part of an Obstetric Anaesthesia Survey which was conducted in 2009. The first part of the Survey, relating to anaesthesia for caesarean sections, was published in 2010. METHODS: The author sent out 432 questionnaires containing questions about hospital size and location, staffing levels and numbers of deliveries per year. There were also questions regarding regional and other pain relief methods used in labour, ways of administration, drugs used and monitoring of patients. RESULTS: The response rate was 24%. Around 45% of responding hospitals had only 1-3 deliveries per year, which makes it difficult to provide separate obstetric anaesthetic cover. Only ten hospitals (11%) employed an anaesthetist for the labour ward. Epidural analgesia was used in 55% of hospitals but only 20% provided the service for 24 hours per day and free of charge. Entonox was used very occasionally, but the most common means of pain relief was pethidine injection. There were marked differences in the medication used for labour epidurals, with 18% of units using high concentrations of local anaesthetics which could result in motor block. Despite a lack of regulations in Polish law and a lack of proper training in 50% of units, midwives were looking after the patients with established labour epidural which could create medico-legal consequences. There was also a marked variation in the parameters monitored during labour analgesia. CONCLUSION: Epidural labour analgesia was offered for 24 hours per day and free of charge in only 20% of hospitals. Without public pressure it will be difficult to get more funding from the National Health Fund (NFZ) to enable other hospitals, especially those with small obstetric units, to introduce regional labour analgesia. Although the 2009 guidelines addressed most of the issues regarding the conduct of epidural labour analgesia, changes need to be made in Polish law to allow midwives to be appropriately trained to look after parturients with regional labour analgesia.

[A survey of anaesthesia for caesarean section in Poland]. / Ankieta na temat praktyki anestezjologii poloiniczej w Polsce.

BACKGROUND: Obstetric anaesthesia and analgesia have come to be regarded as a subspecialty.Various countries and societies have published evidence-based guidelines. In this paper are presented the results of a survey of anaesthesia for Caesarean section (CS), conducted in Poland in 2009. METHODS: 432 questionnaires were sent. The questions asked related to: characteristics of the hospital, premedication, preoperative laboratory screening, methods of anaesthesia, local analgesic agents (LA), postoperative enteral feeding, positioning, and analgesia. RESULT: The questionnaire return rate was 24%. Only 10 hospitals (out of 98) employed anaesthesiologists exclusively for obstetric anaesthesia and analgesia. Alkalinisation of gastric contents, gastric emptying drugs and H blockers were used in 38% of hospitals in elective CS, and in 32% of hospitals in emergency CS. Preoperative laboratory screening was conducted in 93% of hospitals before elective CS, and 77% before emergency CS (usually haematocrit, haemoglobin concentration, red blood count and platelets). In 50% of hospitals, the lowest acceptable concentration of platelets before central blocks was 100,000; while in 30% of hospitals, a level of 50,000 was considered acceptable. Spinal anaesthesia was used in more than 90% of elective CS cases in 75% of hospitals, in emergency CS--in 50% of patients only and in the presence of a foetal stress in 65% of hospitals general anaesthesia was preferred. Bupivacaine remains the most commonly used LA (97%). Lidocaine is still used in 3% of hospitals, and adjuvants are used in 42% of hospitals. The flat supine position was recommended in 75% of hospitals; and 13% of parturients were requested to stay in this position for 24 hours. In 74% of hospitals, enteral feeding was delayed, and in 27% was delayed for 24 hours after CS (27%). Postoperative analgesia was based on parenteral analgesics (usually paracetamol and ketoprofen). Pethidine was used in 35% of hospitals. CONCLUSION: There is an urgent need for national guidelines on obstetric anaesthesia and analgesia in Poland.