ABSTRACT
The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.
Subject(s)
Acute Kidney Injury/therapy , Critical Illness/therapy , Healthcare Failure Mode and Effect Analysis , Renal Replacement Therapy/methods , Safety Management , Aged , Cohort Studies , Critical Care/methods , Female , Humans , Intensive Care Units , Male , Middle Aged , Outcome and Process Assessment, Health Care , Retrospective StudiesABSTRACT
La Calidad de Vida (CV), posterior a un proceso patológico, ha sido reconocida en las últimas décadas como un importante indicador de la asistencia sanitaria. El objetivo de este estudio fue determinar la CV a largo plazo de los pacientes ingresados en una Unidad de Cuidados Intensivos con Traumatismo Craneoencefálico Grave (TCG).Material y método: utilizamos la encuesta MOS 36- ítem Short-Form Health Survey (SF-36) en su versión española, a la que se asoció el Índice de Katz. Incluimos a 78 pacientes con TCG al ingreso, domicilio español, e ingresados desde enero del año 2000 hasta diciembre de 2002. Resultados: 56 pacientes cumplimentaron la encuesta, el 82,2% de ellos con índice de Katz grado A. El dominio de mayor puntuación de la CV fue la Función Social (76,6± 25,8) y el de menor fue el Rol Emocional (64,9±41,2). Todos los valores fueron menores que los obtenidos en la población general española. Conclusiones: las secuelas que produce el TCG a largo plazo condicionan una CV inferior a la media de la población general y recomendamos que debieran plantearse futuros trabajos con instrumentos específicos de medición de la CV para el TCG
The Quality of Life (QL) following a head injury has been recognised in the last decades as an important indicator of healthcare. The objective of this study was to determine the long-term QL in patients admitted in the ICU with severe head injury.Material and method: the Spanish version of MOS 36 Short Form Health Survey (SF-36) was used in conjunction with Katz´s index to survey health status. 78 patients diagnosed with severe head trauma at admission, domiciled in Spain and admitted from 2000 to December 2002, were included in the study.Results: 56 patients completed the survey, in 82,2% of them Katz´s index was grade A. The domain with the highest score for QL was Social Function (76,6±25,8) and the lowest was Emotional Role (64,9±41,2). All values attained were lower than those obtained in the Spanish general population. Conclusions: sequelae from sustaining a major head injury limit long-term QL, shown to be inferior to that of the general population. Hence we recommend that further work is carried out using specific measurement instruments for QF in severe head injury (AU)
Subject(s)
Humans , Craniocerebral Trauma/rehabilitation , Quality of Life , Sickness Impact Profile , Social Support , Health SurveysABSTRACT
Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (p< 0.05). A total of 38 PS were detected, 7 (RI 5-13.8) being the median of the detection day. The chin, occipital and suprascapular zone were the most frequent locations. A total of 42.1% were grade II and 39.5% grade III. The occipital injuries were the most serious and those detected the latest. We conclude that a high index of suspicion of PS due to collar in patients with ACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.
Subject(s)
Braces/adverse effects , Cervical Vertebrae/injuries , Immobilization/adverse effects , Pressure Ulcer/etiology , Spinal Cord Injuries/therapy , Acute Disease , Algorithms , Chi-Square Distribution , Humans , Incidence , Length of Stay , Pressure Ulcer/epidemiology , Pressure Ulcer/prevention & control , Risk FactorsABSTRACT
The continuous renal replacement techniques (CRRT) aim to substitute the altered renal function during a period of time, presenting advantages compared to conventional hemodialysis (CH). This study aims to determine the situation of the CRRT in the Intensive care units (ICU) of the Madrid Community (MC) using a survey distributed to nurses (n = 131) of 14 ICU. It evaluates four aspects of the CRRT: management model, knowledge, problems and degree of satisfaction. It identified four models, the most frequent is that in which ICU nurse and intensivist participate (60%). Self-evaluation of knowledge was fair in 55.7% of the cases and the mean of correct responses in an evaluation of 10 questions was 4.19 and 5.45 in those with previous courses. A total of 84.7% think that CRRT significantly increases the workloads and 62.6% believe that they should be done by the ICU nurses. The main problem is the lack of knowledge to resolve complications during the technique. We conclude that the ICU nursing can handle the CRRT, adapting the nurse/patient ratio; training programs should be established and the role of the teaching nurse defined in critical renal cares.
Subject(s)
Critical Care , Renal Replacement Therapy/methods , Renal Replacement Therapy/nursing , Cross-Sectional Studies , Humans , Spain , Surveys and Questionnaires , Urban HealthABSTRACT
Las técnicas continuas de reemplazo renal (TCRR) intentan sustituir la función renal alterada durante un perÍodo, y presentan ventajas frente a la hemodiálisis convencional (HC). Este estudio pretende determinar la situación de las TCRR en las unidades de cuidados críticos (UCC) de la Comunidad de Madrid (CAM) mediante una encuesta repartida a enfermeras/os (n = 131) de 14 UCC. Evalúa 4 aspectos de las TCRR: modelo de manejo, conocimientos, problemas y grado de satisfacción. Identificó 4 modelos, el más frecuente es el que comparten la enfermera de UCC y el intensivista (60 por ciento). La autovaloración de conocimientos fue regular en un 55,7 por ciento de los casos, y en una evaluación de10 preguntas la media de respuestas correctas fue de 4,19, y de 5,45 en los que tenían cursos previos. El 84,7 por ciento piensa que las TCRR aumentan significativamente las cargas de trabajo. El 62,6 por ciento cree que deben ser asumidas por la enfermería de UCC. El principal problema es el déficit de conocimientos para resolver complicaciones durante la técnica. Concluimos que la enfermería de UCC puede y debe manejar las TCRR adecuándose la ratio enfermera/paciente; deberían establecerse programas de formación y perfilar el rol de enfermera docente en cuidados críticos renales (AU)
