ABSTRACT
OBJECTIVE: To determine the incidence of obstruction and colonization in adult patients in the surgical and medical intensive care units who received inner cannula changes daily versus those who did not. DESIGN: Quasi-experimental prospective study using a convenience sample of patients randomly assigned to one of two methods. SETTING: Mid-Atlantic university-affiliated tertiary care center. PATIENTS: Sixty patients within 24 hours of receiving a surgical tracheostomy. OUTCOME MEASURES: Obstruction and bacterial colonization of inner cannula. INTERVENTIONS: All inner cannulas were checked daily for obstruction and cultured on postoperative days 1 and 3. RESULTS: No statistically significant difference was noted in colonization (p = 0.13) between protocols, and no obstructions were noted in either. CONCLUSION: The study suggests that the routine practice in critical care units of changing tracheostomy inner cannulas may be unnecessary. Although the results of this study are limited, and may not be generalized to other populations, it demonstrates that practice standards related to the care of tracheostomy inner cannula need to be challenged.
Subject(s)
Intubation, Intratracheal/nursing , Tracheostomy/nursing , Adult , Bacterial Infections/epidemiology , Costs and Cost Analysis , Disposable Equipment , Female , Humans , Intubation, Intratracheal/instrumentation , Male , Pilot Projects , Prospective Studies , Respiration, Artificial , Time Factors , Tracheostomy/instrumentationABSTRACT
As part of a continuing quality improvement program, this project was undertaken to define the frequency of hearing loss in patients admitted to a surgical intensive care unit in order to identify patients at risk for impaired communication. The study evaluated 168 consecutive admissions over a ten week period to a ten bed adult surgical intensive care unit in a university hospital. Patients were screened as close to admission to the ICU as possible with otoscopy, tympanometry, and distortion product otoacoustic emissions. A total of 113 patients (226 ears, mean age 58.0+/-15.8 years) were screened within 1.5+/-1.4 days of ICU admission; 55 of the 168 admissions could not be screened (48 out of 55 due to short ICU stays). Of the 226 ears evaluated, 6.6 per cent had abnormal otoscopy and 43.2 per cent abnormal tympanograms. OAE failure occurred in 58.4 per cent of ears while OAE results were uninterpretable due to high ambient noise in 2.7 per cent of ears, and technical difficulty in 3.5 per cent of ears. Mean time for screening was 9.3 minutes. OAEs provide an efficient screening modality for hearing impairment in critically ill adults. The results suggest a significant prevalence of hearing impairment in the population studied. More definitive testing should be considered when clinically indicated in patients who fail OAE screening.
Subject(s)
Cochlea/physiology , Critical Illness , Health Status , Hearing Disorders/diagnosis , Acoustic Impedance Tests/methods , Adult , Aged , Aged, 80 and over , Chronic Disease , Female , Humans , Male , Middle Aged , Psychomotor Agitation/psychology , Psychotic Disorders/psychologyABSTRACT
Within the past 3 years, the Division of Nursing in a large medical center implemented a career ladder and a professional practice model. Peer review was identified as a critical component for the success of these two initiatives and maturation of the model. Limitations in the conduct of peer review among the professional nursing staff centered around the lack of a coherent process. The Coordinating Council, the governing body of the professional nursing staff, formally recognized the accomplishments of a Quality Improvement team and directed the team to implement and evaluate a process of peer review. The development and implementation of peer review as experienced by this Quality Improvement team is described in this article. The process and structure of peer review and specific continuous improvement tools used by the team in developing this process are reviewed.
