ABSTRACT
Continuous reevaluation of protocols for patients' care is necessary to maintain high quality and cost-effectiveness in today's healthcare environment. A study of patients who had cardiothoracic surgery proved that after early extubation, patients could safely be given oxygen via nasal cannula with maintenance of acceptable oxygen saturation. The positive outcomes of this study were shorter exposure to oxygen at higher concentrations, greater compliance by patients, greater comfort for patients, and cost savings for the institution. This project was the result of thoughtful consideration and a willingness to question a standard practice that had been in existence in this cardiothoracic program for 20 years. Both patients and the institution benefit when we question why we do things and thoroughly evaluate our daily practice. All practitioners should always look for ways to change and improve practice for the betterment of patients.
Subject(s)
Oxygen Inhalation Therapy/instrumentation , Oxygen/administration & dosage , Administration, Intranasal , Cardiac Surgical Procedures , Humans , Masks , Nose , Outcome and Process Assessment, Health Care , Postoperative CareABSTRACT
All the nurses in the cardiothoracic ICU are now certified in these advanced skills. The skills are reviewed with current staff members on a yearly basis during the annual evaluation. During their orientation to the cardiothoracic ICU, new staff nurses are certified by using the original process of attending an in-service training program and demonstrating the skill 3 times. The quality management department reviews medical records daily to detect complications. In addition, we (DRZ and MB) conducted a quality assurance review in which we monitored 20 patients being extubated and having PA catheters removed by nurses. No complications were noted during either review. The institution has seen improvements in quality of care and earlier discharge from the hospital. With earlier removal of endotracheal tubes and PA catheters, patients are more comfortable and their rehabilitation can be advanced sooner. Comparison of the mean length of stay for patients undergoing coronary artery bypass graft in March 1995 with the mean length of stay for such patients in March 1998 showed a 50.6% decrease, from 14.94 days to 7.38 days. These advanced skills have provided an increased autonomy for the nurses and have benefited the patients undergoing cardiac surgery in our institution.
Subject(s)
Cardiac Surgical Procedures/nursing , Clinical Competence/standards , Critical Care/methods , Critical Care/standards , Inservice Training/organization & administration , Nursing Staff, Hospital/education , Postoperative Care/methods , Postoperative Care/standards , Thoracic Surgical Procedures/nursing , Total Quality Management/organization & administration , Catheterization, Swan-Ganz/adverse effects , Catheterization, Swan-Ganz/nursing , Humans , Patient Care Planning , Ventilator Weaning/methods , Ventilator Weaning/nursingABSTRACT
BACKGROUND: Arterial and pulmonary artery catheters are often used in the management of critically ill patients. If heparin were not necessary to maintain the patency of arterial and pulmonary artery catheters, these patients could avoid exposure to heparin. OBJECTIVES: The purpose of this study was to determine if the failure rate of arterial and pulmonary artery catheters differs depending on whether a nonheparinized or heparinized solution is used. The null hypothesis was that catheter failure rates would not differ. METHODS: The study was done at a large tertiary medical center in the northeastern United States, and all subjects who had pulmonary artery or arterial catheters inserted were included in the study. A solution of 1 U of heparin per 1 mL of normal saline was used to maintain the patency of the arterial catheter and the distal portion of the pulmonary artery catheter in one group; normal saline alone was used in the other group. Variables used to monitor catheter patency and the reasons for catheter removal were recorded. RESULTS: Failure rates of pulmonary artery catheters were not significantly different between the two groups. For arterial catheters, however, the failure rate was significantly different between the two groups, regardless of whether the subjects had received other anticoagulants. CONCLUSION: The failure rate of pulmonary artery catheters was not affected by the use of nonheparinized solutions. Arterial catheters failed less often when they were maintained with heparinized solutions. The authors recommend that all arterial catheters be maintained with heparinized solutions, unless use of heparin is contraindicated.
Subject(s)
Catheterization, Swan-Ganz , Catheters, Indwelling , Heparin/therapeutic use , Sodium Chloride/therapeutic use , Adult , Aged , Chi-Square Distribution , Equipment Failure , Female , Humans , Intensive Care Units , Male , Middle AgedABSTRACT
Use of a multidisciplinary clinical pathway helps eliminate variations in patients' care. Organizing the care delivered each day of the patient's hospitalization may lead to fewer complications, a quicker recovery, and an earlier discharge. In today's healthcare arena, much attention is being focused on improving the quality of care and decreasing the need for acute care. Clinical pathways facilitate patients' outcomes and earlier discharge and thus reduce the cost of care.
