RESUMO
The aim of this systematic review was to examine the clinical cues used by acute care nurses to recognize changes in clinical states of adult medical and surgical patients that occurred as usual consequence of acute illness and treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist were followed. Four databases and reference lists of included studies were searched: from 1,049 studies, 38 were included. There were 26 subjective and 147 objective cues identified; only 6% of all cues described improvements in patients' clinical states. The most common clinical cues used were heart rate, blood pressure and temperature. Many studies (n = 31) focused on only one element of assessment, such as physiological stability, pain, or cognition. There was a paucity of studies detailing the complexity of acute care nurses' assessment practices as they would occur in clinical practice and a disproportionate focus on the objective assessment of deterioration. Studies are needed to understand the full breadth of cues acute care nurses use to recognize clinical change that includes both improvement and deterioration.
Assuntos
Cuidados Críticos , Sinais (Psicologia) , Papel do Profissional de Enfermagem , Avaliação em Enfermagem/métodos , Sinais Vitais , Adulto , Deterioração Clínica , Humanos , Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/normas , Segurança do PacienteRESUMO
This prospective observational study measured idle central venous catheter (CVC)-days (no medical indication), and ward clinicians' adherence to evidence-based practices for preventing short-term central line-associated bloodstream infections (CLABSIs). In 340 patients discharged from ICU over a 1-year period, 208 of 794 CVC-days (26.2%) were idle. Interventions to prevent CLABSIs were poorly implemented. Ward clinicians need education regarding risk management strategies to prevent CLABSIs, and clear accountability processes for prompt catheter removal are recommended.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateteres Venosos Centrais/efeitos adversos , Sepse/epidemiologia , Cuidados Críticos , Humanos , Incidência , Prevalência , Estudos Prospectivos , Medição de RiscoRESUMO
A comprehensive multidisciplinary approach was used to improve drug infusion safety in an acute care hospital in Melbourne, Australia. This project aimed to reduce the potential for drug infusion-related error, improve drug infusion safety for patients, and encourage incident reporting to inform and guide continuous quality improvement projects. The project applied a systems approach to medication safety, using redesign strategies such as continuous quality improvement (plan, do, study, and act) and re-engineering. Key safety design concepts such as standardization, simplification, and forcing functions were also used.
