American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Use of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort. ⋯ The need to provide efficient care requires the collaboration of all disciplines involved in providing patients' care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.
-
Comparative Study
Administration of sedatives and level of sedation: comparative evaluation via the Sedation-Agitation Scale and the Bispectral Index.
To compare levels of sedation in patients receiving continuous intravenous infusions of sedative/hypnotic or narcotic agents with levels in patients not receiving infusions and to compare subjective (Sedation-Agitation Scale) and objective (Bispectral Index) evaluations of sedation. ⋯ Objective and subjective assessments of sedation are highly correlated. Use of continuous infusions is associated with deeper levels of sedation, and patients receiving continuous infusions are more likely to be oversedated. Sedation therapy should be guided by subjective or objective assessment.
-
Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization. ⋯ Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.
-
Comment Comparative Study
Risk of colonization of central venous catheters: catheters for total parenteral nutrition vs other catheters.
Infected central venous catheters cause morbidity and mortality. ⋯ Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients' care.