American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Multicenter Study
A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit.
Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. ⋯ When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.
-
Practice Guideline
Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children.
Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes. ⋯ The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.
-
The Admission Discharge Transfer-Synergy Model Acuity Tool (ADT-SMAT) was developed to quantify patient intervention intensity and patient response variability and to capture nurses' critical thinking. The tool is based on the American Association of Critical-Care Nurses Synergy Model for Patient Care. ⋯ This is the first study attempting to correlate Synergy Model patient characteristics and acuity while integrating nurses' critical decision-making process. With further testing, the ADT-SMAT could be a valuable tool to quantify and standardize patient characteristics in determining the appropriate level of care associated with admission, discharge, and transfer decisions.
-
Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. ⋯ The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.
-
Developing a sustainable strategy for prescriber-led review of antimicrobial use in a critical care unit may improve antimicrobial use without the need for additional resources. ⋯ Nurse prompting can lead to significant reductions in antimicrobial use, providing a sustainable mechanism for independent antimicrobial reassessment.