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Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

This article by Han et al was published in the Japan Journal of Nursing Science in December 2017.hospital-834152_960_720
Aim:  To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units.
Methods:  A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared.
Results:  After education, there was a significant improvement in the nurses’ self-efficacy and clinical performance in emergency airway management situations.
Conclusion:  Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education.
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Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the Intensive Care Unit: A Stepped-Wedge Cluster Randomized Clinical Trial

This RCT was by Parent et al was published in the January 2018 issue of JAMA surgery.
Importance:  Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Efforts to standardize handoff communication may reduce errors and improve patient safety.
Objective:  To determine the effect of a standardized handoff curriculum, UW-IPASS, on inter clinician communication and patient outcomes.
Design, Setting, and Participants:  This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral centre. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message-based surveys and patient medical records.
Exposures:  The UW-IPASS standardized handoff curriculum.
Main Outcomes and Measures:  The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of inter clinician communication. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analysed. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician.
Results:  A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS-period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19; 95% CI, 0.03-0.74; P = .03). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes; 95% CI, 0.34-9.39; P = .30). Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (-28 orders; 95% CI, -55 to -4; P = .04). Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations.
Conclusions and Relevance:  The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions.
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Critical Care Reviews Newsletter 317 January 2018

This issue contains the final details of the Critical Care Reviews meeting to be held in Belfast nextcritcal care reviews week including information on a number of the trials to be presented.  It also includes links to a research published in journals such as “Effect of pre-oxygenation using non-invasive ventilation before intubation on subsequent organ failures in hypoxaemic patients: a randomized clinical trial” and “The efficacy and adverse effects of buprenorphine in acute pain management: a systematic review and meta-analysis of randomised controlled trials.”
The full copy of newsletter 317 January 2018 can be accessed via this link.

Critical Care Reviews Newsletter 316 January 2018

The Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from across the medical literature over the past seven days.  Thus issue includes trails that are to be presented at the Critical Care Reviews Meeting 2018 such as ADjunctive coRticosteroid trEatment iN criticAlly ilL Patients With Septic Shock (ADRENAL)
The full copy of newsletter 316 January 2018 can be accessed via this link.

Using an intervention mapping approach to develop a discharge protocol for intensive care patients

This article by van Mol and colleagues was published in BMC health services research December 2017 issue.
Background:  Admission into an intensive care unit (ICU) may result in long-term physical, cognitive, and emotional consequences for patients and their relatives. The care of the critically ill patient does not end upon ICU discharge; therefore, integrated and ongoing care during and after transition to the follow-up ward is pivotal. This study described the development of an intervention that responds to this need.
Methods:  Intervention Mapping (IM), a six-step theory- and evidence-based approach, was used to guide intervention development. The first step, a problem analysis, comprised a literature review, six semi-structured telephone interviews with former ICU-patients and their relatives, and seven qualitative roundtable meetings for all eligible nurses (i.e., 135 specialized and 105 general ward nurses). Performance and change objectives were formulated in step two. In step three, theory-based methods and practical applications were selected and directed at the desired behaviors and the identified barriers. Step four designed a revised discharge protocol taking into account existing interventions. Adoption, implementation and evaluation of the new discharge protocol (IM steps five and six) are in progress and were not included in this study.
Results:  Four former ICU patients and two relatives underlined the importance of the need for effective discharge information and supportive written material. They also reported a lack of knowledge regarding the consequences of ICU admission. 42 ICU and 19 general ward nurses identified benefits and barriers regarding discharge procedures using three vignettes framed by literature. Some discrepancies were found. For example, ICU nurses were skeptical about the impact of writing a lay summary despite extensive evidence of the known benefits for the patients. ICU nurses anticipated having insufficient skills, not knowing the patient well enough, and fearing legal consequences of their writings. The intervention was designed to target the knowledge, attitudes, self-efficacy, and perceived social influence. Building upon IM steps one to three, a concept discharge protocol was developed that is relevant and feasible within current daily practice.
Conclusion:  Intervention mapping provided a comprehensive framework to improve ICU discharge by guiding the development process of a theory- and empirically-based discharge protocol that is robust and useful in practice.
Library members can order the full text of journal articles via our website using the article requests online via this link.

Critical Care Reviews Newsletter 315 December 2017

The Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from across the medical literature over the past sevecritcal care reviewsn days.  Research contained in the newsletter includes: the TARDIS randomised controlled trial and a systematic review on Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients


The full copy of newsletter 315 24th December 2017 can be accessed via this link.

Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies.

This research by Russell and colleagues was published in the December issue of “Annals of Intensive Care”.
Background:  Patients with malignant haematological disease and especially those who require intensive care have an increased risk of bleeding and thrombosis, but none of these data were obtained in ICU patients only. We assessed the incidence of bleeding and thrombotic complications, use of blood products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies.
Methods:  We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008-2012. Bleeding in ICU was scored according to the WHO grading system, and risk factors were evaluated using unadjusted and adjusted analyses.
Results:  In total, 116 of 129 ICU patients were included; their median length of stay was 7 (IQR 2-16) days. Of these, 66 patients (57%) had at least one bleeding episode in ICU; they bled for 3 (2-6) days and most often from lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 109 per litre (IQR 13-39). Nine patients (8%) died in ICU following a bleeding episode; five of these had intra-cerebral haemorrhage. Platelet count on admission was associated with subsequent bleeding (adjusted odds ratio 1.18 (95% CI 1.03-1.35) for every 10 × 109 per litre drop in platelet count, p = 0.016). Eleven of the 116 patients (9%) developed a clinically significant thrombosis in ICU, which was the cause of death in four patients. The median platelet count was 20 × 109 per litre (15-48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU.
Conclusions:  Severe and debilitating bleeding complications were frequent in our ICU patients with haematological malignancies, but thrombosis also occurred in spite of low platelet counts. Platelet count on ICU admission was associated with subsequent bleeding.
The full text of this article is freely available without password via this link