medigraphic.com
ISSN 2448-8909 (Print)

2011, Number 2

<< Back Next >>

Med Crit 2011; 25 (2)

Development and implementation fo processes to increase the security of the atention

Carrillo ER, Sosa GJO, Ramírez ZL

Language: Spanish
References: 63
Page: 71-86
PDF size: 915.00 Kb.


ABSTRACT

Introduction: The develop and implementation of processes to ensure optimal care quality and safety is a priority in the Intensive Care Units (ICU).
Objective: Develop processes to improve safety and quality of care in an ICU.
Material and methods: It organized working groups that were assigned to develop a specific process than previously selected and conducted a literature review based on evidence. The conclusions of each of the working groups were analyzed, calibrated, validated and improved by the project leaders with the aim of developing clinical practice guidelines based on algorithms that could be applied in everyday practice based on checklist and for which quality indicators were obtained.
Results: The processes developed were: 1) Prophylaxis of infection related to central venous catheters, 2) Prophylaxis of ventilator-associated pneumonia, 3) Control of serum glucose, 4) Assessment of thromboembolic risk and thromboprophylaxis, 5) Evaluation and nutritional therapy, 6) Sedation and analgesia, 7) Temperature control (therapeutic hypothermia and hyperthermia control), 8) Evaluation and monitoring of sepsis the processes are integrated into a decision-making algorithm. To evaluate its performance quality indicators were developed.
Conclusions: The implementation and monitoring processes through quality indicators is a priority in the care of seriously ill because it improves the quality of care and patient safety and impact on reducing morbidity and mortality, costs and hospital stay.


REFERENCES

  1. Weiner BJ, Alexander JA, Shortell SM, Baker LC, Becker M, Geppert JJ. Quality improvement implementation and hospital performance on quality indicators. Health Serv Res 2006;41:307-334.

  2. Cooke M. American medical education 100 years after the Flexner report. N Engl J Med 2006;355:1339-1344.

  3. Chantler C. The rol and education of doctors in the delivery of health care. Lancet 1999;353:1178-1181.

  4. Brennan TA, Leape LL, Laird N. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study. N Engl J Med 1991;324:370-377.

  5. Leape LL, Brennan TA, Laird N. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377-384.

  6. WHO. http://www.who.int/patientsafety/patients_for_patient/en/

  7. Berwick DM. The 100,000 lives campaign setting a goal and a deadline for improving health care quality. JAMA 2006;295:324-327.

  8. O’Grady NP, Alexander M, Dellinger EP. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2002;35:1281-1307.

  9. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in the critically ill patients: excess lenght of stay, extra costs and attributable mortality. JAMA 1994;271:1598-1601.

  10. Renaud B, Brun-Buisson C. ICU-bacteremia Study Group. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584-1590.

  11. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-1171.

  12. Hockenhull JC, Dwan KM, Smith GW, Gamble CL, Boland A, Walley TJ, et al. The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: a systematic review. Crit Care Med 2009;37:702-712.

  13. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in Medical Intensive Care Units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.

  14. Chastre J. Conference summary: ventilator-associated pneumonia. Respiratory Care 2005;50:975-983.

  15. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care–associated pneumonia, 2003. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53(RR-3):1-36.

  16. Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, Craven DE, Roberts PR, Arroliga AC, Hubmayr RD, Restrepo MI, Auger WR, Schinner R, NASCENT Investigation Group. Silver-coated endotracheal tubes and incident of ventilator-associated pneumonia: The NASCENT randomized trial. JAMA 2008;300:805-813.

  17. Soylemez WR, Wiener DC, Larson JR. Benefits and risks of tight glucose control in critically ill adults. JAMA 2008:933-944.

  18. van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359-1367.

  19. Dellinger RP, Carlet J, Masur H. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004; 30:536-555.

  20. Institute for Healthcare Improvement. Implement effective glucose control: establish a glycemic control policy in your ICU.http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/IndividualChanges/EstablishaGlycemicControlPolicyinYourICU.htm

  21. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract 2007;13(Suppl 1):1-68.

  22. Bland DK, Fankhanel Y, Langford E. Intensive versus modified conventional control of blood glucose level in medical intensive care patients: a pilot study. Am J Crit Care 2005;14:370-376.

  23. Benito B, Conget I, Bosch X. Intensive insulin therapy in non-diabetic patients with acute myocardial infarction and hyperglycaemia: INSUCOR study. Med Clin 2008;130:601-605.

  24. Grey NJ, Perdrizet GA. Reduction of nosocomial infections in the surgical Intensive-Care Unit by stric glycemic control. Endocr Pract 2004;10:46-52.

  25. Angus DC, Abraham E. Intensive insulin therapy in critical illness. Am J Respir Crit Care Med 2005;172:1358-1359.

  26. Vriesendorp TM, DeVries JH, van Santen S. Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med 2006;34:2714-2718.

  27. Crowther MA, Cook DJ. Preventing venous thromboembolism in critically ill patients. Semin Thromb Hemost 2008;34:469-474.

  28. Chan CM, Shorr AF. Venous thromboembolic disease in the Intensive Care Unit. Semin Repir Crit Care Med 2010;31:39-46.

  29. Cook D, Attia J, Weaver B, McDonald E, Meade M, Crowther M. Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients. J Crit Care 2000;15:127-132.

  30. Geerts W, Selby R. Prevention of venous thromboembolism in the ICU. Chest 2003;124:357-363.

  31. Hirsh J, Guyatt G, Albers GW, Harrington R, Schunermann HJ. American College of Chest Physician. Antithrombotic and thrombolytic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008;134:173-178.

  32. Mongardon N, Singer M. The evolutionary role of nutrition and metabolic support in critical illness. Crit Care Clin 2010;26:443-450.

  33. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, et al. Guidelines on parenteral nutrition: intensive care. Clin Nutr 2009;28:387-400.

  34. Sungurtekin H, Sungurtekin U, Oner O, Okke O. Nutrition assessment in critically ill patients. Nutr Clin Pract 2008;23:635-641.

  35. Makhija S, Baker J. The subjective global assessment: a review of its use in clinical practice. Nutr Clin Pract 2008;23:405-409.

  36. Behara AS, Peterson SJ, Chen Y, Butsch J, Lateef O, Komanduri S. Nutrition support in the critically ill: a physician survey. JPEN 2008;32:113-119.

  37. Sztark F, Lagneau F. Agents for sedation and analgesia in the intensive care unit. Ann Fr Anesth Reanim 2008;27:560-566.

  38. Sessler CN, Grap MJ, Ramsay MA. Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care 2008;12:1-13.

  39. Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP. Protocolized intensive care unit management of analgesia, sedation and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 2010;111:451-463.

  40. Sessler CN, Pedram S. Protocolized and target-based sedation in UTI. Crit Care Clin 25:489-513.

  41. Williams TA, Martin S, Leslie G, Thomas L, Leen T, Tamaulinas S, et al. Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain. Am J Crit Care Med 2008;17:349-356.

  42. Robinson BR, Mueller EW, Henson K, Branson RD, Barsoum S, Tsuei BJ. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma 2008;65:517-526.

  43. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol 2008;4:619-627.

  44. Fraser GL, Rikker RR. Sedation and analgesia in the critically ill adult. Curr Opin Anaesthesiol 2007;20:119-123.

  45. Szumita PM, Barotelli SA, Anger KE, Wechsler BE. Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine. Am J Health Syst Pharm 2007;64:37-44.

  46. Sessler DI. Thermoregulatory defense mechanisms. Crit Care Med 2009;37:203-210.

  47. Doufas AG, Sessler DI. Physiology and clinical relevance of induced hypothermia. Neurocrit Care 2004;1:489-498.

  48. Aslami H, Juffermans NP. Induction of a hypometabolic state during critical illness. A new concept in the ICU. Neth J Med 2010;68:190-198.

  49. Dmello D, Cruz-Flores S, Matuschak GM. Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review. Intensive Care Med 2010;36:210-213.

  50. Laupland KB. Fever in the critically ill medical patient. Crit Care Med 2009;37:273-278.

  51. Miñambres E, Holanda MS, Domínguez MJ, Rodríguez JC. Therapeutic hypothermia in neurocritical patients. Med Intensiva 2008;32:227-235.

  52. Morris PE, Prowes JT, Guntupalli FK, Wright PE, Arrows MM. A multi-center, randomized, double-blind, parallel, placebo-controlled trial to evaluate the efficacy, safety, and pharmacokinetics of intravenous ibuprofen for the treatment of fever in critically ill and non-critically ill adults. Crit Care 2010;14:125-130.

  53. Kiekkas P, Velissaris D, Karanikolas M, Aretha D, Samios A, Skartsani C, Baltopoulos GI, Filos KS. Peak body temperature predicts mortality in critically ill patients without cerebral damage. Heart Lung 2010;39:208-216.

  54. Fumagalli R, Bellani G, Perri A. Which drugs for the control of fever in critically ill. Curr Drug Targets 2009;10:881-886.

  55. Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infect Dis Clin North Am 2009;23:471-484.

  56. Polderman KH, Herold I. Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects and cooling. Crit Care Med 2009;37:1101-1120.

  57. Laupland KB, Shahpori R, Kirkpatrick AW, Ross T, Gregson DB, Stelfox HT. Ocurrence and outcome of fever in critically ill adults. Crit Care Med 2008;36:1531-1535.

  58. Gerber K. Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to implementing evidence-based guides. Nurse Crit Care 2010;15:141-151.

  59. Tromp M, Hulscher M, Bleeker-Rovers CP, Peters L, van der Berrg DT, Borm GF, et al. The role of nurses in the recognition and treatment of patients with sepsis in the Emergency Department. A prospective before-and-after intervention study. In J Nurs Stud 2010;15:112-120.

  60. Cardoso T, Carneiro AH, Ribeiro O, Texeira-Pinto A, Costa-Pereira A. Reducing mortality in severe sepsis with the implementation of a core-6 hour bundle: results from the Portuguese communitiy-acquired sepsis study. Crit Care 2010;14:83-88.

  61. Castellanos OA, Suberviola B, Garcia-Astudillo LA, Holanda MS, Ortiz F, Llorca J, Delgado RM. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study. Crit Care Med 2010; 38: 1036-1043.

  62. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 2010;36:222-231.

  63. Ferrer R, Artigas A, Levy MM, Blanco J, González-Díaz G, Garnacho-Montero J, Ibáñez J, Palencia E; Quintana M, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008;299:2294-2303.




2020     |     www.medigraphic.com