18 hours ago · Specializes in ICU. 1,131 Posts. Jul 30, 2011. It's not that someone doesn't "want" the patient. Acuity guidelines often aren't followed. We have doctors admit that they put their patients in our ICU because they "feel better" having them there. The ICU has a certain ratio and a certain amount of nurses. >> Go To The Portal
Add to that the complexity of caring for patients with a wide range of critical illness, the presence of multiple care teams contributing to orders on a single patient, the large number of orders written per patient, and the use of high-risk medications, the atmosphere of the ICU is inherently primed for a medication error.
Intensive Care Unit (ICU) admission delays can negatively affect patient outcomes, but Emergency Department (ED) volume and boarding times may also affect these decisions and associated patient outcomes.
Proactively identifying problem areas in the medication use process and recognising high risk patient populations can improve the safe use of medications in the ICU and ED. Critical care units are fast paced, interruption driven environments.
Focus on the medication reconciliation process is often made at patient admission, transfer from level of care, and discharge from the hospital. Critically ill patients tend to transition through several levels of care while in the same ICU bed due to the dynamic nature of their critical illness.
The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients.
The intensive care unit (ICU) is an ethically charged environment: life and death decisions are made daily. Particularly when medical criteria alone are insufficient in deciding what is the right thing to do, healthcare professionals can be faced with an ethical dilemma. For example, deciding whether to discharge a patient not quite ready for ...
It is important for ICUs and general wards to cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. Image Credit: NHS (Wales) UK.
Care in the ICU is more highly technological and more intensive than in the general ward – ICU personnel are more technically skilled than nurses in the general ward," according to Anke Oerlemans and colleagues at Radboud University Medical Center (the Netherlands).
Background Information: Critical care and emergency medicine are frequently intertwined as the resuscitation of critically ill patients occurs in both environments. While the majority of these patients come through the emergency department (ED), the resuscitation of critically ill patients is not defined by a geographic location, but rather a set of principles designed to deliver appropriate care in a timely fashion. 1,2 Increased numbers of critically ill patients in combination with decreased availability of intensive care unit (ICU) beds and a shortage of intensivists has led to a shift in critical care being delivered in the ED. 3 Furthermore the lack of ICU beds, among many other factors, have contributed to a prolonged length of stay (LOS) of already admitted patients known as “ED Boarding”. Another factor to consider, is that providing prolonged critical care in a traditional ED setting is challenging as it requires more staff and is often associated with increased mortality. Multiple studies have demonstrated an association of worsened outcomes when patient’s ED LOS is greater than 6 hours and, in the United States, 33% of all ICU admissions from the ED have an ED LOS greater than 6 hours. 1,4 A proposed solution has been the development of ICUs housed within the ED known as ED-ICUs. While only a handful exist, this new method of care delivery aims to reduce the time it takes for patients to receive critical care and offset the strain on current ICUs ( Table 1) 4. The authors of this study sought to determine the association of ED-ICUs on 30-day mortality and inpatient ICU admission.
ED-ICUs are becoming increasingly more popular as patients are getting sicker and the demand for critical care rises. While this study opens the discussion on how this care delivery model impacts patient mortality, there are many more factors impacting patient outcomes that need to be considered. Furthermore, the methodology and overall design of this study served as a major limiting factor. In the future as more ED-ICUs are developed, we should be comparing them with actual ICUs or different staffing models in the ED to truly see if where we deliver critical care has any effect on patient outcomes.
Critically ill patients tend to transition through several levels of care while in the same ICU bed due to the dynamic nature of their critical illness. These constant changes require addressing the medication needs of both their acute and chronic conditions on a more frequent basis.
Pharmacokinetic and pharmacodynamic changes that occur in the patient as a result of critical illness and medical interventions should be routinely and systematically addressed in the care assessment and plan daily.
Add to that the complexity of caring for patients with a wide range of critical illness, the presence of multiple care teams contributing to orders on a single patient, the large number of orders written per patient, and the use of high-risk medications, the atmosphere of the ICU is inherently primed for a medication error.
Medication errors can be costly to the healthcare system and detrimental to the individual patient. Applying a systems approach that identifies and resolves institution specific risk areas leading to medication errors is an important step to improve patient safety and quality of care in the ICU and ED. Further, utilising a multidisciplinary team to identify high risk patients, and medications, are necessary measures to minimise the frequency and impact medication errors will have on patients, especially in high risk patient populations such as the critically ill.
In the case of meperidine, accumulation of a toxic metabolite may lead to CNS irritation and seizures. In some cases, the effects of haloperidol and other antipsychotic drugs may accumulate and take several weeks to fully metabolise in an acutely ill older adult with organ dysfunction.
Enhanced educational efforts surrounding medication use should not be overlooked if patterns are identified in specific patient populations or medications, and should include a component of competency assessment for all levels of clinicians involved in the medication use process.
Some of these reasons include: Preventing the spread of infection. Maintaining quiet for other patients because they do not have privacy in the ICU. Allowing your loved one to rest and recover.
If your loved one has been admitted to the intensive care unit of a hospital, this means that his or her illness is serious enough to require the most careful degree of medical monitoring and the highest level of medical care. The intensive care unit (ICU) may also be referred to as the critical care unit or the intensive care ward.
The ICU is a part of the hospital where patients receive close medical monitoring and care. Some hospitals also have specialized ICUs for certain types of patients: Neonatal ICU (NICU): Care for very young or premature babies. Pediatric (PICU): For children who require intensive care.
While there may be curtains for privacy, patients are more visible and accessible to the nurses and doctors who staff the intensive care unit. This allows the healthcare staff to keep a closer watch on patients and to be able to carry out a faster response to any sudden problems.
The ICU allows health care providers, such as doctors, nurses, nursing assistants, therapists, and specialists, to provide a level of care that they may not be able to provide in another setting:
Removal of respiratory support, which is extubation, takes place when a patient is able to breathe independently. Lower Level of Consciousness: If your loved one is unconscious, unresponsive or in a coma, he or she may require care in the ICU, particularly if he or she is expected to improve.
In addition, many ICUs are also equipped with centrally located screens that display patients’ vital signs outside the room. This allows nurses to read several patients’ vital signs even when they are not in the patients’ rooms, and to become aware of important changes promptly.
Helping a dumped patient usually starts when a hospital social worker asks the nursing-home administrator for confirmation that a patient was given due notice; it is surprising just how many nursing home administrators are not aware that a patient must receive 30 days notice before being evicted.
When a hospital discharges a patient, and the nursing home won’t take him or her back, it’s called “hospital dumping. ”. The dumping of mostly low-income nursing-home patients (or those who have become low-income because the nursing home has already taken all the money they have) is a growing problem, one involving a complicated interaction ...
Dumped: When nursing homes abandon patients to the hospital. Margie is an 86-year-old nursing home resident who has developed a bladder infection. As is the case with many elderly women, she also is confused as a result. On her way out the door to a hospital, she struggles and yells that “they better not tell anyone else” about why she is going ...
Nursing facilities have even told a hospital that a patient could not return because his or her cost of care was higher than the state Medicaid rate. And the nursing homes complain that they have too many of these types of residents already—if they keep every difficult low-income case, they will go broke.
She calls her family in a panic, only to learn that they had no idea where she was. Margie wasn’t poor, at least not until about 2 years in the nursing home, which consumed all of her savings, including the money she realized in selling her home.
According to law, if a nursing home can’t meet a resident’s medical needs, the nursing home staff should call the state department of health and senior services. But it’s quicker and cheaper (for the nursing home) to simply dump the patient on the hospital.
The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility; The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
In the first, physicians are unaware that they are over-admitting to the ICU because they do not receive data on a regular basis that help them understand how well they are managing patients from the ED , he says.
Case management also should be a strong component in the ED, helping patients use the proper resources outside the ED rather than returning for things like prescription refills, Johnson says.