10 hours ago · The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. Ethical problems connected to full bed occupancy have in common the weighing of interests (and risks and benefits) of two (or more) patients against each other: delay of ICU ... >> 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.
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.
We can run out of ICU resources for our patients. We can run out of personal protective equipment for ourselves. We can be exposed on the job and get sick. And we can die — many of us did, more than 3,600 from COVID-19 in the first year. Many of us quarantined away from our families to protect the ones we love.
A total of 854 consults for ICU admission were requested by the ED team during the study period with complete data, representing 43.7% of all the ICU consults received.
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 ...
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.
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).
weaning him off the sedation medicine but he is very restless and agitated..he opens his eyes and...
the sedation and were worried about infection. They have now successfully managed to reduce his...
stents were inserted. She has been in icu since then on sedation and a ventilator and they have...
commands by moving his arms and legs! He was on ventalation for 2 weeks and off all sedatives for 9...
people). He is off the ventilator, still in ICU. He has a trach and they are in the process of...
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.
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;