''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
[Aim] Physical restraint was, in principle, prohibited in a nursing-care setting by the Nursing Care Insurance Law on April, 2000 in Japan, which had partly been in response to some sensational mass media reports on restraint cases and the public mood at that time. Since then, there has been a growing trend, even in a hospital setting, to avoid any physical restraint. However in critical care, minimal physical restraint is inevitable to avoid self-extubation of the tubes for life-support. To provide a clear implementation guideline for this dilemma, the task force conducted a nation-wide survey in Japan and presented a guideline based on the survey data.
[Subjects & Methods] A questionnaire regarding physical restraint was sent to nursing directors of all the hospitals with ICU facilities in 2007. Four hundred and ninety three replies out of 1,188 hospitals surveyed (41.5%) were obtained.
[Results] The percentages of the hospital employing / not employing physical restraint were 94.7 / 1.4 %, respectively. In total, 84.2 % of the hospitals surveyed had handling guidelines in any form for physical restraint, which mostly included ‘starting criteria’ and ‘methods to obtain informed consent’. Fifty percent had ‘criteria to discontinue physical restraint’ and 24.3 % had ‘methods to avoid unnecessary physical restraint’ as well.
[Discussion] An ethically-acceptable consensus has been built in Japan to draft a guideline for physical restraint in the ICU setting. The followings are the contents of the guideline currently posted at the web site of the society. 1. Basic concept of physical restraint, 2. Criteria to place, 3. Methods to place, 4. Practical tube management including removal. The guideline should be further evaluated for the utilization in hospital care.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Present ICUs are primarily developed from a medical and technological view and not attuned to present insights about what environmental factors may have on the ICU patients’ recovery processes. Present ICU environments can per se lead to development ICU delirium/syndrome, which leads to a longer ICU-stay, hospitalization and in some cases deaths. We therefore questioning existing ICU design practices and pose an overall research question; if a specially designed patient room in an ICU affects the people who stay there, i.e. patients, next of kin and staff compared to an ordinary ICU patient room.
Aim: This presentation will describe the process of the planning, implement and the testing of a research design of an intervention study performed in an ICU.
Methods: The project has an experimental design.
Results: The intervention consists of the construction of one patient room in an ICU. The planning took place during the years 2008-2010 and started with a review of literature describing physical environments in hospitals. The intervention study involves co-operation among scholars from architecture, environmental medicine and experts from companies within the health care area as well as ICU care practitioners. The intervention room was refurbished according to principles of evidence-based design regard to sound, light, shape and access to nature. New and innovative products, e.g. bed linen in ecological textile materials, cyclic lightning and sound absorbents were installed. Examples of the interior shaping of the intervention room will be presented as well as the planning and implementation process.
Conclusion: There is a great challenge in developing research programs that create healing environments that are more conductive to patients’ recovery processes, next of kin and staff.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Nurses working in intensive care units (ICUs) are expected to provide appropriate end-of-life care such as helping families stay close to their loved one and review the life story of the patient. However, some ICU nurses are reluctant to provide such care. Negative mood is considered one of the factors of unprofessional behavior such as disregarding those families.
Objective: The aim of this study was to compare nurses’ mood administering Scenarios which whether family accepts or refuses withdrawal of life sustaining therapy.
Methods: A self-reporting anonymous questionnaire was distributed to 252 nurses with experience of three or more years in ICUs from sixteen intensive care units in a large urban area located in central Japan from August to October 2009. The questionnaire included demographic data, mood inventory and a scenario that described a case whose family accepted or refused to withdraw life sustaining therapy. Participants were asked to read either scenario of acceptance case (A group) or refusal case (R group) and recall the similar cases. T test was used to compare mood between A group and R group.
Results: Data from 66 nurses in A group and 49 nurses in R group were analyzed. T test showed significant differences between mood scores of A group and R group. R group nurses were found higher scores than A group for negative mood sub scales such as depressive mood, anxious mood, fatigue, and tension and excitement.(Depressive mood, anxious mood and fatigue p<0.05,tension and excitement p<0.01)
Conclusion: The results of this study indicate a possibility that continuing life sustaining therapy increases ICU nurse’ negative mood.
Delirium,Acute confusion,Sugical intensive care unit,risk factor
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background
Delirium is one of the most serious problem in the intensive care unit (ICU), which might complicated with serious problem like prolong hospital stay, increased medical expense and mortality.
We plan to analysis the incidence and risk factors related to delirium in ICU
Method
This is a descriptive , related , and prospective study. For the convenient sampling,30 patients were collected the surgical intensive care unit in one medical center from 1th October,2011 to 6th Norvenber ,2011.The CAM-ICU and RASS score was used to assessed and diagnose Delirium . The data was analyzed by Chi-square,t-test.
Result
According to our study, the incidence of acute delirium in SICU is 46.7%. There is no significant statistic difference in disease type, gender and age . Solitary and alcoholism(P=.05), restriction, fever and indwelling catheters(P< .02), high TISS score and low GCS score (P< .03) is statistic difference significantly.
Discussion
For ICU patient, nursing staff should be cautious to prevent the delirium risk factors , including the necessity for indwelling catheters and physical restriction on patients , and the treatment of fever episode. Pay attention to high TISS score and low GCS score patients, in order to reduce the incidence of delirium.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
U liječenju hematoloških bolesti koriste se razni sintetički pripravci lijekova.Pored njih značajan aspekt u procesu izliječenja i oporavka predstavljaju krvni derivati dobrovoljnih davalaca.Oni se mogu davati jednokratno ili tokom dužeg vremenskog parioda (dana, mjeseci).Liječenje bolesnika sa leukemijom i drugim zloćudnim bolestima krvi i ostalih organa vrlo je uspješno,ali traje mjesecima i zahtijeva velike količine koncentrata krvnih derivata. 70% leukemija u djece i više od 50% leukemija u mlađih odraslih osoba može se potpuno izliječiti primjenom kemoterapije i / ili transplatacijom koštane srži uz redovito transfuzijsko liječenje krvnim pripravcima.
Cilj rada: Prikazati količinu i vrste krvnih derivata koji su ordinirani tokom 2010.god. na Klinici za hematologiju KCUS u sklopu koje je i Hematološko savjetovalište sa dnevnom bolnicom.
Materijal i metode: Klinika za hematologiju raspolaže sa 56 kreveta raspoređenih na tri odjela.U sklopu Savjetovališta nalaze se četiri kreveta za apliciranje terapije.Svi odjeli imaju protokole za evidentiranje osnovnih podataka o promaocu krvi,vrsti ordiniranih krvnih derivata,premedikaciji,transfuzijskim reakcijama,ljekaru i sestri koji su učestvovali u aplikaciji.Za svaki derivat krvi postoje podaci o KG/Rh,fenotipu,interreakciji,testu na transmisione bolesti,datumu uzete krvi od davaoca,vijek trajnosti i registracijskom broju.
Rezultati: Analitičkim dijelom tabelarno i grafički prikazani su parametri: potrošnja krvnih derivata,potrošnja po bolesniku,dijagnozi,pripravaku,posttransfuzijske reakcije.
Zaključak:Tokom 2010.g. na Klinici za Hematologiju je ordinirano 5368 derivata krvi.U Savjetovalištu se,pored kemo-terapija,daju i druge I.V. terapije.Od njih 700, transfuzija krvi je bilo 202.U ovoj godini na Kliniku su primljena 1263 pacijenta od kojih je 286 više puta tretirano sa derivatima krvi.Svaki od čak 67 pacijenata,tokom ležanja je primio više od 15 doza krvnih pripravaka.Svi su liječeni od zloćudnih bolesti krvi sa kemo-terapijom.Kao posljedica toga dolazi do pada vrijednosti parametara krvne slike koje se moraju tretirati derivatima krvi.
sustav kvalitete, sigurnost transfuzijskog liječenja
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
1. Uvod
Uvođenjem sustava kvalitete ISO 9001:2008 i opredjeljenjem za kvalitetu na Odjelu za transfuzijsku medicinu Opće bolnice Varaždin uspostavili smo procese i nadzor nad procesima , ustanovili smo kritične točke u procesu u kojima mjerimo proces. Svi otkloni od zadanih zahtjeva za kvalitetom smatraju se nesukladnošću. Uveli smo sustavno otkrivanje nesukladnosti unutar procesa, otkrivanje uzroka nesukladnosti, te za sve ponavljajuće nesukladnosti i veće nesukladnosti pokreću se korektivne radnje čiji uspjeh evaluiramo.
2. Cilj
Cilja rada je prikazati tipove nesukladnosti prema temeljnim radnim procesima (Uzimanje krvi, prerada krvi, skladištenje i distribucija krvnih pripravaka, serološka i imunohematološka dijagnostika, kliničko – ambulantna djelatnost) tijekom šest mjeseci, te prikaz trenda smanjenja nesukladnosti nakon poduzetih korektivnih radnji.
3. Metode
U radu su korišteni podaci o nesukladnostima prijavljeni na obrascima za nesukladnosti, na obrascima reklamacijama, posttransfuzijskim reakcijama, te o vraćenim krvnim pripravcima. Prijave su učinjene od strane djelatnika u procesu rada, tijekom internih prosudbi, te od strane korisnika proizvoda / usluga. U analizi podataka koristili smo se paretto i trend analizom.
4. Rezultati
U razdoblju od ožujka 2010 do ožujka 2011 u procesu uzimanja krvi zabilježeno je 1,29 % nesukladnosti. U procesu prerade krvi zabilježeno je 1,16 % nesukladnosti od kojih izdvajamo najučestalije, lipemije u krvnim pripravcima (33,2 %), te prisutnost eritrocita u plazmi (29,2 %). Za ova dva pokazatelja poduzete su korektivne i preventivne mjere. Darivateljima sa evidentiranom lipemijom u plazmi šalju se obavijesti o povišenim masnoćama, te preporuke o pravilnoj prehrani, a kao razlog ulaska eritrocita u plazmu utvrđena je potreba češćeg održavanja aparata za separaciju krvnih pripravaka. U procesu skladištenja i distribucije krvnih pripravaka zabilježeno je 0,83 % nesukladnosti. Na temelju analize dobivenih podataka poduzete su edukativne mjere vezane uz uvjete čuvanja krvnih pripravaka (80%), u procesu laboratorijske dijagnostike zabilježeno je ukupno 1,00 % nesukladnosti, od čega 90 % čine neadekvatni uzorci. Poduzete se edukativne mjere o izgledu, vrsti i važnosti adekvatnog uzorka. U kliničko – ambulantna djelatnosti zabilježeno je 1,35 % od čega 95 % čine administrativne greške dokumentacije. Poduzete su korektivne mjere u smislu promjene izgleda zahtjevnica i uputnica, provedena je edukacija djelatnika na odjelima. Nakon poduzetih korektivnih i preventivnih radnji bilježi se tendencija pada nesukladnosti u svim procesima.
Zaključak
Prepoznavanje nesukladnosti, ispitivanje uzroka nesukladnosti, te pokretanje korektivnih radnji i njihova analiza učinkovitosti izuzetno je važan alat u nadzoru nad kvalitetom kao i u kontinuiranom poboljšanju kvalitete u dijagnostici liječenju pacijenata krvnim pripravcima. Svjesni nedostataka u kvalitetnom provođenju i uspostavi željenih razina kvalitete nužne su i neophodne promjene na svim razinama sustava, uključujući svakako sustav obrazovanja, rada i zdravstva.
