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Patient Safety. Department of Internal Medicine Faculty of Medicine Prince of Songkla University. Quality Assurance Report: 30 th November 2007. Department of Internal Medicine Patient Safety project. Patient Safety in Critically ill patients. Prevention of self extubation in medical ICU.
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Patient Safety Department of Internal Medicine Faculty of Medicine Prince of Songkla University Quality Assurance Report: 30th November 2007
Patient Safety in Critically ill patients Prevention of self extubation in medical ICU
Patient Safety IMPACT
Number of medical ICU admission and intubation : 2544 - present
Patient Safety Literature review
Sedation: Current Issues Without a means to objectively titrate the level of sedation, patients may be: • Over-sedated • increased drug costs • delayed weaning • increased ICU length of stay • increased testing • Under-sedated • anxiety and agitation • awareness and recall • post-traumatic stress disorder • increased adverse events • increased use of paralytics
Daily interruption of sedative infusion in critically ill patients undergoing mechanical ventilation Kress. NEJM 2000.
Effect of nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia Quenot. CCM 2007.
Effect of nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia Quenot. CCM 2007.
Sedation Use Recommendations • Lorazepam is recommended for sedation of most patients via intermittant IV or continuous infusion (Grade=B) • Triglyceride levels should be monitored after two days of propofol infusion (Grade=B) • Use of sedation guidelines, an algorithm or a protocol is recommended. (Grade=B) Jacobi J. Crit Care Med 2002; 30(1): 119-142.
แพทย์สั่งระดับ Sedationที่ต้องการ เริ่มให้ยา Bolus injectionและ ให้ยาในระดับต่ำที่สุดตาม guideline ทดสอบระดับ Sedation ของผู้ป่วยทุก 30 นาที และปรับยาขึ้น 1-2 ml/hr จนได้ระดับที่ต้องการ ประเมินความรู้สึกตัวทุก 1ชั่วโมง ระดับ Sedation มากกว่าที่ต้องการ ระดับ Sedation น้อยกว่าที่ต้องการ ระดับ Sedationอยู่ในระดับที่ต้องการ ลดขนาดยาลงครึ่งหนึ่ง หรือ หยุดการให้ยา Bolus ยา และเพิ่มขนาดยาอีก 1-2 ml/hr
Patient Safety outcome
Self extubation rate in medical ICU intervention
Patient Safety learning
Learning • Sedation protocol is effective to prevent self extubation in medical ICU. • Sedation protocol did not increase ventilator day and risk of VAP. • The collaborate of critical care nurse and intensivist is the key of success. • The incidence of extubation could possible reach to ZERO.
Learning • We should be increase awareness and alertness in isolated room patients. • During period of sedation interruption, critical care nurse must pay more attention to the patients in order to prevent self extubation. • This protocol should be implemented in all ventilator care unit.
Patient Safety in cancer patients Oncology nurse driven chemotherapy
Patient Safety IMPACT
Medical error in chemotherapeutic patients • Inaccurate dose and drug • Wrong patients • Leakage of chemotherapy during injection • No medical advice postchemotherapy
Safety in chemotherapy injection Amended injection technique Oncology nurse
Oncology nurse: job description • Give chemotherapy to hospitalized medical oncology patients • Give medical advice for cancer patients • Instruction and sharing the knowledge of caring in cancer patient to ward nurses
Patient Safety outcome
ภาควิชาและมูลค่าที่มีการยกเลิกหลังเตรียมยา(มกราคม – มิถุนายน 2550)
Patient Safety learning
Learning New infusion technique is safe and simple. Oncology nurse should be implemented in all cases of chemotherapy patients. New process may be decrease unused drug.
