Septic shock: Clinical indicators and implications to critical patient care

2021 ◽  
Author(s):  
Luciana Ramos Corrêa Pinto ◽  
Karina de Oliveira Azzolin ◽  
Amália de Fátima Lucena ◽  
Miriane M. S. Moretti ◽  
Jaqueline S. Haas ◽  
...  
Keyword(s):  
Septic Shock ◽  
Patient Care ◽  
Clinical Indicators

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

2019 ◽  
Vol 54 (4) ◽  
pp. 388-396
Author(s):  
Brittany D. Bissell ◽  
Breanne Mefford
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Patient Care ◽  
Fluid Balance ◽  
Clinical Pharmacist ◽  
Improve Patient Care ◽  
Positive Fluid Balance ◽  
Medline Search ◽  
Icu Stay ◽  
Organ Systems

Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.

scholarly journals The Impact of Corticosteroids on Mortality in Adult Patients with Septic Shock

2019 ◽  
Author(s):  
Anthony Henriques
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Data Collection ◽  
Patient Care ◽  
Adult Patients ◽  
Flow Diagram ◽  
Cochrane Library ◽  
Advanced Practice ◽  
Pertinent Data ◽  
The Impact

Septic shock is a complication that affects thousands of patients leading to high mortality rates and increased healthcare costs. One treatment in the attempt to decrease poor outcomes is corticosteroids. A systematic review was conducted to evaluate the impact of corticosteroids on mortality in adult patients with septic shock. Databases searched were CINAHL, PubMed, OVID, and Cochrane Library. A literature review was performed and pertinent data from each article was recorded in data collection tables. A total of six articles were critically analyzed. The Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and flow diagram were used to guide this systematic review. The Critical Appraisal Skills Programme (CASP) checklist assisted in assessing the quality of the articles selected. Cross study analysis was performed via the data collection tables developed by this author. This analysis revealed five of the six trials did not detect a decrease in mortality using corticosteroids in adult patients with septic shock; the sixth study did document a reduction in mortality rate. Four studies were underpowered which may affect the generalizability of their outcomes. Two studies were adequately powered with one demonstrating positive outcomes. Possible benefits were seen in the secondary outcomes such as faster resolution of shock and decreased vasopressor use. Advanced practice nurses are having an increased prominent role in patient care within healthcare. This role provides an opportunity for high quality evidence-based results to be applied to improve patient care. Results of this systematic review provide information to guide decision making by the advanced practice nurse as well as suggestions for further study.

Introducing Health System Change Strategies to Policy Makers

2014 ◽  
Vol 3 (2) ◽  
pp. 1-14
Author(s):  
Brian T. Collopy
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Providers ◽  
Health Care Policy ◽  
Clinical Performance ◽  
Care Providers ◽  
Clinical Indicators ◽  
Policy Makers ◽  
Comparative Feedback ◽  
Indicator Sets

In a world first, for accreditation programs, Clinical Indicators (clinical performance measures) were introduced into the Australian Council on Healthcare Standards (ACHS) accreditation process 21 years ago. The resulting national clinical database now receives data from over 740 health care organisations (HCOs) on 22 indicator sets, for different medical disciplines, containing almost 400 separate indicators. HCOs receive aggregate and peer comparative feedback and the types of action by HCOs in response to their results include further data reviews, policy/procedure changes, education programs, new appointments and equipment changes. Favourable data trends in patient care are evident and, with some indicators, cost avoidance can be demonstrated. Revision of the indicator sets is an essential task to ensure continued relevance to clinicians. The Federal Government response to a study in which patient care in Australian hospitals was, prematurely, judged to compare poorly with care in the USA (and later the UK) resulted in the establishment of The Australian Commission on Safety and Quality in Health Care which has now embarked upon a separate program of hospital-based outcome indicators, as have other health care providers. Advice is provided from the literature and personal experience on issues of presentation of material to health care policy makers.

Enabling quality data reporting: National implementation of standardization pathology reporting.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 122-122
Author(s):  
Avril Kwiatkowski
Keyword(s):  
Patient Care ◽  
Lessons Learned ◽  
International Standards ◽  
Quality Data ◽  
Successful Implementation ◽  
Clinical Indicators ◽  
Adoption And Implementation ◽  
National Implementation ◽  
System Leaders ◽  
Pathology Reporting

122 Background: The Canadian Partnership Against Cancer (the Partnership) launched its Electronic Synoptic Pathology Reporting Initiative (ESPRI) to advance the implementation and promote the wide adoption of standardized synoptic pathology reporting tools in Canada. This presentation will highlight strategies to ensure successful implementation of this program across the Canadian health system as well as lessons learned. Methods: Upon consultation with clinical and system leaders, clear and measureable program targets (such as 90% completeness rates against mandatory elements of the College of American Pathology cancer protocols and disease-specific clinical indicators) were agreed upon. Thorough provincial planning to understand the variances across provincial current states, establish strategies and solidify plans was supported by the Partnership; followed by implementation of those plans. Key approaches to enable adoption and implementation include coordination of Pathologist and Vendor-led education sessions, establishment of clinical expert panels and assignment of Canadian representatives to the College of American Pathologists’ (CAP) Cancer Protocol Review Panels. The Partnership continues to collaborate with national/international standards organizations such as NAACCR, CAP, and Canada Health Infoway to support standards maintenance. Results: As a result of ESPRI, approximately 80% of Canadian pathologists will be reporting synoptically by 2017, across 7 of 10 provinces. It is expected that this will reflect approximately 25,000 reports per year for the five cancer types of focus (breast, colorectal, lung, prostate and endometrial) from about 950 pathologists. The Partnership, with CAP-ACP, has partnered with pathology communities from the US, UK, and Australasia to form the International Collaboration on Cancer Reporting (ICCR) to collaborate on internationally-harmonized core datasets for cancer pathology. Conclusions: Adoption of structured pathology reporting in Canada will enable better patient care, improve data quality, create efficiencies and enable interoperability. Through adoption and implementation efforts, this will impact patient care.

Communications problems affecting patient care in hospitals

JAMA ◽  
1966 ◽  
Vol 195 (1) ◽  
pp. 36-37 ◽  
Author(s):  
J. C. Quint
Keyword(s):  
Patient Care

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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