scholarly journals Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Lina Mosch ◽  
Monique Schieler ◽  
Steffen Weber-Carstens ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Qualitative Study ◽  
Patient Monitoring ◽  
Digital Health ◽  
Alarm Management ◽  
Novel Technology ◽  
Future Patient

BACKGROUND In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. OBJECTIVE The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. METHODS This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach. RESULTS Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. CONCLUSIONS This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. CLINICALTRIAL ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk)

scholarly journals Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

10.2196/13064 ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. e13064 ◽  
Author(s):  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Lina Mosch ◽  
Monique Schieler ◽  
Steffen Weber-Carstens ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Patient Monitoring ◽  
Future Patient

An In-Service Educational Package Improves Alarm Management in the Neonatal Intensive Care Unit (NICU): Before and After Study

2021 ◽  
pp. 097321792110512
Author(s):  
Suryaprakash Hedda ◽  
Shashidhar A. ◽  
Saudamini Nesargi ◽  
Kalyan Chakravarthy Balla ◽  
Prashantha Y. N. ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Response Time ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Alarm Management ◽  
Educational Package ◽  
Before And After ◽  
Before And After Study

Background: Monitoring in neonatal intensive care unit (NICU) largely relies on equipment which have a number of alarms that are often quite loud. This creates a noisy environment, and moreover leads to desensitization of health-care personnel, whereby potentially important alarms may also be ignored. The objective was to evaluate the effect of an educational package on alarm management (the number of alarms, response to alarms, and appropriateness of settings). Methods: A before and after study was conducted at a tertiary neonatal care center in a teaching hospital in India involving all health-care professionals (HCP) working in the high dependency unit. The intervention consisted of demo lectures about working of alarms and bedside demonstrations of customizing alarm limits. A pre- and postintervention questionnaire was also administered to assess knowledge and attitude toward alarms. The outcomes were the number and type of alarms, response time, appropriateness of HCP response, and appropriateness of alarm limits as observed across a 24-h period which were compared before and after the intervention. Findings: The intervention resulted in a significant decrease in the number of alarms (11.6-9.6/h). The number of times where appropriate alarm settings were used improved from 24.3% to 67.1% ( P < .001). The response time to alarm did not change significantly (225 s vs 200 s); however, the appropriate response to alarms improved significantly from 15.6% to 68.8%. Conclusion: A simple structured intervention can improve the appropriate management of alarms. Application to Practice: Customizing alarm limits and nursing education reduce the alarm burden in NICUs

scholarly journals Barriers to reporting clinical errors in operating theatres and intensive care units of a university hospital: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sedighe Ghobadian ◽  
Mansour Zahiri ◽  
Behnaz Dindamal ◽  
Hossein Dargahi ◽  
Farzad Faraji-Khiavi
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Qualitative Content Analysis ◽  
Operating Theatre ◽  
University Hospital ◽  
Care Staff ◽  
Health Care Staff ◽  
Organizational Problems

Abstract Background Clinical errors are one of the challenges of health care in different countries, and obtaining accurate statistics regarding clinical errors in most countries is a difficult process which varies from one study to another. The current study was conducted to identify barriers to reporting clinical errors in the operating theatre and the intensive care unit of a university hospital. Methods This qualitative study was conducted in the operating theatre and intensive care unit of a university hospital. Data collection was conducted through semi-structured interviews with health care staff, senior doctors, and surgical assistants. Data analysis was carried out through listening to the recorded interviews and developing transcripts of the interviews. Meaning units were identified and codified based on the type of discussion. Then, codes which had a common concept were grouped under one category. Finally, the codes and designated categories were analysed, discussed and confirmed by a panel of four experts of qualitative content analysis, and the main existing problems were identified and derived. Results Barriers to reporting clinical errors were extracted in two themes: individual problems and organizational problems. Individual problems included 4 categories and 12 codes and organizational problems included 6 categories and 17 codes. The results showed that in the majority of cases, nurses expressed their desire to change the current prevailing attitudes in the workplace while doctors expected the officials to implement reform policies regarding clinical errors in university hospitals. Conclusion In order to alleviate the barriers to reporting clinical errors, both individual and organizational problems should be addressed and resolved. At an individual level, training nursing and medical teams on error recognition is recommended. In order to solve organizational problems, on the other hand, the process of reporting clinical errors should be improved as far as the nursing team is concerned, but when it comes to the medical team, addressing legal loopholes should be given full consideration.

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Lina Katharina Mosch ◽  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Monitoring ◽  
Digital Health ◽  
Implementation Process ◽  
Health Technology ◽  
High Tech ◽  
Remote Patient Monitoring ◽  
Implementation Framework ◽  
Remote Patient

BACKGROUND Despite the vast potential, the digital transformation of intensive care is lagging behind. Comprehensive evidence, along with guidelines for a successful integration of digital health technologies into specific clinical settings such as the intensive care unit (ICU), are scarce—yet essential. OBJECTIVE We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU. METHODS We conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. RESULTS Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects. CONCLUSIONS The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks. Our proposed framework may guide health providers with concrete, evidence-based, and step-by-step recommendations for implementation practice facilitating the introduction of digital health in intensive care. CLINICALTRIAL ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

scholarly journals Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study (Preprint)

10.2196/22866 ◽  
2020 ◽  
Author(s):  
Lina Katharina Mosch ◽  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Digital Health ◽  
Health Technology ◽  
Implementation Framework

scholarly journals FAST HUG: UMA FERRAMENTA PARA FARMÁCIA CLÍNICA NA ATENÇÃO E SEGURANÇA DO PACIENTE CRÍTICO

2018 ◽  
Vol 10 (2) ◽  
pp. 59-64
Author(s):  
Nayara Aparecida Maioli ◽  
Aline Fernanda dos Santos Ferrari ◽  
Tatiane Domingos dos Santos ◽  
Hernani Cesar Barbosa Santos
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Clinical Practice ◽  
Clinical Pharmacist ◽  
Drug Related Problems ◽  
Specific Training ◽  
Effective Care ◽  
Promote Patient Safety

FAST HUG is a check-listcomposed of seven essential items in daily prescription in patients hospitalized inthe Intensive Care Unit (ICU), allowing the identification of drug-related problems in these units, and seeks to ensure a safe, efficient and effective assistance to patients. The purpose of the discussion is to explain the advantages of using FAST HUG by clinical pharmacists in health care and safety of critically ill patients. In the literature review, it was observed that the FAST HUG to identify and prevent medication errors, promote patient safety, avoid problems arising from the care and maximize intensive care, and underline the importance of pharmaceutical care in clinical practice. Using FAST HUG ensures effective care and patient safety. Although there are still difficulties for specific training of intensive care clinical pharmacist, can be seen several clinical pharmacist action opportunities in the ICU.

scholarly journals Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study

2015 ◽  
Vol 210 (4) ◽  
pp. 629-635 ◽  
Author(s):  
Lisa M. McElroy ◽  
Kathryn R. Macapagal ◽  
Kelly M. Collins ◽  
Michael M. Abecassis ◽  
Jane L. Holl ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Qualitative Study ◽  
Operating Room

scholarly journals Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

2020 ◽  
Author(s):  
Lina Mosch* ◽  
Akira-Sebastian Poncette* ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Monitoring ◽  
Digital Health ◽  
Implementation Process ◽  
Health Technology ◽  
High Tech ◽  
Remote Patient Monitoring ◽  
Implementation Framework ◽  
Remote Patient

Abstract BackgroundIntensive care is lagging with digital transformation. It is essential to provide evidence and guidelines for integrating digital health technologies into the intensive care unit (ICU).We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU.MethodsWe conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects.Conclusions The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks.Trial registrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

scholarly journals Patient Monitoring Alarms of an Intensive Care Unit: Observational Study with DIY Instructions (Preprint)

2020 ◽  
Author(s):  
Akira-Sebastian Poncette ◽  
Maximilian Markus Wunderlich ◽  
Claudia Spies ◽  
Patrick Heeren ◽  
Gerald Vorderwülbecke ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Observational Study ◽  
Response Time ◽  
Monitoring System ◽  
Patient Monitoring ◽  
Monitoring Data ◽  
Patient Monitoring System

BACKGROUND As one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients’ vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast amount of alarms regularly overwhelms staff, and induces alarm fatigue that endangers patients. OBJECTIVE This study focused on providing a complete and repeatable analysis of the alarm data of an ICU’s patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyse their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies. METHODS This observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded on a framework consisting of five dimensions, each with specific metrics: alarm load, ie, alarms per bed per day, alarm flood conditions, alarm per device and per criticality; avoidable alarms, ie, the amount of technical alarms; responsiveness and alarm handling, ie response time; sensing, ie, usage of the alarm pause function; and exposure, ie, alarms per room type. Results were visualized using the R package ggplot2 to provide detailed temporal insights into the ICU’s alarm situation. RESULTS We developed step by step DIY instructions for self-analysis of patient monitoring data, including the scripts for data preparation and analysis. The alarm load in the respective ICU was quantified by 152.5 alarms per bed per day on average (SD 42.2), and alarm flood conditions with on average 69.55 per day (SD 31.12) that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). In regard to avoidable alarms, technical alarms by the ECG were the most frequent (eg, lead fallen off). The median response time to alarms yielded 8s (range 0-600). The alarm pause function was applied 10.86 times per bed per day (SD 2.6), and in 91% (19,334/21,194) was not actively terminated, resulting in a proper pause to pause ratio of 0.09:1. The exposure to alarms per bed per day was higher in single rooms (26%, mean 172.9/137.2 alarms per day per bed). 69% of all alarms (2,199.9/3,202.4, SD 651.2) were on average issued by 7.6 of 21 beds per day (36%). CONCLUSIONS Analyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff’s work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data. CLINICALTRIAL NCT04661735

scholarly journals Developing Patient Safety Standards for Quality Improvement in the NICUs: A Mixed-Methods Protocol

2021 ◽  
Author(s):  
Zahra Shahkolahi ◽  
Alireza Irajpour ◽  
Soheila Jafari-Mianaei ◽  
Mohammad Heidarzadeh
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Mixed Methods ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Safety Standards ◽  
The World

Abstract Background Neonatal intensive care unit is one of the accident-prone environments in the health care system. A range of structural and process factors threaten hospitalized infant safety in this unit. These factors are prevented by identifying safety needs and taking the right actions. In this regard, some countries in the world have developed standards. Developing standards based on current knowledge, available resources, and context that provide care, determine patient injury prevention requirements. Likewise, it can be a source for national development and application of guidelines, protocol, and laws. This study aims to develop patient safety standards in the Neonatal intensive care units of the Islamic Republic of Iran. Methods This mixed methods study will apply the Exploration, Preparation, Implementation, Sustainment framework to develop patient safety standards. The first three phases are the focus of this study. Due to investigating the long-term effects, it doesn't consider Phase 4(Sustainment). In each of these phases, a set of activities takes place. Designing Phase 1 (Exploration) is based on the World health organization model to develop standards. Determining the validity and applicability of developing standards will be done in Phase2 (preparation) and Phase 3 (implementation), respectively. Discussion Patient safety standards from this study are developed based on valid evidence and a comprehensive theoretical view. Additionally, considering parents' roles and the interdisciplinary experts' views in the neonatal intensive care unit. In this regard, determining the minimum requirements to maintain patient safety and developing evidence-based practice will be improved efficiency and effectiveness and contributed to equitable and higher quality health care delivery. The application of developing standards will be improving patient safety and quality of health care in the neonatal intensive care units of Iran.

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