This document discusses unplanned extubations in the intensive care unit (ICU). It provides data on ICU admissions and mortality in the United States. It then focuses on safety issues in ICUs, including classifications of incidents like unplanned extubations. Risk factors for unplanned extubation are examined, like agitation, delirium, and the night shift. Outcomes of unplanned extubation are poorer and include higher rates of reintubation. The document then discusses efforts at one hospital to reduce unplanned extubations through staff education, monitoring high-risk patients, and implementing a care bundle to manage pain, agitation, and delirium.
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)Saeid Safari
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY (American Society of Anesthesiologists)
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY
Non–Operating Room Anesthesia (NORA)
The document discusses improving safety standards for office-based surgery and anesthesia. It notes a lack of uniform regulation has led to increasing complexity of cases performed in office settings. It introduces the Institute for Safety in Office Based Surgery, a non-profit established in 2009 to promote patient safety, develop tools for risk detection, and encourage physician education and evidence-based standards of care. It also references the high-profile case of Joan Rivers' death from complications during an outpatient procedure.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
This document provides an overview of the history and definitions of ambulatory surgery. Key points include:
- Ambulatory surgery is defined as surgery where the patient is discharged on the same working day, in contrast to inpatient surgery where patients stay overnight.
- Ambulatory surgery became common in the 1970s-1980s in developed countries, where now 50-70% of surgeries are done on an ambulatory basis.
- Ambulatory surgery provides benefits in terms of safety, quality, economics, and staff satisfaction compared to traditional inpatient surgery models. When proper standards of care are followed, ambulatory surgery has been shown to be as safe as inpatient surgery.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
This document provides information on preoperative assessments for anesthesia. It discusses performing a clinical assessment of patients including medical history, physical exam, and necessary investigations. Patients are categorized based on medical complexity, with low-risk patients able to schedule surgery and higher-risk patients requiring further testing or specialist consultation. The goals of preoperative assessment are to optimize patient health and identify risks so surgeries are not cancelled due to medical issues. Post-anesthesia care and potential complications are also outlined.
The document provides guidelines for ambulatory anesthesia and surgery. It recommends that anesthesiologists play a leadership role in all ambulatory surgical facilities. The guidelines apply to all settings involving anesthesiology and are meant to encourage high quality patient care. Facilities must be properly equipped and staffed to handle emergencies. Patient care should include a pre-anesthesia evaluation, anesthesia plan, administration or supervision of anesthesia by qualified professionals, and discharge only when medically appropriate.
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)Saeid Safari
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY (American Society of Anesthesiologists)
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY
Non–Operating Room Anesthesia (NORA)
The document discusses improving safety standards for office-based surgery and anesthesia. It notes a lack of uniform regulation has led to increasing complexity of cases performed in office settings. It introduces the Institute for Safety in Office Based Surgery, a non-profit established in 2009 to promote patient safety, develop tools for risk detection, and encourage physician education and evidence-based standards of care. It also references the high-profile case of Joan Rivers' death from complications during an outpatient procedure.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
This document provides an overview of the history and definitions of ambulatory surgery. Key points include:
- Ambulatory surgery is defined as surgery where the patient is discharged on the same working day, in contrast to inpatient surgery where patients stay overnight.
- Ambulatory surgery became common in the 1970s-1980s in developed countries, where now 50-70% of surgeries are done on an ambulatory basis.
- Ambulatory surgery provides benefits in terms of safety, quality, economics, and staff satisfaction compared to traditional inpatient surgery models. When proper standards of care are followed, ambulatory surgery has been shown to be as safe as inpatient surgery.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
This document provides information on preoperative assessments for anesthesia. It discusses performing a clinical assessment of patients including medical history, physical exam, and necessary investigations. Patients are categorized based on medical complexity, with low-risk patients able to schedule surgery and higher-risk patients requiring further testing or specialist consultation. The goals of preoperative assessment are to optimize patient health and identify risks so surgeries are not cancelled due to medical issues. Post-anesthesia care and potential complications are also outlined.
The document provides guidelines for ambulatory anesthesia and surgery. It recommends that anesthesiologists play a leadership role in all ambulatory surgical facilities. The guidelines apply to all settings involving anesthesiology and are meant to encourage high quality patient care. Facilities must be properly equipped and staffed to handle emergencies. Patient care should include a pre-anesthesia evaluation, anesthesia plan, administration or supervision of anesthesia by qualified professionals, and discharge only when medically appropriate.
Organization and guidelines for angloitalian meeting roma 010 on non operati...Claudio Melloni
This document provides guidelines and requirements for non-operating room anesthesia (NORA) and office-based anesthesia. It discusses considerations for patient characteristics, pre-anesthetic preparation, appropriate locations and equipment, monitoring during procedures, and specific requirements for accreditation of ambulatory surgery centers. Key points include the need for adherence to basic standards of care, special precautions for higher-risk patients, adequate facilities and equipment, interdepartmental cooperation, and understanding of procedural requirements.
This document discusses patient selection criteria and preoperative assessment and preparation for ambulatory anesthesia. It covers suitable procedures, duration limits, patient characteristics, contraindications, preoperative evaluation, and both nonpharmacologic and pharmacologic preparation. For patient selection, it recommends considering factors like procedure type, duration, medical history, age and contraindications. It also discusses anxiolysis, sedation, preemptive analgesia and preventing nausea for premedication. The goal is to safely perform procedures as outpatients and facilitate early recovery.
This document discusses ambulatory anesthesia and day-care surgery. It provides a brief history of ambulatory anesthesia, noting key developments from 1903 to present day. It describes the objectives and techniques of anesthesia for day-care surgery, including premedication, induction agents, maintenance techniques, regional versus general anesthesia, advantages and disadvantages, selection criteria for patients, and discharge criteria. The success of day-care surgery depends on appropriate patient selection, facility availability, and type of surgical procedure.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
This study assessed early postoperative complications in 431 adult patients undergoing neurosurgery over four months. The most common complication was nausea and vomiting, which occurred in 38% of patients. Respiratory problems occurred in 2.8% of patients and cardiovascular complications in 6.7%. The highest rates of complications were for spinal (65%) and vascular (66%) surgeries compared to tumor (47%) and other (43%) surgeries. Younger patients undergoing elective spinal surgery had the highest risk of nausea and vomiting. The study found a high overall incidence of early postoperative complications for neurosurgery patients.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures that require anesthesia outside OR settings like radiology suites and ICUs. It also describes the challenges anesthesiologists face in these settings like unfamiliar environments, limited equipment and monitoring, and patient issues. Guidelines are provided for sedation versus general anesthesia based on the procedure and safety standards for monitoring, equipment, and discharge criteria when anesthesia is provided outside the traditional operating room.
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
This document discusses office-based anesthesia. It notes that over 25% of surgeries are now performed in offices rather than hospitals. Office-based anesthesia, also called non-operating room anesthesia or ambulatory anesthesia, involves anesthesia performed in an outpatient setting like a doctor's office rather than an accredited surgery center or hospital. While standards of care are the same, office settings present unique challenges regarding safety, oversight, documentation, and experience level. The document outlines considerations for patient selection, appropriate procedures, personnel requirements, equipment needs, and pre-operative fasting guidelines for office-based anesthesia.
This study summarizes the treatment of 187 patients with penetrating thoracic injuries admitted to a hospital in Taiz, Yemen during 2015-2016. It finds that most patients were male (90.9%), between 18-60 years old (83.4%), and injured by gunshot wounds (70.1%). The majority of injuries were isolated penetrating thoracic injuries (74.9%) rather than combined with abdominal injuries (25.1%). The most common treatment was tube thoracostomy (84.5%), while a minority (15%) required thoracotomy. Treatment options correlated with injury type and mechanism, with more thoracotomies performed for gunshot wounds compared to blast injuries. The study aims to describe management
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
The document discusses preoperative evaluation and management. It aims to identify any medical comorbidities that could affect surgical outcomes rather than broadly screening for disease. A thorough history and physical exam are important to understand preexisting conditions and risks. Investigations should be ordered selectively based on medical history. Preoperative preparation includes securing IV access, emptying bowels if needed, and providing thromboprophylaxis or antibiotics if required. Special considerations depend on the surgery and any cardiovascular, respiratory, or other system involvement.
Here are the common colors of IV cannulas and their meanings:
- Blue cannulas are used for fluids like saline or lactated ringers.
- Pink cannulas are used for medications.
- Green cannulas are used for lipids or total parenteral nutrition (TPN).
- Yellow or orange cannulas are used for blood products like packed red blood cells or platelets.
It's important for nurses to know the standard color coding so the right solutions or medications are administered through the correct IV line. Let me know if you have any other questions! Proper IV administration is important for patient safety.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
This document provides information about perioperative nursing care. It discusses types of surgeries, preoperative teaching and preparation, principles of sterile technique in the operating room, and anesthesia. Key points include identifying diagnostic, curative, palliative and cosmetic surgeries; emphasizing respiratory, cardiovascular and renal assessment preoperatively; explaining preoperative teaching goals and content; and outlining principles of sterile technique and regional anesthesia administration.
This document provides an overview of day care or ambulatory surgery. It discusses the history and development of day care surgery. Key points include that day care surgery aims to have patients discharged on the same day of surgery. Patient selection involves assessing medical, social and surgical factors to identify appropriate candidates. The document also outlines common procedures performed in day care settings and considerations for anesthesia, analgesia, and post-operative recovery and discharge criteria. The overall goal of day care surgery is to provide surgical care without an overnight hospital stay when possible.
1) Early mobilization of critically ill patients in the ICU can reduce ICU-acquired weakness, improve functional recovery during hospitalization, and reduce hospital length of stay. However, many ICUs are still conservative in mobilizing mechanically ventilated patients.
2) A study found that combining daily interruption of sedation with physical and occupational therapy led to more patients returning to independent function at discharge and fewer ICU delirium days compared to interruption of sedation alone.
3) While early mobilization studies have shown it to be safe, some physicians still report patient safety as a barrier; interdisciplinary communication and leadership may help reduce avoidable barriers to early mobilization.
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
Organization and guidelines for angloitalian meeting roma 010 on non operati...Claudio Melloni
This document provides guidelines and requirements for non-operating room anesthesia (NORA) and office-based anesthesia. It discusses considerations for patient characteristics, pre-anesthetic preparation, appropriate locations and equipment, monitoring during procedures, and specific requirements for accreditation of ambulatory surgery centers. Key points include the need for adherence to basic standards of care, special precautions for higher-risk patients, adequate facilities and equipment, interdepartmental cooperation, and understanding of procedural requirements.
This document discusses patient selection criteria and preoperative assessment and preparation for ambulatory anesthesia. It covers suitable procedures, duration limits, patient characteristics, contraindications, preoperative evaluation, and both nonpharmacologic and pharmacologic preparation. For patient selection, it recommends considering factors like procedure type, duration, medical history, age and contraindications. It also discusses anxiolysis, sedation, preemptive analgesia and preventing nausea for premedication. The goal is to safely perform procedures as outpatients and facilitate early recovery.
This document discusses ambulatory anesthesia and day-care surgery. It provides a brief history of ambulatory anesthesia, noting key developments from 1903 to present day. It describes the objectives and techniques of anesthesia for day-care surgery, including premedication, induction agents, maintenance techniques, regional versus general anesthesia, advantages and disadvantages, selection criteria for patients, and discharge criteria. The success of day-care surgery depends on appropriate patient selection, facility availability, and type of surgical procedure.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
This study assessed early postoperative complications in 431 adult patients undergoing neurosurgery over four months. The most common complication was nausea and vomiting, which occurred in 38% of patients. Respiratory problems occurred in 2.8% of patients and cardiovascular complications in 6.7%. The highest rates of complications were for spinal (65%) and vascular (66%) surgeries compared to tumor (47%) and other (43%) surgeries. Younger patients undergoing elective spinal surgery had the highest risk of nausea and vomiting. The study found a high overall incidence of early postoperative complications for neurosurgery patients.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures that require anesthesia outside OR settings like radiology suites and ICUs. It also describes the challenges anesthesiologists face in these settings like unfamiliar environments, limited equipment and monitoring, and patient issues. Guidelines are provided for sedation versus general anesthesia based on the procedure and safety standards for monitoring, equipment, and discharge criteria when anesthesia is provided outside the traditional operating room.
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
This document discusses office-based anesthesia. It notes that over 25% of surgeries are now performed in offices rather than hospitals. Office-based anesthesia, also called non-operating room anesthesia or ambulatory anesthesia, involves anesthesia performed in an outpatient setting like a doctor's office rather than an accredited surgery center or hospital. While standards of care are the same, office settings present unique challenges regarding safety, oversight, documentation, and experience level. The document outlines considerations for patient selection, appropriate procedures, personnel requirements, equipment needs, and pre-operative fasting guidelines for office-based anesthesia.
This study summarizes the treatment of 187 patients with penetrating thoracic injuries admitted to a hospital in Taiz, Yemen during 2015-2016. It finds that most patients were male (90.9%), between 18-60 years old (83.4%), and injured by gunshot wounds (70.1%). The majority of injuries were isolated penetrating thoracic injuries (74.9%) rather than combined with abdominal injuries (25.1%). The most common treatment was tube thoracostomy (84.5%), while a minority (15%) required thoracotomy. Treatment options correlated with injury type and mechanism, with more thoracotomies performed for gunshot wounds compared to blast injuries. The study aims to describe management
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
The document discusses preoperative evaluation and management. It aims to identify any medical comorbidities that could affect surgical outcomes rather than broadly screening for disease. A thorough history and physical exam are important to understand preexisting conditions and risks. Investigations should be ordered selectively based on medical history. Preoperative preparation includes securing IV access, emptying bowels if needed, and providing thromboprophylaxis or antibiotics if required. Special considerations depend on the surgery and any cardiovascular, respiratory, or other system involvement.
Here are the common colors of IV cannulas and their meanings:
- Blue cannulas are used for fluids like saline or lactated ringers.
- Pink cannulas are used for medications.
- Green cannulas are used for lipids or total parenteral nutrition (TPN).
- Yellow or orange cannulas are used for blood products like packed red blood cells or platelets.
It's important for nurses to know the standard color coding so the right solutions or medications are administered through the correct IV line. Let me know if you have any other questions! Proper IV administration is important for patient safety.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
This document provides information about perioperative nursing care. It discusses types of surgeries, preoperative teaching and preparation, principles of sterile technique in the operating room, and anesthesia. Key points include identifying diagnostic, curative, palliative and cosmetic surgeries; emphasizing respiratory, cardiovascular and renal assessment preoperatively; explaining preoperative teaching goals and content; and outlining principles of sterile technique and regional anesthesia administration.
This document provides an overview of day care or ambulatory surgery. It discusses the history and development of day care surgery. Key points include that day care surgery aims to have patients discharged on the same day of surgery. Patient selection involves assessing medical, social and surgical factors to identify appropriate candidates. The document also outlines common procedures performed in day care settings and considerations for anesthesia, analgesia, and post-operative recovery and discharge criteria. The overall goal of day care surgery is to provide surgical care without an overnight hospital stay when possible.
1) Early mobilization of critically ill patients in the ICU can reduce ICU-acquired weakness, improve functional recovery during hospitalization, and reduce hospital length of stay. However, many ICUs are still conservative in mobilizing mechanically ventilated patients.
2) A study found that combining daily interruption of sedation with physical and occupational therapy led to more patients returning to independent function at discharge and fewer ICU delirium days compared to interruption of sedation alone.
3) While early mobilization studies have shown it to be safe, some physicians still report patient safety as a barrier; interdisciplinary communication and leadership may help reduce avoidable barriers to early mobilization.
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
The document outlines several parameters for assessing quality of care in the intensive care unit (ICU). It discusses objective criteria for ICU admission including vital signs, laboratory values, imaging results, ECG findings, and physical exam findings. It also describes the roles and responsibilities of nurses in the ICU in monitoring patients, administering treatments, and advocating for patients. Key indicators of quality that are mentioned include mortality rates, complication rates, length of stay, adherence to best practices, rates of errors and infections, staff satisfaction, and patient satisfaction.
Fisiol e anat ponv.PONV anatomy and physiology,risk of Claudio Melloni
This document discusses risk factors for postoperative nausea and vomiting (PONV) from several studies. It identifies non-anesthetic factors like female gender, history of motion sickness or PONV, and anesthetic factors like use of volatile anesthetics, nitrous oxide, and opioids as increasing PONV risk. Surgical factors like longer duration and types of surgery also impact risk. A key study developed a PONV prediction model using logistic regression to calculate individual patient risks based on their characteristics and procedure. Understanding risk factors can help optimize PONV prevention and management.
The document discusses the value of information in healthcare and analyzing temporal patterns in patient care and health services. It provides examples of studies that analyzed patterns in test follow-up rates and mortality rates for weekend hospital admissions. While the studies found issues like high rates of unreviewed tests and higher mortality for weekend admissions, further analysis of temporal patterns provided insights into potential causative factors and opportunities for intervention. The value of information is realized when it leads to changes in decisions and care processes that improve outcomes.
QUALITY AND SAFETY IMPROVEMENT EFFORTS OUTSIDE OPERATING ROOMPallavi Ahluwalia
This document discusses quality and safety improvement efforts for anesthesia provided outside the operating room (NORA). It outlines common NORA locations like radiology, endoscopy, intensive care, and lists challenges faced including unfamiliar surroundings, patient positioning issues, and lack of monitoring and recovery resources. Guidelines are presented for ensuring adequate space, equipment, monitoring and personnel to safely conduct NORA. Complications associated with NORA are reviewed along with tools like checklists and protocols to improve reliability and safety. Specific considerations for different NORA locations like radiology, MRI, and interventions are highlighted. The importance of adherence to standards, continuous quality improvement, and interdisciplinary communication are emphasized for enhancing NORA safety.
An audit is a thorough examination of healthcare processes and outcomes aimed at quality improvement. It involves comparing objectives and realities to identify opportunities to enhance care. Auditing an ICU involves examining structures, processes, and outcomes using quality indicators and comparing performance internally over time and externally to other ICUs. Key reasons to audit an ICU include improving patient safety and outcomes, enhancing team performance, and ensuring efficient resource use. Audit findings should be used to standardize care, learn from mistakes, and apply strategies to both clinical work and teamwork.
An audit examines processes and outcomes in intensive care to identify opportunities for quality improvement. It involves comparing objectives and reality by assessing structure, process, and outcomes. Auditing an ICU's performance is important for patient safety, professional development of staff, and efficient use of resources. Key indicators that should be audited include adherence to evidence-based practices for conditions like sepsis, ventilation protocols to prevent pneumonia, and checklists for procedures like central line insertion. Collecting data on adverse events through confidential reporting allows teams to learn from mistakes and standardize care processes. Implementing care "bundles" that group several evidence-based practices for a given condition can help improve outcomes more than single interventions alone. Regular auditing is essential for ongoing assessment and
How to reduce time between patient arrival and punctureDr Vipul Gupta
1) The document discusses strategies to reduce time between patient arrival and puncture for endovascular stroke treatment. It emphasizes the importance of a multidisciplinary stroke team and efficient protocols.
2) Times were significantly reduced through parallel processing that allowed for concurrent clinical assessment, imaging, and lab preparation while alerting the neurointervention team.
3) A case example showed door-to-recanalization times under 90 minutes were possible through strict adherence to the parallel processing protocol.
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
1) A 31-year-old man presented with a stab wound to the chest and became unresponsive. Emergency thoracotomy is indicated to treat pericardial tamponade, control hemorrhage, perform open cardiac massage, and temporarily occlude the thoracic aorta.
2) A 29-year-old pregnant woman at 34 weeks gestation collapsed in PEA. Perimortem cesarean section should be considered to deliver the fetus within 5 minutes of maternal cardiac arrest.
3) A 37-year-old man with a GCS of 6 following an MVC had proptosis and firmness of the left eye. He was diagnosed with orbital compartment syndrome and treated with lateral
This document summarizes the practice of anesthesia. It discusses preoperative, intraoperative, and postoperative management. Preoperative management includes taking a patient history, performing an examination, ordering relevant investigations, and administering premedication drugs. Intraoperative management involves monitoring the patient, choosing a position and type of anesthesia, inducing and maintaining anesthesia, administering fluids, and extubating the patient. Postoperative management consists of transferring the patient to the ward or ICU, providing pain management, and treating any complications.
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Salon 1 15 kasim 09.30 10.30 eunok kwon
1. Unplanned extubation of patients in ICU
Eunok Kwon, RN, PhD
Nursing Director of Operating room,
Seoul national University Hospital, South Korea
10th International Congress of World Federation of Critical Care Nurses,
Antalya, Turkey , November 12~ 15th 2014.
2. Safety Issues in ICU
• More than 5 million patients are admitted to intensive
care units each year in the United States.
• Mortality rates in patients admitted to the ICU average
10% to 20% in most hospitals.
• Overall, approximately 200,000 patients die in U.S.ICU
each year.
3. Safety issues in ICU
Classification of incidents used in the Australian AIMS
• Airway and ventilation: e.g. unplanned extubation and
disconnections.
• Drugs and medications: e.g. allergic reactions and drug
errors.
• Procedures, equipment and catheters: e.g. inadvertent
carotid artery cannulation.
• Patient environment: e.g. a lack of appropriate beds
causing pressure sores.
• ICU management: e.g. incidents caused by an over reliance
on agency staff.
4. Patient’s outcome indicators in ICU
( European Society of Intensive Care Medicine)
Domain Description Consensus (%)
Structure Intensive Care Unit (ICU) fulfills national requirements to
provide Intensive Care.
100
24-h availability of a consultant level Intensivist 94
Adverse event reporting system 100
Process Presence of routine multi-disciplinary clinical ward rounds 100
Standardized Handover procedure for discharging patients 100
The maintenance of continuing medical education according to
77
national standards
The maintenance of bed occupancy rates below a threshold level. 82
Outcome Reporting and analysis of standardized mortality ratio (SMR) 100
ICU re-admission rate within 48 h of ICU discharge 94
The rate of central venous catheter-related blood stream
infection
100
The rate of unplanned endotracheal extubations 100
The endotracheal re-intubation rate within 48 h of a planned
77
extubation
The rate of ventilator-associated pneumonia 77
11. Unplanned endotracheal extubations in ICU
Unplanned extubation rate; 0.1~3.6/100 intubation days.
Risk factors;
male gender, APACHE score≥ 17(OR9.0), COPD,
restlessness/agitation(OR3.3-30.6),
lower sedation level(OR2.0-5.4),
Higher consciousness level(OR 1.4-2.0),
Use of physical restrains (OR3.1).
Reintubation rates 1.8-88% of unplanned extubation.
Preventive measures; Standardization of procedures,
staff education, staff surveillance & identification &
management of high risk patients -
decreasing rate; 22~53%
Best methods; securing E tube & use of Physical
restraints ??
12. Nurse staffing factors related patient
outcomes in ICU
• 28 research RN-to patient ratio vs patient outcome odds
ratio
• RN staffing ratio vs ICU mortality OR 0.91(95%Cl)0.86-
0.96 surgical 0.84 medical 0.94
• Increase by 1RN per patient day decreased VAP OR
0.7(95%Cl 0.56-0.88) unplanned extubation
(OR,0.49;95%Cl),respiratory failure(0.40;95%Cl), cardiac
arrest in ICU(OR 0.72;95%Cl),lower risk of failure to
rescue in surgical patients(OR0.84;95%Cl), Length of stay
was shorter by 24% in ICUs(OR 0.76;95Cl)& 31% in surgical
patients(OR,0.69;95%Cl)
• The association of registered nurse staffing levels and patient oucomes;Med care.2007
Dec;45(12)1195-204 Kane RL et al
13. Safety model related to unplanned extubation in ICU ;
SEIPS model(Carayon et al.2006)
14. Introduction- Critical care unit in
SNUH
MICU
22 bed
SICU1
18bed
CPICU
8 bed
SICU2
14bed
CCU
8 bed
EICU
12 bed
Adult ICU;
70 bed
NICU
40bed
PICU
20bed
1821 total hospital
beds,
154 ICU Beds
Emergency center
Children’s
Hospital
16. Case; SNUH adult ICU
• A case-control study over 3 years period from
January 1,2010 through December 31,2012.
• A 62-beds medical & surgical intensive care unit
of 1800 beds tertiary hospital
17. Unplanned VS planned extubation Patients
• Data were retrospectively
collected from electronic
medical records.
• A total 230 episodes of
deliberate unplanned
extubation in 242 patients
from 41,207 mechanically
ventilated patients for 3
years(frequency 0.53%).
• 460 episodes in 460
patients with planned
extubation age, gender &
diagnosis-matched controls
were analyzed in this
case-control study.
18. Predictors related to unplanned extubation
in SNUH cases
Predictors associated with unplanned extubation
include
•Better motor response (OR 1.3),
•Admission route via ER(OR 1.8),
•Higher APACHE Ⅱscore(1.061),
•Mode of mechanical ventilation (CPAP, PSV: OR4.1,
SIMV:3.0),
•Peripheral O2 saturation(OR:0.9), heart rate(OR:
1.0), respiration rate(OR:1.0)
19. Predictors related to unplanned
extubation in SNUH cases
• Pain (OR:0.3),
• Agitation(OR:9.0),
• Delirium(OR:11.6),
• Night shift(OR:6.0)
&morning care
time(OR:0.5).
20. Predictors related to unplanned extubation
in SNUH cases
The patients’ & organizational outcomes of
unplanned extubation were
•Reintubation(OR;85.66)
•Poor discharge result(OR:0.2)
•Longer length of stay in the ICU (adj R-square:
7%)and a longer length of stay in the
hospital(adj R-square:4.3%).
21. High predictive factors of unplanned
extubation in SNUH cases
• Delirium, agitation, ventilation mode and night shift are
high predictive factors of unplanned extubation.
• The outcomes of unplanned extubation were
increasing reintubation, a poor patient outcome
at the time of discharge and poor
organizational outcome including longer length
of stay in the ICU and hospital.
29. 2013 PAD care bundle of ICU in SNUH
iPAD(ICU Pain, Agitation, Delirium) Care Bundle
PAIN AGITATION DELIRIUM
ASSESS
Assess pain ≥ 2/shift
Patient able to self-report
→ NRS (0-10)
Unable to self-report
→ CNPS (0-9)
Assess agitation,
sedation ≥ 2/shift
RASS (-5 to +4)
Assess delirium Q shift
CAM-ICU (+ or -)
Delirium present if CAM-ICU
is positive
TREAT
Treat pain with
analgesia therapy
Targeted sedation: RASS
-2 to 0(light sedation)
Treat with sedatives for
light sedation
Treat patients with
nursing intervention:
•Reorient patients
•Use patient`s
eyeglasses, hearing aids
•Familiarize
surroundings
30. Indication: The patient can’t report by self due to consciousness change, sedation, artificial airway,
mechanical ventilation
Assess: 2 fr ≥ duty, ASSESS
intervention: 3 score ≥ CNPS, give pain killer.
reevaluation:
Critical Care Nonverbal Pain Scale
Pain scale in
SNUH ICU
item tip score
day
time
1
Facial
expressio
n
Natural expression 0
tears 1
Painful expression 2
Biting endotracheal tube 3
2
Physical
response
No movement, relax 0
Slow motion 1
Nodding, try to touch painful site 2
Severe movement 3
3
Synchron
y with
ventilator
(intubate
d
patients)
No alarm sound,no cough 0
Intermittent alarm, cough, 1
Frequent alarm, hyperventilation 2
Asynchrony with ventilator, consistent cough 3
Voice
sound
(extubate
d
patients)
normal 0
moaning 1
Express about pain 2
Loud voice, Cry, aggressive 3
sum
Pain scale in
SNUH ICU
31. Education based on simulation
about unplanned extubation
Simulation training related to
unplanned extubation
32. I see you in ICU
Safety based nursing
A nurse will always give us hope, an angel with a
stethoscope.
~Terri Guillemets
33. References
• A. Rhodes, R. P. Moreno, E. Azoulay, M. Capuzzo, J. D. Chiche, J. Eddleston. et
al(2012). Prospectively defined indicators to improve the safety and quality of
care for critically ill patients: a report from the Task Force on Safety and
Quality of the European Society of Intensive Care Medicine (ESICM), Intensive Care
Med 38, 598–605.
• Atkins, P. M., Mion, L. C., Mendelson, W., Palmer, R. M., Slomka, J., & Franko, T.
(1997). Characteristics and outcomes of patients who selfextubate from ventilatory
support: A case- control study. Chest, 112(5),1317–1323.
• Curry, K., Cobb, S., Kutash, M., & Diggs, C(2008). Characteristics associated with
unplanned extubations in a surgical intensive care unit. American Journal of
Critical Care, 17(1), 45–51
• Da Silva, Lucas, Fonseca & Machado(2012). Unplanned extubation in the intensive
Care unit: systematic review, Critical Appraisal, and Evidence-Based
recommendations. Anesthesia & Analgesia, 114(5), 1003-1014.
• Juliana Barr, et al(2013). Clinical Practice Guidelines for the Ma- nagement of
pain, Agitation, and Delirium in Adult Patients in the intensive care unit.
Critical care medicine 41(1), 263-306.
• L-C Chang, P-F Liu, Y-L Huang, S-S Yang,W-Y Chang(2011). Risk factors associated
with unplanned endotracheal self extubation of hospitalized intubated patients: a
3-year re- trospective case-control study. Applied Nursing Research 24, 188–192.
• Mary Jarachovic, Maggie Mason, Kathleen Kerber & Molly McNett (2011). The role of
standardized protocols in unplanned extubations in a medical intensive care unit.
Am J Crit Care. 20, 304-312.