These data show that for ARDS, at least, mortality outcome can be comparable in a community ICU to a tertiary referral institution. The pattern of disease in an urban Australian community hospital is different to that often reported from tertiary centres. The incidence of ARDS in an Australian urban community is comparable to the reported incidence in North America and Western Europe.
This article reviews the need for planning and implementation of an organized emergency response to stroke as a secondary diagnosis. Patients who are admitted to hospitals with a diagnosis other than stroke and experience stroke symptoms warrant immediate identification and rapid intervention. Code Gray is an emergency team response for inpatient stroke. Modeled after the response for Code Blue, this team quickly assesses, obtains further diagnostic studies, and provides appropriate intervention to patients who experience stroke symptoms while being hospitalized for some other diagnosis or problem. This emergency team response provides the ingredients for improved patient outcomes and promotes quality patient care.
Objective: This program was designed to evaluate the effect of morbidity and mortality peer review conferences (MMPRCs) for ventilator-associated pneumonia (VAP) on nurse accountability and compliance with evidence-based VAP prevention practices. Background: Ventilator-associated pneumonia is associated with longer average length of stay (ALOS), greater cost, and increased morbidity and mortality. Traditionally, passive or punitive methods have been used to reduce undesirable outcomes. The MMPRC is not a conventional nursing intervention. Methods: Each MMPRC included case history, relevant hospital course, diagnostic comorbidities, and compliance with VAP prevention strategies. The preventability of each VAP was determined by RN peers. Ventilator days, VAP bundle compliance, VAP incidence, ICU ALOS, cost, and satisfaction data were collected. Results: Nurse accountability improved significantly (# 2 = 24.041, P G .001), and VAP incidence was reduced. Data demonstrated satisfaction with the MMPRC. Number of ventilator days and ALOS did not change significantly, although VAP bundle compliance improved from 90.1% to 95.2%. Conclusions:The nonpunitive MMPRC process was cost-effective and should be considered for other nurse-sensitive indicators to increase nurse accountability and improve outcomes.
The training of a new critical care nurse is not solely the transmission of a determined body of knowledge or skill set. When one begins to consider what actually makes a critical care nurse a critical care nurse, one realizes that the training is much more complex. It involves the teaching of appropriate thought processes, and use of the body of knowledge and/or skill set in application with respect to a specific patient, disease state, or a group of symptoms. Teaching a new critical care nurse to think, talk, act, and respond like a critical care nurse is just as important as sharing knowledge--that is what makes a critical care nurse. This article summarizes one hospital's critical care training program and orientation for new critical care nurses with and without critical care experience. This is done in pursuit of excellence in patient care, by providing a comprehensive and complete, full-service training program. All nurses deserve the very best education and training-our patients demand it.
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