Transcript Critical Care Safety

Critical Care Safety
Linda Staubli, RN, BSN, CCRN
Clinical Nurse Educator
Burn Trauma Intensive Care Unit
Background
• The 2005 Critical Care Safety Study found that:
– adverse events in ICUs occur at a rate of 81 per 1,000
patient-days
– serious errors occur at a rate of 150 per 1,000 patientdays
• Nearly half of the adverse events in the Critical
Care Safety Study were deemed preventable
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Background (cont.)
• Common ICU errors include:
– Treatment and procedure errors (especially errors in
ordering or carrying out medication orders)
– Errors in reporting or communicating clinical
information
–Failures to take precautions or follow
protocols
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Example:
Failure to Take Precautions
• A patient on the unit, who had not
previously required oxygen suddenly
went into respiratory distress. The
flow meter had been removed from
the patients room and moved to
another room. The patient continued
to decline while staff found another
flow meter. The team called a
CODE for the Anesthesia team to
manage the airway.
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Example:
Failure to Take Precautions
• An agitated patient on tube feeds and 2L nasal
cannula partially pulled his novartis. His oxygen
saturation dropped rapidly. The RN and Charge
RN went in to assess the patient who was
coughing. No suction was hooked-up to quickly
suction the patient and minimize aspiration. The
patient’s oxygen requirements increased from
2L NC to non-rebreather and the AM x-ray
showed aspiration
Example:
Failure to Follow Protocols
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• A heparin drip order was inadvertently
discontinued during day shift for a patient with
chronic a-fib, DVTs, and PEs. The drip ran dry
during the following shift and there was no
order for a new drip. The MD was called for a
new order. Several hours passed before the
physician entered a new order and the bag was
hung. During this time, the patient’s PTT
dropped from a therapeutic range to 29. The
patient coded later in the night.
• 2 primary opportunities to check and recheck all
safety precautions are in place and protocols are
followed:
1. Admission/ Room set-up
2. Room-rounds at change of shift
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Critical Care Safety:
Room Set-up
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Critical Care Safety:
Room Set-up
• Airway
– Suction set up and functioning WITH available yankeur
• Breathing
– Flow-meter in room with Christmas tree
– Ambu Bag with mask and peep valve
• Are all *3* parts in the bag? Bag, mask and peep valve?
– do you know how to use a peep valve?
– Is Ambu Bag sealed?
• Circulation
– Monitor and leads in room?
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Critical Care Safety:
Room Set-up
• Disability
– Does your patient require spine precautions? Is the
appropriate mattress in your room?
– Do you know how to appropriately care for these
precautions?
• Environment
– Do you know how to operate the CPR function on
the Bed/Surface
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Critical Care Safety:
Room Rounds
• Airway
– *Suction set up and functioning WITH available
yankeur
– ETT secure
– Spare trach in room? Where?
• Breathing
– *Flow-meter in room with Christmas tree
– *Ambu Bag with mask and peep valve
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Critical Care Safety:
Room Rounds
• Circulation
– Infusing IV drips checked and verified against
medication order in MAR
• You MUST have the MAR pulled up in the room to check
concentration, weight and dosing against bag and pump
• dual sign-off for all high alert medications
– Do you have a functioning IV/ emergency line?
Where?
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Critical Care Safety:
Room Rounds
• Disability
– *Is your patient in appropriate spine precautions?
• (c-collar, blue bed mattress)
– Do you know how to appropriately care for these
precautions?
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Critical Care Safety:
Room Rounds
• Environment
– Presence of patient ID band and verify correct
patient/ID
– Review critical aspects of patient assessment
(i.e. Neuro checks, vascular checks, CRRT etc.)
– *Ensure you know how to operate the CPR function
on the Bed/Surface
– Ensure your bed alarm is on
– Check your Alarm Settings-- are they appropriate?
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---At this point, you can walk out of
your room knowing that when you come
back in you are prepared to deal with
whatever emergency may be waiting----
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Critical Care Safety:
Following Protocols
• Sterile Water for patients with NG/ OG
• Incentive Spirometer
• RNs must attend physician/multidisciplinary rounds on
their assigned patients. If unable to attend due to patient
care needs, RN will obtain updates with the primary
medical team caring for the patient
• Change suction canisters, tubing, and yankeur Q24h at
0600, date and time
*Bold= direct quote from ICU Standards of Care
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Critical Care Safety Audit
Date: ________________________________________________________________________________
Off-going RN: _________________________________________________________________________
On-coming RN: ________________________________________________________________________
Yes
Airway and Breathing
Flow-meter is in room with Christmas tree
Ambu Bag with mask and peep valve
Suction is set up and functioning WITH available yankeur
ETT secure
Spare trach is in room? Where
Circulation
Infusing IV drips were checked and verified against
medication order in MAR
Off-going RN knows where emergency IV line is
Disability
Appropriate spine precautions followed
Environment
Pt had correct ID band on pt or foley (not on computer)
Alarms are appropriate
Bed Alarm is on
Other
Daily weight recorded
Incentive Spirometer in room
Sterile water for NG/ OG
Suction canister changed AND LABELED around 0600
RN attended rounds
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No
NA
Where?
References
• ICU Standards of Care
• 2005 Critical Care Safety Study
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