The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort

Purpose

There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown.

Methods

We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors.

Results

Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p = 0.04) and lung (p = 0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60 % of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3 %) cardiac arrest patients not requiring high doses of vasoactive drugs within 24 h.

Conclusion

The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.     

Consequences of medical errors in intensive and semi-intensive care units

This report was aimed at characterizing medication errors and evaluating their consequences for the patients' conditions and for the nursing workload in the Intensive Care Units (ICU) and Semi-Intensive Care Units (SICU) of two hospitals in the city of S?o Paulo. The sample was 50 patients, and data was gathered in record logs. The severity of the conditions and the nursing workload were assessed before and after the occurrence. Out of a total of 52 medication errors, 12 (23.80%), were non-administration of dosage, 11 (21.15%) were wrong medication, and 9 (17.31%) excessive dosage. There were no changes in patient conditions (p=0.316), but the nursing workload increased (p=0.009). As for the medication group, i.e, potentially dangerous or non-dangerous, there were no statistically significant differences either in the severity of the patients (p=0.456) or in the nursing workload (p=0.264) after the occurrence.     

Guidelines and levels of care for pediatric intensive care units

The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education.     

Medication errors at the administration stage in an intensive care unit

Objective: To assess the type, frequency and potential clinical significance of medication-administration errors. Design: Prospective study using the observation technique as described by the American Society of Health-System Pharmacists but eliminating the disguised aspect. Setting: Medical intensive care unit (ICU) in a university hospital. Patients and participants: 2009 medication administration interventions by nurses. Interventions: Pharmacist-performed observation of preparation and administration of medication by nurses, comparison with the original medical order and comparison with the data available in the literature. Measurements and results: 132 (6.6 % of 2009 observed events) errors were detected. Their distribution is as follows: 41 dose errors, 29 wrong rate, 24 wrong preparation technique, 19 physicochemical incompatibility, 10 wrong administration technique and 9 wrong time errors. No fatal errors were observed, but 26 of 132 errors were potentially life-threatening and 55 potentially significant. Conclusion: According to this first observation-based study of medication administration errors in a European ICU, these errors were due to deficiencies in the overall organisation of the hospital medication track, in patient follow-up and in staff training. Received: 18 May 1998 Accepted: 4 December 1998     

儿童重症监护室非计划性拔管现状调查及分析

目的描述非计划性拔管在儿童重症监护室的现状及原因。方法2008年1—12月上海某三级甲等儿科医院中3个重症监护室发生非计划性拔管的患儿共21例,根据意外事件报告单,对发生非计划性拔管的原因进行系统分析。结果患儿的年龄、患儿身体约束不当、镇静不足、胶布固定无效和护理人力不足是造成患儿非计划性拔管的高危因素。结论非计划性拔管率是重症监护质量的重要指标,建立一套有效的预防非计划性拔管标准包括有效约束、有效胶布固定、有效的镇静,合理护理人力配置以及提高护士的评估能力将有助于降低非计划性拔管发生率,提升重症监护室的护理品质。     

儿科重症监护病房临床标本中细菌的分布

重症感染性疾病伴全身炎症反应综合征(SIRS)是引起儿童多脏器功能衰竭及死亡的最主要因素。控制感染，合理应用抗菌药是治疗的关键，但对于危重患儿来讲，抗菌治疗常是在获得细菌培养结果之前的经验性治疗。因此，临床医生需了解当前当地有关细菌感染的流行病学和细菌药敏资料，才能合理应用抗菌药。我们对2000年5月至2003年2月从儿科重症监护病房(PICU)分离出的菌株进行分析。     

Medication errors involving continuously infused medications in a surgical intensive care unit

OBJECTIVE: To document the incidence of medication errors related to medications administered by continuous infusion. DESIGN: Observational study. SETTING: Sixteen-bed surgical intensive care unit. MEASUREMENTS AND MAIN RESULTS: All continuous infusions in the surgical intensive care unit were evaluated at least once daily for correct flow-sheet charting, concentration, infusion rate, and dose administered, as well as patients' heights and weights (actual, ideal, and "dry"). Collected information was examined to determine the error rate, types of errors occurring, and weight used for dose calculation. Variations inpatient weight measures were compared. Seventy-one patients with 202 total infusions were observed. Errors involving continuously infused medications in our surgical intensive care unit occurred at a rate of 105.9 per 1,000 patient days. For nonweight-based infusions, 94% of doses were delivered correctly. Slightly >10% of the doses administered for weight-based infusions (dose based on dry body weight) were incorrect. Significant differences were found between the weight measurements recorded, but this did not translate into statistically significant differences in the apparent calculated doses delivered. CONCLUSIONS: Medications delivered by continuous infusion, particularly those that are weight based, can contribute to medication errors in the intensive care unit. A large proportion (87.6%) of doses for weight-based infusions was calculated based on estimated or unreliable admission weights. There were no severe consequences resulting from the errors observed in this 1 month investigation; however, depending on the pharmacokinetic characteristics of the drug being administered, there is a potential to deliver artificially low or high doses resulting in subtherapeutic or adverse effects.     

Continuous end-tidal carbon dioxide monitoring in pediatric intensive care units

Purpose

End-tidal carbon dioxide (ETCO₂) monitoring has a variety of clinical applications in critically ill pediatric patients. This study was designed to explore the current availability and utilization patterns for continuous ETCO₂ monitoring in pediatric intensive care units.

Methods

A Web-based survey was distributed to directors of all accredited pediatric critical care fellowship programs in the United States.

Results

Sixty-six percent of directors completed this survey. One hundred percent of directors had access to ETCO₂ monitoring for intubated patients and 57% for nonintubated patients. Eighty-three percent of respondents used ETCO₂ monitoring “always” or “often” for endotracheal tube confirmation. Fifty percent of respondents used ETCO₂ monitoring “always” or “often” for cardiopulmonary resuscitation, 38% for moderate sedation, and 5% for acid-base disturbances. All respondents who used ETCO₂ monitoring felt that it was easy to use. The most common reason for not using ETCO₂ monitoring was lack of availability (75%).

Conclusions

End-tidal carbon dioxide monitoring is widely available and used for intubated patients. However, it could be applied more frequently in other clinical situations in pediatric intensive care units.