急诊危重患者院内安全转运的护理

目的：总结急诊危重患者院内安全转运的护理。方法：对2011年10月～2012年10月应用转运制度及流程对197例危重患者的院内转运情况进行回顾性分析。结果：共发生各类不良事件82起,其中35起（42．68％）是患者本身相关的不良事件,47起（57．32％）是由于仪器设备引起的相关不良事件,经过一系列护理措施的改进,降低了患者转运途中风险的发生,确保了转运患者的安全。结论：加强护理工作者的护理安全防范意识,提高专业知识,认真执行各项制度,是确保医疗安全、提升医疗质量的关键举措。     

Use of a specialized transport team for intrahospital transport of critically ill patients.

The transport of critically ill patients is challenging for nurses and patients alike. It is imperative that patient safety be the primary focus. The use of a specialized transport team can help to alleviate many of the adverse effects of the transport.     

预警分级管理在急诊危重症患者院内转运中的应用效果

目的 探讨预警分级管理在减少急诊危重症患者院内转运不良事件中的应用效果。方法 我科成立项目团队,明确急诊危重症患者院内转运质量改进目标,分析患者院内转运过程中存在的问题,从病情、设备、转运人员等方面建立预警分级管理,并应用在急诊危重症患者院内转运中,比较实施前(2017年6-12月)及实施后(2018年1-6月)患者院内转运时间及转运过程中不良事件发生情况。结果 实施后,急诊科患者转运至CT室、重症病房及手术室的时间均短于实施前(t=60.557,P<0.001;t=14.096,P<0.001;t=45.117,P<0.001);实施后转运期间不良安全事件发生率显著低于实施前(χ²＝58.699,P<0.001)。结论 预警分级管理能有效缩短院内转运时间,降低急诊危重症患者院内不良安全事件发生率,提高患者院内转运安全性。     

A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines

ObjectivesCritically ill patients are often transferred from the intensive care unit (ICU) to other locations around the hospital during which adverse events, some life threatening, are common. An intercollegiate guideline covering the transport of critically ill patients exists in Australasia; however, compliance with this guideline has previously been shown to be poor, and its role in improving safety in transportation of patients in the ICU is unknown. We performed a pre–post interventional study in a tertiary metropolitan ICU, assessing the impact of the introduction of a transport checklist on guideline compliance.MethodsWe performed a prospective, pre–post interventional study, including a total of 76 transfers of critically ill patients between August 2016 and April 2017.ResultsAfter introduction of the checklist, aggregate median (interquartile range) guideline compliance improved from 86.7% (80.0–92.9) to 90% (86.7–100) (p = 0.01). Significant improvements were found in notification of the transport destination (83.7% vs 100%, p = 0.010) and transporting doctors' knowledge of the Cormack–Lehane grade of laryngoscopy (60.5% vs. 84.2%, p = 0.021). There was, however, a reduction in the proportion of full oxygen cylinders taken on transports (100% vs. 76.3%, p = 0.002).ConclusionsWe conclude that a checklist is useful in improving safety in the transport of a critically ill patient population.     

ICU重症病人院内转运安全性的现状及研究进展

作者综述了ICU重症病人院内转运过程中的并发症以及决策与知情同意,详细总结了转运前的准备工作和转运过程中的病情观察及护理,并对ICU重症病人院内转运工作的发展,提出了自己的观点。     

Factors that contribute to complications during intrahospital transport of the critically ill.

Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. A high incidence of serious hemodynamic or respiratory alteration is associated with the intrahospital transport of critically ill patients. In one third of critically ill intrahospital transports, technical mishaps (eg, i.v. disconnects, which could potentially lead to deleterious physiologic outcomes) may occur. As patient acuity increases, there is a greater risk of hemodynamic instability. The purpose of this study was to further investigate the patient complications during transportation to and from the ICU to a diagnostic or treatment site. The sample consisted of thirty-five critically ill patients from the Neuro/Trauma ICU who required continuous physiological monitoring and had an arterial catheter in place. The systemic blood pressure, heart rate and peripheral oxygen saturation were monitored at nine time points throughout the transport process. The incidence of defined technical mishaps that occurred when the patient was off the unit were also recorded. Transport factors examined included the length of time spent off the unit and the number and level of personnel accompanying the patient. A within-subject repeat measure design was used to examine the physiologic changes and mishaps that occurred. Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment.     

应用体外膜肺氧合联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理

本文总结了2例应用体外膜肺氧合(ECMO)联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理经验,包括成立ECMO转运小组、三级防护、转运前准备以及转运中和转运后的安全管理,以期为进一步提升新型冠状病毒肺炎患者院内转运效率提供参考。     

Recommendations for the intra-hospital transport of critically ill patients

Introduction  

This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT).     

Intrahospital transport of critically ill patients

Severe complications sometimes occur in critically ill patients during intrahospital transport. Possible causes may be inadequate ventilation, insufficient monitoring, interrupted application of vasoactive drugs, or disconnections and accidental extubation. We constructed a transport unit equipped with a respirator; capnometer; monitor to measure ECG, arterial and intracranial pressures, and temperature; and two syringe pumps that can be connected easily to the patient's bed. Gas is supplied by cylinders with oxygen and air. Electrical power is supplied by two accumulators connected to recharger and transformer devices that deliver 220 V (110 V). Since this transfer unit was introduced, we have had no unanticipated problems during intrahospital ICU patient transport.     

Intrahospital transport of critically ill patients.

Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of the transport process go a long way toward safer transfers of the critically ill.     

儿科危重病人院间转运

危重病人的院间转运越来越受到重视,本文综述了转运中的风险评估和降低转运过程中不良影响的措施等,达到提高转运质量和效果的目的 .     

Nutrition support of critically ill patients. Guidelines for optimal management

Nutrition support is an important component of the management of critically ill patients. Before support is initiated, realistic goals should be established and risks and benefits considered. Initially, hemodynamic status should take precedence over nutritional status. Enteral feeding is the preferred route when the gastrointestinal tract is functioning. In most cases calorie requirements can be estimated adequately with use of the Harris-Benedict equation. Indirect calorimetry provides valuable information in patients with impending respiratory failure; withdrawing excess calories and substituting lipid calories for carbohydrate calories, if necessary, may be beneficial. Clinical response can be assessed by nitrogen balance studies and weekly measurement of weight and serum transferrin levels.     

《中国重症患者转运指南(2010)》(草案)

重症患者转运是重症监护病房(ICU)的重要工作内容之一,转运途中患者发生并发症的风险增加,甚至死亡.为规范重症患者转运过程,提高转运安全性,减少不良事件的发生,使医务人员对重症患者的转运有一个统一的认识,中华医学会重症医学分会组织相关专家,依据近年来国内外研究进展和临床实践,制定了<中国重症患者转运指南>.本指南旨在为各级医院提供重症患者转运的基本原则,以便各医疗机构根据自身现有资源制定重症患者转运计划并规范临床实施.     

《中国重症患者转运指南(2010)》(草案)

重症患者转运是重症监护病房(ICU)的重要工作内容之一,转运途中患者发生并发症的风险增加,甚至死亡.为规范重症患者转运过程,提高转运安全性,减少不良事件的发生,使医务人员对重症患者的转运有一个统一的认识,中华医学会重症医学分会组织相关专家,依据近年来国内外研究进展和临床实践,制定了<中国重症患者转运指南>.本指南旨在为各级医院提供重症患者转运的基本原则,以便各医疗机构根据自身现有资源制定重症患者转运计划并规范临床实施.