Improving Outcomes of ICU Patients

John Hoyt, M.D., director of the ICU at Mercy Hospital in Pittsburgh (PA, USA) and clinical professor of critical care medicine at the University of Pittsburgh. ICU patients are critically ill and therefore especially vulnerable. If intensivists are providing their care, they are three times less likely to die than patients cared for by nonintensivists. The nurse-to-patient ratio is also important. The risk for several pulmonary complications doubles when an ICU nurse cares for three or more patients. Since ICU patients take twice as many medications as other patients, they are more prone to medication errors. However, having a pharmacist in the ICU reduces medication errors.

Safety experts are working on ways to improve systems to prevent errors. One safeguard is the refitting of the nitrous oxide tubes to prevent them from connecting to oxygen tubing, thereby preventing patients from getting low blood oxygen. Another safeguard is removing the concentrated form of potassium chloride from the ICU. Lower concentrations can prevent a fatal overdose.

Visual warning signs also help prevent errors. For example, a clip or mark on a pulmonary artery catheter can tell healthcare workers when the catheter has been inserted far enough. Inserting the catheter too far into the heart is not an uncommon medical error that may result in death. Epidural pain medication must be connected with an epidural catheter, not to the intravenous line, which could be a deadly mistake. A bright sticker on the catheter that says "epidural” would warn against this error. An even better solution would be to make it impossible to connect the epidural to the intravenous line.

"Most patients admitted to the ICU suffer some potentially life-threatening event,” said Dr. Hoyt. "We need to focus on the systems of care to reduce the risk of adverse events.”




Related Links:
Society of Critical Care Medicine