Category Archives: Conferences

Working in intensive care unit can be very daunting without acquiring constant knowledge. In Intensive care unit, there are many factors to consider especially emergency cases both expected and unexpected.  At any time patient condition can deteriorate and this can be challenging.

ICU patients can be subdivided into three levels, Level3, Level2 and Level1. Level 3 group of patients are Critically very ill as well as most Level2, the group2 patients are not intubated and Level one’s are the step-down patients awaiting to be discharged to the ward. Each level of care require knowledge and understanding of care management and process to avoid lapses. However, these group of patients can slowly or quickly deteriorate especially those in Level2 category and Level1 if omissions or delayed treatment should occur clinically. These patients  in group2 and group1 can revert into Level 3 or 2 even worse can lose the patient all to-together if appropriate attention is not given. Contributing factors include missed observations such as Neurology, Respiratory, Cardiac instability, Renal dysfunction, post surgery care, vital signs, skin assessment, blood gas analysis, laboratory results, warning signs to mention a few. Inadequate knowledge and lack of critical care observation skills can cause more harm than good the Philosophers stated that  “Prevention is better cure”.

Advance Nursing Knowledge is required and that’s why its important to attend Conferences to learn from the experts. The Intensive Care Professor Physicians and Consultants, Dr’s, Nurses, Dietician, Physiotherapist, Pharmacist and guest speakers from all over the world are usually present given evidence based teaching and research outcome on (ICU) medical and Nursing care.

Discussion on compensated and decompensated organ phase based on multiple-organ sysdrome are front-line topics. Neurological circumstances, cardiac cases, respiratory failure, Ventilaton,  teaching on individual system and diagnosis, Pharmalogical awareness, Nutrition, complications and management of system by system. Having attended these conferences l gained improvement on thorough observations and assessment and to inform the Charge Nurse and Doctors on time of any changes in patients even if it is nothing “A stitch in time saves Nile”. Give drugs to patient on time as prescribed, understanding the consequences of backlog and effects on patients. If a drug is prescribed 2 hourly such as Nimodipine or 4hourly for example, and 2pm is given at 3pm or 4pm the late administration will affect the rest of the hours overall leading to ommision at some point, this type of care is unprofessional and would have a negative effect on patient’s recovery phase physiologically. I understand we can be extremely busy however, drugs comes as priority. It is crucial to comply with drug chart prescribed time and to give the drugs as of when due unless unable for some clinical reasons such as patient not fit for oral in this circumstrance report to Charge Nurse and Doctor should they wish to prescribe Intravenous route instead. As a Nurse its important to advocate for all patients in every situation.

Attending Conferences has really improved my confidence, understanding and efficiency in practice. I am able to pass on the knowledge to my Nursing Students, Medical Students, colleagues and stand up for good practice.  It is good to practice effectively and preserve patient safety. This is the most reason ICU patients should have one-one care or 2:1 ratio while promoting Prioritising People and to effectively promote professionalism and Trust.

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Drug infusions is drawn by a Registered Nurse and be used within own shift only. Most often Nurses draw-up drug infusion for the next shift and the incoming staff think this is great.

Preparing drug infusion for the next shift can be very dangerous. It is not advisable to use an infusion not present when it was drawn up as errors could have occured during dilution or wrong drug all together. Take for instance Noradrenaline could have been prepared in 50mls of 5% Dextrose and nicely labelled however, due to busy schedule of the Unit the Nurse may have forgotten to add the Noradrenaline to the infussion and the next shift uses this infusion what happens then? The patient blood pressure starts to drop and eveyone thinks why is the patient’s blood pressure dropping doctor will say go higher on the Noradrenaline and eventually prescribe fluid start dose but little would anyone knows that there is no Noradrenaline added to the infusion syringe. l have come across such incident whereby you just have to prepare a new infusion and connect to patient thereafter blood pressure and mean arterial pressure improve nicely to the parameter set by the Physician, or Neurologist, and Neurosurgeon and good  perfusion observed. Failure of Noradrenaline can be detected when it failed to work what about other infusions.

Having attended the European Society of Intensive Care Medicine (ESICM) Conferences, it was said not to use a drawn up infusion that has been prepared by a colleague in your absent evidence based practice suggest safety of the patient is priority, staff, Unit and the Trust in  question.

Personally do not use a drawn up infusion neither draw up one for the next shift. If an infusion is coming to an end towards the start of next shift, l will prepare the infusion connect to the patient, start the infusion and handover. This is to avoid a delay in treatment following clinical time judgement.

Drug infusion can be drawn-up shift by shift by so doing will not compromise patients safety, avoid drug error, and cost effective. Throwing away drawn-up infusions due to uncertainty becomes unnecessary wastage. Hospitals should implement actions to avoid drawn up infusions for the next shift or staff. This is not about lack of trust but it is all about safety measures for all.

References:

European Society of Intensive Care Medicine 2015

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