Iatrogenic occurrences with medication in I. C.U: nurse's procedures and feelings

Ocorrências iatrogênicas com medicação na UTI são eventos indesejáveis que exigem pronta intervenção do enfermeiro. Opresente estudo foi realizado com os seguintes objetivos:- verificar a conduta dos enfermeiros diante de uma ocorrência commedicação, identificar os sentimentos vividos nessas situações e caracterizar os fatores relacionados a esses eventos. Pormeio de um questionário respondido por 148 enfermeiros de UTI (76,7%) de 7 hospitais do Município de São Paulo, nosanos de 1997 e 1998, os dados foram obtidos e analisados segundo freqüência absoluta e percentual. Os resultados permitiramconcluir que as condutas mais citadas incluíram: comunicar o fato ao médico (31,7%), intensificar os controles (26,5%) ecomunicar a chefia de enfermagem (13,5%). Ansiedade, impotência e culpa foram sentimentos mais apontados com38,1%, 14,6% e 12,3%, respectivamente. O fator relacionado às ocorrências mais freqüente foi a displicência do funcionário(23,1%). Quanto à vivência desse tipo de ocorrência, a maior porcentagem (43,2%) referiu ter vivido situação semelhanteraras vezes.Ocurrencias iatrogénicas com medicamentos en UCI no son hechos esperados y necesitan rápida actuación de los enfermeros.El estudio tuvo los siguientes objectivos: verificar la conducta de los enfermeros delante de una ocurrencia iatrogénica commedicamnetos; identificar los sentimientos provocados por tales situaciones y identificar los factores vinculados a talesocurrencias. Ciento cuarenta ocho enfermeros (76,7%) de 7 UCI de la ciudad de São Paulo, Brasil, contestaran una encuestaen los años de 1997 y 1998. Los resultados llevan a concluir que las conductas más frecuentes incluyeran: comunicar elhecho al médico (31,7%), aumentar los controles (26,5%) y comunicar el hecho al director de enfermería (13,5%). Ansiedad(38,1%), impotencia (14,6%) y culpa (12,3%)fueranlos sentimientos más frecuentes. El factor más importante relacionado a las ocurrencias iatrgénicas fue la falta de atención del trabajador de enfermería (23,1%). Otros 64 enfermeros (43,2%)relataran teneren vivido situaciones semejantes raras vetes.Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this studywere: - to identify nurse's procedures and feelings in this situation; - to characterize factors related to this kind of event inICU settings. A questionnaire was answered by 148 ICU nurses (76,7%) from 7 hospitals in São Paulo city, in 1997 and1998. The results showed that of 407 mentioned procedures, 31,7% included to comunicate the event to the doctor, followedby to intensify the patient control (26,5%). Regarding the 260 feelings informed by the nurses, anxiety and impotence werethe most frequent, respectively, 38,1% and 14,6%. Of 303 factors related to the occurrences nurses pointed out neglet (24,6%)and professional innexperience (15,1%) as the most important. Forty three point two per cent (43,2%) of the nurses hardlyexperimented this situation in their professional life in ICU

Ocorrências iatrogênicas com medicação em Unidade de Terapia Intensiva: condutas adotadas e sentimentos expressos pelos enfermeiros Ocurrencias iatrogénicas com medicamentos en Unidad de Cuidados Intensivos: conductas y sentimientos de los enfermeros Iatrogenic occurrences with medication in I. C.U: nurse's procedures and feelings

Ocorrências iatrogênicas com medicação na UTI são eventos indesejáveis que exigem pronta intervenção do enfermeiro. Opresente estudo foi realizado com os seguintes objetivos:- verificar a conduta dos enfermeiros diante de uma ocorrência commedicação, identificar os sentimentos vividos nessas situações e caracterizar os fatores relacionados a esses eventos. Pormeio de um questionário respondido por 148 enfermeiros de UTI (76,7%) de 7 hospitais do Município de São Paulo, nosanos de 1997 e 1998, os dados foram obtidos e analisados segundo freqüência absoluta e percentual. Os resultados permitiramconcluir que as condutas mais citadas incluíram: comunicar o fato ao médico (31,7%), intensificar os controles (26,5%) ecomunicar a chefia de enfermagem (13,5%). Ansiedade, impotência e culpa foram sentimentos mais apontados com38,1%, 14,6% e 12,3%, respectivamente. O fator relacionado às ocorrências mais freqüente foi a displicência do funcionário(23,1%). Quanto à vivência desse tipo de ocorrência, a maior porcentagem (43,2%) referiu ter vivido situação semelhanteraras vezes.<br>Ocurrencias iatrogénicas com medicamentos en UCI no son hechos esperados y necesitan rápida actuación de los enfermeros.El estudio tuvo los siguientes objectivos: verificar la conducta de los enfermeros delante de una ocurrencia iatrogénica commedicamnetos; identificar los sentimientos provocados por tales situaciones y identificar los factores vinculados a talesocurrencias. Ciento cuarenta ocho enfermeros (76,7%) de 7 UCI de la ciudad de São Paulo, Brasil, contestaran una encuestaen los años de 1997 y 1998. Los resultados llevan a concluir que las conductas más frecuentes incluyeran: comunicar elhecho al médico (31,7%), aumentar los controles (26,5%) y comunicar el hecho al director de enfermería (13,5%). Ansiedad(38,1%), impotencia (14,6%) y culpa (12,3%)fueranlos sentimientos más frecuentes. El factor más importante relacionado a las ocurrencias iatrgénicas fue la falta de atención del trabajador de enfermería (23,1%). Otros 64 enfermeros (43,2%)relataran teneren vivido situaciones semejantes raras vetes.<br>Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this studywere: - to identify nurse's procedures and feelings in this situation; - to characterize factors related to this kind of event inICU settings. A questionnaire was answered by 148 ICU nurses (76,7%) from 7 hospitals in São Paulo city, in 1997 and1998. The results showed that of 407 mentioned procedures, 31,7% included to comunicate the event to the doctor, followedby to intensify the patient control (26,5%). Regarding the 260 feelings informed by the nurses, anxiety and impotence werethe most frequent, respectively, 38,1% and 14,6%. Of 303 factors related to the occurrences nurses pointed out neglet (24,6%)and professional innexperience (15,1%) as the most important. Forty three point two per cent (43,2%) of the nurses hardlyexperimented this situation in their professional life in ICU

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)