Voluntary Incident and Near-Miss Reporting

Baptist Health South Florida (BHSF) is the largest not-for-profit healthcare organization in South Florida that is comprised of six hospitals. Mariners Hospital is part of BHSF and is located 65 miles south of Miami in the Florida Keys. It is a 25 Bed Critical Access Hospital that in fiscal year 2013 treated 597 inpatients, 11,514 emergency visits, 20,740 outpatients and 5,000 encounters in the employed physician\u27s offices. With our desire to provide the highest quality of care, it is crucial to have any unanticipated or near-miss events reported. Incident reports provide valuable information for quality improvement. Not all hospital employees know what events should be reported. Under reporting of incidents remains a serious issue in healthcare. Nationally, there are 5-20% of incidents never reported

Receptive Music Therapy for Patients Receiving Mechanical Ventilation in the Intensive Care Unit

BACKGROUND: Live music therapy provided by a board-certified music therapist reduces anxiety, decreases pain, and improves the physiological response of patients in the intensive care unit (ICU). OBJECTIVES: To examine the effect of live music therapy on the physiological parameters and pain and agitation levels of adult ICU patients receiving mechanical ventilation. METHODS: A total of 118 patients were randomly assigned to live music therapy or standard care. The music therapy group received 30 minutes of live music therapy tailored to each patient\u27s needs. The Richmond Agitation-Sedation Scale and the Critical Care Pain Observation Tool were completed by critical care nurses immediately before and after each session, and the patients\u27 heart rates, respiratory rates, and oxygenation levels were measured. RESULTS: Patients who received live music therapy had significantly different scores on the Richmond Agitation-Sedation Scale (P \u3c .001) and the Critical Care Pain Observation Tool (odds ratio, 6.02; P = .002) compared with the standard care group. Significant differences between groups were also reported in heart rate (P \u3c .001). No significant differences were found in oxygen values. CONCLUSIONS: Live music therapy significantly reduced agitation and heart rate in adult patients receiving mechanical ventilation in the ICU. These findings provide further evidence for the benefits of music therapy in the ICU, including in intubated patients

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

ObjectivesIn a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy.Study designA multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months.ResultsA total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy.ConclusionsA substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF