Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study

Abstract Introduction Family members of critically ill patients often experience increased incidence of physical and mental health issues. One of the first ways family members suffer is by losing sleep. The purpose of this study is to understand sleep quality, levels of fatigue and anxiety, and factors contributing to poor sleep in adult family members of critically ill patients. Methods A questionnaire was designed to evaluate sleep, fatigue and anxiety during the intensive care unit (ICU) admission. We incorporated three validated instruments: General Sleep Disturbance Scale (GSDS), Beck Anxiety Index (BAI) and Lee Fatigue Scale (NRS-F). Adult family members of patients in ICU for more than 24 hours were approached for questionnaire completion. Patient demographics were recorded. Results The study population consisted of 94 respondents, (49.1 ± 12.9 years, 52.7% male); 43.6% were children and 21.3% were spouses of ICU patients. Sleep quality was rated as poor/very poor by 43.5% of respondents, and good/very good by 15.2%. The most common factors contributing to poor sleep were anxiety (43.6%), tension (28.7%) and fear (24.5%). Respondents' most common suggestions to improve sleep were more information regarding the patient's health (24.5%) and relaxation techniques (21.3%). Mean GSDS score was 38.2 ± 19.3, with 58.1% of respondents experiencing moderate to severe sleep disturbance. Mean BAI was 12.3 ± 10.2, with 20.7% of respondents experiencing moderate to severe anxiety. Mean NRS-F was 3.8 ± 2.5, with 57.6% of respondents experiencing moderate to high fatigue. Family members who spent one or more nights in the hospital had significantly higher GSDS, BAI and NRS-F scores. The patient's Acute Physiology and Chronic Health Evaluation (APACHE) II score at survey completion correlated significantly with family members' GSDS, BAI and NRS-F. Conclusion The majority of family members of ICU patients experience moderate to severe sleep disturbance and fatigue, and mild anxiety

Errors Associated with IV Infusions in Critical Care

ABSTRACTBackground: All medication errors are serious, but those associated with the IV route of administration often result in the most severe outcomes. According to the literature, IV medications are associated with 54% of potential adverse events, and 56% of medication errors.Objectives: To determine the type and frequency of errors associated with prescribing, documenting, and administering IV infusions, and to also determine if a correlation exists between the incidence of errors and either the time of day (day versus night) or the day of the week (weekday versus weekend) in an academic medicosurgical intensive care unit without computerized order entry or documentation.Methods: As part of a quality improvement initiative, a prospective, observational audit was conducted for all IV infusions administered to critically ill patients during 40 randomly selected shifts over a 7-month period in 2007. For each IV infusion, data were collected from 3 sources: direct observation of administration of the medication to the patient, the medication administration record, and the patient’s medical chart. The primary outcome was the occurrence of any infusion-related errors, defined as any errors of omission or commission in the context of IV medication therapy that harmed or could have harmed the patient.Results: It was determined that up to 21 separate errors might occur in association with a single dose of an IV medication. In total, 1882 IV infusions were evaluated, and 5641 errors were identified. Omissions or discrepancies related to documentation accounted for 92.7% of all errors. The most common errors identified via each of the 3 data sources were incomplete labelling of IV tubing (1779 or 31.5% of all errors), omission of infusion diluent from the medication administration record (474 or 8.4% of all errors), and discrepancy between the medication order as recorded in the patient’s chart and the IV medication that was being infused (105 or 1.9% of all errors).Conclusions: Strict definitions of errors and direct observation methods allowed identification of errors at every step of the medication administration process that was evaluated. Documentation discrepancies were the most prevalent type of errors in this paper-based system.RÉSUMÉContexte : Toutes les erreurs de médication sont sérieuses, mais celles impliquant la voie d’administration intraveineuse (i.v.) entraînent souvent les conséquences les plus graves. D’après la littérature, les médicaments i.v. sont associés à 54 % des événements indésirables potentiels et à 56 % des erreurs de médication.Objectifs : Déterminer le type et la fréquence des erreurs associées à la prescription, à la consignation et à l’administration de perfusions i.v., et établir s’il existe une corrélation entre l’incidence des erreurs et le moment de la journée (jour ou nuit) ou le jour de la semaine (en semaine ou en fin de semaine) dans une unité de soins intensifs médicochirurgicaux universitaire non dotée d’un système informatisé de saisie des ordonnances et de consignation.Méthodes : Dans le cadre d’un projet d’amélioration de la qualité, on a mené une vérification observationnelle prospective de toutes les perfusions i.v. administrées à des patients gravement malades, pendant 40 quarts de travail choisis au hasard au cours d’une période de sept mois en 2007. On a collecté des données sur chaque perfusion i.v. à partir de trois sources : l’observation directe de l’administration du médicament au patient, le registre d’administration des médicaments et le dossier médical du patient. Le principal paramètre d’évaluation était la survenue d’une erreur de perfusion, sans distinction du type. Une erreur de perfusion était définie comme toute erreur d’omission ou de commission dans le contexte de l’administration d’un médicament par voie i.v. qui a eu ou aurait pu avoir un effet délétère pour le patient.Résultats : On a déterminé que jusqu’à 21 erreurs distinctes pouvaient survenir en association avec l’administration d’une seule dose de médicament par voie i.v. Un total de 1882 perfusions i.v. ont été évaluées et un total de 5641 erreurs ont été mises en évidence. Les omissions ou les divergences de consignation comptaient pour 92,8 % de toutes les erreurs. Les erreurs les plus courantes dans chacune des trois sources étaient l’étiquetage incomplet de la tubulure i.v. (1779 ou 31,5 % de toutes les erreurs), l’omission d’inscription du diluant de la perfusion dans le registre d’administration des médicaments (474 ou 8,4 % de toutes les erreurs) et une divergence entre l’ordonnance telle qu’inscrite dans le dossier du patient et le médicament perfusé par voie i.v. (105 ou 1,9 % de toutes les erreurs).Conclusions : Des définitions strictes des erreurs et des méthodes d’observation directe ont permis de mettre en évidence des erreurs à toutes les étapes du processus d’administration des médicaments qui ont été évaluées. Les divergences de consignation constituaient le type d’erreur le plus fréquent dans ce système non informatisé

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease