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Understanding the experience of medically-induced unconsciousness
37 AUSTRALIAN CRITICAL CARE
Understanding the experience of medically-induced unconsciousness L Sheen Frankston Hospital Penninsula Health Care Network, Victoria In the critical phase of their illness, patients in intensive care units (ICUs) are often sedated and therefore appear unresponsive. Many health professionals assume they are not experiencing anything memorable under this sedation. This study challenged that assumption by investigating the phenomenon of medically-induced unconsciousness, in order to enhance practice and knowledge within critical care nursing.
(280), sedatives/anaesthetics (135), analgesics (132), anti-clotting (132), antimicrobial (129), electrolytes (128), plasma expand/ blood products (126) and vasodilators (105). Delayed/failed administration (213), wrong infusion rate (162), incorrect dose/ frequency (159), labelling error (111) and wrong drug concentration (110) were the most frequently reported errors. Estimated patient outcomes included nil/minor physiological change (1003), major physiological change (146) and actual physical injury (18). Fifty-two per cent of incidents occurred out of hours, with 88 per cent identified during ongoing care of the patient. Nursing staff detected 88 per cent of them by routinely checking charts (36 per cent), equipment (33 per cent) and patients (21 per cent). Most frequently identified contributing factors included: fatigue/haste/ distraction (433), failure to follow protocol (404), incorrect drug charting (433) and high unit acuity (239).
The purposive sample comprised five former ICU patients. Taped, in-depth conversations were conducted and interpreted utilising the phenomenological method, as outlined by Husserl. The literature review was biphasic, with phase 1 providing a foundation for the study and phase 2 relating to the findings.
Conclusion: the data highlight the fact that multiple contributing factors may result in a medication error occurring in patients in intensive care and highlights the potential risk to patient safety.
Three essences were identified: utter helplessness, cognition and succour. The themes within utter helplessness were linked. Participants were aware of various procedures and felt they had lost control of their physical body; hence they felt threatened. Because they could not communicate, participants felt they were treated differently. This led to feelings of depersonalisation and, ultimately, loneliness. Altered cognitive functioning was reported. Dreaming, dissociation, altered time-space relatedness and chaos were all a part of their cognition. Succour was the most positive essence of the experience of medically-induced unconsciousness. Participants reported a sense of security in the ventilator, comfort in human voices and presence and a relatively pain-free experience.
An analysis of effective chest compression and bag-valvemask ventilation with different compression-ventilation ratios in paediatric cardiopulmonary resuscitation
Participants in this study experienced a myriad of events, despite appearing unresponsive. The results indicated that nurses are caring for their patients’ physical needs but must also focus on the psychological care of sedated patients.
An analysis of medication errors identified in the first 3800 incident reports submitted to the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU) M Durie, U Beckmann, I Baldwin, I Morrison & L Shaw Australian and New Zealand Intensive Care Society and Australian Patient Safety Foundation Introduction: drugs are an essential component of intensive care treatment. However, their administration and treatment planning expose the patient to potential risks. Study objectives: utilising data from the AIMS-ICU project, identify medication errors occurring in adult patients in intensive care and assess their estimated effect on patient outcome. Methods: descriptive analysis of reports submitted to the AIMSICU national database relating to medication errors. Results: a total of 1762 medication errors were identified. Drug groups most commonly involved in these incidents were inotropes VOLUME 12
S Kinney The University of Melbourne, Victoria Introduction: the ideal chest compression and ventilation ratio for children has not been established and guidelines vary depending on several factors. This study was undertaken to determine if a group of graduate nurses could deliver more effective cardiopulmonary resuscitation (CPR) on a child-sized resuscitation mannequin using a particular compression-ventilation ratio. Method: a repeated measures experimental design was developed to investigate whether there was a difference in the ventilation or effective chest compression that 18 subjects could achieve at compression-ventilation ratios of 5:1, 10:2 and 15:2. The subjects were required to work as pairs, with one performing the ventilation and the other the chest compression for a period of 1 minute for each ratio. Chest compression was performed at a rate of 100/minute, as guided by a metronome. Bag-valve-mask ventilation was used to inflate the chest of the mannequin and expired tidal volumes were measured. The number of effective chest compressions was also recorded. Results: there were no significant differences in the ventilation (mean tidal volumes) or percentage of effective chest compressions delivered for each compression-ventilation ratio. The findings also demonstrated that ventilation was inadequate, irrespective of the ratio. Conclusion: these results suggest graduate nurses do not perform more effective CPR at any one compression-ventilation ratio. Further research is necessary, with the aim of establishing a universal compression-ventilation ratio for all age groups. There is also a need to determine the most appropriate technique for managing non-invasive ventilation when resuscitating the small child.
NUMBER 1
MARCH 1999
Understanding the experience of medically-induced unconsciousness L Sheen Frankston Hospital Penninsula Health Care Network, Victoria In the critical phase of their illness, patients in intensive care units (ICUs) are often sedated and therefore appear unresponsive. Many health professionals assume they are not experiencing anything memorable under this sedation. This study challenged that assumption by investigating the phenomenon of medically-induced unconsciousness, in order to enhance practice and knowledge within critical care nursing.
(280), sedatives/anaesthetics (135), analgesics (132), anti-clotting (132), antimicrobial (129), electrolytes (128), plasma expand/ blood products (126) and vasodilators (105). Delayed/failed administration (213), wrong infusion rate (162), incorrect dose/ frequency (159), labelling error (111) and wrong drug concentration (110) were the most frequently reported errors. Estimated patient outcomes included nil/minor physiological change (1003), major physiological change (146) and actual physical injury (18). Fifty-two per cent of incidents occurred out of hours, with 88 per cent identified during ongoing care of the patient. Nursing staff detected 88 per cent of them by routinely checking charts (36 per cent), equipment (33 per cent) and patients (21 per cent). Most frequently identified contributing factors included: fatigue/haste/ distraction (433), failure to follow protocol (404), incorrect drug charting (433) and high unit acuity (239).
The purposive sample comprised five former ICU patients. Taped, in-depth conversations were conducted and interpreted utilising the phenomenological method, as outlined by Husserl. The literature review was biphasic, with phase 1 providing a foundation for the study and phase 2 relating to the findings.
Conclusion: the data highlight the fact that multiple contributing factors may result in a medication error occurring in patients in intensive care and highlights the potential risk to patient safety.
Three essences were identified: utter helplessness, cognition and succour. The themes within utter helplessness were linked. Participants were aware of various procedures and felt they had lost control of their physical body; hence they felt threatened. Because they could not communicate, participants felt they were treated differently. This led to feelings of depersonalisation and, ultimately, loneliness. Altered cognitive functioning was reported. Dreaming, dissociation, altered time-space relatedness and chaos were all a part of their cognition. Succour was the most positive essence of the experience of medically-induced unconsciousness. Participants reported a sense of security in the ventilator, comfort in human voices and presence and a relatively pain-free experience.
An analysis of effective chest compression and bag-valvemask ventilation with different compression-ventilation ratios in paediatric cardiopulmonary resuscitation
Participants in this study experienced a myriad of events, despite appearing unresponsive. The results indicated that nurses are caring for their patients’ physical needs but must also focus on the psychological care of sedated patients.
An analysis of medication errors identified in the first 3800 incident reports submitted to the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU) M Durie, U Beckmann, I Baldwin, I Morrison & L Shaw Australian and New Zealand Intensive Care Society and Australian Patient Safety Foundation Introduction: drugs are an essential component of intensive care treatment. However, their administration and treatment planning expose the patient to potential risks. Study objectives: utilising data from the AIMS-ICU project, identify medication errors occurring in adult patients in intensive care and assess their estimated effect on patient outcome. Methods: descriptive analysis of reports submitted to the AIMSICU national database relating to medication errors. Results: a total of 1762 medication errors were identified. Drug groups most commonly involved in these incidents were inotropes VOLUME 12
S Kinney The University of Melbourne, Victoria Introduction: the ideal chest compression and ventilation ratio for children has not been established and guidelines vary depending on several factors. This study was undertaken to determine if a group of graduate nurses could deliver more effective cardiopulmonary resuscitation (CPR) on a child-sized resuscitation mannequin using a particular compression-ventilation ratio. Method: a repeated measures experimental design was developed to investigate whether there was a difference in the ventilation or effective chest compression that 18 subjects could achieve at compression-ventilation ratios of 5:1, 10:2 and 15:2. The subjects were required to work as pairs, with one performing the ventilation and the other the chest compression for a period of 1 minute for each ratio. Chest compression was performed at a rate of 100/minute, as guided by a metronome. Bag-valve-mask ventilation was used to inflate the chest of the mannequin and expired tidal volumes were measured. The number of effective chest compressions was also recorded. Results: there were no significant differences in the ventilation (mean tidal volumes) or percentage of effective chest compressions delivered for each compression-ventilation ratio. The findings also demonstrated that ventilation was inadequate, irrespective of the ratio. Conclusion: these results suggest graduate nurses do not perform more effective CPR at any one compression-ventilation ratio. Further research is necessary, with the aim of establishing a universal compression-ventilation ratio for all age groups. There is also a need to determine the most appropriate technique for managing non-invasive ventilation when resuscitating the small child.
NUMBER 1
MARCH 1999