Page 793 - ACCCN's Critical Care Nursing

770 A P P E N D I X A W O R L D F E D E R AT I O N O F C R I T I C A L C A R E N U R S E S P O S I T I O N S TAT E M E N T S

What are the causes of an unsafe ICU and attributed to problems of communication between the
how can we improve the safety culture and physicians and nurses. Applying human factor engineer-
ing concepts to the study of the weak points of a specific
environment within our intensive care units? ICU may help to reduce the number of errors. Errors
Defining and assessing safety and quality are only one should not be considered as an incurable disease, but
side of the issue. Often in clinical practice the problem rather as preventable phenomena, if systems were
is broader than individual errors, and the whole system designed to cope and to minimize the effects and the
is at fault or at the least predisposes to an unsafe consequences of these errors. 43
environment. When assessing an ‘unsafe’ ICU, several
factors need to be understood, and these fit into two The challenges for the future
main categories: problems with the organization and Medicine in the last 200 years has changed dramati-
structure of the unit and problems with the process of cally. The nature of health and disease has altered
care used. irrevocably, pain has been conquered with anesthesia,
Perhaps the most obvious factors from the organization and infectious diseases have been fought through a
or structural point of view relate to the volume of work combination of drugs and better public health systems.
performed and outcome. This topic remains conten- At the same time our understanding of the pathophysi-
23
tious , although there is good evidence to support ological process underpinning these changes has
centralization and increased volume services in many cir- improved exponentially. Despite these advancements,
cumstances 24,25 (Nathens, 2001 no.10382). Some authors our knowledge as to how health-care systems interact
have described the relationship between patient to nurse and influence the delivery of safe and quality care are
26
ratios and nosocomial infection rates , medication poor. The recent ‘discovery’ of the epidemic of ‘medical
errors, complications and resource use after esophagec- error’ as an important cause of morbidity and mortal-
20
18
tomy or more broadly even all the aspects of safety and ity should not be a surprise.
quality in the hospital. These works lead many authors The first step to overcome this preventable epidemic is by
27
to conclude that a high-acuity nurse–patient ratio is cost- the recognition of its existence. For this reason the ESICM
28
effective , and that it is crucial to have ICUs adequately is promoting an initiative to bring together all the stake-
staffed. 29 holders who relate to our specialty in a process aimed at
The process of care relates to issues of teamwork, collabo- not only raising the profile of patient safety, but to actu-
ration and communication. These issues are far more ally improve the outcome of our patients.
difficult to quantify and are often obscure and forgotten.
In intensive care medicine they were perhaps first raised Appendix 1
by Pascale le Blanc and Wilmar Schaufeli in the EURICUS 1. We, the Leaders of the Societies representing the
studies. 30,31 They demonstrated these variables to be medical specialty of intensive care medicine, met
32
associated with increasing nosocomial infection rates. in Vienna on 11 October 2009. Together with the
Among these aspects, the issue of nurse–physician col- representatives of the main institutions and
laboration in ICUs 33-35 seems to be crucial. Also, the issue stakeholders who speak up for patient safety,
of the transmission of individual information between we declare:
36
professionals is today a critical issue , first raised by 2. We recognize that patient safety and clinical team
19
37
Donchin in 1995 and later confirmed in the SEE study. safety are of paramount importance to every prac-
Notwithstanding these issues, it is important not to forget ticing health professional and represents one of
38
the well-being of intensive care nurses or the effect of a the major challenges in modern day medicine.
pharmacist’s and/or a nurse’s interventions on cost and This affects the lives of women, men, and children
adverse effects of drug therapy in the ICU. 39-41 in every country. Without a safe environment it is
not possible to provide the quality of care that we
The need for a multidimensional approach to the mini-
mization of error and the consequent improvement in all aspire to. This is especially true in intensive
the clinical and economical effectiveness of an ICU care medicine, given the very fragile nature of the
42
is becoming increasingly clear. When comparing the patients we care for, often in the extremes of age,
‘most efficient’ with ‘least efficient’ ICUs, Rothen and unconscious and with minimal margins for error
co-workers demonstrated that only interprofessional imposed by their deranged physiology. This global
rounds, the presence of an emergency department and problem requires a global solution.
the geographical region of the hospital were significantly 3. We believe that improving levels of safety for criti-
asso ciated with improvement in quality indicators. The cally ill patients is achievable in all units and in
adoption of electronic prescribing over handwritten pre- all countries, irrespective of the available resources.
scription has also been shown to lead to the prescrip- If the safety of our patients is increased, then the
tions being more readable and complete, with fewer quality of care that we can provide will improve.
errors. This should result in improved prescribing and 4. We strongly believe that increasing patient safety
a safer environment for the giving of drugs to our is as crucial to the development of medical prac-
patients. tice as the increase in the effectiveness of our
interventions.
In conclusion, a significant number of dangerous human 5. We have today therefore pledged to do whatever
errors occur in the ICU. Many of these errors can be is necessary to: