Nicole De Palma的动态

Quality Indicators for Anesthesia as per NABH_202410161000: Quality indicators for anesthesia as per the National Accreditation Board for Hospitals and Healthcare Providers (NABH) are designed to ensure the safety, quality, and efficiency of anesthesia services. Some key indicators include: Adverse Anesthesia Events Percentage: Tracks the percentage of adverse events occurring during or immediately after anesthesia administration. This helps monitor patient safety and implement corrective measures. Medication Error Rate: Measures the incidence of medication errors related to anesthesia drugs, typically reported per 1,000 patient days. This indicator helps in identifying and reducing errors through staff training and process improvements. Monitoring Compliance: Ensures that patient monitoring during anesthesia, such as temperature, heart rate, respiratory rate, blood pressure, end tidal CO2 and oxygen levels, is done as per the standards. Surgical Site Infection Rates: Evaluates the rate of infections at surgical sites post-anesthesia, indicating the effectiveness of sterile procedures and perioperative care. Time to Initial Assessment: Monitors the time taken from patient arrival to the initial anesthesia assessment. Shorter times can indicate better workflow and preparedness. Close monitoring during the anesthesia must me monitored continuously and documented every 10 minutes. Anesthesia is one of the most complex specialty to monitored and followed. Data Collection for these indicators are challenging for so many institutes. #AkashTiwari #JCI #NABH #AACI #PatientSafety #Healthcare #Excellence

Tuesday Thought The **2024 National Patient Safety Goals** set by The Joint Commission focus on several key areas to enhance patient safety across various healthcare settings. Here are some of the main goals: 1. **Identify Patients Correctly**: Use at least two ways to identify patients, such as their name and date of birth, to ensure each patient receives the correct treatment and care. 2. **Improve Staff Communication**: Ensure that important test results are communicated to the right staff person on time. 3. **Use Medicines Safely**: Label all medicines, especially those not in their original containers, and take extra care with patients on blood thinners. 4. **Use Alarms Safely**: Ensure that alarms on medical equipment are heard and responded to promptly. 5. **Prevent Infection**: Follow hand hygiene guidelines and use proven guidelines to prevent infections that are difficult to treat. 6. **Identify Patient Safety Risks**: Focus on identifying patients at risk for suicide. 7. **Improve Health Care Equity** Address health care disparities in the patient population and develop a written plan to improve health care equity. 8. **Prevent Mistakes in Surgery**: Make sure the correct surgery is performed on the correct patient and at the correct site on the patient’s body. These goals are designed to address significant patient safety issues and provide specific actions to prevent harm and improve the quality of care.

???????????? ??????????: Understanding Tracheotomy: A Lifesaving Procedure ????????????????????????: A tracheotomy is a surgical procedure where an opening is created in the trachea (windpipe) to help someone breathe more easily. It’s often used in emergency situations or for people with medical conditions that make it hard for air to reach their lungs through the usual pathways. ?????????????? ???? ?? ?????????????????????? The main reason for a tracheotomy is to provide an alternative airway for breathing when the usual route is blocked or damaged. It’s commonly performed for patients facing severe respiratory issues or trauma to the head and neck. ?????????????????? ?????? ???????????????? ???????????????????? A tracheotomy can be done in an emergency to save a person’s life, or it can be planned (elective) for patients needing long-term breathing support due to conditions like cancer, severe injuries, or chronic lung disease. ?????????????????? ?????????????? During the procedure, a small incision is made in the neck just below the Adam’s apple. A tube, called a tracheostomy tube, is inserted into the opening to allow air to flow directly into the trachea and lungs. ??????????-???????? ?????? ????????-???????? ?????????????????????????? For some, a tracheotomy is a temporary measure, removed once they regain normal breathing. However, some patients require it long-term, often with specialized tracheostomy care for months or even years. ???????????????????? ???? ???????????????? ???????? In ICU (intensive care units), tracheotomies are often performed to reduce the risks of long-term intubation, helping patients breathe with less discomfort and a reduced risk of infection or lung injury. ?????????????? ?????????????????????????? ???????????????????? With a tracheostomy tube, speaking is often difficult. Many patients rely on writing, hand signals, or specialized speaking devices to communicate, which can impact their daily life and emotional well-being. ???????? ?????? ?????????????????????????? Like any surgical procedure, tracheotomies have risks, including infection, bleeding, or damage to nearby tissues. Proper care and hygiene of the tracheostomy tube are essential to avoid complications. ???????? ???? ???????????????????????????? ?????? ???????????????? Tracheotomies enable patients to participate in physical therapy, helping to strengthen their breathing muscles and gradually regain normal function. Over time, many patients can have the tube removed and transition back to breathing normally. ???????????? ???????????? ?????????? ???? #?????????????????????? #???????????????????????? #?????????????????????????????????? #?????????????????????????????????? #?????????????????????? #?????????????????????????????????????? #???????????????????????????????? #???????????????????????????????? #?????????????????????????????????????????????? #??????????????

Promoting Patient Safety with the Modified Early Warning Score (MEWS) What is MEWS? The Modified Early Warning Score (MEWS) is a standardized assessment tool designed to identify patients at risk of clinical deterioration early. It evaluates key physiological parameters, assigns scores based on deviations from normal ranges, and triggers appropriate interventions when thresholds are exceeded. Key Parameters Assessed by MEWS: Heart Rate (HR): Indicates cardiac function. Systolic Blood Pressure (SBP): Reflects circulatory status. Respiratory Rate (RR): Signals respiratory efficiency. Body Temperature: Monitors signs of infection or hypothermia. Level of Consciousness (LOC): Assessed using the AVPU scale (Alert, Verbal, Pain, Unresponsive). How Does MEWS Work? Each vital sign is scored based on its value compared to established thresholds. The individual scores are combined into a total score. A higher score signifies a greater risk of deterioration and prompts immediate clinical action. Why is MEWS Important? 1. Early Detection of Deterioration: MEWS identifies subtle changes in a patient’s condition before they become critical. 2. Improved Patient Outcomes: By enabling timely interventions, MEWS reduces the risk of complications, ICU admissions, and mortality rates. 3. Enhanced Communication: Provides a clear and objective framework for communication among healthcare teams. 4. Support for Clinical Decision-Making: Empowers nurses and physicians with data-driven insights for patient management. Integration with Modern Healthcare Systems Advanced healthcare systems like Cerner FirstNet and EPIC are incorporating MEWS into their platforms. These integrations allow for automated scoring, continuous monitoring, and real-time alerts, further improving patient safety and care quality. Real-World Impact of MEWS: Reduction in emergency escalations by 30% in clinical trials. Improved confidence and efficiency among nursing staff when managing acutely ill patients. A proactive approach to patient safety that aligns with global healthcare standards. #Nursing #PatientCare #RN

For those of you who hear from material managers, CFOs, and the like that having sales reps in the OR is unnecessary and drives up the cost of implants, consider this analysis by Mark Copeland. If you can't explain and defend your value, don't expect hospitals to understand and see it either.

Differences Between Critical Care and Emergency Department Levels in the ER In the healthcare system, particularly in emergency settings, the distinction between "critical care" and "emergency department (ED) levels" is essential for appropriate patient management, resource allocation, and billing. Both terms refer to levels of patient care within the emergency room (ER), but they denote different intensities of treatment and monitoring. Understanding these distinctions is crucial for healthcare professionals and administrators alike. This article explores the key differences between critical care and ED levels in the ER. 1. Definition of Critical Care vs. ED Levels Critical Care: Critical care refers to the treatment provided to patients with life-threatening conditions that require constant monitoring and high-level interventions. It is typically necessary for patients who are unstable and require intensive treatment to maintain vital organ function. In the ER, critical care includes managing conditions like severe trauma, septic shock, cardiac arrest, respiratory failure, or organ dysfunction. Physicians and nurses who provide critical care must have advanced training in life support and critical interventions. ED Levels: ED levels, often categorized by codes such as Level 1, Level 2, Level 3, etc., represent the various stages of care in the emergency department. These levels are determined by the severity of a patient’s condition and the amount of resources or time required to treat them. Lower levels (like Level 1) involve minor issues that can be resolved quickly with minimal interventions, such as simple sprains, minor infections, or cuts that only require basic treatment. Higher levels indicate more complex cases that require greater medical attention, but they do not reach the intensity or urgency of critical care. 2. Patient Severity and Medical Needs** Critical Care: Patients in need of critical care are usually in life-threatening situations that demand immediate intervention. These patients often require mechanical ventilation, continuous monitoring, IV medications to maintain blood pressure or heart function, or other advanced life support measures. Common examples include severe heart attacks, major strokes, or multi-organ failure. The patient is usually hemodynamically unstable, meaning their blood pressure, heart rate, and other vital signs are abnormal and need constant regulation. ED Levels: In contrast, ED levels vary based on the acuity of the condition. For example, a Level 1 patient may present with minor complaints, such as a cold or small cut. A Level 3 or 4 patient might have moderate health issues such as fractures or non-life-threatening asthma exacerbations. While these cases may require diagnostic tests like X-rays or laboratory work, they don’t need the intensive, round-the-clock monitoring characteristic of critical care. #medicalbilling #medicalcoding #emergencyrooms #Er #coding #healthcare #edlevels

A pneumothorax is when air gets inside your chest cavity and creates pressure against your lung, causing it to collapse partially or fully. Underlying medical conditions, injuries or medical procedures can cause it. Go to the nearest emergency department if you have symptoms of a pneumothorax, including difficulty breathing, chest pain or blue skin, nails or lips pneumothorax (collapsed lung) happens when there’s air in the space between your chest wall and your lung (pleural space). Air in the pleural space can build up and press against your lung, causing it to partially or fully collapse. Pneumothorax is also called a punctured lung The two main types of pneumothorax are spontaneous and traumatic. Spontaneous pneumothorax A spontaneous pneumothorax is a collapsed lung that happens without an injury. Types include: Primary spontaneous pneumothorax: When no underlying health condition or disease causes the collapsed lung. This can happen if abnormal air pockets in your lung (blebs) break apart and release air. Secondary spontaneous pneumothorax: Certain lung diseases can lead to a collapsed lung. This can happen when your lung is blocked, causing bulging areas (bullae) that can burst. Traumatic pneumothorax Injuries and medical procedures can cause a traumatic pneumothorax. Types include: Injury-related pneumothorax: When injury to your chest, like a fractured rib or knife wound, punctures your lung. Iatrogenic pneumothorax: When your lung is punctured during a medical procedure, like a lung biopsy or a central venous line insertion. Other types of pneumothorax Other types of pneumothorax include: Tension pneumothorax: When air can get into your lungs but can’t get out. The one-way valve effect causes pressure to build up inside of your chest. This is a serious form of pneumothorax that’s a medical emergency. Catamenial pneumothorax: A rare condition that can affect people with endometriosis. Endometrial tissue growing outside of your uterus can form cysts that can bleed into the pleural space, causing your lung to collapse. The seriousness of a punctured lung depends on the cause and how much of your lung is collapsed. Some cases aren’t serious, and some are medical emergencies. A healthcare provider can tell you how much of your lung is collapsed and what your treatment Signs and symptoms of a pneumothorax include: Chest pain on one side, especially when taking breaths. Cough. Fast breathing. Fast heart rate. FatigueFatigue Providers usually diagnose a collapsed lung by listening to your lungs and by using imaging. This includes chest X-rays, CT scans (computed tomography scans) or a lung ultrasound. They may also use an arterial blood gas test to measure the levels of oxygen and carbon dioxide in your blood. #RaiseAgainstAutism #PinnacleSaysItAll #PinnacleBloomsNetwork #1AutismTherapyCentresNetwork

Reducing the risk of Nosocomial Infections in the ICU through the application of preventive measures was one of the topics debated at the Perioperative Medicine and Intensive Care Conference at the end of June 2024 - Cluj-Napoca/Romania : https://lnkd.in/dUJgEJBt?One of the procedures indicated to be practiced in the ICU for Avoiding Ventilator Associated Pneumonia is subglottic secretion drainage. In the article published in ICU Management&Practice with the title Errors in Nursing Interventions in Critically Ill Patients, we notice among other interventions in the nursing interventions in the ICU, ? ?Given its invasive nature, the aspiration of secretions carries (in Routine Endotracheal Tube Secretion Aspiration)?a high risk of complications, including hypoxemia, trauma, cardiac arrest, and potentially fatal outcomes. ? and another article ? Multiple complications associated with high cuff pressures have been reported, including tracheal mucosal ischaemia, mucosal inflammation, stridor post-extubation, tracheal ulceration, granulation and stenosis, tracheo-oesophageal fistula, tracheomalacia and tracheal rupture. In contrast, common difficulties experienced with low cuff pressures include inadequate ventilation due to loss of tidal volume and micro-aspiration, potentially resulting in ventilator associated complications. ? Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland. A possible technical solution in removing these complications could be TrachFlush - innovative device - VAP prevention & tracheal secretion removal without the need for suction, through the 2 features: Cuff Control and Flush Control

?? ??????'?? ?????????? ???????? ???? ?????? ???? ?????? ?????????? ???????? ?????? ?????????? ???????? ??????. YOU might think Reps are ????????????????? (Hospital Administration) or ?????????????????? (Reps). Here's how I would value Reps in the OR. ??'?? ?????????? ???????? ?????????? ?????? ?????????? ???????? ???????????????? ???? ?????????? ????????????????. To reflect the good work good coverage reps do... ?????????????? ?????????????? ???? ???????? ?????????? ???? ????????. ???????? ????????: ???????????????? ???????? ?????? ???? ???????? (5 min at $50/min = $250) ???????????????? ?????????????? ???????? (5 min = $250) ???????????????????? ?????????????? ?? ?????????????? ???? "?????????? ???? ???????? ????????/????????????????????/?????????????? ??????????" (5 min = $250) ??$?????? ?????? ??????????????????. Not bad. Also, 2 Coordinators the hospital would have to hire for logistics ($150,000 fully burdened) And 3 more SPD people go put everything back together. ($150,000 fully burdened) ????????'?? ???? ???????? ?????? ?????????????? ???? ?????? ?????????? ???????????????? ????????...?????????? ????????. ?????????????????? ???? ?????? ?????????? ???? ??????????????????????. Our high-revenue generating OR and SPD are understaffed. Every minute wasted ???????????????????????????????? ??infection potential, blood loss and ↘? outcomes. Every minute wasted ?????????????? cases ↘? OR utilization, ??costs and frustrates staff/surgeons. An ???????????????????? ???? $??,??????,?????? annually in total joint implants delivers 1000 implants ($4,000/implant), Instruments and 2 cover reps and $????,??????,?????? ?????? ???????? ?????????????? (reimbursement) ???????????????????? ???????????????? ??????????????: ??$350,000 and 5 FTEs avoided ??$750,000 OR intraop times saved ??$1,000,000 in instrument set purchases avoided. (??? ???????, ???????????? ?????????? ????? ??????????????????????, ????????'?? ?????) ???????????????????? ???????? ??????????????: ↗? In surgeon satisfaction ↗? In OR Staff Satisfaction ↗? SPD staff Satisfaction ↗? HCAHPS scores ↘? In infection rates (Despite what Rep Scrubs says about Infection Prevention) 2 Reps to handle 1000 cases are worth about $??,??????,?????? in costs ??????????????. $??????,?????? ????????. Not to mention all the other "qualitative" stuff. But we are talking to the C-Suite. So reps... ???????????? ???????? ????????????... "They couldn't do cases here without us". It's melodramatic and hyperbolic. Try this instead... ???????? ?????????????? ???????????????? ???? ??????????????????????, ???????????????? ???????????????? ?????? ?????????????? ????????????????????????, ?????????????? ?????????????? ???????????? ?????? ???????????????? ?????????????????? ??????????. ?????? ?????? ?? ?????????? ???????????????? ??????????????????'?? ??????????. ?????????? ???????????? ???????? ????. #sales #medicaldevices

Daily Critical Care Pearls #175: Sedatives and ICU Delirium ?? Both the 2013 and?2018 SCCM guidelines for sedation?in the ICU recommend avoiding benzodiazepine infusions for sedation in the ICU. The reason for this is in part concern that benzodiazepines cause more delirium than non-benzodiazepine-based sedatives ?? These guidelines also recommend using light sedation over deep sedation whenever possible for the same purpose – avoiding delirium ?? A retrospective cohort study, published in Critical Care Medicine and involving over 10,000 patients, compared propofol and benzodiazepine-based ICU sedation to determine the risk of each strategy on post-extubation delirium ?? The analysis found that a higher proportion of days under deep sedation was associated with 3 fewer delirium-free days post-extubation. The interesting finding was that the use of benzodiazepines compared with propofol only increased the risk of post-extubation delirium in patients who received a high proportion of deep sedation ?? The cohort of benzodiazepine patients who received a low proportion of deep sedation did not have a higher risk of delirium compared with patients who received propofol ?? While this data will not lead to benzodiazepines becoming 1st line sedatives in ICU patients, it does provide useful information that when benzos are used, care should be taken to limit or eliminate the time spent in deep sedation. The article can be accessed at: https://lnkd.in/dT6Avgdh #criticalcare #clinicalpharmacy #medicine #pearls