Scrutinizing Hospital Quality: Preventing Mishaps In The Intensive Care Units

Intensive care is, without a doubt, the scariest part of any hospital

. Some of the more recently constructed intensive care units (ICUs) look like a scene in a science fiction movie, with all the electronic monitoring devices and life-support machines. Most people who have to stay in such places are critically ill and need a lot more than a regular hospital floor can provide. Part of dealing with catastrophic illness is the intimidating effect of the high-technology machines. Nurses and physicians usually connect critically ill patients to such equipment by attaching wires to the skin and inserting tubes into various parts of the anatomy. The sights and sounds of all this will understandably generate feelings of apprehension and may prevent you from being able to scrutinize the services objectively. This feeling of being overwhelmed is simply a response to finding yourself in unfamiliar territory. In order to avoid being intimidated and be able to evaluate the quality of the services being provided, it is essential to learn a few basic facts about the equipment, multiple drug administration, blood transfusion, dialysis, and staffing in critical care for adults, children (pediatrics), and newborn infants (neonates).

Although we can also find the same high-tech devices and complications on regular floors, we shall explore those in this chapter because they are more common in the critical care areas. We shall also look at a strange phenomenon called ICU psychosis, which is a common reaction to all the elements of critical care. Finally, in the last segment of this series, we will look into standing orders, appropriate staffing levels, and the code (cardiopulmonary resuscitation).

What You Need to Know About Wires and Tubes

The wires adhere to the chest skin surface with sticky pads for monitoring the heart rate and rhythm. Sometimes you will find multiple wires attached to the scalp and hooked up to an electroencephalograph. This measures brain wave patterns. These monitoring systems are benign and do not directly cause any complications. However, the monitor screen is only as good as the person who is watching it. If no one is keeping an eye on it, then it is useless. Therefore, when you arrive on the unit, your first question should be, "Who is watching the monitors?" Although these electronic gadgets all have alarm systems, many staff members learn to ignore them because they often go off for no reason. The danger associated with cardiac monitors is the possibility that a potentially lethal heart rhythm and/or rate would appear on the display and no one would notice.

There are six different functions for the various-sized plastic tubes, which are the same for infants and children as for adults: infusion, blood and blood product transfusion, feeding, drainage, monitoring, and breathing. We'll look at each of these, go over the most common threatening complications associated with each, and learn how to prevent permanent damage. Although some complications cannot be avoided, most often the difference between a complication resulting in permanent injury or not depends upon how the nurses and doctors respond - with the nurses being the first line of defense (to be continued).

by: Moshe Sharon

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