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A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

Curry JP, Jungquist CR - Patient Saf Surg (2014)

Bottom Line: Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCLA Department of Anesthesiology, Hoag Memorial Hospital Presbyterian, One Hoag Drive, 92663 Newport Beach, CA, USA.

ABSTRACT
Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

No MeSH data available.


Related in: MedlinePlus

Lung capacities and volumes.
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Related In: Results  -  Collection

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Figure 1: Lung capacities and volumes.

Mentions: Functional Residual Capacity (FRC) depicted above in Figure 1 is an important, albeit virtual anatomic structure whose job is tocontinually provide our bodies any additionally needed oxygen beyond that beingdelivered within our moment to moment tidal volumes, so to maintain thestability our arterial oxygen content. It functions largely as an oxygenreservoir, playing a vitally important role as a necessary and constantcontributor to our respiratory physiology, maintaining our generally stablearterial oxygen saturations. FRC is a combination of two real and separateanatomic volumes called Expiratory Reserve Volume and Residual Volume, but ismore easily remembered as the lung air left over after normal exhalation. Ourlungs hold approximately 6 L of air for men and less than 5 L forwomen at full capacity, achieved only during deepest inspiration. But on averageour lungs normally operate at rest with our taking in tidal volume(VT) breaths of 500 ml ‘atop’ the FRC.Exhalation occurs approximately 16 times a minute leaving on average 2 L ofair behind. Without our FRC, the tidal volumes we depend on to‘freshen’ our FRC would only be capable of introducing oxygen intoour circulations during a small portion of our ventilatory cycles. The FRC addsa comfortable cushion, allowing for continual restocking of oxygen desaturatedblood that recurs reliably (to a point) even when lungs are partially damaged orbreathing stops over short time intervals, like when consciously holding ourbreaths or with short episodic airway losses. Unfortunately, more prolongedapneas can deplete this FRC reservoir regardless how robust it might be undernormal circumstances, which is germane to our coming discussions. But ourprimary reason for discussing FRC here is that all three RECC Patterns ofRespiratory Dysfunction can be thought to have their indiviually distinctpathologic influences on it.


A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

Curry JP, Jungquist CR - Patient Saf Surg (2014)

Lung capacities and volumes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4109792&req=5

Figure 1: Lung capacities and volumes.
Mentions: Functional Residual Capacity (FRC) depicted above in Figure 1 is an important, albeit virtual anatomic structure whose job is tocontinually provide our bodies any additionally needed oxygen beyond that beingdelivered within our moment to moment tidal volumes, so to maintain thestability our arterial oxygen content. It functions largely as an oxygenreservoir, playing a vitally important role as a necessary and constantcontributor to our respiratory physiology, maintaining our generally stablearterial oxygen saturations. FRC is a combination of two real and separateanatomic volumes called Expiratory Reserve Volume and Residual Volume, but ismore easily remembered as the lung air left over after normal exhalation. Ourlungs hold approximately 6 L of air for men and less than 5 L forwomen at full capacity, achieved only during deepest inspiration. But on averageour lungs normally operate at rest with our taking in tidal volume(VT) breaths of 500 ml ‘atop’ the FRC.Exhalation occurs approximately 16 times a minute leaving on average 2 L ofair behind. Without our FRC, the tidal volumes we depend on to‘freshen’ our FRC would only be capable of introducing oxygen intoour circulations during a small portion of our ventilatory cycles. The FRC addsa comfortable cushion, allowing for continual restocking of oxygen desaturatedblood that recurs reliably (to a point) even when lungs are partially damaged orbreathing stops over short time intervals, like when consciously holding ourbreaths or with short episodic airway losses. Unfortunately, more prolongedapneas can deplete this FRC reservoir regardless how robust it might be undernormal circumstances, which is germane to our coming discussions. But ourprimary reason for discussing FRC here is that all three RECC Patterns ofRespiratory Dysfunction can be thought to have their indiviually distinctpathologic influences on it.

Bottom Line: Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCLA Department of Anesthesiology, Hoag Memorial Hospital Presbyterian, One Hoag Drive, 92663 Newport Beach, CA, USA.

ABSTRACT
Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

No MeSH data available.


Related in: MedlinePlus