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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

RECC Type I pattern of respiratory dysfunction. Details -SPO2: oxygen saturation; PaCO2: arterialcarbon dioxide tension; PACO2: alveolar carbon dioxidetension; P-50: oxygen tension where hemoglobin is 50% saturated; Ve:minute ventilation; RR: respiratory rate.
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Figure 2: RECC Type I pattern of respiratory dysfunction. Details -SPO2: oxygen saturation; PaCO2: arterialcarbon dioxide tension; PACO2: alveolar carbon dioxidetension; P-50: oxygen tension where hemoglobin is 50% saturated; Ve:minute ventilation; RR: respiratory rate.

Mentions: This pattern of hyperventilation compensated respiratory distress reflects aclinically evolving process associated with microcirculatory failure induced byfamiliar RECC conditions like sepsis, congestive heart failure (CHF),aspiration, and pulmonary embolism (PE). It’s the most common pattern ofour three, with prevalence for respiratory complications reaching as high as2.7% in some postoperative populations [21]. Let’s first examine how the onsets of our four RECC examplesabove disrupt the FRC and its ability to stabilize oxygen saturation. Thepattern unfolds with processes that begin to replace healthy lung (FRC)immediately. With CHF, water does the replacing. In sepsis, it’s pus(inflammatory factors). It’s gastric and bowel content with eventual pusin cases of aspiration, and with pulmonary embolism, portions of the FRC arereplaced immediately (converted to dead space). Identifying the correctreplacement process early, before a critical mass of lung is irreversiblyharmed, becomes essential for optimal recovery.The Type I pattern generallybegins with subtle hyperventilation and a persisting respiratory alkalosis (RA),regardless subsequent progressive increases in anion gap and lactic acid levels.This initial stage occurs well before the development of dominant metabolicacidosis (MA), which is usually associated with its later, and very lateterminal stages. These progressive pattern phases (initially isolated RAfollowed by mixed RA and MA, in turn followed by dominant MA) comprise thetypical progression seen (Illustrated in Figure 2below).


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

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

RECC Type I pattern of respiratory dysfunction. Details -SPO2: oxygen saturation; PaCO2: arterialcarbon dioxide tension; PACO2: alveolar carbon dioxidetension; P-50: oxygen tension where hemoglobin is 50% saturated; Ve:minute ventilation; RR: respiratory rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: RECC Type I pattern of respiratory dysfunction. Details -SPO2: oxygen saturation; PaCO2: arterialcarbon dioxide tension; PACO2: alveolar carbon dioxidetension; P-50: oxygen tension where hemoglobin is 50% saturated; Ve:minute ventilation; RR: respiratory rate.
Mentions: This pattern of hyperventilation compensated respiratory distress reflects aclinically evolving process associated with microcirculatory failure induced byfamiliar RECC conditions like sepsis, congestive heart failure (CHF),aspiration, and pulmonary embolism (PE). It’s the most common pattern ofour three, with prevalence for respiratory complications reaching as high as2.7% in some postoperative populations [21]. Let’s first examine how the onsets of our four RECC examplesabove disrupt the FRC and its ability to stabilize oxygen saturation. Thepattern unfolds with processes that begin to replace healthy lung (FRC)immediately. With CHF, water does the replacing. In sepsis, it’s pus(inflammatory factors). It’s gastric and bowel content with eventual pusin cases of aspiration, and with pulmonary embolism, portions of the FRC arereplaced immediately (converted to dead space). Identifying the correctreplacement process early, before a critical mass of lung is irreversiblyharmed, becomes essential for optimal recovery.The Type I pattern generallybegins with subtle hyperventilation and a persisting respiratory alkalosis (RA),regardless subsequent progressive increases in anion gap and lactic acid levels.This initial stage occurs well before the development of dominant metabolicacidosis (MA), which is usually associated with its later, and very lateterminal stages. These progressive pattern phases (initially isolated RAfollowed by mixed RA and MA, in turn followed by dominant MA) comprise thetypical progression seen (Illustrated in Figure 2below).

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