Preliminary Study On The Implement Of Main Guidelines And Its Influence Factors In An Guidelines And Its Influence Factors In An Intensive Care Unit

Objective:The primary objective of this study was to to investigate the implement of main guidelines and its influence factors in an emergency intensive care unit (EICU) in a tertiary care, university-affiliated hospital. The study also aimed to pursue for potential solutions and improve the quality of ICU care through reviewing foreign experiences.Methods:The cross-sectional investigation was adopted and the study was conducted in an EICU in a general tertiary care university affiliated hospital from January1,2015, to February1,2015. The daily survey focusing on attention and/or implement of head of bed elevation for mechanically ventilated patients, sedation, nutrition therapy, central venous catheter (CVC) and venous thrombus embolism (VTE) was developed based on current main critical care guidelines. The researcher is responsible for interviewing daily with bedside nurses and residents for indicator attention for each patient after morning patient care rounds in the EICU, whereas attending physicians and senior registrars were interviewed only once for the first day of patients admitted into the EICU. The implement of the aforementioned indicators were checked and documented daily at12:00by the researcher. The attention and implement of the above indicators were described generally and then on different periods (weekdays&weekends, the first, second and third ten days of the period), different care teams and different types of residents. Multivariable logistic regression was used to purse for potential influencing factors.Results:1. There are seventy nine patients included in the study during the study period, of them fifty seven (72.2%) were male. There are fifty seven health care providers’ consisted of thirty seven bedside nurses, sixteen residents, two attending physicians, and two senior registrars interviewed during the study period. The response rate of interview with bedside nurses, residents, attending physicians, and senior registrars was99.39%,98.98%,65.96%, and42.11%, respectively.2. The attention rate of head of bed elevation from bedside nurses, residents, attending physicians, and senior registrars was96.50%,63.27%,100%, and0.00%, and the execution rate of head of bed elevation was91.33%. The attention rate of sedation from bedside nurses, residents, attending physicians, and senior registrars was95.34%,65.68%,100%, and75.00%, and the execution rate of sedation was43.22%. The attention rate of nutrition from bedside nurses, residents, attending physicians, and senior registrars was84.07%,86.78%,53.14%,45.16%, and92.31%, and the execution rate of nutrition was43.22%. The attention rate of CVC from residents, attending physicians, and senior registrars was43.40%,94.44%, and27.27%. The attention rate of VTE from residents, attending physicians, and senior registrars was60.29%,77.42%, and73.08%, and the execution rate of VTE was43.22%.3. On weekends&weekdays, the attention rate of head of bed elevation from bedside nurses and residents was96.46%vs96.51%and55.26%vs67.25%, and the execution rate of head of bed elevation was94.34%vs89.86%. The attention rate of sedation from bedside nurses and residents was96.10%vs94.97%and62.34%vs67.30%, and the execution rate of sedation was51.95%vs45.28%. The attention rate of nutrition from bedside nurses and residents was86.46%vs85.05%,88.54%vs88.14%and46.83%vs63.19%, and the execution rate of nutrition was73.02%vs71.20%. The attention rate of CVC from residents was38.55%vs45.60%.In the upper, middle and lower third of the study period, the attention rate of head of bed elevation from bedside nurses, residents, and attending physicians was99.10%vs96.60%vs94.26%,59.05%vs72.41%vs58.20%, and100%vs100%vs100%, and the execution rate of head of bed elevation was85.15%vs92.73%vs95.54%. The attention rate of sedation from bedside nurses, residents, and attending physicians was94.29%vs95.35%vs96.25%,61.43%vs67.44%vs67.55%, and100%vs100%vs100%, and the execution rate of sedation was38.50%vs41.86%vs61.25%. The attention rate of nutrition from bedside nurses, residents, and attending physicians was89.01%vs76.14%vs86.21%,84.62%vs88.64%vs87.07,49.32%vs63.50%vs58.72%, and60.00%vs30.00%vs50.00%, and the execution rate of nutrition was69.86%vs67.63%vs75.58%. The attention rate of CVC from attending physicians and senior registrars was43.68%vs47.25%vs39.08%and83.33%vs100%vs100%.4. On medical care team land2, the attention rate of head of bed elevation from bedside nurses, residents, attending physicians, and senior registrars was97.52%vs95.60%,57.14%vs68.70%,100%vs100%, and0.00%vs0.00%, and the execution rate of head of bed elevation was92.62%vs90.20%. The attention rate of sedation from bedside nurses, residents, attending physicians, and senior registrars was96.15%vs94.90%,62.82%vs67.10%,100%vs100%, and50.00%vs100%, and the execution rate of sedation was35.90%vs53.20%. The attention rate of nutrition from bedside nurses, residents, attending physicians, and senior registrars was81.82%vs82.42%,86.90%vs92.30%,62.88%vs51.30%,50.00%vs38.50%, and100.00%vs66.67%, and the execution rate of nutrition was80.52%vs65.50%. The attention rate of CVC from residents, attending physicians, and senior registrars was36.21%vs48.99%,90.91%vs100.00%, and16.67%vs40.00%. The attention rate of VTE from residents, attending physicians, and senior registrars was67.56%vs51.60%,77.22%vs84.60%, and95.00%vs0.00%, and the execution rate of VTE was85.29%vs81.25%.5. For critical care residents and the other residents, the attention rate of head of bed elevation from mechanically ventilated patients, sedation, nutrition therapy, CVC and VTE was64.41%vs61.34%,66.87%vs63.41%,51.70%vs62.50%,42.56%vs36.00%, and83.02%vs84.62%. For residents in training and in advanced studies, the attention rate of head of bed elevation from mechanically ventilated patients, sedation, nutrition therapy, CVC and VTE was57.62%vs72.52%,61.15%vs73.86%,57.30% vs52.40%,33.53%vs53.61%, and89.29%vs78.95%. The correlation coefficient between the numbers of patients per sickbed admitted during the period and the attention to head of bed elevation for mechanical patients, sedation, nutrition therapy, CVC and VTE was r=-0.57(P=0.04), r=-0.42(P=0.13), r=-0.54(P=0.03), and r=-0.09(P=0.77).6. Weekday&weekends, various care teams, different types of residents and the numbers of patients per sickbed admitted during the period were found to be associated independently with attention to indicators through conducting a separate multivariable logistic regression model.Conclusion:1. The health care providers’ attention to the major guidelines as well as the implement in this EICU were not satisfactory, whereas nurses performed better than residents.2. The experience, level of training, work arrangement, and work intensity of clinicians were the significant factors affecting attention guidelines.3. Electronized-checklists might be valuable for improving compliance with guidelines.