Ventilator-associated pneumonia: prevention is better than cure

Background: The prevention of ventilator Assisted Pneumonia (VAP), a hospital acquired infection, among intensive care patients is a major clinical challenge. It is a condition that is associated with high rates of morbidity, mortality, length of stay and hospital costs. Aim: The aim of this paper is to critically review the available literature and identify current evidence based nursing and medical interventions to support practitioners in preventing VAP in their patients. Methods: A literature search using keywords, including ‘ventilator‐associated pneumonia’ were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, however only a small sample came from nursing journals. Only those papers, which discussed specific strategies for managing VAP were selected for analysis and inclusion in this review. Discussion: We identified a number of practical and evidence based strategies that nurses can incorporate into their practice to prevent VAP and to reduce its incidence. In addition, the introduction of newer techniques, advances in equipment and use of multidisciplinary care bundles can further support and improve the quality and delivery of safe patient care. Conclusion: Targeted strategies aimed at preventing VAP, should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Front‐line critical care nurses need to understand the factors which place their patients at risk of developing VAP and, institute evidence‐based interventions that will compromise the patients’ survival and recovery.     

Radiocontrast-induced nephropathy. Prevention is better than cure.

The principal predisposing factor in radiocontrast-induced nephropathy appears to be underlying renal insufficiency. Identifying patients at risk is of paramount importance when a diagnostic study is being chosen. Contrast-reliant studies should be avoided, if possible, in high-risk patients. If challenge with a contrast medium is essential, appropriate risk stratification and adequate patient preparation should be done beforehand. Ultimately, prevention is a better approach than cure.     

Performance requirements of tests performed nearer the patient

Commercial test systems which can be used outside the laboratory are proliferating, but there are doubts about the quality of results obtained when they are used by unskilled staff. Although rapid but approximate results can be invaluable in some clinical situations, they can be disastrous in others, particularly when the results conflict with those obtained by conventional laboratory techniques. The clinician needs to define his requirements for the quality of such tests, and the manufacturer encouraged to produce equipment which gives accurate results, independent of the skill of the operator. The laboratory scientist has an important role in the development and effective application of tests performed nearer the patient.     

The management of a simulated emergency: better teamwork, better performance

Objectives

To determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours.

Methods

Design - Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting - Six secondary and tertiary Maternity Units in Southwest England. Participants - 140 healthcare professionals, in 24 teams. Assessment - Blinded analysis of recorded simulations. Main outcome measures - Correlation of team performance (efficiency conducting key clinical actions, including the administration of an essential drug, magnesium), and generic teamwork scores (using a validated tool that assesses skills and behaviours, by Weller et al.).

Results

There was significant positive correlation between clinical efficiency and teamwork scores across all three dimensions; skills (Kendall's tau_b = 0.54, p < 0.001), behaviours (tau_b = 0.41, p = 0.001), and overall score (tau_b = 0.51, p < 0.001). Better teams administered the essential drug 2½ min more quickly (Mann-Whitney U, p < 0.001).

Conclusions

The clinical conduct of a simulated emergency was strongly linked to generic measures of teamwork. Further studies are needed to elucidate which aspects of team working are critical for team performance, to better inform training programs for multi-professional team working.