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Patient Safety and Quality of Care in Intensive Care Medicine

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Rui P. Moreno(Hg.), Andrew Rhodes(Hg.), Christian Putensen(Hg.), Jean-Daniel Chiche(Hg.), Patient Safety and Quality of Care in Intensive Care Medicine (2009), Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, ISBN: 9783954661923

Beschreibung / Abstract

The maxim “Primum non nocere” is almost as old as the practice of medicine. In combination with the principles of beneficence, autonomy and justice, and whilst keeping in mind the confidence and dignity of the patient, it should constitute the basis of our behaviours as physicians and nurses.
Since diagnostic and therapeutic interventions have become more complex and their risk/benefit ratios more difficult to assess, the importance of safety and quality of care rises. Avoiding the infliction of harm on our patients has moved into the focus of clinical medicine. Patient safety is now viewed as a priority even by the Presidency of the European Union.
Physicians in intensive care medicine deal with the most fragile and dependent human beings, often struggling with multiple co-morbid diseases and physiological derangements at the limits of survival. These patients are often reliant on numerous invasive technologies for their survival. Moreover, the almost universal need for multiple pharmacological interventions – combinations of which have often never been rigorously tested before – places the critically ill patients at a very high risk of being harmed by the physician’s interventions.
More than 120 internationally known experts introduce their current knowledge of patient safety and quality of care in intensive care medicine in over 50 chapters covering the following fields:
- Safety in intensive care medicine
- Decision making
- Culture and behaviour
- Structure and processes
- Protocolised medicine
- First, do no harm
- Safety during technical support
- Training, teaching and education
- Risk management
- Ethical issues
- Future approaches
This book should be read by every manager who has responsibility for the acutely ill. It is an invaluable educational and reference tool for physicians and nurses in intensive care medicine and will help to improve the safety and overall care for critically ill patients.

Beschreibung

with contributions from: LM Aitken, R Alvisi, R Amerling, PJD Andrews, A Artigas, D De Backer, N Badjatia, M Bauer, G Bertolini, A Biasi Cavalcanti, JF Bion, BW Böttiger, CSC Bouman, A Boumendil, FA Bozza, J Braithwaite, G Brattebø, FM Brunkhorst, DDG Bugano, M Capuzzo, M Cecconi, W Chaboyer, J Chen, E Coiera, K Colpaert, CR Cooke, JR Curtis, BH Cuthbertson, AL Cuvello Neto, KJ Deans, J Decruyenaere, J-M Dominguez-Roldan, Y Donchin, C Druml, G Dubreuil, R Endacott, A Esteban, R Ferrer, H Flaatten, J Fragata, F Frutos-Vivar, C Garcia-Alfaro, M Garrouste-Orgeas, TD Girard, ARJ Girbes, J Graf, D Grimaldi, ABJ Groeneveld, B Guidet, U Günther, N Harbord, DA Harrison, C Hartog, N Heming, F Hernandez-Hazañas, K Hillman, P Holder, MH Hooper, M Imhoff, U Janssens, JM Kahn, E Knobel, M Knobel, J Lipman, T Lisboa, Y Livne, S Lorent, M Makdisse, A Marques, GD Martich, ML Martinez, SA Mayer, DK Menon, PC Minneci, J-P Mira, X Monnet, RP Moreno, T Muders, C Natanson, A Navas, G Ntoumenopoulos, SA Nurmohamed, HM Oudemans-van Straaten, R Paterson, O Peñuelas, JG Pereira, C Pierrakos, LF Poli-de-Figueiredo, CE Pompilio, D Poole, A Pronovost, C Putensen, K Reinhart, J Rello, A Rhodes, Z Ricci, C Richard, F Rincon, JA Roberts, E Roeb, C Ronco, GD Rubenfeld, D Salgado, JIF Salluh, G Satkurunath, A Schneider, C Schwebel, E Silva, M Singer, EGM Smit, M Soares, L Soufir, A Tabah, J-L Teboul, P Teschendorf, N Theuerkauf, J-F Timsit, M Ulldemolins, A Valentin, JM Varghese, J-L Vincent, B Volpe, CS Waldmann, RR West, S West, JF Winchester, H Wrigge

Inhaltsverzeichnis

  • Cover
  • Titel
  • Editors
  • Preface
  • Content
  • Improving safety in intensive care – What does it mean?
  • A. Safety in Intensive Care Medicine
  • Current definitions of patient safety
  • How unsafe is my ICU?
  • Patient safety – What we have learned over the past years
  • Building a safety culture within the ICU
  • Shall we publish our error rates?
  • Moving from safe ICUs to safe systems
  • B. Decision making
  • Risk/benefit ratios in critical care decisions
  • Safe triage decision
  • C. Culture and behaviour
  • The importance of ICU culture
  • Training teamwork using simulation
  • Efficacy versus efficiency – A safety issue
  • Identifying barriers to change – The gap between perception and practice
  • To err is human. But how to communicate these errors to patients and family?
  • D. Structure andprocesses
  • Quality in critical care
  • Volume and outcome in intensive care
  • Documenting care in the ICU – An expert witness view
  • Open versus closed units
  • Quality and safety in critical care: Rapid response, medical emergency or outreach teams?
  • E. Protocolised medicine
  • Should care be homogenised?
  • Implementing the state of the art – Sepsis bundles
  • Guidelines have done more harm than good
  • Do nurse-led protocols reduce intensive care unit stay?
  • Developing guidelines – The example of the Surviving Sepsis Campaign
  • Protocolised sedation to improve outcomes
  • Protocolised approach to the post-surgical patient improves outcome
  • Electronic Prescribing: Can it reduce error?
  • F. First do no harm
  • Does pharmacokinetics impact on clinical practice?
  • Avoiding toxicity of antibiotics
  • Frequently forgotten factors in empirical antibiotic treatment
  • Primum non nocere: Avoiding harm during mechanical ventilation
  • Avoiding harm in fluid resuscitation: Emerging evidence for the toxicity of synthetic colloids in critically ill patients
  • Avoiding harm in metabolic management
  • Avoiding harm in cardiovascular care
  • Avoiding harm in acute renal failure
  • Avoiding harm in neurocritical care
  • Avoiding harm in CPR
  • Avoiding harm after cardiac surgery
  • Avoiding harm during intra- and inter-hospital transport
  • How do you safely mobilise your intubated and ventilated patient?
  • G. Safety during technical support
  • Patient safety and physiological monitoring
  • Patient safety and respiratory support
  • Patient safety during continuous renal replacement therapy
  • Patient safety and infusion technology
  • Patient safety and health informatics
  • Pulmonary artery catheter: Balance between safe and optimal use
  • H. Training, teaching,and education
  • Approaches to improving the reliability and safety of patient care
  • Core curriculum and competencies for advanced training in neurocritical care – The American way
  • I. Risk management
  • Measuring the impact of Patient Safety Programmes: The Value of Process and Outcome Evaluation
  • Risk adjustment in neurocritical care (the RAIN study)
  • Applying the results of a randomised controlled trial: Caveat emptor
  • J. Ethical issues
  • Protecting the patients, supporting the investigators, transparency for the public – The role of research ethics committees
  • Performing safe and timely identification of the organ donor
  • K. Future approaches
  • Theragnostics: Change we can believe in!

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