|Year : 2017 | Volume
| Issue : 5 | Page : 1-5
|Date of Web Publication||17-Apr-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstract. Saudi Crit Care J 2017;1, Suppl S1:1-5
| A Multifaceted Approach to Prevent Hospital Acquired Pressure Ulcers in a Large Tertiary Care Center|| |
Joan Olivier, D Gangadharan, E Kunjulwa, A Chan, J Guirhem, R Booi, WL Fun, J Lamparas, JD Allchin, Y Arabi
King Abdullah International Medical Research Center, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
Background: Hospital Acquired Pressure Ulcers (HAPU) has been identified by the Adult ICU Medical Surgical Nursing team as a Key Performance Indicator as well as a patient safety initiative. The objective of this study is to achieve “Zero HAPU.” Methods: This quality improvement project was started in January 2011 and is being continued at King Abdul-Aziz Medical City –Riyadh in a 21 bed Adult Medical Surgical Unit. A multidisciplinary team was formed including the Nurses, Physicians, Dieticians, wound care specialist, Physiotherapists and Respiratory therapists responsible for ensuring the implementation of Pressure Ulcer Prevention (PUP) Nursing Sensitive plan of Care Guidelines. A dedicated High Risk PUP team member from the nursing services was also allocated to support and educate the staff. Monthly audits are done using the checklist developed by the HAPU team on the basis of these guidelines. The results are shared and discussed during regular Nursing staff meetings as well on a monthly basis in HAPU meetings. Results: Between 2010-2015 a total of 325 HAPUs were reported, 31 of them were reported in 2010, 68 in 2011, 121 in 2012 and further on the incidence declined from 2013 onwards with 46 in 2013, 42 in 2014 and the lowest of 19 in 2015. Comparing the three stages of pressure ulcers, stage 2 was the highest reported followed by stage 3 and in the last four years none of the stage 4 was reported. The 2012 has the highest number of HAPUs which could be attributed to mandatory reporting. Conclusion: Reducing pressure ulcer rate in the critically ill patients requires multiple approach system implemented at the same time from a tool and/or guidelines that correctly predict the risk to the active engagement of front line staff.
| Incidence and Outcome of Acute Kidney Injury Applying (p-RIFLE) Criteria for Children Receiving Extracorporeal Membrane Oxygenation after Heart Surgery|| |
Raja Abou Elella, Eiad Habib, Pavla Mokrusova, Princy Joseph, Hani Adalaty, Mamdouh AlAhmadi, Zohair AlHalees
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Objective: We aim to systematically define the incidence, clinical course and outcome of AKI while utilizing the p-RIFLE criteria. Sample: All pediatric patients' records that underwent cardiac surgery and required being on ECMO postoperatively, between 1st January 2011 and 1st January 2016 were reviewed. Method: Retrospective, observational study. AKI was classified according to the p-RIFLE criteria 48 hours after ECMO initiation. Demographics and concomitant therapies for all patients were collected. Outcome was assessed by recovery of AKI at time of discharge, ICU stay and mortality. Results: Fifty-nine patients needed ECMO after cardiac surgery during the study period. Their mean age & weight was 11±16.5 month & 5.5±3.6 kg respectively. All patients had central VA ECMO inserted. A total of 53 patients (90%) developed AKI after ECMO initiation. The majority of patients (57%) were categorized as p RIFLE-Failure, having a higher mortality rate (28/34 patients, 82%) in comparison to the p RIFLE-Injury and p RIFLE-Risk groups. A total of 29 patients (49%) required either peritoneal dialysis (PD), or renal replacement therapy (RRT) or both. There was a statistically significant difference between mean ECMO duration and ICU stay for patients with AKI (9±8) & (37±41) days and non-AKI patients (6±2) & (21±5) days with p 0.02 & 0.03 respectively. The overall mortality rate was 58%, with a significant difference (P = 0.03), between AKI and non-AKI groups. All the patients who survived had normal creatinine clearance at hospital discharge. Conclusion: There is a high incidence of AKI in pediatric patients requiring ECMO after cardiac surgery, and it is associated with higher mortality, increased ECMO duration, and increased ventilator days. The pediatric validated pRIFLE classification system is useful in this particular patient population. Summary: AKI (acute kidney injury) is common in patients treated with extracorporeal membrane oxygenation (ECMO). The RIFLE criteria demonstrated clinical relevance for diagnosing AKI and classifying its severity.
| The Comprehensive Unit Safety Program for Mechanically Ventilated Patients Project in Saudi Arabian Intensive Care Units|| |
Department of Intensive Care, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Objective: To describe the results of a multicenter national quality improvement project for improving the care of mechanically ventilated patients. Methods: A total of 15 ICUs from 6 hospitals in Saudi Arabia participated in the Comprehensive Unit Safety Program for Mechanically Ventilated Patients (CUSP 4 MVP) Project in collaboration with the Armstrong Institute for Patient Safety, Johns Hopkins University over a one year period (Nov 2015-Nov 2016). The project included multiple interventions (CUSP team formation, training, audit, and feedback) to improve several aspects of the care of mechanically ventilated patients following evidence-based guidelines. We compared the performance of different indicators in the between the last 4 months compared to the first 8 months of the project. Results: The cohort included 10124 patient days for 2634 patients. Over the intervention period, there was significant increase in the use of subglottic endotracheal tubes from 43% (663/1542) to 57% (287/505) p < 0.0001, increase in days without sedation from 54% (3816/7017) to 71% (2197/3111) p < 0.0001, and an associated reduction in mortality from 21% (372/1747) to 16% (147/887) p = 0.005. There was no significant change in ventilator associated events or the duration of mechanical ventilation. Conclusions: This project demonstrates the feasibility of performing a multicenter quality improvement project. Over the relatively short period of time, there was significant improvement in key indicators of the care of mechanically ventilated patients with reduction in mortality. A large-scale project with a longer duration may lead to major impact on the care of mechanically ventilated patients in Saudi Arabia.
| Saudi Family Perceptions of Family Witnessed Resuscitation in the Adult Critical Care Setting|| |
Abdulaziz Alshaer, Khaled Alfaraidy, Florence Morcom, Wasaif Alqahtani, Zahra AlSadah
Intensive Care Unit, King Fahad Military Hospital, Dahran, Saudi Arabia
Background: During cardio-pulmonary resuscitation, family members are usually pushed out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Some health organizations worldwide such as American Heart Association and the Resuscitation Council in the UK supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such polices yet. This is the first study explores the Saudi family member's opinion for family witness resuscitation in adult critical care setting. Objectives: To investigate whether patients next of kin would like to have been present in the resuscitation room during attempted cardiopulmonary resuscitation of their relative, and their experience or knowledge of what is involved in cardiopulmonary resuscitation. Methods: A retrospective, descriptive telephone survey of families of patients who had admitted in critical cares areas from January 2016 to June 2016. A family presence survey was developed to determine the desires, beliefs, and concerns about family witnessed resuscitation. Results: Out of the 235 respondents 143 (60.9%) wanted to be present into the room of their loved one just before death while CPR was going on. 182 (77.4%) of the respondents believed that the family members should be with their loved one before death. More than half 141 (60.0%) of the respondents believed that their presence might have eased the suffering of the deceased. 157 (66.8%) of the family members thought that their presence with the deceased in their last moments could have helped their sorrows and sadness. Conclusion: Most relatives of patients requiring cardiopulmonary resuscitation would like to be offered the possibility of being in the resuscitation room; this could have several benefits, so this study suggests that institutions should consider establishing programs of witnessed cardio-pulmonary resuscitation for family members.
| The Impact of Temperature and Time Variation in Various Parameters of Arterial Blood Gas Analysis|| |
Tayf Hamad Bin Sheeha, Jaylan Ismail Almas, Raghad Abdullatif Algosi, Chris Mathew, Kavita Sudersanadas, Winnie Philip
College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Introduction: An arterial blood gasses test is a commonly ordered test in hospitals, particularly in ICU settings, where the results almost have the potential to elect an immediate or urgent response from the healthcare team. The results of arterial blood gasses can, however, be inaccurate due to pre-analytic factors such as storage temperature and time delay. Objective: To evaluate the impact of temperature and time variation on ABG parameters at two different temperatures and a three-timed interval. Methods: Arterial blood samples were obtained from patients with an indwelling arterial line catheter; one sample was stored at room temperature (23-26°C) while the other sample was kept on ice (0-4°C). ABG parameters and electrolytes were measured at a three-timed interval 0, 15 and 30 minutes. Data was analyzed using SPSS (version 22). Statistical analysis of data involved with mean and standard deviation of all variance. The study was approved by IRB of KAIMRC. Results: In 15 minutes, there were no clinical or statistically significant change in ABG parameters that were stored in room temperature or ice. In 30 minutes, the samples that were stored at room temperature showed clinically significant decrease in pH, Ca2+ and increase in K+. In 30 minutes, the samples that were stored at ice showed decrease in the pH and increase in PO2. But, statistically there were no significant changes with P value > 0.05. Conclusion: In order to reduce the incidence of pre-analytic errors in ABG and electrolytes analysis, samples should be analyzed immediately if the sample is stored at room temperature and up to 15 minutes if stored on ice.
| Pervasiveness, Occurrence and Consequences of Chronic Obstructive Pulmonary Disease among Saudi Population|| |
Noora Mumenah, Gadah Al-Oshish, Sahar Aljoiser, Salem Al Qahtani1, Kavita Sudersanadas2, Winnie Philip3
Respiratory Therapy Program, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Departments of 1Respiratory Therapy, 2Nutrition and 3Biostatistics, College of Applied Medical Sciences, Riyadh, Saudi Arabia
Background: Chronic Obstructive Pulmonary Disease (COPD) is a condition characterized by an airway obstruction which is progressive & irreversible that leads to difficulty in breathing. The current study was conducted as there is paucity of data with respect to the pervasiveness and occurrence and outcome of COPD in KSA. Objectives: The aim of the study is to determine the pervasiveness, occurrence and consequences of COPD among Saudi population who were registered in King Abdul-Aziz Medical City (KAMC), Riyadh. Methods: 140 adults aged ≥40 years from both genders with COPD and visited KAMC during the period from 1 June to 31 September/2016 formed the subjects of this retrospective study. Data with respect to diagnostic parameters, management measures and treatment modalities were taken. The data was analyzed by using SPSS (Version 22). The results of the study were elucidated by frequency distributions, percentage, mean, standard deviation and Wilcoxon signed rank test. Results: The results of the study indicated that the pervasiveness of COPD among the Saudi population was 66.66 per cent with the rate of occurrence of 2.85%. The outcome of COPD management indicated that the majority of the subjects discharged with home ventilation (60.71 per cent), 21.42 per cent were shifted from ICU to different wards whereas 15.71 per cent were discharged in stable condition. During the period of study, it was observed that 2.14 per cent were of the subjects died in the hospital due to COPD. Conclusion: The study found that there is very high pervasiveness of COPD (66.66%) with the rate of occurrence of 2.85% among Saudi population. The outcome of COPD ranged from living with home ventilation to mortality.
Keywords: Chronic obstructive pulmonary disease, management and outcome, occurrence, pervasiveness
| Determination of the Most Common Morphological Patterns of Anemia among Saudi Anemic Patients Attending King Abdulaziz Medical City-Riyadh|| |
Abdullah Mesfer Al Qahtani, Mohieldin Abass Abdalla Elsayid
Department of Hematology and Immunohematology, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Background: Anemia is a medical condition in which the red blood cells count and hemoglobin are less than normal range. The main causes of anemia are a decrease in red blood cells, decrease of hemoglobin synthesis or increased red blood cells destruction. The aim of this study is to determine the most common morphological pattern of anemia in Saudi anemic patients who were treated in King Abdulaziz Medical City-Riyadh. Methods: A useful method for classification of anemias is based on the morphological appearance of red blood cells in ideal stained blood smear; the main terms used in such classification are normocytic normochromic, microcytic hypochromic and macrocytic anemia. Retrospectively we evaluated the results of complete blood count (CBC) and peripheral blood picture (PBP) of all anemic patients attending during the year 2013. Results: Participants in this study included one hundred fifty patients (13, infants; 27, children, 12, youth, 52, adults and 46, old). The gender distribution showed 70 males and 80 females. The results of (CBC) and (PBP) showed 113 (75.3%) normocytic normochromic patterns, 36 (24%) microcytic hypochromic patterns, and 1 (0.7%) macrocytic patterns. Conclusion: In conclusion the normocytic normochromic pattern of anemia is highly frequent among Saudi population, while the macrocytic pattern of anemia is the lowest. According to gender group microcytic hypochromic pattern of anemia is more common among females, while the normocytic normochromic pattern of anemia is found with high frequency among males.
| Incidence and Outcome of Tracheostomy Patients in Intensive Care Unit of King Abdulaziz Medical City|| |
Arwa Alrowily, Nourah Aldekhayel, Hind Alshabanat, Sreekanth Mohan, Winnie Philip, Farhan Alenezi1,2,3
College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Science, 1Respiratory Therapy Program, College of Applied Medical Sciences, 2College of Medicine, 3King Abdulaziz Medical City, Riyadh, Saudi Arabia
Background: Tracheostomy is one of the common procedures that is performed in the intensive care unit (ICU) for airway management. The primary aim of this study was to review the role of tracheostomy, its benefits and risks in ICUs of King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia with a view to realize factors affecting the patient's outcome. Methods: A retrospective study reviewed the charts of various adult ICUs of KAMC from the patients' medical records. Patients who aged 18 years and above and underwent tracheostomy in the ICU were evaluated for the incidence and hospital outcome. Statistical analysis of the data was done by SPSS (version 22). Frequencies and Percentage were used for categorical variables. Continuous variables were expressed as Mean and SD. To find the relationship between the variables, Pearson Chi square tests were used. Other statistical tests were used depending on the type of variables. Results: Total number of 128 patients was tracheostomies with the predominance of males and with mean age of 61.30 ± 20.05 years. The majority were diagnosed with Stroke/Traumatic Brain Injury (28.1%) followed by Carcinoma (13.3%). The predominant reason for tracheostomy was prolonged intubation 54.7% while the main complication was fever and Infection (30.8%). The mean duration of the ICU length of stay was 37.01 ± 38.60 days. The outcome of this study showed low mortalities for tracheostomy patients. Conclusion: Tracheostomy performed in the ICUs of KAMC was dominantly done in males mainly with the main indication of prolonged intubation. It was associated with fever and Infection as complication and with low mortality rate.
Keywords: Incidence, intensive care, mechanical ventilation, outcome, tracheostomy
| Transforming Healthcare through Performance Measurement|| |
King Fahad Specialist Hospital, Dammam, Saudi Arabia
There are many factors that compel today's leaders to transform healthcare. The economic challenges, the increase demand for healthcare, the heightened awareness of consumers and the demand for better quality of care. Knowing these facts, the leadership and the decision makers in the kingdom of Saudi Arabia have recognized the need to transform the entire healthcare delivery and financing system and have called for strategies to develop the transformation of 2030. Transformation 2030 needs a comprehensive system that will address areas of change and the tools used to measure the effectiveness of these multiple plans. The system should take into account the complexity of the healthcare environment and the need to integrate information from different areas to show the big picture. This presentation will demonstrate how healthcare leaders can effectively lead transformation and make decisions that positively impacts clinical and financial outcomes by using tools that displays comprehensive integrated information in timely fashion.
| Pediatric Emergency Department during the Holidays: Findings from a 10-year Analysis of Visit Rates and Trauma Patterns|| |
Faisal Alhusain, Nada Alhassan, Wijdan Aljohi, Fahd Alrumaih1, Nawfal Aljerian2, Nesrin Alharthy3
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 1College of Medicine, King Saud University, 2Department of Emergency Medicine, King Abdulaziz Medical City, 3Department of Emergency Medicine, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
Background: With recent years, it has been observed that the volume of Emergency Department ED visits has been continuously increasing globally. In Saudi Arabia, from 2003 to 2005, the number of ED visits rate has increased by 29.4%. It has been previously observed that certain days might affect ED visits and trauma patterns. In previous literature, there is controversy regarding the correlation of PED visits during the holiday season. (3) In this study, we aimed to determine the impact of the holidays on overall ED visits, trauma characteristics and rates among children in the PED, in KAMC, Riyadh, Saudi Arabia. Methods: This is a retrospective time-series analysis of ED visits and pediatric trauma from 2004-2013 conducted in KAMC, a tertiary care hospital and level I trauma center in Riyadh. Data Collection: We extracted all emergency visits during the ten years period (1,862,397 cases) from the hospital information system. Additionally, we have included all trauma related visits recorded in the pediatric trauma registry of KAMC from the same period (3641 cases). We marked the days as holidays (including Summer vacation, weekends, Eid Al Fitir, Eid Al Adha, and national day) or non-holidays based on the calendar set for each year. Statistical Analysis: SAS Ver. 9.3 was used for analysis. For descriptive analysis, frequencies and percentages were generated for categorical variables, while mean and standard deviation were calculated for continues variables. Chi square test was used to compare the pattern of trauma visits between holidays and no holidays. Rates of trauma related visits were compared between holidays and non- holidays using negative binomial regression. All results were reported using rate ratio and 95% confidence interval. Significance was declared at P-value < 0.05.
Results: From 2004-2013, out of the 1,862,397 ED visits, 296,346 were pediatric, and 3641 of them were trauma patients [Table 1] and [Figure 1]. Holidays were associated with a decrease rate of PED visits by 13% (P < 0.001) compared to non-holidays. Pediatric trauma was increased during holidays by 30%. The highest percentage of change was observed during the summer, where there is a 32% decrease of all PED visits (P < .0001) [Table 2]. By contrast, during the summer, there was a 56% increase in trauma rates (P < .0001). The weekends had a contrasting effect, with an 8% increase of all PED visits (P = 0.0428) and a 7% decrease in trauma (P = 0.1571). In Eid Al Fitir, all PED visits decreased by 28% (P = .0001), while pediatric trauma increased by 70% (P < .0001). Out of the pediatric trauma patients, 68.3% (2482) were males and majority of the injuries were blunt (73.5%) then burn\scald (16.4%). During non-holidays, almost one third of time of arrival (36.4%) were during Shift A (8:00 am – 3:59 pm), in comparison with 21.9% of holiday trauma patients. Conclusion: Holidays appear to be associated with higher rates of trauma related ED visits and lower rates of ED visits which suggests a potential public health concern. More studies are needed to understand the underlying reasons behind such variations. A nationwide study is also recommended to report the Varity of contributing factors to pediatric trauma in order to build nation preventive strategies.
|Table 1: Demographics of pediatric trauma between holidays and non-holidyas|
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|Figure 1: Impact of holidays on overall pediatric emergency department visits and pediatric trauma|
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|Table 2: Associations between variables in comparison with 21.9% of holiday trauma patients|
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[Table 1], [Table 2]
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