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Ástand og vöktun sjúklinga fyrir óvænta innlögn á gjörgæsludeild

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Authors
Þorsteinn Jónsson
Alma Möller
Lovísa Baldursdóttir
Helga Jónsdóttir
Issue Date
2009-06-01

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Other Titles
Patients’ condition and nursing observation before unplanned admission to the intensive care unit
Citation
Tímarit hjúkrunarfræðinga 2009, 85(3):50-6
Abstract
Tilgangur og markmið. Tilgangur rannsóknarinnar var að skoða ástand og vöktun sjúklinga fyrir óvænta innlögn á gjörgæsludeild. Rannsókninni var ætlað að vekja hjúkrunarfræðinga til umhugsunar um alvarleg og bráð veikindi og efla skilning á mikilvægi vöktunar. Þannig er leitast við að tryggja viðeigandi meðferð fljótt og stuðla um leið að færri óvæntum innlögnum á gjörgæsludeild. Aðferðafræði. Aðferðafræði rannsóknar var afturvirk og lýsandi (retrospective - descriptive) þar sem gögnum var safnað úr sjúkraskrám sjúklinga við óvænta innlögn á gjörgæsludeild Landspítala - háskólasjúkrahúss á rannsóknartímabilinu 1. október 2006 til 31. desember 2006. Óvænt innlögn á gjörgæsludeild var skilgreind sem innlögn sem telst tilkomin vegna alvarlegra eða bráðra veikinda og fór ekki í gegnum skurðstofu. Helstu niðurstöður. Í rannsókninni var safnað gögnum hjá 132 sjúklingum af alls 152 í þýði rannsóknarinnar, þetta er 87% þátttaka. Tæplega helmingur (49%) óvæntra innlagna á gjörgæsludeild kom frá legudeildum LSH. Algengasta ástæða innlagna var öndunarbilun og næst kom sýklasótt. Sjö sjúklingar (5%) voru endurinnlagðir á gjörgæsludeild innan tveggja sólarhringa frá útskrift. Ekki reyndist unnt að reikna stigun bráðveikra sjúklinga (modified early warning score) út frá síðustu skráðu lífeðlisfræðilegu gildum fyrir innlögn á gjörgæsludeild þar sem skráningin var ófullnægjandi. Sá þáttur, sem gaf bestu vísbendingar um alvarleika ástands sjúklinga fyrir óvænta innlögn á gjörgæsludeild, var öndunartíðni en hún var hins vegar lakast skráð. Öndunartíðni var skráð í sjúkraskrá hjá níu sjúklingum af 65 sjúklingum (14%) á legudeildum vaktina fyrir innlögn á gjörgæsludeild. 15 sjúklingar af 65 sjúklingum á legudeildum (23%) fengu 100% súrefni fyrir óvænta innlögn á gjörgæsludeild LSH. Umræða/ályktun. Efla þarf þekkingu, árvekni og skráningu heilbrigðisstarfsfólks á vöktun sjúklinga. Leggja þarf sérstaka áherslu á að bæta vöktun með öndun sjúklinga í ljósi þess að stærstur hluti óvæntra innlagna á gjörgæsludeild er tilkominn vegna vandamála frá öndunarfærum. Liður í að efla vöktun gæti verið fólginn í að innleiða mælitækið stigun bráðveikra sjúklinga sem og að setja á laggirnar sérskipulagt gjörgæsluteymi sem hefur þann tilgang að aðstoða og styðja legudeildir í vöktun og mati bráðveikra og alvarlega veikra sjúklinga.
Aims and objectives. The purpose of this study was to explore and describe the condition and nursing observation of patients prior to emergency admission to intensive care units. The aim of this study was to promote nursing observation and collaboration between general wards and the intensive care units at Landspitali - University Teaching Hospital in Iceland. Methods. The study was retrospective and descriptive. Data was collected from medical records of patients who presented as emergency admissions to the intensive care units at Landspitali University hospital, between October 1st 2006 and December 31st 2006. Results. Data was collected from 132 patients, representing 87% participation of all emergency ICU admissions (152) during the three month period. Almost half (49%) of the admissions came from general wards. Seven patients (5%) were readmitted to the ICU within 48 hours. Respiratory failure was the primary reason for admission, followed by sepsis. Respiratory rate is a good indicator for patients clinical condition prior to their ICU admission, but was at the same time the least documented vital observation in this study. Respiratory rate was documented for nine (14%) patients of 65 patients from general wards prior to ICU admission. The accuracy of the Modified Early Warning Score (MEWS) relies on documentation of physiological parameters, and can be used to assess the need for intervention from the Medical Emergency Team. Lack of patient data from the general wards in this study diminished the effectiveness of this risk assessment tool. Conclusion. There is a need to promote nursing education and awareness regarding the importance of recording vital observations in patients. This particularly applies to documentation of respiratory rate, as this study has shown that respiratory failure is the primary cause of emergency in-patient admission to intensive care. One part in prompting nursing observation is to implement Modified Early Warning Score (MEWS) to regular practice on general wards. Another, is the implementation of a Medical Emergency Team service as a strategy to improve patient care.
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