专家从不同角度探索,降低ICU中的医疗错误

Looking at Various Perspectives, Researchers Seek to Reduce Errors in the ICU
Disclosures
Antonios Liolios, MD
Introduction
Medical errors have recently received international attention as a cause of excessive and possibly preventable morbidity and mortality. Errors in the intensive care unit (ICU) environment play an even greater role, as minor omissions or deviations from standard therapy may have dramatic consequences. A panel of critical care experts evaluated the occurrence of errors in the ICU and their relation to the ICU organization and to the presence of an intensivist-directed team.

  The ICU From the Medical Perspective
  The ICU From the Surgical Perspective
  The ICU From the Anesthesia Perspective
  The ICU From the Nursing Perspective
  The ICU From the Pharmacy Perspective

Conclusions
  he ICU is an area where patients with complicated conditions are cared for by multidisciplinary teams and receive complex and interactive treatment. Errors do happen in this setting, and it is crucial to develop an environment of trust that will promote error reporting and registration. In the complex ICU milieu, errors do occur mainly because of system failures. Establishing strategies to improve the system's performance is crucial.
  The direction of the ICU by a dedicated and certified intensivist helps optimize patient care and even reduce mortality and cost. Even when an intensivist cannot be physically present, telemedicine has a favorable effect on patients' outcomes. Nursing staff shortage is a growing and serious problem as higher nurse to patient ratios have been shown to increase mortality and complications. The pharmacist plays a very important role in the ICU as his or her regular presence in ICU rounds as a full ICU member has considerably decreased prescription errors. Newer technologies substantially assist in decreasing adverse drug events.
  Overall, the ICU is a very sophisticated and exponentially growing complex environment. It should be kept in mind, though, that human vigilance and direct physician-patient interaction are the most important and often overlooked factors that prevent errors. Despite much improvement, humans do not go along well with machines. Even with the newest models of monitoring or drug administering devices, a human may be easily confused and the patient's care jeopardized. Spending more time at the bedside and obtaining a more detailed history are often the most essential factors that will help prevent an error or recognize it in time.
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