The extended use of pentobarbital coma in head‐injured patients creates a feeding problem because of the drug‐induced ileus. We evaluated the tolerance and safety of enteral feeding for head‐injured patients in pentobarbital coma. Baseline nutritional assessments of the 22 patients revealed no severe nutritional deficits. Pentobarbital was initiated on admission at a rate of 128 ± 39 mg/hr for 9.9 ± 6.0 days. Enteral feedings were started at a rate of 25 ml/hr and were increased according to tolerance to a predetermined maximum rate which required 6.5 ± 4.5 days. Daily chest x‐rays revealed no aspiration pneumonia. Whereas eight patients tolerated enteral feedings, seven had minor gastrointestinal complications, including diarrhea (n = 5) and constipation (n = 2). A total of 11 patients had residual volumes of 50 ml or more, but only four required alteration of the solution or route of administration. These data indicate that the majority of patients in pentobarbital coma can safely be fed enterally with only minor complications.
AimsIn-situ simulation training indicated the need for accurate setup of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP) prior to newborn resuscitation. Our project aimed to improve the quality of team learning from latent inaccuracies in PIP and PEEP settings, to reduce harm and improve outcomes for newborn infants through a series of targeted interventions.MethodsDuring 2016, we have undertaken a quality improvement project to measure baseline set-up of resuscitaires in the delivery suite and post-natal wards. The first pdsa (plan do study act) cycle was performed through a prospective daily check of all resuscitaires (n=12) PIP and PEEP settings over a one week period. When issues were identified, an ‘on the spot’ one to one simulation training of midwifery staff was performed. During the second pdsa cycle we introduced ‘resuscitaire flashcards’ to support all team’s learning and to be used as aid memoire for the daily safety checklist on delivery suite.ResultsDuring the first pdsa cycle, 10% of the resuscitaires PIP was high (>30 cm H2O) and PEEP was set incorrectly in 48% of the cases. Inaccuracies in PEEP were either too high flow settings (>5 cm H2O) in 22% of cases or too low flow settings (<5 cm H2O) in 26% of the cases. Following the interventions, 100% of PIP was correctly set and only 11% of PEEP was inaccurate (high flow for PEEP setting). Overall, this quality improvement programme led to 76% improvement in performance.ConclusionTargeted quality improvement interventions through simulation have improved PIP and PEEP resuscitaires settings. This led to a reduction in latent errors and improved the care given to newborns requiring resuscitation at birth.
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