Using a Best Practice Approach to Prevent Treatment Interference in Critical Care

Abstract

Treatment interference, also known as therapy disruption, device disruption, or self extubation, is a common and especially difficult clinical problem in critical care. This paper presents creative and practical clinical innovations and relevant research findings as a "best practice approach" to prevent treatment interference in critical care settings. Key principles are presented to guide patient assessment and selection of nursing strategies. Nursing assessment parameters are described and a wide range of nonrestraint strategies are discussed.

Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes

“…Though not observed in this series, self-extubation has been associated with a higher ICU mortality rate [26]. Also, patientinitiated device removal incurs higher ICU costs [27,32].…”

Nurse and Patient Interaction Behaviors’ Effects on Nursing Care Quality for Mechanically Ventilated Older Adults in the ICU

“…Improved nurse-patient communication is important because it has the potential to enhance patient understanding of the treatment plan and decrease behaviors that lead to adverse outcomes. Physical restraint use, pain management, sedation use, and unplanned device removal are nursing care quality indicators potentially linked to communication (Alasad & Ahmad, 2005; Happ, 2000; Happ, Tuite, Dobbin, DiVirgilio-Thomas, & Kitutu, 2004; Weinert, Chlan, & Gross, 2001). To best inform communication interventions and intervention testing, research is needed to understand how nurse-patient interaction behaviors affect nursing care quality and safety for vulnerable, critically older adults.…”