BACKGROUND: Patients receiving extracorporeal membrane oxygenation have high mortality rates, yet integrating palliative care for this population is not standardized. LOCAL PROBLEM: This quality improvement project evalu...BACKGROUND: Patients receiving extracorporeal membrane oxygenation have high mortality rates, yet integrating palliative care for this population is not standardized. LOCAL PROBLEM: This quality improvement project evaluated whether early palliative care consultation for adult patients receiving extracorporeal membrane oxygenation would reduce the time to consultation and shorten cardiothoracic intensive care unit and overall hospital stays. METHODS: An extracorporeal membrane oxygenation rounding checklist was introduced into daily interprofessional rounds to guide integration of palliative care. The intervention was structured according to the Donabedian model of assessing care quality. The Donabedian model is based on improving patient outcomes by improving clinical processes. Retrospective and prospective length-of-stay data were collected and analyzed. RESULTS: Among 60 patients (mean age, 54 years; 62% male; 58% White), the mean time from admission to palliative care consultation decreased from 10.8 days to 6.1 days (P = .18). The mean intensive care unit stay decreased from 26 days to 22.8 days (P = .64). Total hospital stay decreased from 31 days to 27.3 days (P = .58). CONCLUSION: Although not statistically significant, the findings are clinically and economically meaningful, suggesting that early palliative care consultation can shorten intensive care unit and hospital stays for patients receiving extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation checklist was easy to use, requiring minimal training. Full implementation was achieved in less than 7 days, making the intervention replicable across health care facilities. Further research with larger samples is needed to better understand the impact of palliative care in this population.
BACKGROUND: Critical care nurses often experience stress, anxiety, and burnout as a result of their high-stress work environments, frequent life-or-death situations, frequent need to make critical decisions, and high-acu...BACKGROUND: Critical care nurses often experience stress, anxiety, and burnout as a result of their high-stress work environments, frequent life-or-death situations, frequent need to make critical decisions, and high-acuity patients. These negative emotional states-which were exacerbated by the COVID-19 pandemic-may affect their work, personal lives, and overall well-being. LOCAL PROBLEM: A survey of employees of a cardiovascular specialty hospital showed that 9.7% of nurses working in the intensive care unit rated their degree of stress at work as unmanageable, with 8.3% reporting moderate stress. In addition, 11.1% of the nurses reported severe burnout. Therefore, a quality improvement project was implemented to reduce stress, anxiety, and burnout levels among these critical care nurses by at least 30% over a 3-month period using the Emotional Freedom Technique. METHODS: A workshop was developed for critical care nurses on how to appropriately use the Emotional Freedom Technique to reduce stress, anxiety, and burnout. Participating nurses were surveyed before and after the intervention. All of the participants demonstrated understanding using the educational technique of return demonstration. RESULTS: A total of 68 critical care nurses were invited to participate in this project, of whom 64 attended the workshop and completed the surveys. Use of the Emotional Freedom Technique resulted in overall reductions in stress, anxiety, and burnout of 35%, 18%, and 3%, respectively, with the results being statistically significant (P < .05). CONCLUSION: Use of the Emotional Freedom Technique is an effective strategy for reducing stress, anxiety, and burnout among critical care nurses.
England MT, Wilkes C, Hauth M
… +2 more, Bruno J, Canada T
Crit Care Nurse
· 2026 Feb · PMID 41620113
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BACKGROUND: Electrolyte abnormalities occur often in critically ill patients with cancer. Correction of these abnormalities improves patient outcomes. Administration of intravenous electrolytes is associated with risks....BACKGROUND: Electrolyte abnormalities occur often in critically ill patients with cancer. Correction of these abnormalities improves patient outcomes. Administration of intravenous electrolytes is associated with risks. Order sets have been implemented to improve standardization, timeliness of administration, and patient safety. LOCAL PROBLEM: At a large academic cancer center, a nurse-driven central venous catheter intravenous electrolyte replacement order set was available in the intensive care unit, but adherence and barriers to use had not been assessed. The purpose of this quality improvement project was to define the baseline adherence rate to the electrolyte replacement order set. METHODS: A retrospective medical record review was conducted of medical intensive care unit patients with an active intravenous electrolyte replacement order set. All intravenous electrolytes administered within the first 72 hours of the intensive care unit stay were assessed for order set adherence. RESULTS: The order set adherence rate was 78.5%. The mean turnaround time from laboratory result to electrolyte administration was 3.1 hours. Deviations were predominantly characterized by administration of a lower electrolyte dose than indicated by the order set and administration of the incorrect electrolyte salt form. CONCLUSION: The intensive care unit intravenous order set adherence rate revealed issues with administration of potassium, magnesium, and phosphate. In response, the interprofessional intensive care unit team implemented an electronic health record feature that displays the most recent electrolyte laboratory result for nurse review before electrolyte administration.
Crit Care Nurse
· 2026 Feb · PMID 41620106
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BACKGROUND: Moral distress continues to strain the nursing workforce, impacting job satisfaction, turnover, interprofessional relationships, and quality of care. The critical care setting is especially conducive to distr...BACKGROUND: Moral distress continues to strain the nursing workforce, impacting job satisfaction, turnover, interprofessional relationships, and quality of care. The critical care setting is especially conducive to distress due to complexity of care, family dynamics, mortality, and interprofessional communication. LOCAL PROBLEM: Stress level is one indicator measured at our urban health care center, but nurses may not be familiar with the phenomenon of moral distress. Moral distress is unique to the individual; therefore, training on its existence and ways to reduce it should include a variety of evidence-based interventions. METHODS: In this quality improvement initiative we used the Measure of Moral Distress for Healthcare Professionals survey to assess the influence of a new moral distress and peer coaching program, the RAISE program, on moral distress in the critical care environment. INTERVENTIONS: The RAISE Program incorporates conflict resolution, communication, recognition, and self-care techniques. Charge nurses (primary learners) received training in the RAISE program and coached bedside nurses (secondary learners) for 3 months. The dissemination of educational and coaching efforts and its effect on moral distress was assessed before and after program implementation. RESULTS: Moral distress after RAISE program implementation was statistically significantly reduced for primary learners (P = .002) but not for secondary learners (P = .44) compared with before program implementation. CONCLUSIONS: The RAISE program's educational dissemination and peer-to-peer coaching did not impact moral distress for secondary learners in this short-term quality improvement initiative. However, the RAISE program is a promising intervention for decreasing moral distress in primary learners, as they learn to recognize conflict, advocate, intervene, and support and empower their peers.
Jividen RA, Ford PJ, Sankary L
… +1 more, Morley G
Crit Care Nurse
· 2026 Feb · PMID 41620104
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INTRODUCTION: Extracorporeal membrane oxygenation is a life-sustaining therapy that can produce complex ethical scenarios. Ethical challenges include patient selection and initiation, a frequently abbreviated informed co...INTRODUCTION: Extracorporeal membrane oxygenation is a life-sustaining therapy that can produce complex ethical scenarios. Ethical challenges include patient selection and initiation, a frequently abbreviated informed consent process, ambiguity related to ongoing benefit and withdrawal of extracorporeal membrane oxygenation, resource intensity, and moral distress. CLINICAL FINDINGS AND DIAGNOSIS: A 50-year-old man with mucinous colorectal carcinoma was admitted to the hospital. He encountered treatment complications and received cannulation for extracorporeal membrane oxygenation twice during his stay. Ethical issues included the potentially limited physiological benefits of extracorporeal membrane oxygenation, fluctuations in his decision-making capacity, and need to ensure that decisions honored his preferences. INTERVENTIONS: A novel Values Balancing framework is used to identify and address ethical issues, possible courses of action, applicable values, open questions, other perspectives, and ethically supportable courses of action. With this framework, an action plan is established and the team is encouraged to review, reassess, and reflect on outcomes. The framework is applied to the case study. OUTCOMES: The patient was transitioned to comfort care according to his wishes and died in the intensive care unit. CONCLUSION: Using a structured framework to approach ethical challenges may facilitate decision-making and collaborative discussions that optimize ethical approaches to extracorporeal membrane oxygenation. Critical care nurses can assist with goals-of-care discussions, support families, and advocate for early involvement of bioethics and palliative support personnel to navigate ethical challenges.
Galt S, Barg-Walkow L, Bennett H
… +6 more, Smith A, Diaz E, Dunning H, Widmer K, Byrne L, Loi MM
Crit Care Nurse
· 2026 Feb · PMID 41620102
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BACKGROUND: Preventing hospital-acquired conditions is paramount to patient safety. Critically ill children are highly susceptible to hospital-acquired harm. LOCAL PROBLEM: To prevent hospital-acquired conditions, the pe...BACKGROUND: Preventing hospital-acquired conditions is paramount to patient safety. Critically ill children are highly susceptible to hospital-acquired harm. LOCAL PROBLEM: To prevent hospital-acquired conditions, the pediatric intensive care unit at a quaternary care center implemented a novel interprofessional high-risk rounding program to improve unit work culture and address increased hospital-acquired condition rates before and during the COVID-19 pandemic. METHODS: Patients at greatest risk for selected hospital-acquired conditions were identified for the high-risk rounding program. This program offered rounds with scripted questions about elements of hospital-acquired conditions followed by education and/or acquisition of needed resources. Primary quality improvement outcomes were overall preimplementation and postimplementation rates of the following hospital-acquired conditions: central line [catheter]-associated bloodstream infection, catheter-associated urinary tract infection, unplanned extubation, and pressure injury. Sustainability of the project was also evaluated. RESULTS: Over 2 years, 624 rounds for 488 unique patients were conducted. Rounds resulted in 351 interventions, including escalation of concerns, direct patient care, resource procurement, and education. Patients who received high-risk rounds were less likely than those who did not receive rounds to incur a hospital-acquired condition. A χ2 test of association revealed a significant negative association between hospital-acquired conditions and receipt of high-risk rounds (χ2 = 22.5, P < .001). The mean rate of project hospital-acquired conditions decreased from 5.41 to 2.89 events per 1000 patient days following detection of special cause variation. High-risk rounds prevented an estimated 50 hospital-acquired conditions during the project period. CONCLUSION: Implementation of high-risk rounds reduced the rate of project-specific hospital-acquired conditions by 46.5%, which was sustained over the 2-year project period.