Heart and Lung the Journal of Acute and Critical Care, Jan 3, 1995
External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners wi... more External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners with essential information about cranial dynamics as well as a means to maintain the balance within the cranium. Infection has been cited in the literature as the most common complication associated with ICP monitoring. This article reviews the research literature for the risk factors suggested to increase infection, presents data and practice guidelines from one institution where ICP monitors have been maintained infection free for more than 10 years, and summarizes the experiences of another institution where the 6-month infection rate of 55% associated with external ventriculostomy was reduced to 0% in the subsequent 6-month period. The actions taken by the multidisciplinary team to reduce the risk of infection are detailed. Recommendations for minimizing the risk of infection are made by the authors and are based on research studies and experience.
Ischemic stroke patients presenting to acute care hospitals require an organized response from mu... more Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset. Guidelines have been established identifying critical elements for hospitals in order to be designated as primary or comprehensive stroke centers. Research studies exploring treatment options for stroke, as well as general care priorities exist in the scientific literature but must be integrated into hospital-based protocols. Recommended interventions are highlighted to assist critical care practitioners in the delivery of care for stroke patients. Coordinated teams using an evidence-b...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Critically ill patients are at marked risk of hospital-acquired infections, which increase patien... more Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not signifi...
Therapeutic hypothermia and temperature management, 2011
... Omar H. Osborn waves: an inverse correlation with core body temperatures. ... The Use of Hypo... more ... Omar H. Osborn waves: an inverse correlation with core body temperatures. ... The Use of Hypothermia Therapy in Traumatic Ischemic/Reperfusional Brain Injury: Review of the Literatures. Shoji Yokobori, Janek Frantzen, Ross Bullock, Shyam Gajavelli, Stephen Burks, Helen ...
Use of technology in the management of the severely brain-injured patient has increased over the ... more Use of technology in the management of the severely brain-injured patient has increased over the past decade and can be confusing and overwhelming to the critical care nurse clinicians who are new to the field of neurology. This article will describe normal physiology and cerebral dynamics and potential abnormal physiology encountered after brain injury. The technology reviewed will include intracranial pressure monitoring, cerebral blood flow monitoring and autoregulation, cerebral oxygen consumption and tissue oxygen monitoring, metabolism, sedation, and temperature monitoring. Integration of appropriate technology into patient management will be discussed using a case study to explore the utility of information at the bedside. Recognizing the difficult task of trying to control secondary injury in our patients is the first step to better outcomes. Implementing the use of technology to mitigate the situation must be done with careful consideration and a team approach to achieve th...
Critical care nursing clinics of North America, 2000
Providing care to the TBI patient population with severe injuries requires an integrated multidis... more Providing care to the TBI patient population with severe injuries requires an integrated multidisciplinary approach. The team in clinical practice must be willing to examine its own practice, seek out the latest information on TBI, and critically analyze the information. Members must be open to changing their own practice when the data presented support change. Interventions based on scientific evidence provide a strong foundation for delivering care. The standardization of these interventions into protocols facilitates team communication and coordination. Measuring outcomes is imperative for evaluating the effectiveness of current treatment algorithms. Changes in treatment practice should be based on the measured outcomes and advances in the scientific literature.
Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatic... more Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Gla...
ABSTRACT In the critical care setting, the focus of care during the first few weeks following acu... more ABSTRACT In the critical care setting, the focus of care during the first few weeks following acute brain injury is prevention of secondary brain injury by optimizing cerebral perfusion. Ensuring adequate oxygenation and perfusion of cerebral tissues requires attention to all of the body systems. Chest percussion therapy (CPT) promotes pulmonary hygiene and optimizes gas exchange by opening the alveoli. However, many patients with brain injury have intracranial pressure (ICP) monitoring, and conventional wisdom supports limiting activities such as CPT that may stimulate the patient and increase ICP. The purpose of this study was to explore the effects of CPT on ICP. Thirty participants were enrolled over a 6-month period. Data were collected at 1-minute intervals for 1 hour. Each patient was randomized to receive automated CPT (using specialty beds) for 10 minutes, starting at 10, 20, 30, or 40 minutes into the hour. There were no differences in mean ICP values before, during, or after CPT. This study provides evidence that it is safe to perform CPT in patients with ICP monitoring in situ.
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2009
From 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mi... more From 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mission Viejo, California) uncovered deficits in knowledge and judgment in the hours preceding 75% of our non-ICU patients. Nearly half of all arrests were occurring outside the ICU, with an overall mortality rate of 60%. In addition, transfers into ICU from the floor averaged 96 patients per month. A multidisciplinary team met for 12 months to develop a specialized nurse-driven rapid response team (RRT) to reduce the incidence and mortality of non-ICU arrests, reduce transfers to the ICU from the floor, and provide ICU-level nursing care for emergency department (ED) patients in extremis. The team developed an RRT protocol, a methodology for rounds and calls, and a data collection system. After gaining consensus among the nursing managers, 4.2 full-time equivalent (FTE) RRT nurse positions were created by each unit contributing portions of an FTE. Prospective data collected demonstrated a...
Developing processes to create a culture of safety. BACKGROUND: It's estimated that as many a... more Developing processes to create a culture of safety. BACKGROUND: It's estimated that as many as 98,000 hospitalized patients lose their lives each year in the United States because of medical errors that could have been prevented. While standardized reporting and safety checklists have been shown to improve communication and patient safety, implementation of these tools in hospitals remains challenging. OBJECTIVE: To implement standardized nurse-to-nurse reporting along with safety checklists at Mission Hospital, a 522-bed facility in Mission Viejo, California, using Lewin's change theory and Knowles's adult learning theory. METHODS: Nurses were tested to assess their knowledge of the standardized nurse-to-physician reporting method called SBAR (Situation, Background, Assessment, Recommendation), their understanding of the concept of the nurse-to-nurse reporting method called SBAP (Situation, Background, Assessment, Plan), and the use of safety checklists. Then, after vie...
A variety of technologies have been developed to assist decision-making during the management of ... more A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.
Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial... more Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring fails to recognize episodes of cerebral oxygen desaturation. We found and characterized frequent episodes of desaturation of jugular venous oxygen (SjO2) in the face of normal ICP and CPP.
Heart and Lung the Journal of Acute and Critical Care, Jan 3, 1995
External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners wi... more External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners with essential information about cranial dynamics as well as a means to maintain the balance within the cranium. Infection has been cited in the literature as the most common complication associated with ICP monitoring. This article reviews the research literature for the risk factors suggested to increase infection, presents data and practice guidelines from one institution where ICP monitors have been maintained infection free for more than 10 years, and summarizes the experiences of another institution where the 6-month infection rate of 55% associated with external ventriculostomy was reduced to 0% in the subsequent 6-month period. The actions taken by the multidisciplinary team to reduce the risk of infection are detailed. Recommendations for minimizing the risk of infection are made by the authors and are based on research studies and experience.
Ischemic stroke patients presenting to acute care hospitals require an organized response from mu... more Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset. Guidelines have been established identifying critical elements for hospitals in order to be designated as primary or comprehensive stroke centers. Research studies exploring treatment options for stroke, as well as general care priorities exist in the scientific literature but must be integrated into hospital-based protocols. Recommended interventions are highlighted to assist critical care practitioners in the delivery of care for stroke patients. Coordinated teams using an evidence-b...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Critically ill patients are at marked risk of hospital-acquired infections, which increase patien... more Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not signifi...
Therapeutic hypothermia and temperature management, 2011
... Omar H. Osborn waves: an inverse correlation with core body temperatures. ... The Use of Hypo... more ... Omar H. Osborn waves: an inverse correlation with core body temperatures. ... The Use of Hypothermia Therapy in Traumatic Ischemic/Reperfusional Brain Injury: Review of the Literatures. Shoji Yokobori, Janek Frantzen, Ross Bullock, Shyam Gajavelli, Stephen Burks, Helen ...
Use of technology in the management of the severely brain-injured patient has increased over the ... more Use of technology in the management of the severely brain-injured patient has increased over the past decade and can be confusing and overwhelming to the critical care nurse clinicians who are new to the field of neurology. This article will describe normal physiology and cerebral dynamics and potential abnormal physiology encountered after brain injury. The technology reviewed will include intracranial pressure monitoring, cerebral blood flow monitoring and autoregulation, cerebral oxygen consumption and tissue oxygen monitoring, metabolism, sedation, and temperature monitoring. Integration of appropriate technology into patient management will be discussed using a case study to explore the utility of information at the bedside. Recognizing the difficult task of trying to control secondary injury in our patients is the first step to better outcomes. Implementing the use of technology to mitigate the situation must be done with careful consideration and a team approach to achieve th...
Critical care nursing clinics of North America, 2000
Providing care to the TBI patient population with severe injuries requires an integrated multidis... more Providing care to the TBI patient population with severe injuries requires an integrated multidisciplinary approach. The team in clinical practice must be willing to examine its own practice, seek out the latest information on TBI, and critically analyze the information. Members must be open to changing their own practice when the data presented support change. Interventions based on scientific evidence provide a strong foundation for delivering care. The standardization of these interventions into protocols facilitates team communication and coordination. Measuring outcomes is imperative for evaluating the effectiveness of current treatment algorithms. Changes in treatment practice should be based on the measured outcomes and advances in the scientific literature.
Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatic... more Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Gla...
ABSTRACT In the critical care setting, the focus of care during the first few weeks following acu... more ABSTRACT In the critical care setting, the focus of care during the first few weeks following acute brain injury is prevention of secondary brain injury by optimizing cerebral perfusion. Ensuring adequate oxygenation and perfusion of cerebral tissues requires attention to all of the body systems. Chest percussion therapy (CPT) promotes pulmonary hygiene and optimizes gas exchange by opening the alveoli. However, many patients with brain injury have intracranial pressure (ICP) monitoring, and conventional wisdom supports limiting activities such as CPT that may stimulate the patient and increase ICP. The purpose of this study was to explore the effects of CPT on ICP. Thirty participants were enrolled over a 6-month period. Data were collected at 1-minute intervals for 1 hour. Each patient was randomized to receive automated CPT (using specialty beds) for 10 minutes, starting at 10, 20, 30, or 40 minutes into the hour. There were no differences in mean ICP values before, during, or after CPT. This study provides evidence that it is safe to perform CPT in patients with ICP monitoring in situ.
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2009
From 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mi... more From 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mission Viejo, California) uncovered deficits in knowledge and judgment in the hours preceding 75% of our non-ICU patients. Nearly half of all arrests were occurring outside the ICU, with an overall mortality rate of 60%. In addition, transfers into ICU from the floor averaged 96 patients per month. A multidisciplinary team met for 12 months to develop a specialized nurse-driven rapid response team (RRT) to reduce the incidence and mortality of non-ICU arrests, reduce transfers to the ICU from the floor, and provide ICU-level nursing care for emergency department (ED) patients in extremis. The team developed an RRT protocol, a methodology for rounds and calls, and a data collection system. After gaining consensus among the nursing managers, 4.2 full-time equivalent (FTE) RRT nurse positions were created by each unit contributing portions of an FTE. Prospective data collected demonstrated a...
Developing processes to create a culture of safety. BACKGROUND: It's estimated that as many a... more Developing processes to create a culture of safety. BACKGROUND: It's estimated that as many as 98,000 hospitalized patients lose their lives each year in the United States because of medical errors that could have been prevented. While standardized reporting and safety checklists have been shown to improve communication and patient safety, implementation of these tools in hospitals remains challenging. OBJECTIVE: To implement standardized nurse-to-nurse reporting along with safety checklists at Mission Hospital, a 522-bed facility in Mission Viejo, California, using Lewin's change theory and Knowles's adult learning theory. METHODS: Nurses were tested to assess their knowledge of the standardized nurse-to-physician reporting method called SBAR (Situation, Background, Assessment, Recommendation), their understanding of the concept of the nurse-to-nurse reporting method called SBAP (Situation, Background, Assessment, Plan), and the use of safety checklists. Then, after vie...
A variety of technologies have been developed to assist decision-making during the management of ... more A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.
Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial... more Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring fails to recognize episodes of cerebral oxygen desaturation. We found and characterized frequent episodes of desaturation of jugular venous oxygen (SjO2) in the face of normal ICP and CPP.
Uploads
Papers by Mary Kay Bader