Becker's Clinical Quality & Infection Control

31 QUALITY IMPROVEMENT & MEASUREMENT Viewpoint: ICU care often result in new harm and injuries — here's how to fix it By Mariah Taylor T here is an evidence-based approach to reducing death, length of hospital stay, cost of care and additional injuries during intensive care unit treatment, but most hospitals are not using it, according to one expert. Wes Ely, MD, a professor of critical care medicine at Nashville-based Vanderbilt University Medical Center, shared his ABCDEF care bundle model at the Association of American Medical Colleges' annual meeting Nov. 14 in Nashville. e care model allows patients to achieve greater mobility and mental clarity and renew personal connections while healing, he said. e traditional approach of heavy sedation and immobilization can lead to a number of injuries, such as ICU delirium, post-intensive care syndrome, muscle atrophy, and PTSD and mental health issues — usually a result of hallucinations. Delirium predicts a 10 percent increased risk of death and 35 percent increase of brain dysfunction. Patients can lose 10 percent to 25 percent of their muscle mass in four to five days, according to the article. Dr. Ely said his six-step safety bundle prevents most of these treatment injuries: 1. A — Analgesia, get rid of the ventilator and the sedation as soon as possible. 2. B — Both, a daily attempt to remove sedatives and breathing machines. 3. C — Choice of analgesia and sedation. 4. D — Delirium, treat it correctly and include environmental steps like lighting to match day/night cycles. 5. E — Early mobility, get patients up and walking. 6. F — Family, have them present and engaged. n Paxlovid cuts long COVID-19 risk, early VA findings show By Erica Carbajal P eople who take the antiviral Paxlovid within the first few days of a COVID-19 infection may have a 25 percent lower risk of developing a number of conditions associated with long COVID-19, according to findings published Nov. 5 in the preprint server medRxiv. Researchers used electronic health records from the Department of Veterans Affairs to identify patients who tested positive for COVID-19 between March 1 and June 30. The study included more than 56,000 veterans, including 9,217 patients who were given Paxlovid within five days of testing positive. Those who were given the oral antiviral medication had a 25 percent lower risk of developing heart disease, blood disorders, fatigue, liver disease, kidney disease, muscle pain, neurocognitive impairment and shortness of breath in the 90 days after infection. Researchers found a lower risk of developing long COVID symptoms after Paxlovid treatment regardless of vaccination status or whether it was a patient's first infection. For new onset diabetes and cough, there was not a statistically significant association between taking Paxlovid and risk of developing the two conditions. "Paxlovid reduces the risk of severe COVID-19 in the acute phase, and now we have evidence that it can help reduce the risk of long COVID," said Ziyad Al-Aly, MD, study author and chief of research and development at the VA St. Louis Health Care System. "This treatment could be an important asset to address the serious issue of long COVID." n Michigan Medicine rolls out 'post-mortality' surveys to guide care improvements By Erica Carbajal M ichigan Medicine implemented post-mortality surveys, which are sent to caregivers after an inpatient death and meant to serve as a resource to identify areas for care improvement. "The purpose of this survey is not to place blame on providers or judge quality of care," Sandeep Vijan, MD, program director for quality analytics at the Ann Arbor, Mich.-based system, said in a Nov. 9 blog post. "Instead, we want to use this as an opportunity to learn how we might make care better." The electronic survey is sent to all team members involved in a patient's care within 48 hours of inpatient death. It includes "many different care-based questions" and takes a few minutes to complete. The health system clarified the survey's use as separate from the safety event reporting process. "The safety event reporting process should always be used if there are any concerns about patient safety and/or deviations from standard processes of care. On the other hand, the post-mortality survey is sent to caregivers only after an inpatient death," the health system said, adding that both are resources to guide system care improvements. n

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