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15. Canadian experience with patient care classification.

Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment of client or patient needs in regard to the category, type, and level of care. Experimentation with the proposed classification system in several provinces confirms the need in long-term care to include assessment of nursing requirements, physical functioning, and psychosocial assets and liabilities, and points to the importance of using such a classification for planning and evaluating patient care as well as for administrative purposes.

Activities of Daily Living

Adapting the patient care conference to primary nursing.

Patient care conferences are a crucial element in the concept of primary nursing. The authors compare and contrast team and primary nursing patient care conferences. Changes in format and approach needed for patient care conferences in the primary nursing system are discussed, and specific behaviors for conducting primary nursing patient care conferences are outlined.

Congresses as Topic

Computer-assisted patient-care management.

A computer-assisted patient-care management system is currently operating in two patient-care units as part of a pilot project at the Hôpital Cardiologique, a member institution of the Hospices Civils de Lyon. The system includes the management of administrative records (notice of admission set to the patient-care unit, appointment for admission sent to the patient, notice of admission set to the physician requesting hospitalization, admissions and discharges, patient census) and of patient-care records (orders, examinations, laboratory tests, medications, injections and treatments, a summary list or orders to be carried out during the day, labels for laboratory specimens and requistions for the tests and examinations to be performed); and the medical management of the patient (clinical summary of patient status at admission, results of tests and examinations, summary of hospitalization, data for research and statistics). Computerization was begun in 1977, following the implementation of individualized patient-care records in 1976. The system will be evaluated in 1978 and extended to the remainder of the hospital (18 patient-care units) by the end of 1979.

Computers

Food as a source of Klebsiella species for colonisation and infection of intensive care patients.

Food prepared for intensive care patients was frequently contaminated with Klebsiella species. Sixty-eight per cent of nasogastric feeds were contaminated with up to 10(4) klebsiellae per ml. Hospital kitchens were the source of contamination. Three patients ingested klebsiellae and subsequently excreted the same serotype in their faeces. Over a four-week period there was a correlation between kitchen, food, faecal, and clinical serotypes of klebsiellae. Serotypes ingested by intensive care patients occurred more frequently in clinical isolates from intensive care patients than from other hospital patients. Patients often acquired a food strain that had been ingested by another patient on the same ward.

Cross Infection

Models of patient care for operating room nurses.

The focus of quality assurance programs in nursing is on improving the quality of care delivered to patients. Three methods of assesing quality of care for surgical patients are retrospective chart review, process audit, and expected patient outcomes as identified in models of patient care and individual care plans. Care plans specify nursing activities necessary to achieve established goals and, therefore, can be used in assessing the quality of care surgical patients receive.

Humans

[Effect of amino acid infusions on fructose-induced chemical blood changes in intensive care patients].

Influence of the infusion of amino acid solutions on metabolic changes caused by parenteral nutrition with fructose. In eleven unconscious polytraumatized patients of the intensive care station, intravenous infusions with fructose (0.5 g/kg bodyweight and hour) were performed. During the last 24 hours of the 72 hours infusion period, amino acid solutions (1.0 g/kg bodyweight and 24 hours) were given in addition to fructose. The investigations were initiated after an eight hour "starvation period" preinfusion. During this time only electrolytes were given. For comparison 48 hours intravenous infusions with fructose (0.5 g/kg B.W. and hour) were performed with six healthy volunteers. In both groups of subjects the intravenous fructose was metabolized very well, renal losses were less than 2% of the whole amount given. Considering the metabolic healthy volunteers, the blood glucose concentration remained unaltered despite the high dosage carbohydrate infusion. The patients of the intensive care station showed a slight increase of blood glucose values which were elevated already before infusion. Additionally, during fructose infusions, the increase in blood lactate concentration was more pronounced in the intensive care patients than in healthy volunteers. However, in contrast to the healthy volunteers, no increase in serum bilirubin concentration and only a slight increase in serum uric acid concentration was observed in the intensive care patients, despite the high-dose fructose infusion for 72 hours. Additionally, the fructose-induced hypertriglyceridemia was of a minor degree in the intensive care patients. In volunteers the increase in triglyceride concentration was 200% in 48 hours, whereas only a 50% increase was observed in intensive care patients during 72 hours. The pronounced nitrogen sparing effect of fructose in healthy volunteers was not seen in the intensive care patients to the same degree. The most prominent side effect of the fructose infusions in intensive care patients was the strong decrease in serum phosphate concentration seen in some patients. The additional infusion of amino acid solutions lead to a further diminution of the slight alterations caused by fructose infusions. In conclusion, it can be stated that total parenteral nutrition with fructose and amino acid solutions is possible in intensive care patients without danger of side effects. However, it should be mnetioned that hyperalimentation can cause fatty liver.

Amino Acids

Nurse mentor system cuts costs, boosts quality of patient care.

A new approach to patient care, which combines the mentor concept used in industry and the team concept used in traditional health care delivery systems, is helping to solve one hospital's problems of a chronic regional shortage of registered nurses, regularly rising costs, lack of recognition for individual interpersonal and clinical expertise, and the lack of an ongoing staff development program. The nurse mentor at Children's Hospital of San Francisco acts as a patient advocate and also counsels, teaches, coaches, supports, promotes, and inspires the members of her primary nursing team.

California