Centofanti John Eugenio, Duan Erick H, Hoad Neala C, Swinton Marilyn E, Perri Dan, Waugh Lily, Cook Deborah J
1Department of Anesthesia, McMaster University, Hamilton, ON, Canada. 2Department of Medicine, McMaster University, Hamilton, ON, Canada. 3Department of Critical Care, St Joseph's Healthcare, Hamilton, ON, Canada. 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Crit Care Med. 2014 Aug;42(8):1797-803. doi: 10.1097/CCM.0000000000000331.
To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds.
Our three data collection methods were as follows: (1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. (2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. (3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources.
Fifteen bed closed ICU in a tertiary care, university-affiliated hospital.
Medical-surgical ICU patients.
None.
Field observations: The daily goals checklist was completed for 93% of observed rounds, largely by residents (86%). The champion of the verbal review was commonly a resident (83%) or medical student (9%). Document analysis: Domains with high completion rates included ventilation, sedation, central venous access, nutrition, and various prophylactic interventions. Interviews: The daily goals checklist enhanced communication, patient care, and education. Nurses, physicians, and pharmacists endorsed its enhancement of interdisciplinary communication. It facilitated a structured, thorough, and individualized approach to patient care. The daily goals checklist helped to identify new patient care issues and sparked management discussions, especially for sedation, weaning, and medications. Residents were prominent users, finding served as a multipurpose teaching tool.
The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds.
了解重症监护病房（ICU）临床医生对查房时使用每日目标清单的看法和态度。
我们的三种数据收集方法如下：（1）实地观察：两名研究人员进行实地观察，以了解在6天内对80例ICU患者查房时每日目标清单的使用方式和使用者。（2）文件分析：使用混合方法对观察查房中72份已完成的每日目标清单进行分析。（3）访谈：对56名临床医生进行半结构化的个人访谈和焦点小组访谈，采用定性描述方法和内容分析对访谈记录进行分析。由一个多学科调查团队使用两种研究方法和三个数据源实现三角互证。
一所大学附属医院的拥有15张床位的封闭式ICU。
内科-外科ICU患者。
无。
实地观察：93%的观察查房完成了每日目标清单，主要由住院医师完成（86%）。口头回顾的倡导者通常是住院医师（83%）或医学生（9%）。文件分析：完成率较高的领域包括通气、镇静、中心静脉通路、营养和各种预防性干预措施。访谈：每日目标清单增强了沟通、患者护理和教育。护士、医生和药剂师认可其增强了跨学科沟通。它促进了一种结构化、全面且个性化的患者护理方法。每日目标清单有助于识别新的患者护理问题并引发管理讨论，特别是对于镇静、撤机和药物治疗。住院医师是主要使用者，认为其是一种多功能教学工具。
每日目标清单被认为通过创建一种系统、全面的患者护理方法并设定个性化的每日目标，改善了危重症患者的管理。据报道，每日目标清单改善了跨专业沟通和实践，还提高了患者安全性和每日进展，鼓励了危重症恢复的进程。每日目标清单回顾为多学科学习者在晨间查房时提供了教学机会。
