Visualization of Nursing Practice from Order to Hand-off in ICU and Analysis of Related Incidents

Abstract

 This study visualized the nursing practice of medical care assistance from order to hand-off in ICU (Intensive Care Unit) using flow diagram and analyzed the relationship between the flow diagram and the related 114 incidents reported in one year. There were 12 types of physician’s order; medication, examination, medical device, water balance, nutrition, blood transfusion, rest level, rehabilitation, dialysis, visiting other department, entry and exit. These processes start from physician’s order, followed its acceptance by nurse, preparation, execution, recording, observation, completion process, and hand-off. The mapping of incidents related with medical care assistance to the flow diagram components showed that all of the incidents could allocate to each item of the flow diagram as following: the order was 5.3％, the acceptance was 21.1％, the preparation was 16.7％, execution was 26.3％ and observation was 30.7％. This shows the clear relationship between nursing practice and incident. However, according to the incident classification of the Japan Council for Quality Health Care, 87.7％ of these incidents were classified to the “drag” and “drainage tube or other tube” categories. These results showed that the flow diagram had effectiveness to take appropriate measures.