ABSTRACT (Content)

International Congress on Critical Care Medicine: Systems, Technology & Management October 17 - 18, 2018 Tehran, Iran International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

Oral Presentation Presenter Title Page Authors Seyed Hossein Evolutional technologies in icu Ardehali 26 Dr. Mohammad A look at the future horizons of critical care 27 Fathi medicine Niloofar Gilani Visible systemic issues in hospitals’ critical care 28 Larimi departments Dr Mehran Pain management in icu setting Kouchek 30 Implementation of antimicrobial stewardship Dr. Mehran Lak 31 program (ams) Eva K Lee Transforming healthcare in multiple fronts 33

Dr Nader Medical error & adverse event in critical care Markazi 35 Moghaddam medicine: application of gtt The effect of family-based care on increasing the Samaneh satisfaction of family members of patients Mirzaei 37 admitted to special care units Zahra Mohammadi Prenatal regionalization network modeling 39 Daniali Improving icu patients to access ct scan Parisa Moodi services: a simulation based analytics of 40 resources (code: 1069) Masoud The role of evidence in intensive care decision- 41 Mousavinasab making Atabak Najafi Variable ventilation stochastic or physiologic 45

Mihammad Local patient registry, global patient impact Farzad Rashidi 47 18

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Oral Presentation Presenter Title Page Authors

Mohammad Palliative care medicine in icu, what is possible 48 Farzad Rashidi and what is the best?

Sustaining critical care: using evidence-based Somayeh Sadat 49 simulation to evaluate icu management policies A generic simulation model of the relative cost- Somayeh Sadat effectiveness of icu versus step-down (imcu) 50 expansion Intensive care observational registries: big data Ali Sanaie analytics as a clinical decision support for critical 51 care medicine The impact of computerized physician order Zand F 52 entry on prescription orders

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مقاالت سخنرانی صفحه عنوان سخنرانی نویسنده مسئول استفاده از مدل خطی تعمیم یافته برای پیش بینی ضربان قلب محمد پیش نماززاده 54 بیمار در حال انتقال بررسی مقایسه ای هزینه بستری بیماران داخلی و جراحی بستری 55 در بخش مراقبت های ویژه کودکان در مرکز اموزشی درمانی امام محمدرضا حبیب زاده حسین)ع( در سال ۱۳۹۶ 56 مراقبت تسکینی در منزل راهکاری برای آزادسازی تخت های ویژه عبدالرحیم حزینی

58 تاثير اينترنت اشيا بر مراقبتهاي ويژه پریسا خاکشور

دکتر محمد مهدی 60 مهندسی سیستمهای سالمت و ICU سپهری

مدل های رهبری در ICU دکتر علی امیر 61 سوادکوهی ارزیابی بخش های مراقبتهای ویژه مبتنی بر شاخص های 62 عملکردی دکتر مجتبی صداقت 63 بهره وری و مدیریت هزینه در نظام سالمت: بخش مراقبت ویژه دکتر شهرام غفاری مصطفی فروغی 64 تفکر و یادگیری تأملی برای پزشکان و کارکنان مراقبتهای ویژه نعمتاللهی 65 پیاده سازی برنامه آنتی میکروبیال استواردشیپ دکتر مهران لک بررسی تاثیر ابزار جداسازی پارسی در جداسازی بیماران ضربه به 66 سر از دستگاه تهویه مکانیکی ساره محمدی ICU 67 هوشمند عطا محمودپور دکتر امید مرادی Tele ICU 68 مقدم

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Poster Presentation Presenter Title Page Authors Mohammad A comparative study about the impact of sensory 70 Adineh stimulation performed by family members and ... Mohammad Comparing two methods of enteral nutrition in 71 Adineh terms of their complications and the time ... Rahimeh Incidence of adverse events during intrahospital 72 Alizadeh sharafi transfer of critically ill patients based on nurses ... Mohammad Prioritization of performance indicators in intensive 73 Amin jarrahi care units Seyed ehsan Pain and anxiety and their relationship with medi- 74 Asadi cation doses in the intensive care unit. Seyed ehsan Factors associated with nurses’ perceptions, self- 75 Asadi confidence, and invitations of family presence ... Using prognostic models for resource allocation and Alireza Atashi 77 quality control in intensive care units Somayeh A review on the effect of family-centered empower- 78 Azimpour ment model on lifestyle of patients in intensive ... The effect of expiratory manual rib cage compres- SHahram Baraz 80 sion before suctioning on blood oxygen ... Examining the types of information and communi- Khadije Bargbid 81 cation technology in the intensive care unit Use of bispectral index and the critical-care pain ob- Arvin Barzanji 82 servation tool for the detection of pain in ... Mehri Doosti Conflict experience in visiting in the intensive care 83 irani unit A review of prospective payment mechanisms for Reza Esmaeili 85 intensive care in selected high income countries ... Fatemeh Determining the user-interface problems of a nurs- 86 Farahani ing information system in the icu of the social ... The effect of educational-supporting program on Nasrin Galehdar 88 anxiety, stress, and depression in patients family ... The impact of liaison nurse on satisfaction and per- Nasrin Galehdar 90 21 ceived social support of the family members of ...

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Poster Presentation Presenter Title Page Authors Effect of using eye mask and earplugs on status and Chiman Ghaderi 92 quality of night-time sleep in cardiac intensive ... Kobra Transition care: best practices based on evidence 94 Ghorbanzadeh Improve the patient’s flow process in the heart’s icu Abas Gomar 95 using the brownie line model Mohamadreza Prevalence of vitamin d deficiency and its correla- 97 Habibzade tion with mortality in pediatric intensive care unit Ali Investigating the effect of using wireless sensors in 98 Hajipourtalebi providing good care for patients in intensive care ... Ali The impact of using emr on dotech tablets on re- 100 Hajipourtalebi ducing nurses’ drug mistakes in the intensive ... Ali Investigating the impact of tele-icu technology par- 102 Hajipourtalebi ticipation on the quality of patient care and safety Ali Qualitative assessment of the online communica- 104 Hajipourtalebi tion of diabetic patients with the facebook ... Reliability and predictive validity of outcome at Reza Heidarifar 106 discharge of glascow coma scale in an intensive ... Predictive validity and inter-rater reliability of the Reza Heidarifar 107 persian version of full outline of unresponsiveness .. Effect of lavender aromatherapy on anxiety and Reza Heidarifar 108 hemodynamic changes: a randomized clinical trial Design and localization of software for recording Maryam Idani 110 and reporting drug-drug interactions Maryam Comparison between life satisfaction and burnout 111 Janatolmakan among nurses in intensive care unit and general ... Maryam Relationship between communication skills of nurs- 112 Janatolmakan es with patients’ safety status in intensive care .. Maryam Quality of care in pediatric intensive care unit from 113 Janatolmakan the perspective of nurses: qualitative study 22

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Poster Presentation Presenter Title Page Authors Maryam Comparison of knowledge and skills of nurses in the 114 Janatolmakan field of medicine in the pediatric intensive care ... Maryam Assess the quality of services provided in the inten- 115 Janatolmakan sive care unit using the servqual model Maryam Evaluation of the standards of intensive care units 116 Janatolmakan of kermanshah hospitals Mohamad Application of management dashboards in intensive 117 Jebraeily care unit Zahra Mohebbi The effect of family-based care on satisfaction of 118 dehnavi the family of patients admitted to intensive care ... Seyed maryam Parenteral nutrition in neonates and pediatrics: a 119 Mousavi review Aliyeh Effect of airway pressure release ventilation mode 121 Pasandideh on intracranial pressure and cerebral ... Pharmaceutical management project in critical care Fatemeh Rahimi 123 unit using the medication management and use Survey of postoperative cares in selected hospitals Arefeh Ranjbar 125 in qom in 2018 Family experience survey in the intensive care unit: Yaser Saeid 126 a integrative review A comparative study on the effects of open and Amir Shafa 128 closed endotracheal suction systems on arterial ... Manijeh Effect of family members’ voice on level of con- Shahriary 129 sciousness of comatose patients admitted to the ... kalantary Manijeh Effect of aminophylline on renal function of brain Shahriary 130 injury patients with acute renal failure admitted ... kalantary Mohadeseh Improvement of fuzzy expert system using particle 131 Shahsavand swarm optimization algorithm for diagnosis of ... 23

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Poster Presentation Presenter Title Page Authors The effects of manual lung hyperinflation on pulmo- Mahboube nary function after weaning from mechanical venti- 133 Yazdani lation among patients with abdominal surgeries Dimension of futility at the end of life: nurses’ expe- Leili Yekefallah 135 riences in intensive care units Frequency of futile care in viewpoint of icu nurses in Leili Yekefallah 136 province of qazvin Developing tool for evaluation of causes of futile Leili Yekefallah 137 care in icus Effect of tactile stimulation on consciousness and Leili Yekefallah vital signs of head trauma patients in intensive care 138 units Usability evaluation of critical care information Azam Zanganeh systems in bohlool hospital in 2018: evaluation of 139 the system usability scale Mitra Comparison of the quality of physician-nurse rela- 140 Nourbakhsh tions of the nurses in apachi-ii and m-score groups

www.ic3med.ir ABSTRACT (Oral Presentation)

Evolutional Technologies in ICU Seyed Hossein Ardehali ,MD

Department of Anesthesiology & Critical Care, Shohadaye – Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Technology has continued to change healthcare since the Stethoscope was invented in 1816.As with contemporary technology, the device didn’t replace the work of clinicians, but rather enhanced & expanded their capabilities. Medical technology permits a more precise and timely diagnosis and treatment than when the modern era of intensive care began medical technologies have now expanded beyond the equipment. Some technologies broaden medical knowledge, improve clinical performance, and lead to the further development of relevant technologies. And the introduction of digital technology has opened up new horizons in clinical practice. Tele-ICU systems could be an alternative mechanism for physicians to manage a larger number of critical care patients and to enable 24 h, 7 day ICU coverage. Digital technology could be used as a communication facilitator between care providers and patient’s family. In contrast, the latest medical technologies are frequently expensive, and the clinical outcomes do not always justify the expense. Another concern is that a high dependence on technology will lead to deterioration in clinical reasoning abilities and the skill levels of critical care trainees. To overcome such concerns, the most desirable advances in medical technology would be to simplify complex procedures and make them less error prone. Medical technology also has to be further focused on reducing the cost of public health and improving ICU care quality. To achieve these goals, physicians should enter into effective partnerships with the technology developers, who are often not familiar with the requirements of an ICU. In addition, all of these processes should be performed in ethical ways to avoid undesirable conflicts of interest.

Keywords: Technology, Critical care, Technology

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A look at the future Horizons of critical care medicine Dr. Mohammad Fathi

Head of the Care Quality Improvement Research Center Anesthesiologist and specialist in intensive care, asso¬ciate professor, Shahid Beheshti University of Medical Sciences Urbanization and its implications such as pollution, mental and physical stresses, social harms, malnourishment and sedentary life style together with population aging have tremendously increased the risk of cardiac and neurovascular events. In addition, despite all the efforts, road traffic accidents or similar injuries have become an inseparable part of urban life. This fact demonstrates that the continuous development of critical care services in parallel with quality improvement, is a powerful and robust trend. Critical care is an interdisciplinary field which has different scientific, technological, social, moral, legal, economic, political, andeven environmental dimensions. It is also interwoven with certain strategic national issues beyond public health, which increases its sensitivity and importance. Successful development of critical care services, identification of risks and clarification of ambiguities in the future of this domain requires design of an appropriate theoretical framework and conceptual model to deal with these complexities, and to empower policymakers to make informed decisions alongside sustainable planning. Applying interdisciplinary fields such as futures studies, is an appropriate approach to meetthis requirements. To the best of our knowledge, none of the published papers on the future of critical care services, has a comprehensive view on different dimensions of this interdisciplinary field. Also foreign governmental policy reports about critical care, could not be directly mapped from their native context to another society. In order to draw a comprehensive roadmap of critical care (innovative product) we need to develop our Indigenous model that includes all above mentioned dimensions based on our social structure and norms in Iran, with consideration of the powerful regional and international adversaries and competitors (innovative process). The Research Center for Quality Improvement in Critical Care has been qualified to become one of main founders of medical policy movement in Iran, by concentration on development of indigenous Futures studies pattern. This center should not only improve its foresight capabilities to have a consistent and comprehensive roadmap for its internal research purposes but should also become the pioneer of this field at the national level to help relevant organizations to improve their attitudes and practices.

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Visible systemic issues in hospitals’ critical care departments Niloofar Gilani Larimia, Rouzbeh Ghousia

a School of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran Background and aim: One of the vital challenges of healthcare systems is to improve the critical care departments in hospitals which classifies into two categories as intensive care unit (ICU) and coronary care unit (CCU). The top five issues are (1) inherent demand uncertainty, (2) nurses’ capacity limitation, (3) disruption risks, (4) ignoring the various level of services, and (5) locating critical care departments in hospitals.

Methods: The problem presents in a systemic viewpoint to find the research gap which is extracted from the relevant literature, experts’ knowledge, and observation.

Results: Inherent demand uncertainty: There are several types of patients’ requirements in critical care departments regarding their application, in which the most significant ones are blood products, medicines (e.g., War- farin, Digoxin, etc.), artificial respiratory system, and so on. Evaluating the number of expected artificial respiratory system and medicines is one of the principal issues in medical centers. Moreover, some patients suffer from drug toxicity, which drastically increase the necessity of fresh frozen plasma (FFP) units. The required quantity of blood products increases in open heart ICU, noteworthy, the perishability of blood products augments problem complexity.

- Nurses’ capacity limitation: Since expert and specialized nurses are assigned to ICU and CCU, hospitals may encounter considerable critical care nursing shortage. It may lead to a delay in patients’ scheduling, which consequently increases the rate of unsatisfied demand.

- Disruption risks: The disruption risks can be arising due to normal activities and operational errors. This condition refers to interrupt activities which impose a substantial cost in the system. An example of this issue is medical device failure which directly effects on patient satisfaction rate. Furthermore, the rarity of some kinds of medicines or medical equipment in 28

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran disaster and disruption situation can result in life-threatening conditions for patients.

- Ignoring the various level of services: One of the essential points that should be paid attention is categorizing ICU wards based on different types of patients and the required service level. Generally, ICU patients arein seven categorizations as burn ICU, infectious ICU, general ICU, neonatal ICU, neurologic ICU, open heart ICU, and surgical ICU. However, most of the medical centers only have general ICU, neonatal ICU, and open heart ICU. Although different ICU wards consideration in the system increases the total costs, it decreases patients’ dissatisfaction rate, which consequently placed the medical center as a subspecialty hospital with better ranking.

- Locating CCU in medical centers: Some important criteria such as the distance of CCU to the cardiac emergency, imaging centers, and catheterization laboratory (Cath lab) in each hospital impact on patient satisfaction rate as well as hospital rankings. For this purpose, medical centers’ priority can be evaluated by different multi-criteria decision-making methods. Moreover, locating the critical care departments in newly established hospitals is crucial and can be considered via mathematical models.

Conclusion: Examining the stated challenges via systemic approaches and mathematical models can helps the practitioners to improve the system based on their view point (i.e., cost-efficient, service-oriented, profit-oriented, and etc..).

Keywords: intensive care unit, coronary care unit, patient satisfaction, systemic approaches

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Pain Management in ICU Setting Dr Mehran Kouchek

Anesthesiologist & Intensivist One thousand years ago, Avicenna, “the Prince of Physicians “ codified 15 types of Pain and of course their management and treatment. Many centuries later we are confronted with Pain in Intesive Care Units and we should be able to manage several types of Pain in ICU which is one the biggest challenges in modern medicine. Pain management in ICU has its own problem and difficulties in order to reduce pain and suffering near the hopeless and somehow, helpless population of patients. Yet, multimodal approach is better applied and well tolerated in critically ill patients. Here we discuss about many aspects and modalities of pain control for reducing these patients’ sufferings such as pharmacological and non- pharmacological methods. Managing pain in an unconscious patient is a big challenge. How to measure pain? How to assess it regularly? How to give therapeutic plans to care givers? How to control and diminish pain killers’ side effects? What is the position of Regional Analgesia for pain management in ICU? Hopefully the awareness about pain management in critical care medicine is more and more increased and less patients are suffering Pain, in comparison to even recent decades, in ICUs all over the world.

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IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAM (AMS) Dr. Mehran Lak

Assistant Professor of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences All facilities that provide intensive care services should implement an antimicrobial stewardship program, but, in fact, wherever an antibiotic is prescribed, this program is required. AMS is based on coordinated interventions to improve the appropriate antibiotic administration by promoting the optimal selection of antibiotic regimens, including the dose, duration of treatment, and prescribing method. The benefits of this program include improving the quality of patient care and the treatment outcome, maintaining or reducing microbial resistance, and reducing unnecessary costs. The strongest backup of this program is its scientific basis. Many strategies have been used to reduce the damage caused by the use of antibiotics. The strategies of “preauthorization” and/or” prospective audit and feedback” are the central component of any antimicrobial stewardship program. Along with AMS clinical paths and guide lines should be written. The interventions of the AMS are diverse and each facility should decide on its own needs and resources. The best model has not yet been identified, but all health care providers can perform it according to their chosen model. To implement this program, first, the core elements must be defined and its standards specified, and then the values, structure and tasks are written. The main elements of the program include leadership commitment to dedicating resources- accountability of leader responsible for clinical outcomes- drug expertise single pharmacist leader-Action to support the optimal antibiotic use-tracking by monitoring antibiotic use and resistance- reporting of antibiotic use and resistance and finally education for clinicians, patients and their families. Program standards include the establishment AMS as an organizational priority- educate staff about AMS and Microbial Resistance -educate patients and families about the appropriate use of antibiotics and establish a multi-disciplinary AMS team. AMS values include decreased antibiotic days of therapy – lower use of high cost antibiotics - switching intravenous antibiotics to oral antibiotics - reduced drug toxicity - reduced Clostridium difficile infection and reduced pneumonia readmission. The Organizational structure of a comprehensive AMS is multidisciplinary and includes an epidemiologist - an infection control professional - director of information 31

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systems - director of clinical microbiology - infectious clinical pharmacologist - hospital director and chairman pharmacy and therapeutics committee. At the heart of this structure is the Antimicrobial Stewardship manager. An AMS program has the following tasks, in line with quality improvement theory: Baseline assessment including measure baseline antimicrobial use, dosing, duration, costs and use patterns- study type of microbial isolates, susceptibilities, and trends thereof- Identify clinician indications for prescriptions . Goals of desirable antimicrobial use including definition “appropriate”, rational antimicrobial use for the facility, individual patient units, and empiric treatment versus culture-directed antimicrobial treatment - Establish treatment guidelines for clinical syndromes.- Interventions on antimicrobial prescribing and Provide feedback-continuing education

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Transforming Healthcare in Multiple Fronts Eva K Lee, PhD Virginia C. and Joseph C. Mello Chair and Professor, School of Industrial and Systems Engineering

Director, NSF-Whitaker Center for Operations Research in Medicine and HealthCare Co-Director, NSF I/UCRC Center for Health Organization Transformation Distinguished Scholar in Health Systems, Emory University School of Medicine & Georgia Tech Professor, College of Computing Georgia Institute of Technology Fellow, The Institute for Operations Research and the Management Sciences- (IN FORMS)

Transforming Healthcare in Multiple Fronts The effect of big data is being felt everywhere, from business to science, from government to the arts. Information has gone from scarce to overabundant. This makes it possible to do many things that previously could not be done: uncover business trends, prevent diseases, combat crime, plus a multitude of other possibilities. Harnessing the data well may bring huge and innovative benefits, unlock new sources of economic value, provide fresh insights into science and provide policy makers with solid and convincing evidence to support their stands. Yet critical challenges lie ahead, including data security, privacy, and yet-to-be-discovered technology to effectively and efficiently analyze the data for business innovation. Multi-source data system modeling, machine learning and big data analytics play an increasingly important role in modern business enterprise. Many problems arising from multi-source data can be formulated into mathematical models and can be analyzed using sophisti- cated optimization, decision analysis, and computational techniques. In this talk, we will share some of our successes in healthcare in personalized and optimal drug delivery, novel drug design pipeline, and reducing opioid reli- ance through improvement in clinical practice guidelines. Biosketch Dr. Eva Lee is Virginia C. and Joseph C. Mello Chair and Professor in the H. Mil- ton Stewart School of Industrial and Systems Engineering at Georgia Institute of Technology, and Director of the Center for Operations Research in Medi- cine and HealthCare, a center established through funds from the National 33

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Science Foundation and the Whitaker Foundation. She is a Distinguished Scholar in Health Systems, Health System Institute at Georgia Tech and Emo- ry University. She is also the Co-Director of the Center for Organization Trans- formation, an NSF Industry/University Cooperative Research Center. Lee partners with business leaders to develop novel transformational strategies in service delivery, quality, safety, operations efficiency, information management, change management and organizational learning. Lee’s research focuses on mathematical programming; information technology; game theory; networks; machine learning for risk assessment, decision making, predictive analytics, and knowledge discovery; and systems and performance optimization. She has made major contributions and advances to business operations transformation, emergency response and medical preparedness (CBRN), medical care and procedures, and healthcare operations. Specifical- ly, her work has focused on multiple critical infrastructures, including power plant and energy, telecommunication, finance, healthcare, and supply-chain and logistics. Dr. Lee serves on the National Preparedness and Response Science Board; works with the White House National Security Council Directors of Medical and Biodefense Preparedness Policy on chemical, biological, radiological, and nuclear strategies; and global health security agenda. She has served on multiple National Academies committees including evaluating BioWatch and National Biosurveillance Systems, medical countermeasures working groups, assessment and strategies for destroying the Blue Grass Chemical Agent- Destruction Pilot Plant, optimizing scheduling and access in healthcare, and system approaches for health innovation. She is the principle investigator of an online interoperable information exchange and decision support system for mass dispensing, emergency response, and casualty mitigation. Lee has received prestigious analytics and practice excellence awards including the INFORMS Franz Edelman Award for Achievement in Operations Research and the Management Sciences; the Daniel H. Wagner Prize for Excellence in Operations Research Practice; and Pierskalla award for research excellence in health care management science. She is an INFORMS Fellow, and has received patents on innovative devices and medical systems.

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Medical Error & Adverse Event in Critical Care Medicine: Application of GTT Dr Nader Markazi Moghaddam, MD-PhD Abstract Medical errors and adverse events are a major threat for the patient safety during the provision of care and treatment. Recent estimates suggest that there are between 210,000 and 4100,000 preventable deaths per year in the USA.In New Zealand adverse events were associated with 13 percent of admissions. AEs occurred in the ICU with a typical diurnal frequency distribution. Medication-related AEs were the most prevalent. Studies suggest that errors are common in the ICU, resulting in serious adverse events in 17%of patients. Adverse events incidence varies between % 0.87 to % 34.7 in ICUs. The overall goal of improved safety in health care is to reduce patient injury or harm. Traditional efforts to detect adverse events have focused on voluntary reporting and tracking of errors. But only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to identify events that do cause harm to patients in order to quantify the degree and severity of harm. In this study 127 patient records were reviewed by Global Trigger Tool for finding triggers and adverse events.The GTT is a methodology developed by the IHI to identify adverse events using medical record reviews. IHI Global Trigger Tool contains six “modules” or groupings of triggers: Cares, Medication, Surgical, Intensive Care, Perinatal, and Emergency Department. In this study 4 modules Cares, Medication, Surgical, and Intensive Care in ICU were reviewed. Patient records were reviewed by two nurses and a physician. Triggers and adverse events were identified. Adverse Events contained adverse events related to triggers and adverse events without triggers. Each of the identified adverse events was categorized to 5 categories: E, F, G, H, I E: Temporary harm to the patient and required intervention. F: Temporary harm to the patient and required initial or prolonged hospitalization G: Permanent patient harm H: Intervention required sustaining life

I: Patient death 35

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The numbers of triggers were 622, adverse events related to triggers were 277 and adverse events without triggers were 121.Total adverse events were 398.The number of adverse events related to each category: In E category were 245 and the common adverse events were: Poor monitoring during the blood transfusion, hemorrhage due to coagulation disorders, abnormal Lab-test without intervention, Poor Patient history taking (Poor diagnosis). In F category were 83 and the common adverse events were: VAP, Pressure ulcer infection , Antibiotic Resistance. In G category was1 and it was in-hospital stroke. In H category, 46. The common adverse events in this category were: Operative complication (Peritonitis, Severe hemorrhage), In-hospital renal failure, heart dysrhythmia intra-op or intra dialysis (Without Previous history). In I category, 23.The common adverse events in this category were: Sepsis, DIC. Identification and measurement of adverse medical events is central to patient safety. Compared with other methods of detecting patient harm (voluntary reporting errors), IHI GTT is reasonably sensitive and reliable, but should be seen as only part of a range of measurement tools that provide an insight into the causes of patient harm.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

The effect of family-based care on increasing the satisfaction of family members of patients admitted to special care units Samaneh Mirzaei1*, Adel Eftekhari1, Sima Ghazanfari2, Fatemeh Ghazanfari3

1. Department of Health in Emergency and Disaster, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2. Shahid doctor rahnemoon hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3. Shahid Sadoughi hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Background and Aim: Family-based care is a care where collaboration and close communication is established between the staff and the family of the patient. In such a space, not only the patient but the family and health personnel will also benefit from it. Satisfaction of hospitalized patients’ families is one of the measurable components of patient care quality. The involvement of families in the care of their patients is important in their satisfaction. The purpose of this study was to assess the effect offamily- based care on the satisfaction of family members of patients admitted to intensive care units. Methods: This is a descriptive study in ICU in Shahid Ranmoon Hospital in Yazd. Sampling was carried out in 60 members of the family of patients admitted in special sections by available sampling method. The tools used in the 30-item Persian version of the Satisfaction Questionnaire of family members of adult patients admitted to ICU with three subscales of satisfaction with the treatment, comfort and decision making function. The questionnaire was completed on the third and one week after admission. After the initial completion of the questionnaire, the family of patients in the intervention group under a family-based care and control group were routinely cared for. The provisions of the intensive care unit, equipment and space related to the patient and the staff of the department, as well as the type of disease to one of the family members of the patient Taught. He was then asked to participate in the care of the nurse in accordance with the patient’s needs and, as he wished, to do some of the daily care of the patient, such as baths, hair styles, hands and feet massage, eye care, oral care and nutrition. Then, the data before and after the intervention were analyzed by SPSS 22 software with paired t-test. Results: The mean age of participants was 35.16 ± 10.26. The response rate to the questionnaire was 92%. The findings of the study showed that the 37

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primary score of satisfaction in the control group was 58.58 ± 24.16 and in the intervention group was 55.83 ± 24.49, which was not statistically significant (57.5 ± 22.14, p> 0.05) . After intervention, the significant increase in satisfaction score in the intervention group was 62.75 ± 22.22 in comparison with the control group (p <0/001) Conclusion: According to the results of the study, the family-centered care model in intensive care units is effective in increasing family satisfaction. Nurses working in intensive care units, using this type of care, can play a significant role in satisfaction of more families. Keyword: care, Family-centered, Intensive Care Unit, Satisfaction, Family

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

Prenatal Regionalization Network Modeling Zahra Mohammadi Daniali

PhD in Industrial Engineering The importance of health care systems has significant role in the quality of life and social welfare in modern society. Many countries are faced with growing costs of health care services and focus on cost-saving and improve efficiency through optimization methods. Hospitals are one of themost important health care facilities in every society. One way to promote quality of service in healthcare system is regionalization. Regionalization is a structural system to select and transfer patient to predetermined centers. The goal of regionalization is elevating service level and reducing costof services moreover, regionalization is an economical method in countries with restriction in natural resources, human resources, technical process, capital and knowledge. In 2004, American Academy of Pediatric defined 3 distinct levels of neonatal care, including with subdivisions in 2 ofthe levels. Level I centers provided basic care; level II centers provided specialty care, with further subdivisions of IIA and IIB centers; and level III centers provided subspecialty care for critically ill newborn infants with subdivisions of level IIIA, IIIB, and IIIC facilities. Prematurity/low birth weight is the most common cause of neonatal mortality in the world. Several studies show that risk of neonatal death increase when very low birth weight (VLBW). Location-allocation analysis determines an optimal location for one or more facilities that service demand from the surrounding population. This analysis are using in several businesses like retail business to determine where to open a new store or a new warehouse in supply chain management problems, site new libraries, schools or hospitals by government. Optimization in this analysis is finding the best solution to the problem considering constraints. This survey is an interdisciplinary research to bridging the gap of healthcare systems and engineering fields by using knowledge of NICU experts to define problem accurately and translate problem to operational models by engineering experiences to optimize the problem by mathematical tools. In order to design an efficient network on the case of prenatal care regionalization, at first the hospital location allocation criteria were defined throw interviews and literature, then network of hospitals is mathematically modeled by object of minimizing cost of services and maximizing service levels. It is also assumed that there is constraints on capacity of services in centers. Inputs of model are as follows: distance between hospitals, bed capacity, demand of hospitals for each level of services. Solving the model con- cluded that, in which hospital NICU should be activated and what is optimal referral destination 39

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Improving ICU patients to Access CT Scan Services: a Simulation based Analytics of Resources (code: 1069) Parisa Moodi, Atefeh Panahi, Nazanin Abdolahzade, Elham Yavari Recent studies anticipate an increasing demand for health services. Meeting this demand requires provisioning of more resources. Researchers are increasingly seeking for ways to improve the efficiency or utilization of existing resources. Due to the critical condition of patients in the intensive care unit (ICU), process improvement plays vital role on patients’ health. When inpatients need ancillary services, they would leave the clinical unit and be transferred to the ancillary department, under supervision of a medical team. This paper simulates CT-scan process for patients in neurosurgery ICU department of a general Hospital. The main goal is to reduce the average waiting time of ICU patients in the process. Oneof the best techniques to improve patient flow is simulation. Discrete-event simulation is a powerful tool for identifying and reconstructing bottlenecks in a system, which can effectively model a system in order to examine various systemic changes for process improvement. In this research, we first gathered data and constructed a conceptual model of a neurosurgery ICU in a general hospital. Next, we generated the computer model with ARENA simulation software. Our focus is on the CT-scan process for ICU patients, but due to the common use of CT-scan resources, we consider other hospital wards in simulation, as well. After validating and verifying the modeland making sure that the built model is applicable to the real world, the output data is used to analyze and compare different scenarios to improve the process. Suggested scenarios include: 1) Assigning a full-time neurosurgery ICU specialist 2) Assigning a porter for transferring ICU patients 3) Determining a specific time interval to perform CT-scan merely for ICU patients 4) Increasing the number of CT-scan devices by one The simulation outputs indicate that the utilization factor of the CT-scan machine is very high in the current setting. In addition, due to the higher priority of ICU patients, their service time is lower than general patients. According to two-sample T means comparison, the first and second scenarios do not reduce the average waiting time considerably, while the implementation of the third and fourth scenarios will significantly improve the average waiting time for ICU patients. The results and analysis show that, despite one’s expectation, the third scenario would lead to a relatively significant improvement in average waiting time without any additional expense. The fourth scenario has a greater impact on reducing average waiting time. Further cost analysis would examine the utility of this scenario more 40 precisely.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

The role of evidence in intensive care decision-making Masoud Mousavinasab MD

Intensivist. Anesthesiologist SBMU. Shahid Modarres hospital

DEFINITION The approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research has improved the care of the hospitalized patients significantly. This method of practice has been calling Evidence-Based-Medicine (EBM) for the recent two decades. Evidence-Based-Medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients. •Conscientious – being careful, and thorough, in what you do •Explicit – being “up-front”, open, clear and transparent •Judicious – using good judgement and common sense

Expert opinion resources like text books, E-books, Up-to-date etc. are of Low- est level of evidence, while review articles and meta-analysis are the highest ones. 41

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Steps of practicing EBM •Ask a focused question •Find the best available evidence •Critically appraise evidence for its validity, effect size, precision •Apply the evidence in practice: amalgamate the valid evidence with other relevant information (values & preferences, clinical / health issues & system issues); implement the decision in practice. questions to ask 1. How common is the problem 2. Is early detection worthwhile 3. Is the diagnostic test accurate 4. What will happen if we do nothing 5. Does this intervention help 6. What are the harms of an intervention

Critically appraise evidence for its validity, effect size, precision Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research (evidence) to judge its trustworthiness, value and relevance in a particular context. Critical appraisal looks at the way a study is conducted and examines factors such as internal validity, generaliz- ability and relevance. 42

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Some initial appraisal questions you could ask are: 1. Is the evidence from a known, reputable source? 2. Has the evidence been evaluated in any way? If so, how and by whom? 3. How up-to-date is the evidence? Second, you could look at the study itself and ask the following general appraisal questions: 1. How was the outcome measured? 2. Is that a reliable way to measure? 3. How large was the effect size? 4. What implications does the study have for your practice? Is it relevant? 5. Can the results be applied to your organization? Apply the evidence in practice • Identify abnormal physiology through interpretation of clinical signs associated with patient deterioration • Critically analyze and synthesize current evidence and research informed concepts and approaches to ensure effective clinical reasoning and decision making • Demonstrate advanced knowledge and confidence in managing the acutely ill adult including assessment, planning, implementation, evaluation and -es calation of care • Demonstrate initiative and collaborative working with the multi-professional team and family within professional, legal, ethical and local/national frameworks. Summary Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well- designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was 43 originally used to describe an approach to teaching the practice of medicine

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and improving decisions by individual physicians about individual patients. [1] Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations (“evidence-based practice policies”).[2] It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields (evidence-based practice). Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations, or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators. It thus tries to assure that a clinician’s opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the scientific literature so that best practice can be determined and applied. It promotes the use of for- mal, explicit methods to analyze evidence and makes it available to decision makers. It promotes programs to teach the methods to medical students, practitioners, and policy makers.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

Variable Ventilation Stochastic or Physiologic

Atabak Najafi1* MD. Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. variability of tidal volume and respiratory rate in normally breathing man has long been demonstrated [1]. However because of lack of knowledge and technology primary ventilators could only deliver a fixed tidal volume in a fixed rate the so called volume controlled ventilation (VCV). VCV was volume preset time triggered and cycled and there was no synchronization with patient’s breaths. At that time ventiltory management was associated with serious lung damage caused by ventilator [2-3]. Today that is referred as ventilator induced lung injury. Frequent complications of ventilatory support forced physicians and engineers to develop newer modes of mechanical ventilation. Advances in control mechanisms, servo valves, flow and pressure sensors led to introduction of synchronized modes of ventilation like synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation (PSV). Synchronization of mechanical ventilation was a big step toward physiological ventilation and showed fewer complications compared with non synchronized ventilation [4]. Patient can interact with ventilator in initia- tion of inspiration and in PSV respiratory rate is controlled by the patient’s inspiratory effort so patient is not locked to a fixed respiratory rate delivered by the ventilator. PSV is more physiological form of mechanical ventilation in being patient triggering, pressure limited and flow cycled. Although PSV was introduced as a weaning mode of ventilation it showed it is effectiveness in ventilatory management of respiratory failure [5]. Even in severe cases of acute respiratory failure PSV provided better oxygenation with higher tidal volumes and lower peak inspiratory pressure compared with assist control ventilation [6]. So it is commonly used in critical care setting. After releasing patients from fixed respiratory rate during mechanical ventilation, technological advances in field of mechanical ventilation released patients from fixed support pressure and tidal volume by introduction of proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) in both forms of ventilation level of support pressure is determined by patient’s inspiratory effort. For PAV negative pressure generated at the beginning of inspiration and for NAVA electrical activity of diaphragm controls the level of pressure support. Although tidal volume is variable during PSV but variability of tidal volume is more with PAV [7] and PAV is accompanied with lesser work of breathing and asynchrony than PSV [8] PAV and NAVA both prevent hyperinflation of lungs, decrease patient`s ventilator asynchrony and restore variability of tidal volume and breathing pattern compared with PSV [9]. Another 45

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form of ventilation recently introduced to clinical practice is noisy pressure support ventilation (noisy PSV). In noisy PSV in contrast with PAV and NAVA there is no percent of support pressure setting and intensivist can set the level of support and percentage of variability in pressure support. Support pressure and tidal volume are randomly changing during ventilation so it is very similar to spontaneous breathing. Suki B et al. showed the benefits of variability and noise in life support systems [10]. Variability of tidal volume is effective in recruiting atelectatic lung [11] also variable tidal volume improves lung mechanics and gas exchange in animal model of acute lung injury [12]. Noisy PSV is also superior to PSV and pressure controlled ventilation (PCV) in terms of oxygenation and lung protection [13]. Noisy ventilation improves lung function and reduces lung damage compared with standard lung protective strategies [14]. Noisy PSV in surfactant depleted pigs redistributes perfusion toward nondependent lung regions [15] variable tidal volumes enhances surfactant secretion in alveoli [16] in acute hypoxemic respiratory failure noisy PSV was associated with better synchrony than PSV [17]. Variable ventilation has many benefits in being similar to spontaneous physiological ventilation so patients with better respiratory condition have more variability of breathing and vice versa [18]. Variability of tidal volume generated by the computer is comparable with physiologically derived noise from the aspect of lung mechanics and gas exchange [19]. There have been tremendous advances in field of mechanical ventilation specially in assisted modes of ventilation but we do not see the same level of improvement in controlled modes of ventilation. The question is: how can we help non spontaneously breathing patients? They have the same physiology and same lung so if spontaneously breathing patients benefit from variability of ventilation why should we fetter apneustic patients to a fixed rate and tidal volume. Now it is time for ventilator producing companies to be more thoughtful of these patients and give them the chance to breathe more physiologically by adding stochastic noise or variability to their respiratory rate and tidal volume in conventional controlled modes of mechanical ventilation like pressure controlled or volume controlled ventilation.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

Local patient registry, global patient impact Mihammad Farzad Rashidi

Anesthesiologist & Intensivist The ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE) has provided a bi-national peer review and quality assurance program to provide audit and benchmarking services for Intensive Care Units (ICU’s) across Australian and New Zealand since 1992. This capability is uniquely provided by ANZICS, which offers this program across regional, state, national and international jurisdictions. Data submitted to the registries is used for comparative benchmarking by the ICU peer groups with reports provided to submitting units ICUs and jurisdictional funders. AIMS of the ICU Registries Program Provision of comparative benchmarking reports to submitting ICUs and health departments detailing variation in process measures, quality of care indicators and risk-adjusted clinical outcomes Identification and analysis of outlier ICUs Provision of Data Quality training workshops to support submission of high quality data Assist researchers to identify potential areas for improvement of Intensive Care practices and patient outcomes. All Australian and New Zealand Intensive Care Units are invited to contribute to the ANZICS CORE Registries. Free software (COMET) is provided to units to assist in the collection of data. Data submitted to the ANZICS CORE Registries supports research on a broad range of topics related to Intensive Care including: disease patterns and the effectiveness of critical care interventions, critical care workforce, and planning for emerging issues such as pandemics or biosecurity.

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

Palliative care medicine in ICU, what is possible and what is the best? Mohammad Farzad Rashidi

Anesthesiologist & Intensivist End-of-life care in the ICU poses a daily challenge for clinicians across the world for which a clear understanding of the global and local ethical, societal, legal, and cultural considerations is required. The benefits of intensive care treatment include the prolongation of life and the minimisation of disability. The potential benefits of treatment must be weighed against the burden, which might include pain, suffering, and compromise of dignity. In most situations, assessment of the potential benefits and burdens of treatment is based on probability rather than certainty. Although a number of ethical standards and consensus statements for end-of-life care in the ICU have been developed and published by Intensive and Critical Care Societies, similar documents have not been formalised in many other countries. The ethical principles that inform medical practice include respect for human life and dignity, patient autonomy, justice, beneficence and non-maleficence. These principles are sometimes in conflict. Resolution of such conflict depends on the particulars ofthe situation (including the likely patient outcome), and the philosophical viewpoints of those involved. The goal of palliative care is to improve the quality of life of patients with an active, progressive disease that has little or no prospect of a cure. With the growth and ageing of population, and an increase of chronic and generally incurable illnesses, the types of patient groups requiring palliative care has widened. To improve global end-of-life care in the ICU, there is an imperative for Intensive and Critical Care Societies across the world to develop consensus and evidence-based statements that define and guide processes and procedures for ethical and effective end-of-life care in the ICU relevant to each country and culture. 48

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies Somayeh Sadat

PhD in Industrial Engineering Intensive Care Units (ICU) are costly yet critical hospital departments that should be available to care for patients needing highly specialized critical care. Shortage of ICU beds in many regions of the world and the constant firefight- ing to make these beds available through various ICU management policies motivated this study. The paper discusses the application of a generic system dynamics model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to explore the dynamics of intended and unintended consequences of such ICU management policies under a natural disaster crisis scenario. ICU management policies that can be implemented by a single hospital on short notice, namely premature transfer from ICU, boarding in ward, and general ward admission control, along with their possible combinations, are modeled and their impact on managerial and health outcome measures are investigated. The main insight out of the study is that the general ward admission control policy outperforms the rest of ICU management policies under such crisis scenarios with regards to reducing total mortality, which is counter intuitive for hospital administrators as this policy is not very effective at alleviating the symptoms of the problem, namely high ED and ICU occupancy rates that are closely monitored by hospital management particularly in times of crisis. A multivariate sensitivity analysis on parameters with diverse range of values in the literature found the superiority of the general ward admission control to hold true in every scenario.

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

A Generic Simulation Model of the Relative Cost-Effectiveness of ICU versus Step-Down (IMCU) Expansion Somayeh Sadat

PhD in Industrial Engineering Background: Many jurisdictions are facing increased demand for intensive care. There are two long-term investment options: intensive care unit (ICU) versus step-down or intermediate care unit (IMCU) capacity expansion. Relative cost-effectiveness of the two investment strategies with regard to patient lives saved has not been studied to date. Methods: We expand a generic system dynamics simulation model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to estimate the long-term effects of expanding ICU versus IMCU beds on patient lives saved under a common assumption of 2.1% annual increase in hospital arrivals. Two alternative policies of expanding ICU by two beds versus introducing a two-bed IMCU are compared over a ten-year simulation period. Russel equation is used to calculate total cost of patients’ hospitalization. Using two possible values for the ratio of ICU to IMCU cost per inpatient day and four possible values for the percentage of patients transferred from ICU to IMCU found in the literature, nine scenarios are compared against the baseline scenario of no capacity expansion. Results: Expanding ICU capacity by two beds is demonstrated as the most cost effective scenario with an incremental cost-effectiveness ratio of 3684 (US $) per life saved against the baseline scenario. Sensitivity analyses on the mortality rate of patients in IMCU, direct transfer of IMCU-destined patients to the ward upon completing required IMCU length of stay in the ICU, admission of IMCU patient to ICU, adding two ward beds, and changes in hospital size do not change the superiority of ICU expansion over other scenarios. Conclusions: In terms of operational costs, ICU beds are more cost effective for saving patients than IMCU beds. However, capital costs of setting up ICU versus IMCU beds should be considered for a complete economic analysis.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

INTENSIVE CARE OBSERVATIONAL REGISTRIES: BIG DATA ANALYTICS AS A CLINICAL DECISION SUPPORT FOR CRITICAL CARE MEDICINE Ali Sanaie

Master of Industrial Engineering Background and Aim: Quality of Intensive care has got more attention in case of the high cost of healthcare and potential for harm. Poor-quality care causes excessive cost and quality improvement initiatives in the ICU lead to improvement in outcomes as well as decrease in costs. One of the crucial tools that allow physicians and nurses to monitor change in a quality improvement effort is the development of an electronic database for data collection and reporting. The objective of Intensive Care Observational Registries is to create a high quality registry of patients through collaboration of academic health centers performing uniform data collection with the purpose of improving the quality and accuracy of healthcare decisions and provide data-driven clinical decision support system for critical care medicine. Methods: This article with survey research method, reviews real world data sources in healthcare and considers observational registry as a main tool to address health services and outcomes research questions in critical care, and briefly describes objective, inputs and outputs of intensive care observational registries. Furthermore, huge data that gathered through these registries can be analysed with big data analytics process to support clinical decisions in intensive care medicine. As it can be comprehended from library research, the combination of patient clinical care data, quality parameters, and ICU operating costs, integrated in an electronic database, provides a valuable tool for quality improvement and overall efficiency of offered care. Results: The effective use of big data analytics as a clinical decision support within intensive care units can result in supporting a new wave of clinical discovery, leading to earlier detection and prevention of a wide range of deadly medical conditions. The ability to process multiple high-speed clinical data streams from multiple centers could dramatically improve both healthcare efficiency and patient outcomes. Conclusion: To gain this goal, developing reliable and standardized health analytics platforms as well as quality improvement processes that translate analytical results into new clinical guidelines, is recommended.

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The impact of computerized physician order entry on prescription orders Zand F, Khammarnia M, Sharifian R, Barati O, Keshtkaran A, Sabetian G,Vazin A, Shahrokh N, Setoodezadeh F One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. We conducted a before-after prospective study in 2 intensive care units (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). In conclusion, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. CPOE may improve the quality of delivered services in hospitals.

www.ic3med.ir مقاالت سخنرانی

اولـین کنگـره بین المللـی سیستم ها، فناوری و مدیریت پزشکی مراقبتهای ویـژه 25 و 26 مهر 1397 تهران، مرکز همایش های بین المللی دانشگاه شهید بهشتی، تاالر ابوریحان International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

استفاده از مدل خطی تعمیم یافته برای پیش بینی ضربان قلب بیمار در حال انتقال محمد پیش نماززاده دکتری مهندسی صنایع مقدمه انتفال بیماران فرایندی پر ریسک و مهم برای بیمار و بیمارستان است. این فرایند نیازمند در نظر گرفتن مجموعه ای از سیاست هاست تا به واسطه آن بتوان ریسک انتقال را کاهش داد. انتقال بیمار مابین بخش ICU و سایر بخش ها، به دلیل انجام برخی اقدامات پیشگیرانه و درمانی، اجتناب ناپذیر است. تمامی اقدامات الزم که در بخش ICU انجام می شود، می بایست در طول انتقال نیز انجام شود. زیرا بیماران بخش ICU آسیب پذیر تر بوده، لذا هر فعالیتی که شرایط پایدار آنها رو مورد تهدید قرار دهد می تواند منجر به بروز شرایط خطرناکی برای آنها گردد. بنابراین می بایست یک سیستم برای کنترل دائم شرایط آنها در نظر گرفته شود تا بتوان ریسک انتقال را کاهش داد و یا از حرکات شدید آنها جلوگیری نمود. از یک طرف هیچ گونه استاندارد مشخصی برای بیمارانی که در صف انتقال از ICU هستند وجود ندارد و از طرف دیگر، تاخیر برای انتقال در بیمارستان ها بسیار معمول است. بنابراین در نهایت می بایست مجووعه ای از سیاست ها اتخاذ گردند تا بتوان از تاخیر برای انتقال جلوگیری نمود. اولویت بندی بیماران می تواند یک راهکار مناسب برای کاهش تاخیر ها باشد. یکی از شاخص ها برای اولویت بندی، ریسک بیمار است. در تحقیق حاضر، به بررسی اولویت بیماران بر اساس ریسک آنها پرداخته می شود. عالئم حیاتی بیمار به عنوان یک شاخص برای اندازه گیری ریسک در نظر گرفته شده است. با توجه به آنکه هنگام انتقال ممکن است شرایط بیمار بحرانی شود، هدف تحقیق پیش بینی ضربان قلب بیمار در هنگام انتقال است. از مدل خطی تعمیم یافته)Generalized Linear Model( برای پیش بینی ضربان استفاده شده است. روش ها: داده های جمع آوری شده از ICU بیمارستان لقمان برای انتقال مابین بخش ذکر شده و بخش های پاراکلینیک و اتاق عمل برای این تحقیق مورد استفاده قرار گرفت. ضربان قلب 65 بیمار به عنوان معیار ریسک بیماران انتفال یافته استخراج شد. بر پایه مصاحبه ها و مطالعات پیشین، تمامی شاخص ها و فاکتورهایی که روی ریسک بیماران تاثیر می گذارند استخراج شدند و ارتباط مابین این فاکتور ها و ضربان قلب مورد بررسی قرار گرفتند. نتایج: رابطه معنا دار آماری مابین ضربان قلب و فاکتور های مدت زمان بستری، سطح هوشیاری و دفعات انتقال یافت شد. میزان تاثیر هر کدام از عامل های فوق نیز مورد بررسی قرار گرفتن. نتیجه گیری: نتایج نشان می دهند که تعداد دفعات انتقال تاثیر زیادی روی ضربان قلب بیماران دارد. برای تحقیقات آتی می توان تخصیص تجهیزات بر پایه اولویت بندی بیماران را مورد بررسی قرار داد.

کلمات کلیدی: لجستیک بیماران،ICU، ریسک، مدل خطی تعمیم یافته 54

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

بررسی مقایسه ای هزینه بستری بیماران داخلی و جراحی بستری در بخش مراقبت های ویژه کودکان در مرکز اموزشی درمانی امام حسین)ع( در سال ۱۳۹۶ محمدرضا حبیب زاده فوق تخصص ICU ، استادیار دانشگاه علوم پزشکی شهید بهشتی چکیده مقدمه: بیماران بر اساس تشخیص اصلی بیماری ، در دو سرویس داخلی یا جراحی ، در بخش مراقبتهای ویژه بستری می شوند . هدف این مطالعه ، مقایسه ی هزینه های بستری بیماران داخلی و جراحی در بخش مراقبتهای ویژه ی کودکان بوده است . روش ها: در این مطالعه ، تعداد ۱۲۰ بیمار بستری در بخش مراقبتهای ویژه ی کودکان ، بر اساس معیارهای ورود و خروج ، مورد بررسی قرار گرفتند . اطالعات آنها از پرونده های بیمارستانی استخراج شد ، وهزینه های بستری بیماران داخلی و جراحی با هم مقایسه گردید . نتایج: هزینه های بستری بیماران داخلی ، در مجموع باالتر از بیماران جراحی بود )P>0.05( ، که به دلیل مدت زمان بیشتر بستری این بیماران بود . اما هزینه های پروسیجرها ، بخصوص در ۰ ۱روز اول بستری ، در بیماران جراحی باالتر بود . نتیجه گیری : دستیابی به هزینه های مطلوب بیمارستانی ، برای بیماران داخلی و جراحی ، مدیریت متفاوت ، در زمینه های متفاوت را می طلبد .

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

مراقبت تسکینی در منزل راهکاری برای آزادسازی تخت های ویژه عبدالرحیم حزینی1، محمد فتحی2، فاطمه حیدری3، حسنیه سلیمان زاده4 1. فوق تخصص آنکولوژی و طب تسکینی، مسئول بخش طب تسکینی بیمارستان فیروزگر، دانشگاه علوم پزشکی ایران 2. دانشیار گروه بیهوشی، فلوشیب مراقبت های ویژه، رئیس مرکز تحقیقات بهبود کیفیت مراقبت های ویژه، دانشگاه شهید بهشتی 3. دکترای فقه و مبانی حقوق 4. کارشناس ارشد آمار زیستی، مرکز تحقیقات بیماری های عصبی، عضالنی، اسکلتی، دانشگاه علوم پزشکی ایران )نویسنده مسئول( [email protected]

چکیده مقدمه: افزایش شیوع بیماریهای مزمن در تمام دنیا پدیدهای غیرقابل انکار است. در کشور ایران سرطان به عنوان سومین علت مرگ و میر شناخته شده است، ساالنه حدود 40 هزار بیمار مبتال به سرطان در ایران فوت میشوند. در حال حاضر درصد باالیی از این بیماران در بخشهای ویژه بیمارستان فوت می شوند. این در حالی است میزان اشغال این تختها، در حد بحران است و از طرفی هزینه راه اندازی یک تخت آی سی یو در ایران چیزی حدود 600 میلیون تومان است. در این میان، سازمان جهانی بهداشت، مراقبت تسکینی مبتنی بر منزل را به عنوان رویکردی مناسب برای مراقبت از بیماران سرطانی معرفی کرده است. یکی از وظایف مهم مراقبت تسکینی ایجاد فرصتی برای مدیریت و ساماندهی بیماران مزمن در روزهای پایان عمر به منظور هدایت بیماران از بخشهای ویژه به منزل و اجرای مراقبتهای درمانی در منزل می باشد. هدف این مطالعه، توصیف رویکرد و تجربه 9 ساله مراقبتهای تسکینی در ایران در زمینه آزادسازی تختهای ویژه است. روشها: از سال 1389 با شروع فعالیت رسمی مرکز طب تسکینی آالء در بیمارستان سیدالشهدای اصفهان، خدمات مراقبت تسکینی در منزل به صورت رایگان، ویژه بیماران سرطانی فاز انتهایی )end-stage(، برای نخستین بار در ایران ارائه شد و پس از آن در سال 1392در بیمارستان شهدای تجریش تهران ادامه یافت و در نهایت در سال 1393در بیمارستان فیروزگر تهران، اولین بخش طب تسکینی ویژه بیماران سرطانی ترمینال افتتاح شد. نحوه ارجاع بیماران براساس معرفی انکولوژیستها بود، بعد از تایید اینکه بیمار وارد فاز انتهایی شده، نخست family care انجام میشد و سپس روند بستری بیمار در منزل صورت میپذیرفت. سرویس مراقبت در منزل به صورت کامال رایگان و توسط یک گروه کامال دوره دیده انجام میشد. به جز خدمات فوق، تجهیزات پزشکی مورد نیاز بیمار به صورت امانی در اختیار بیمار قرارداده میشد. 56

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یافته ها: حدود 15 هزار بیمار که 84 درصد از آنها مبتال به سرطان و در فاز انتهایی بیماری بودند پذیرش شدند. 41 درصد این بیماران تحت پوشش مراقبت در منزل قرار گرفتند که 62درصد آنها در منزل یا بیمارستانهای غیرآموزشی و غیردانشگاهی فوت کردند. پس از بررسی عمیق تجربه 9 ساله این مرکز، دو دسته مزایای بیمارستانی من جمله آزادسازی تختهای مراقبتهای ویژه در بیمارستان، کاهش هزینه های بیمارستانی، کاهش نرخ مرگ و میر بیمارستانی،کاهش فرسودگی شغلی کارکنان و مزایای شخصی بیمار من جمله ارتقای کیفیت زندگی بیمار، ادامه مشاوره و درمان در منزل با رعایت کلیه مسائل علمی، اخالقی و قانونی، رضایت بیماران و همراهان، ارائه پروسه مرگ به صورت یک فرآیند طبیعی استخراج گردید. نتیجه گیری: از آنجا که نگهداری و در پی آن فوت بیماران در بیمارستان اقدامی پرهزینه و غیرعقالیی میباشد، تعیین تکلیف بیماران مزمن بویژه عالج ناپذیر از اقدامات مثبت و تأثیرگذار در ادغام مراقبتهای طب تسکینی در نطام سالمت و بیمارستانها به شمار می آید. بنابراین، نتایج مطلوب و رضایت بخش 9 ساله مراقبت های تسکینی، پس از اقدامات کارشناسی، قابل تسری و اجرا در سراسر کشور خواهد بود.

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

تاثير اينترنت اشيا بر مراقبتهاي ويژه پریسا خاکشور دکتری مهندسی صنایع اينترنت اشيا )IOT( دنياي جديدي را به تصوير ميكشد كه در آن هرچيزي، از جمله اشياي بيجان براي خود هويت ديجيتال دارند. به تعبير ديگر با كمك اينترنت اشيا ميتوان دو دنياي فيزيكي و مجازي/سيستمهاي اطالعاتي را با يكديگر تلفيق نمود. اينترنت اشيا ميتواند با استفاده از فناوريهاي مختلف مانند NFC، برچسبهاي RFID، سنسورها، محركها، -Wi Fi، Bluetooth و ZigBee در حوزههاي مختلفي مانند سالمت و مراقبتهاي بهداشتي كاربرد داشته باشد. پي شبيني شده است كه سهم بازار اينترنت اشيا در حوزه سالمت به 117 بيليون دالر تا سال 2020 برسد. در اين سخنراني به صورت خاص به بررسي تاثير اينترنت اشيا بر مراقبتهاي ويژه پرداخته خواهد شد. بخش مراقبتهاي ويژه )ICU/CCU/ITU( از بخشهاي تخصصي بيمارستاني براي مراقبت از افراد دچار بیماریها یا جراحات شدید یا تهدیدکننده حیات است كه بيماران در آن به طور لحظهاي و شبانهروزي تحت پايش و حمایت بوسیله تجهیزات و داروهای اختصاصی قرار دارند تا کارکردهای طبیعی بدن در آنها حفظ شود. باال بودن نسبت کارکنان به بیماران و دسترسي به منابع و تجهیزات پزشکی پیشرفته به عالوه نياز به پايش و حمايت مداوم بيماران بستري در بخش مراقبتهاي ويژه، اهميت به كارگيري استفاده از اينترنت اشيا در اين بخش را به ويژه در بيمارستانهاي هوشمند، پررنگتر ميكند. به عنوان مثال IOMT (Internet Of Medical Things( يكي از زيرشاخههاي اينترنت اشيا است كه در بخش مراقبتهاي ويژه بسيار اثربخش است و به پزشك و ساير پرسنل پزشكي در بيمارستان اين امكان را ميدهد تا دادههاي دستگاهها و تجهيزات مختلف پوشيده شده توسط بيمار را جمعآوري كرده و در يك ابر براي تحليل شرايط سالمت ذخيره كند. كاربردهاي اصلي اينترنت اشيا در بخش مراقبتهاي ويژه عبارتند از: - تسهيل پايش و نظارت بر وضعيت بيمار با بهرهمندي از مزاياي سالمت همراه، - تسهيل پايش و نظارت بر تجهيزات و دستگاههاي موجود در بخش مراقبتهاي ويژه، - مديريت هشدارها و يادآورها بهگونهاي كه برخي از آنها توسط دستگاهها و تجهيزات مديريت شده و نياز به حضور پرسنل نداشته باشد، - كاهش فشار كاري پرسنل بخش مراقبتهاي ويژه - نمايش هوشمند دادههاي جمعآوري شده براساس نياز افراد مختلف مانند پزشك، پرستار، مدير بخش و ...، 58

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

- بهرهمندي از يكپارچگي در دادهها مانند دسترسي به پرونده بيمار و ثبت دادهها در آن، - پررنگتر كردن نقش پزشكي از راه دور در درمان بيمار بستري شده در بخش مراقبتهاي ويژه، - و تسهيل ايجاد بخش مراقبتهاي ويژه در منزل كه منجر به استفاده بهينه از تختهاي موجود در بخشهاي مراقبتهاي ويژه و فراهم كردن آسايش بيشتر براي بيمار است. اين كاربرد بهخصوص براي مناطق دورافتاده نقش پررنگتري مييابد. در این سخنرانی اهم مطالبی که شرح داده خواهد شد عبارتند از: * تعریف جامع اینترنت اشیا * نقش اینترنت اشیا در حوزه بهداشت و درمان * کاربرد و تاثیر اینترنت اشیا بر بخش مراقبت های ویژه * معرفی سه کلید واژه Smart ICU و Tele-ICU و E-ICU * دغدغههاي پيادهسازي اينترنت اشيا در بخش مراقبتهاي ويژه مانند امنيت و محرمانگي، قابليت همكاري و يكپارچگي، زيرساختهاي مورد نياز و هزينه

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

مهندسی سیستمهای سالمت و ICU دکتر محمد مهدی سپهری

دکتری مهندسی صنایع، استاد و مدیر گروه مهندسی صنایع در دانشکده مهندسی صنایع و سیستم ها دانشگاه تربیت مدرس مهندسی سیستم های سالمت تخصص و رشته ی نوظهور است که پژوهشگران این تخصص با رویکردی سیستمی به واکاوی، طراحی و گسترش خدمات سیستم های سالمت و پیچیدگیهای آن میپردازند. متخصصان این رشته بر پایه "پیشی گرفتن از امید، بهبود تجربه، و بیشینهسازی خشنودی" با خدمت دهی به ذینفعان مستقیم نظام سالمت )بیماران، خانواده آنان، پزشکان، پرستاران و دیگر خدمتگزاران نظام سالمت( و همچنین دیگر ذینفعان این نظام، بهبود، پیشرفت، تعالی، و سرآمدی سیستم های سالمت را با اندیشهورزی و عملگرایی مهندسی و ساماندهی میکنند. طراحی و مهندسی راهکارهای جامع ارائه خدمات کارا و اثربخش سالمت در این تخصص با بهرهگیری از روشها و ابزارهای بهینهیابی و تحقیق در عملیات، مهندسی صنایع و سیستم ها، فناوری اطالعات و دیگر رشتههای مرتبط مهندسی و علوم صورت میگیرد. ضرورت توجه به ویژگیهای اساسی و جدایی ناپذیر نظامهای سالمت - "ارزش باال"، "هزینه کم" و "پرهیز از کاستیهای ناخوشایند" - همواره مالک عمل و مبنا در تمامی راهکارها و مسئله گشاییها است. واحد مراقبت های ویژه بخشی از بیمارستان است که مراقبت از افراد با بیماری ها و جراحت های شدید را بر عهده دارد. نظارت دقیق و مداوم و همچنین استفاده صحیح از تجهیزات و سایر منابع برای حیات بیمار ضروری است. در این سخنرانی به نقش و تعامالت مهندسی سیستم های سالمت در بهبود سیستم بخش مراقبت های ویژه و یاریرسانی به متخصصان شرایط حاد و بحرانی، بیهوشی و پرستاران مجرب مراقبت های ویژه و حیاتی از جنبه های گوناگون سیستمی میپردازیم. مواردی نظیر بهبود و روانسازی جریان بیمار، بهبود شاخص های کیفی، پیش بینی صحیح و به موقع دارو برای بیماران، تخصیص تجهیزات به بیماران و ایجاد تعادل برای حجم کاری پرستاران، و ارائه و پیشنهاد برنامههایی برای بهبود شاخص های هزینه، کیفیت و بهره¬وری از نمونههای این تعامالت است. در این راستا به معرفی "سیستم تعامل بیمار در بخش مراقبت¬های ویژه - IPIS" پرداخته میشود. این سیستم برای انجام بهتر فعالیت¬ها و توسعه ارتباطات میان عوامل این بخش پیشنهاد شده است. وجود این سیستم در بخش مراقبت های ویژه موجب کاهش ریسک و مخاطرات، افزایش ایمنی، تخصیص بهینه تجهیزات و کاهش اختالل در انجام اقدامات درمانی می شود. این سیستم با درنظر گرفتن شاخص هایی مانند زمان، هزینه، ریسک و عوامل تاثیرگذار بر وضعیت بیمار می تواند در بهبود هرچه بیشتر فرآیندهای این بخش تاثیرگذار باشد. 60

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

مدل های رهبری در ICU دکتر علی امیر سوادکوهی

فوق تخصص ICU رئیس انجمن مراقبتهای ویژه ایران متخصص بيهوشي و فوق تخصص مراقبتهاي ويژه عضو هيئت علمي دانشگاه شهيد بهشتي

از سبک رهبری ماهتما گاندی و وینستون چرچیل گرفته تا مارتین لوترکینگ و استیو جابز،سبک ها و شیوه های متفاوتی برای رهبری و هدایت افراد وجود دارد. خوشبختانه متخصصین حوزه های کسب و کار و روان شناسی چارچوب های مفیدی برای تشریح شیوه های اصلی هدایت و رهبری افراد، ارائه کرده اند. وقتی این چارچوب ها را درک کنید، می توانید رویکرد رهبری خود را مشخص کنید و در نهایت تبدیل به رهبر موثرتر و کارآمدتری شوید. در این مقاله برخی از رویکردهای رایج رهبری را معرفی می کنیم و مزایا و معایب هر کدام از آنها را بررسی خواهیم کرد. چارچوب های مفید سبک های رهبری در این قسمت نگاهی خواهیم انداخت به برخی از رویکردهای مفید رهبری ) به ترتیب تاریخ مطرح شدن آنها ( که می توانید جهت تبدیل شدن به یک رهبر موثر و کارآمد از آنها استفاده کنید . رویکرد شخصی شما میتواند ترکیبی از این رویکردها باشد و کامال به ترجیحات و نیاز های شما و موقعیتی که در آن قرار دارید بستگی دارد.

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ارزیابی بخش های مراقبتهای ویژه مبتنی بر شاخص های عملکردی دکتر مجتبی صداقت

دکتری پزشکی اجتماعی، دانشیار دانشگاه علوم پزشکی ایران در این ارائه پس از بیان تعاریف واژه هائی نظیر مدیریت، کنترل ) شامل پایش و ارزیابی (، انواع ارزیابی معرفی می گردد. مؤلفه های عملکرد شامل مؤلفه های کمی و کیفی و ابعاد هر یک ) با مدل ,Safety, Timeliness, Effectiveness, Efficiency, Equity Patient Centeredness – STEEEP ( تعریف می گردند. برای دستیابی به استانداردهای خدمات مفاهیم واژه های حوزه)Domain(، معیار)Criteria(، شاخص)Indicator( و استاندارد)Standard( ، همچنین منابعی که می توان از طریق آنها استاندارد ها را شناسائی یا مشخص کرد، بیان خواهد شد. بخش های اصلی دیگر این ارائه شامل روش های اندازه گیری شاخص عملکرد در بخش های ویژه و تحلیل تغییرات شاخص ) با استفاده از Run Charts یا Control Charts(، طراحی و تثبیت اقدامات اصالحی ) بر اساس مدل USAIDS( خواهد بود. یکی از مهمترین اجزا این ارائه، معرفی نمودار های جریان )Run Charts( و الگو های مشاهده شده رایج در این نمودارهاست. این نمودارها حاصل ترسیم اعداد شاخص های محاسبه شده در فاصله های زمانی مطلوب ) این فاصله ها می تواند از دقیقه و ساعت تا هفته و ماه متغیر باشد( در یک محور مختصات می باشند. همچنین، خط میانگین یا میانه داده ها در یک بازه زمانی ) معموال مربوط به 15 تا 20 تا از شاخص های اندازه گیری شده( در نمودار ترسیم می گردد. مشاهده هر یک از الگو های زیر بیانگر احتمال بروز یک پدیده سیستماتیک و غیر تصادفی در عملکرد سیستم، اتفاقی نبودن پدیده و ضرورت بررسی عوامل بروز تغییر در عملکرد می باشند: 1- 6 نقطه پشت سرهم در یک طرف خط )Shift( 2- 5 نقطه پشت سرهم صعود یا نزول)Trend( 3- عبور خیلی زیاد یا خیلی کم مسیر حرکت داده ها از خط وسط)Runs( 4- داده فضائی)Astronomical Point(

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

بهره وری و مدیریت هزینه در نظام سالمت: بخش مراقبت ویژه دکتر شهرام غفاری دکتری اقتصاد سالمت نظام سالمت یک نظام بسیار پیچیده با بازیگران و ذی نفعان متعددی است که هر کدام منافع خود را دنبال می کنند. منافعی که الزاما در راستای هم نبوده و در راستای کلی نظام سالمت هم ممکن است نباشد. با توجه به ماهیت سالمت از جمله کم کشش بودن، امکان ایجاد تقاضای القایی، رشد روزافزون روش ها و تکنولوژی های درمانی، افزایش انتظارات مردم از نظام سالمت، پدیده سالمندی و ...، هزینه های سالمت در حال افزایش است به طوری که در اکثر کشورها حتی با نرخی بیشتر از نرخ رشد تولید ناخالص داخلی افزایش پیدا می کند. در چنین شرایطی، مدیریت و کنترل هزینه ها و استفاده بهینه از منابع در سالمت یا افزایش تولید خدمات سالمت )با نهاده های موجود( ضروری اما آسان نخواهد بود. مدیریت و کنترل هزینه یا افزایش تولید بر اساس نهاده های موجود، می تواند از طریق افزایش بهره وری انجام گیرد. بدیهی است این مهم در مواردی از قبیل بخش های مراقبت ویژه که هزینه های تولید بسیار گرانتر است از اهمیت بیشتری هم برخوردار خواهد بود. بهره وری ، نشان دهنده تغییر کارایی در نقاط مختلف زمانی یا مقایسه کارایی دو بنگاه مشابه است. بهره وری یک سازمان بنگاه اقتصادی، یا یک مرکز درمانی را می توان به صورت بهره وری کل عوامل تولید و یا بهره وری چندعاملی و تک عاملی اندازه گیری کرد. بهره وری کل عوامل تولید به صورت معادله زیر قابل بیان است: منظور از TP بهره وری کل، و منظور از TE کارایی کل می باشد و اندیس ها نیز زمان را نشان می دهند. بیمارستانها هم مثل هر بنگاه اقتصادی دیگر ناگزیر است از منابع محدود در اختیار، به شکلی استفاده کند که بیشترین سالمت را برای جامعه تولید کند. این مهم در بخش مراقبت ویژه نیز همانند سایر بخش ها از طریق کاهش عوامل تولید، افزایش ستانده و یا هر دو توامان قابل دسترسی است. البته بهره وری زمانی به حداکثر می رسد که اثربخشی خدمات ارایه شده نیز بیشینه باشد. به عنوان نمونه یک مرکز درمانی می تواند خروجی )ستانده( خود را با پذیرش و درمان بیماران غیرضرور افزایش دهد اما این مهم الزاما منجر به افزایش بهره وری نخواهد شد و برای نظام سالمت نیز اتالف منابع است. در واقع برای افزایش بهره وری در بخش مراقبت های ویژه اوال باید بیماران غیر ضروری وارد نشوند که به نوبه خود با استفاده بهینه از منابع باعث افزایش بهره وری نظام سالمت خواهد شد. ثانیا بیمارانی که به سطح قابل قبول درمان رسیده اند ترخیص شوند تا فضا برای جذب بیماران دیگر باز شود و تولید افزایش یابد. جهت پذیرش بیماران ضرور و ترخیص به موقع، معموال راهنمای بالینی مفید فایده هستند. ثالثا مدیریت کارایی و بهره وری در فرآیند درمان انجام شود که نتیجه آن استفاده بهینه از نهاده ها و حداکثرسازی تولید می باشد. بدون تردید بهبود مدیریت، استفاده مناسب از تکنولوژی های جدید، و بهبود فرآیندها از الزامات افزایش بهره وری در بخش مراقبت ویژه نیز می باشند.

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

تفکر و یادگیری تأملی برای پزشکان و کارکنان مراقبتهای ویژه مصطفی فروغی نعمتاللهی دکتری مدیریت منابع انسانی طی سالهای اخیر مفهوم تأمل توجهات زیادی را بهعنوان یکی از اجزای اصلی رفتار حرفهای نیروهای درمان و بهعنوان یک راهبرد آموزشی برای کسب دانش و یادگیری از طریق تجربه به خود جلب کرده است. تأمل، یک فرایند آگاهانه تفکر نقادانه درباره تجربه بالینی است، که میتواند منجر به توسعه بینش و تغییر رفتار حرفهای شود. محققان معتقدند که تأمل این فرصت را در اختیار متخصصان قرار میدهد تا از طریق تجربه بالینی دانش خود را خلق کنند، قدرت قضاوت خود را توسعه دهند، مهارتهای ارتباطی خود را ارتقا بخشند، تجربیات همکاری تعاملی خلق کنند و در نهایت سطح خدمات مراقبتی و درمانی را برای بیمار را ارتقا دهند. بهطورکلی فرض میشود که کارکنان حرفهای به چرایی و چگونگی تأمل واقف هستند، این در حالی است که یافتههای مطالعات پژوهشی نشان میدهد که فرایند تفکر تأملی نیاز به آموزش بیشتر و تمرین مداوم دارد، همچنین این فرایند ممکن است به دالیل مختلف متوقف شود یا با موانعی روبرو شود که نیازمند دریافت کمکهای بیرونی و ایجاد فرصتهای بازآموزی است. هدف اصلی این ارائه بیان ضرورت بهکارگیری تفکر تأملی و تشریح مفاهیم و مبانی اولیه آن است. بعالوه یک مدل مبنایی پرکاربرد برای ساختاربخشیدن به تفکر و یادگیری تأملی معرفی شده است. گرچه مفهوم اصلی تأمل موضوع جدیدی در یادگیری و آموزش محسوب نمیشود، بیان نوین آن به تفکرات جان دیویی بازمیگردد. دیویی )1933( معتقد است که یادگیری حاصل تجربه و تأمل در تجربه است که امکان برقراری ارتباط بین باورها، افکار و رفتار را فراهم میکند. در رویکرد ساختگرایی به یادگیری، یادگیری فرایند فعالی است که طی آن یادگیرنده اصول، مفاهیم و حقایق را برای خود کشف میکند. یادگیری تأملی فرایند بررسی و کشف درونی موضوعی است که بهواسطه تجربه مورد توجه قرار گرفته است، ِخود فرد معنا را تولید و واضح میسازد و درنتیجه دیدگاه مفهومی فرد تغییر مییابد این نوع تفکر گذشتهنگر است بدینصورت که فرد به گذشته مینگرد، تجربیات خود را مرور میکند و از این تجربیات درس میگیرد. در منابع مختلف، روشها و رویکردهای مختلفی برای ارتقای یادگیری تأملی پیشنهاد میشود که یکی از برترین آنها نگارش نوشتارهای تأملی از تجربیات است. در چنین نوشتارهایی یادگیرنده رویداد را تشریح کرده و سپس نکات مهم آن را در یادگیری و توسعه حرفهای خود مورد توجه قرار میدهد و ارتباطات بین این رویداد و آموختههای نظری قبلی خویش را پیدا مینماید. مدل ساختارمند رالف و همکاران )2001( میتواند بهعنوان چارچوب مناسبی برای نوشتارهای تأملی مورداستفاده قرار گیرد.

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

پیاده سازی برنامه آنتی میکروبیال استواردشیپ دکتر مهران لک

استادیار بیماری های عفونی و گرمسیری دانشگاه علوم پزشکی شهید بهشتی

کلیه بیمارستان هائی که خدمات مراقبت های ویژه را ارائه می دهند باید برنامه آنتی میکروبیال استوارد شیپ را پیاده سازی کنند؛اما درواقع هرجا آنتی بیوتیک تجویز می شوداجرای این برنامه مورد نیاز است. این برنامه برپایه مداخالت هماهنگ برای بهبود تجویزآنتی بیوتیک مناسب از طریق ترویج انتخاب بهینه رژیم آنتی بیوتیکی شامل دوز ، مدت درمان و روش تجویز است. فواید این برنامه شامل بهبود کیفیت مراقبت از بیمار و بهبود نتیجه درمان ، ثابت نگه داشتن یا کاهش مقاومت میکروبی و درآخرکاهش هزینه های غیرضروری است . قویترین پشتیبان این برنامه مبنای علمی آن است. استراتژی های زیادی برای کاهش آسیب ناشی از مصرف آنتی بیوتیک ها تا کنون به کار گرفته شده اند .« استراتژی تائید قبل از تجویز« و یا« استراتژی ممیزی بعد از تجویز و بازخورد »اجزای مرکزی هربرنامه آنتی میکروبیال استوارد شیپ هستند. همراه با برنامه آنتی میکروبیال استواردشیپ باید مسیرهای بالینی و گایدالین ها نوشته شوند. مداخالت برنامه آنتی میکروبیال استوارد شیپ متنوع است و هر مرکز باید بر اساس نیازها و منابع در دسترس خودش تصمیم گیری کند. بهترین مدل هنوز مشخص نشده است اما تمامی مراکز ارائه دهنده خدمات مراقبت بهداشتی می توانند براساس مدل انتخابی خود آن را اجرا کنند.برای پیاده سازی این برنامه ابتدا باید عناصر اصلی تعریف شوند و استانداردهای آن مشخص گردند، سپس ارزش ها،ساختارو وظایف آن تدوین شوند . عناصر اصلی برنامه شامل تعهد مدیریت برای اختصاص منابع- مسئولیت پذیری مدیریت در برابر نتایج بالینی- خبرگی در تجویز دارو- اقدام برای حمایت از مصرف بهینه آنتی بیوتیک- پی گیری از طریق پایش مصرف آنتی بیوتیک و مقاومت میکروبی و باالخره آموزش برای پزشکان ، بیماران و خانواده آنها است. استانداردهای برنامه شامل برقرار کردن برنامه آنتی میکروبیال استوارد شیپ به عنوان یک اولویت در بیمارستان- آموزش کارکنان بیمارستان در مورد استوارد شیپ و مقاومت میکروبی- آموزش بیماران و خانواده آنهادر باره استفاده مناسب از آنتی بیوتیک ها و برقرار کردن تیم چند رشته ای آنتی میکروبیال استوارد شیپ است. ارزش های برنامه آنتی میکروبیال استوارد شیپ شامل کاهش روزهای مصرف آنتی بیوتیک - کاهش مصرف آنتی بیوتیک های گران قیمت- سوئیچ آنتی بیوتیک های وریدی به آنتی بیوتیک های خوراکی - کاهش عوارض سمی آنتی بیوتیک ها- کاهش موارد عفونت با کلستریدیوم دیفیسیل و کاهش موارد بستری مجدد بیماران مبتال به پنومونی است. ساختار برنامه آنتی میکروبیال استوارد شیپ چند رشته ای است وشامل اپیدمیولوژیست - کارشناس کنترل عفونت - مدیرفناوری اطالعات- مدیر میکروبیولوژی بالینی - مدیر فارماکولوژی بالینی عفونی–و مدیر بیمارستان و رئیس کمیته دارو و درمان است. در مرکز این ساختار مدیر برنامه استوارد شیپ قرار دارد. برنامه آنتی میکروبیال استواردشیپ در مسیر بهبود کیفیت قراردارد و وظایف آن شامل ارزیابی پایه ای– هدف گذاری تجویز مطلوب آنتی بیوتیک- تدوین مداخالت در تجویز آنتی بیوتیک و ارائه آموزش مداوم و بازخورد آن است. 65

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

بررسی تاثیر ابزار جداسازی پارسی در جداسازی بیماران ضربه به سر از دستگاه تهویه مکانیکی ساره محمدی دکتری مهندسی صنایع صدمات شدید مغزی از قبیل صدمات مغزی ناشی از تروما و خونریزی های مغزی یکی از علل رایج بستری در بخش های مراقبت ویژه و استفاده از تهویه مکانیکی می باشد، این بیماران باید از نظر خطر بروز آسیب های ثانویه مغزی حمایت شوند و تهویه مکانیکی باید به گونه ای باشد که منجر به افزاش فشار داخل جمجمه نگردد. با توجه به نبود مقیاس مشخص برای جداسازی این گروه بیماران از دستگاه تهویه مکانیکی آمار شکست در جداسازی)38درصد( و تاخیر در خروج لوله تراشه در این بیماران باالاست . ابزار جداسازی پارسی به صورت تخصصی برای سنجش آمادگی بیمار برای جداسازی از دستگاه تهویه مکانیکی در سال 2016 توسط ایرجی پور و همکاران طراحی شده است . این ابزار شامل 3 معیار اصلی تنفسی، قلبی- عروقی و عمومی می باشد. معیار تنفسی 9 آیتم ، معیار قلبی – عروقی 4 و معیار عمومی 13 آیتم را شامل میشود. هر آیتم می تواند به ترتیت نمره 1 )برای شرایط بحرانی که بیماران نیاز به اقدام فوری دارند(، نمره 2)برای شرایطی که بیمار نیاز به مراقبت دارد( و نمره 3)برای بیماران با شرایط مناسب( دریافت می کند همچنین برای مواردی که پاسخ قطعی برای آیتمی وجد نداشته باشد گزینه غیر قابل بررسی وجود دارد. حداکثر نمره 75 و حداقل 26 می باشد که در صورت کسب نمره 57 و باالتر بیمار را می توانیم از دستگاه تهویه مکانیکی جدا کنیم. آیتم های تنفسی شامل میزان ترشحات راه هوایی، PH خون شریانی، فشار دی اکسید خون شریانی، اندکس تنفس سطحی و سریع، نسبت فشار اکسیژن خون شریانی به کسر اکسیزن دمی، میزان فشار مثبت انتهای بازدمی، اندکس ونتیلیشن ، نسبت تهویه دقیقه ای در تنفس های خود به خودی به تهویه دقیقه ای کل و کمپلیانس استاتیک می باشد. معیار قلبی عروقی ابزار پارسی شامل فشار متوسط شریانی، تعداد ضربان قلب، میزان فشار ورید مرکزی و میزان هموگلوبین و معیار های عمومی شامل درد، رفلکس ها )سرفه، گگ و بلع(، خونریزی، درجه حرارت بدن در 8 ساعت گذشته، قدرت و تحمل عضالت بدن، واکنش حرکتی، ترس و اضطراب، خواب و استراحت، تحمل تغذیه ای، عملکرد کلیوی، الکترولیت ها، میزان اوره و کراتینین می باشد. این پژوهش که با هدف مقایسه میزان موفقیت در جداسازی بیماران با استفاده از ابزار جداسازی پارسی و روش روتین در بیماران ضربه به سر انجام شد، 60 بیمار انتخاب شدند ودر دو گروه کنترل و مداخله قرار گرفتند. در گروه مداخله بیماران با ابزار جداسازی پارسی نمره دهی شدند در صورتی که بیماران نمره 57 و باالتر را کسب می کردند از ونتیالتور جدا و به مدت 2 ساعت روی T-piece قرار داده میشد ودر صورتی که عالیم عدم تحل تنفس خود به خودی ظاهر میشد بیمار مجدد به دستگاه متصل میشد. بیمارانیکه به مدت 2 ساعت معیار های تحمل تنفس خود به خودی را داشتند به عنوان جداسازی موفق در نظر گرفته شدند و جهت خروج لوله تراشه آماده شدند. بعد از خروج لوله تراشه در صورتیکه تا 48 ساعت بعد نیاز به لوله گذاری مجدد نداشتند به عنوان اکستوباسیون موفق در نظر گرفته شدند نتایج این گروه با گروه کنترل که با روش روتین جداسازی و اکستیوب می شدند مقایسه شد . نتایج نشان داد میزان موفقیت در جداسازی بیماران ضربه به سر از دستگاه تهویه مکانیکی در گروه مداخله به طور معنا داری از گروه کنترل بیشتر بود و نتایج اکستوباسیون بیماران نشان داد تفاوت معنا داری در گروه کنترل و مداخله وجود ندارد. 66

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

ICU هوشمند عطا محمودپور استاد تمام – متخصص بیهوشی – فلوشیپ مراقبت های ویژه – دانشکده پزشکی –دانشگاه علوم پزشکی تبریز ایجاد یک محیط هوشمند یکی از بزرگترین چالش های روز علم مراقبت های ویژه می باشد .با توجه به تنوع زیاد بیماران بستری درICUو همچنین داروهای متعدد با ریسک و عوارض باال میزان کار و سختی آن در پرسنلICUبسیار زیاد می باشد .سیستم های فعلی موجود درICU فقط اطالعات را جمع آوری می کنند اما در آینده در اختیار ICUهای هوشمند خواهد بود که نه تنها اطالعات را تجزیه و تحلیل می کنند بلکه امکان مدیریت و راهکارهای درمانی را برای امنیت و تاثیر بیشتر جهت بیماران فراهم می آورند این سیستم ها می توانند اطالعات اولیه و خام را آنالیزو تجزیه تحلیل نموده آنها را به صورت پروتوکل های مداخله ای ارائه نمایند و بدین ترتیب اطالعات بیهوده و غیرضروری را از اطالعات مفید و موثر جدا نمایند . چنین سیستمی باید برای کادر پزشکی جذاب وقابل استفاده به راحتی باشد )پزشکان وپرستاران (همچنین باید میزان و حجم کار پرسنل را کاهش داده و راحتتر سازد.همچنین باید الگوهایی را طراحی نماید که بتواند برای شناسایی مشکل سیستم ها استفاده شده و خود آموز باشد .طبعا چنین سیستم هایی اجازه مراقبت های پزشکی با کیفیت بهتر و ایمنی بیشتر بیمار را فراهم خواهند ساخت . چنین سیستم هایی از تکنولوژی تفسیر اطالعات استفاده می کنند که می تواند اطالعات خام را به اطالعات مفید و موثر برای درمان و مدیریت تبدیل نماید .امروزه تنها سیستم برای تجزیه و تحلیل اطالعات مربوط به مدیریت و درمان بیماران ، مغز پزشکان می باشد که سبب افزایش بار اطالعات وحجم کاری پزشکان می شود وبر این اساس متخصصین ICUباید به صورت سریعوموثر عمل نمایند تا از اطالعات موجود و تحلیل آن تصمیم های درستی در مورد بیماران بگیرند . در چنین شرایطی سیستم های هوشمند اجازه می دهند تا پزشکان سریعتر و موثرتر تجزیه و تحلیل اطالعات را داشته باشند و بنابراین با اطالعات بیشتر تصمیم های صحیح تری بگیرند و بنابراین زمان پزشکان کم تر صرف تحلیل و پردازش اطالعات شده و کمک بیشتری در جهت بهبود پیش آگهی بیماران خواهند نمود . عطا محمودپور : استاد تمام – متخصص بیهوشی – فلوشیپ مراقبت های ویژه – دانشکده پزشکی –دانشگاه علوم پزشکی تبریز آدرس :تبریز – جاده ائل گلی – بیمارستان شهدا – بخش مراقبت های ویژه تلفن :09141160888 Email:[email protected]

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Tele ICU دکتر امید مرادی مقدم فوق تخصص مراقبت ویژه عضو هیات علمی دانشگاه علوم پزشکی ایران Tele icu شبکه های ارتباطی صوتی -تصویری وسیستم های کامپیوتری هستند که فوق تخصص های مراقبت ویژه )اینتنسیویست(را به بخش های مراقبت ویژه بیمارستان های دورمرتبط می کنند. فوق تخصص های مراقبت ویژه در مرکز فرماندهی می توانند با پرسنل ICU در بیمارستانی دور با صوت در ارتباط باشند و اطالعات بالینی بیماران را دریافت کنند ودر عین حال مراقبت مستقیم بیمار توسط کادر درمان ) پزشکان و پرستاران مراقبت ویژه (بیمارستان دور انجام می پذیرد و در نتیجه می توان با تعداد کمی فوق تخصص مراقبت ویژه بیماران زیادی را از راه دور مدیریت کرد. ICU در حال حاضر یکی از مهمترین بخش های بیمارستان می باشد.با اینکه اکثر بخش های بیمارستانی به سمت کاهش اندازه می رود ،نیاز به تخت های ویژه رو به افزایش است،چرا که بیماران بحرانی رو به افزایش می باشند )بعلت باال رفتن سن بیماران و افزایش تعداد بیماران ترومایی( و همچنین این بیماران روزبروز به تکنولوژی های جدیدتری برای درمان نیاز دارند. فوق تخصص های مراقبت ویژه موجب کاهش هزینه های بیمارستانی ،کاهش مورتالیتی بیمارستانی تا سی درصد و کاهش زمان بستری در بخش مراقبت ویژه تا سه روز می شود . Tele-ICU به اصالح و ارتقای این فرایند کمک میکند و نسبت پوشش فوق تخصص به تخت های ویژه را افزایش میدهد و بطوری که یک پزشک و چهار پرستار می تواند هفتاد و پنج بیمار را پوشش دهد و حتی در حال حاضر هر مرکز فرماندهی تا سیصد تخت را می تواند مدیریت کند. با این وجود مشکالتی در tele-ICU وجود دارد.هزینه های باالی راه اندازی ،هزینه های باالی جاری سالیانه مراکز،مقاومت پزشکان بخش های ویژه دوردست در اجرای فرامین درمانی مراکز فرماندهی ،پوشش ناکامل بیمه فرایند Tele-ICU.

www.ic3med.ir ABSTRACT (Poster Presentation)

A COMPARATIVE STUDY ABOUT THE IMPACT OF SENSORY STIMULATION PERFORMED BY FAMILY MEMBERS AND NURSES ON VITAL SIGNS OF PATIENTS AT ICU: A RANDOMIZED CLINICAL TRIAL Submission Author: Mohammad Adineh

Mohammad Adineh1

1. Nursing Care Research Center in Chronic Diseases, Department of Nursing, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRAN

Background and Aim : Some studies have shown the effects of sensory stimulation on vital signs of patients at intensive care unit (ICU).- Howev er, little knowledge is available about family role compared to the role of nursing staff in this issue and current results are controversial.. The aim of this study is to compare the impact of sensory stimulation performed by family members and nurses on vital signs of patients at ICU.

Methods : In this study, 9669 patients were categorized into two intervention groups and one control group by stratified block randomization method.- Dy ang sensory stimulation was provided by family members and nursing staff. No intervention was performed for control group. Sensory stimulation was performed 2 hours a day for 6 consecutive days. The vital signs were assessed 5 minutes before and 30 minutes after intervention.Data analysis was performed by ANCOVA, ANOVA and repeated measures.

Results : The results showed that there was significant difference between the experimental groups in terms of vital signs before and after the intervention (p<0.001). Of this aspect, family group was the best, nursing group was the second and control group was the last group in classification

Conclusion : The effect of sensory stimulation on vital signs of comatose patients was greater when provided by family members.

Keywords : Family member, Nurse, Intensive care unit, Sensory stimulation, Vital signs

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran

COMPARING TWO METHODS OF ENTERAL NUTRITION IN TERMS OF THEIR COMPLICATIONS AND THE TIME NEEDED TO REACH GOAL CALORIE IN CHILDREN HOSPITALIZED IN ICU Submission Author: Mohammad Adineh

Mohammad Adineh1

1. Nursing Care Research Center in Chronic Diseases, Department of Nursing, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRAN

Background and Aim : Nutrition support and noticing the required goal calories in patients having critical conditions are essential aspects of medical care in preventing malnutrition in these patients.

Methods : This research is a clinical trial which was done on 60 children aging between 5 to 17 years old hospitalized in Intensive Care Unit (ICU) of Shiraz’s Namazee hospital, South West of Iran, during April to September 2015. Patients were separated randomly into two groups. Enteral nutrition was done with infusion pump for one of the groups and intermittently for the other one. The data was collected for 7 days by a check list regarding enteral nutrition method, complications and the time needed to reach goal calories. Data analysis was done using SPSS-18 software through Chi-square and t-student test

Results : The results of this study showed that there was a significant difference of the mean time needed to reach target goal calorie between the continuous and intermittent nutrition methods (P<0.05), so the time was less in continuous infusion method. Results showed that there was no significant difference between the GI complications of the two groups (P>0.05).

Conclusion : This study showed that continuous enteral nutrition method has better outcomes in children hospitalized in ICU than intermittent method.

Keywords : Children, Enteral Nutrition, Goal calorie, Intensive Care Unit, Nutrition Support.

www.ic3med.ir International Congress on Critical Care Medicine: Systems, Technology & Management (ICCCMSTM)

INCIDENCE OF ADVERSE EVENTS DURING INTRAHOSPITAL TRANSFER OF CRITICALLY ILL PATIENTS BASED ON NURSES EXPRIENCE Submission Author: Rahimeh Alizadeh sharafi

Rahimeh Alizadeh sharafi1

1. Student of medical surgical nursing of Tabriz medical sciences university

Background and Aim : Intrahospital transport of critically ill patients to perform diagnostic and therapeutic procedures is associated with significant adverse events and complications. adverse events are prevalent during an intrahospital transport, which may have adverse consequences. The purpose of this study was to evaluate the incidence of adverse events based on the experiences of nurses and provide solutions and measures to prevent these complications and enhance the patient’s safety during intrahospital transport. Methods : : This is a descriptive study. The data were collected through interviews with critical care nurses of Sina university hospital using a checklist of adverse events conducted in recent studies and analyzed by the SPSS version 21 software. Results : This study performed on 100 critical care nurses of Sina Hospital with an average age of 32 years who usually accompany average three intrahospital transport per month for diagnostic procedures. The highest incidence of adverse events was sao2 decrease, agitation, nausea and aspiration risk, oxygen storage, infusion pump subtraction, exiting or elongation of patient connections such as NGT, foly catheter, and IV line of the patient , Loss of oxygen capsule, patient fall during displacement, and few cases of cardiac arrhythmia during transport. Conclusion : The results of the study indicate that the incidence of adverse events during intrahospital transport is high, similar to other studies. The most important measures and suggestions based on nurses’ experiences in order to prevent the occurrence of adverse events, including ensuring stability of the hemodynamical condition prior transport, The presence of a sufficient transfer staff, including the presence of the physician during the transfer, the provision of advanced equipment for the transfer of the patient, the assurance of the health of the equipment and devices in pre transport phase, the control of the full amount of oxygen capsules, training the members of the patient’s transfer team and increasing the accuracy and focus during the transport. Keywords : Intrahospital transport, Adverse events, Critical care, patient 72 safety

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PRIORITIZATION OF PERFORMANCE INDICATORS IN INTENSIVE CARE UNITS Submission Author: Mohammad Amin jarrahi

Mohammad Amin jarrahi1, saba naderian2

1. Healthcare researcher, AArya Salamat AAbtin-AASAA corporation, Tehran, Iran

2. Healthcare researcher, AArya Salamat AAbtin-AASAA corporation, Tehran, Iran

Background and Aim : Prioritization of performance indicators in hospitals is one of the essential issues in optimization literature. In the other hand, Intensive care units have a special position in hospitals. Many indicators are expressed as known performance indicators for ICU ward. This study aimed to investigate and prioritize the performance indicators for ICU’s ward professionally

Methods : Analytic hierarchy process, a multiple-attribute decision-making technique, is used in this study to evolve such a model. The steps consisted of identifying the critical success factors for the best performance of an ICU, comparing them pairwise and deriving their relative importance and ratings. Every step in the model was derived by group discussions, brainstorming, and consensus among intensivists.

Results : After AHP calculation, the sequence of indicators in order of importance (that is combination of qualitative and quantitative indicators) have attained as follows: The ratio of dead to the hospitalized patients, Patient comfort, Bed occupancy, Supply-chain management, Monitoring, Iatrogenic complications, The ratio of active bed to the fixed bed, The average patient’s stay, The ratio of acceptance per each bed, Distance of bed turning, Antibiotic usage, Capital equipment and Maintenance of equipment.

Conclusion : The present study establishes AHP as a valuable tool to design a model for Prioritization performance indicators of an ICU. Every ICU may apply this model and have the ratings for the factors and arrive at individual conclusions.

Keywords : Intensive care units, performance indicators, Analytic hierarchy process 73

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PAIN AND ANXIETY AND THEIR RELATIONSHIP WITH MEDICATION DOSES IN THE INTENSIVE CARE UNIT. Submission Author: Seyed ehsan Asadi

Seyed ehsan Asadi1, Ahmad Rahimi2, elahe mohtasham3, Sodabe mohamadi4, Maryam Ghorbani5 1. phd in Nursing, Esfahan Medical University,Isfahan, Iran. 2. Nursing Student OF Dehaghan University ,Isfahan .Iran 3. Midwifery Student OF shahrekord University ,shahrekord .Iran 4. Nursing Student OF Khorasgan University ,Isfahan .Iran 5. Nursing Student OF Khorasgan University ,Isfahan .Iran

Background and Aim : Pain and anxiety are understudied despite their importance to the general medical condition. The aim of the present study was to examine the effects of pain and anxiety and their relationship to the doses of opioids and anxiolytics administered in intensive care unit (ICU) patients.Methods : The subjects included 1000 conscious, critically ill patients admitted to an ICU. Psychiatrists evaluated the patients daily for pain and anxiety. Data regarding the doses of opioids and benzodiazepines administered were gathered. Linear mixed model was used for analysis. Results : The pain and anxiety experienced by patients in the ICU were significantly correlated. Pain had significant main effects on the dose of opioids administered. No significant effectsof anxiety on the daily dose of anxiolytics or opioids given were detected. Conclusion : Due to their closely linked relationship, pain and anxiety, can affect one another, and one can influence the other to appear more severe. In addition, anxiety can be underestimated in ICU patients. The present study suggests the need for precise evaluation and a comprehensive approach to the management of pain and anxiety. In addition, this study implies that management of anxiety may affect pain reduction, given the close correlation between the two.

Keywords : Anti-anxiety agents; Anxiety; Critical illness; Intensive care units; Pain 74

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FACTORS ASSOCIATED WITH NURSES’ PERCEPTIONS, SELF-CONFIDENCE, AND INVITATIONS OF FAMILY PRESENCE DURING RESUSCITATION IN THE INTENSIVE CARE UNIT: A CROSS-SECTIONAL SURVEY. Submission Author: Seyed ehsan Asadi

Seyed ehsan Asadi1, Ahmad Rahimi2, elahe mohtasham3, Sodabe mohamadi4, Maryam Ghorbani5 1. phd in Nursing, Esfahan Medical University, Isfahan, Iran. 2. Nursing Student OF Dehaghan University ,Isfahan .Iran 3. Midwifery Student OF shahrekord University ,shahrekord .Iran 4. Nursing Student OF Khorasgan University ,Isfahan .Iran 5. Nursing Student OF Khorasgan University ,Isfahan .Iran

Background and Aim : Family presence during resuscitation is not widely implemented in clinical practice. Prior research about nurse factors that may influence their decision to invite family members to remain in the room during resuscitation is contradictory and inconclusive.To describe intensive care unit nurses’ perceptions, self-confidence, and invitations of family presence during resuscitation, and to evaluate differences according to nurse factors.A cross-sectional survey design was used for descriptive and correlational analyses.A convenience sample of 450 nurses working in intensive care units across the Iran was obtained.

Methods : Participants completed a survey to collect personal, professional, and workplace information. The Family Presence Risk-Benefit Scale and Family Presence Self-confidence Scale were administered, and frequency of inviting family members to be in the room during resuscitation was collected by self-report. Following descriptive analysis of univariate distributions, a series of hierarchical OLS regression analyses was used to identify which personal, professional, or workplace factors yielded the largest unique impact on nurse perceptions, self-confidence, and invitations of family presence during resuscitation.

Results : Despite high frequency of performing resuscitative care, one-third of participants had never invited family members to be in the - roomdur 75

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ing resuscitation during their careers, and another 18% had invited family members to be present just 1-5 times. Having had clinical experience with family presence during resuscitation was the strongest predictor of positive perceptions, higher self-confidence, and increased invitations. In addition, having received education on family presence during resuscitation anda written facility policy were found to be key professional and workplace predictors of perceptions and invitations.

Conclusion : Nurses who work in a facility with a policy on family presence during resuscitation, are educated on it, and have experienced it in the clinical setting are more likely to have positive perceptions and higher self-confidence, and to invite family members to be in the room during resuscitation with increased frequency. Nurses in leadership roles should create policies for their units and provide education to nurses and other healthcare providers. Due to the apparent importance of clinical experience with family presence during resuscitation, it is recommended to initially provide this experience using simulation and role modeling.

Keywords : Cross-sectional survey; Family presence; Family presence during resuscitation; Family-centered care; Intensive care nursing

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USING PROGNOSTIC MODELS FOR RESOURCE ALLOCATION AND QUALITY CONTROL IN INTENSIVE CARE UNITS Submission Author: Alireza Atashi

Alireza Atashi1, Zahra Rahmatinezhad2, Fariba Tohidnezhad3, Mirmohammad Miri4, Saeid Eslami5 1. Tehran University of Medical Sciences 2. Mashhad University of Medical Sciences 3. Mashhad University of Medical Sciences 4. Mashhad University of Medical Sciences 5. Mashhad University of Medical Sciences

Background and Aim : Accurate outcome prediction by the means of available clinical contributing factors will support researchers and administrators in realistic planning, workload determination, resource optimization, and evidence-based quality control process. This study is aimed to evaluate APACHE II and SAPS II prediction models in an Iranian population. Methods : To calculate APACHE II and SAPS II for all consecutive patients admitted to intensive care units, a prospective cross-sectional study was conducted in four tertiary care referral centers located in the top two most populated cities in Iran, from August 2013 to August 2015. The Brier score, Area Under the Receiver Operating Characteristics Curve (AUC), and Hosmer-Leme- show (H-L) goodness-of-fit test were employed to quantify models’ performance. Results : A total of 1799 patients (58.5% males and 41.5% females) were included for further score calculation. The overall observed mortality (24.4%) was more than international rates due to APACHE II categories. The Brier score for APACHE II and SAPS II were 0.17 and 0.196, respectively.Both scoring systems were associated with acceptable AUCs (APACHE II = 0.745 and SAPS II = 0.751). However, none of prediction models were fitted to dataset (H-L ρ value _ 0.01) Conclusion : With regards to poor performance measures of APACHE II and SAPS II in this study, finding recalibrated version of current prediction models is considered as an obligatory research question before applying it as a clinical prioritization or quality control instrument.

Keywords : Intensive Care Unit, Prediction Models, Performance Measures, Iran. 77

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A REVIEW ON THE EFFECT OF FAMILY-CENTERED EMPOWERMENT MODEL ON LIFESTYLE OF PATIENTS IN INTENSIVE CARE UNITS Submission Author: Somayeh Azimpour

Somayeh Azimpour1, Adel eftekhari2

1. shahid sadoughi university of medical sciences,ziaee hospital ardakan, yazd. Iran

2. Department of health in Disasters and emergencies,school of public health, shahid sadoughi university of medical sciences, yazd, Iran

Background and Aim : The family has an undeniable effect on the behavior and lifestyle of patients. Family-centered empowerment is a model used to improve the quality of life and change the lifestyle of patients in the special department. Empowerment is a dynamic, positive, interactive, and social process. A process that has been formed in relation to others, leading to accountability, better interaction with health authorities, satisfaction, better response to treatment, prevention of complications, reduction of treatment costs, positive look at the disease, and ultimately improving the quality of life of patients and their families. Gets The main purpose of the family-centered empowerment model is to empower the family system (patient and other family members) to improve the level of health, which has been designed with emphasis on the effectiveness of family role in three dimensions of psychological and functional motivation and its main stages include perceived threats Self-efficacy, self-esteem and evaluation. Due to the importance of this issue, this study aimed to investigate the effect of family-centered empowerment model on the lifestyle of patients in the intensive care unit Methods : The present study is a review article based on the data collected from the systematic search of resources in the Google scholar, SID, Magiran, Medline, Irandoc web sites during the period 2017- 2010, from related literature publications and library studies. extracted Results : : Family-based care has empowered individuals and families, enhances independence and independence, and provides them with care. It supports decision-making and family care, and chooses a family and patient. And their values, beliefs and cultural backgrounds. Teaching family members for disease control and even prevention can be very helpful as there is a strong relationship between the family and the health status of its members Conclusion : : Implementing the family-centered empowerment model with 78

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran family participation improves the lifestyle of patients to a satisfactory level. Since implementing a family-centered empowerment model with emphasis on family members can promote knowledge, self-efficacy, self-esteem and ultimately quality of life, this approach is a good solution for care programs and it is suggested that this model be implemented for patients in the special department

Keywords : Family-centered empowerment model, Lifestyle, Patients of the intensive unit

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THE EFFECT OF EXPIRATORY MANUAL RIB CAGE COMPRESSION BEFORE SUCTIONING ON BLOOD OXYGEN SATURATION IN PATIENTS Submission Author: SHahram Baraz

SHahram Baraz1

1. Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background and Aim : One of the most common ways put into practice to the clearance of the airway of patients who are under mechanical ventilation is applying suctioning into trachea. Some physiotherapeutic procedures including rib cage compression parallel to exhale and prior to suctioning can facilitate the egression of discharges. The present study aimed to determine the effect of rib cage compression during the exhale before suctioning on O2 saturation changes in patients receiving mechanical ventilation.

Methods : The research is a clinical trial study. The sample involved 55 patients who received mechanical ventilation hospitalized in special sections of health centers at Golestan and Emam-Khomeini hospitals in Ahvaz. The patients were divided into control and intervention groups by convenience sampling as paying attention to random involvement criteria. Blood oxygen saturation, within 5 minutes before and 15 and 25 minutes after suctioning were measured for intervention group using rib cage compression technique and the data were analyzed by independent t-test, and paired t-test as well as repeated measures design.

Results : The level of oxygen saturation increased by the trachea suctioning through rib cage compression technique and it is statistically meaningful at p< 0.05 .

Conclusion : With respect to the improvement of blood oxygen saturation in intervention group, the technique is recommended for intubed patients.

Keywords : Suctioning, compressing the rib cage, O2saturation, mechanical ventilation

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EXAMINING THE TYPES OF INFORMATION AND COMMUNICATION TECHNOLOGY IN THE INTENSIVE CARE UNIT Submission Author: Khadije Bargbid

Khadije Bargbid1, atefeh abbasi2

1. Department ofHealth information technology, Faculty of Paramedicine, medical University Tehran, tehran, Iran

2. Department ofHealth information technology, Faculty of Paramedicine, medical University Tehran, tehran, Iran

Background and Aim : Information and communication technology(ICT) includes all digital technologies that support electronic recording, storage, processing and information exchange. Today, the importance of information and communication technology in the intensive care sector (ICU) is increasing, but the adop- tion of information systems and ICT technologies will help us to determine the Efficiency and effectiveness of these technologies in the field of intensive care. Methods : This research is a review article based on library studies and Internet searches in reputable databases such as Pubmed, Googlescholar, Magiran and Science Direct. In this study, 100 internal and external texts on the types of information and communication technologies, tools We obtained information, new technologies, warning systems and information and communication systems in the intensive care unit as well asICU traps between 2015 and 2018, which resulted in a total of 30 sources. Results : In the health sector, Information and communication technology ( ICT) refers to a set of services that focus on distance learning, interdisciplinary support, and knowledge transfer. Types of information and communication technologies include clinical information systems, PACS archiving and communication systems, and telemedicine services that are both simultaneously (real-time) and remote therapy simultaneously. Conclusion : The study shows that information and communication technologies ( ICT) in Intensive Care Unit significant impact on providing quality service to patients, staff workload, reducing the cost of health care, care is efficient and reduce errors.

Keywords : ICT, Intensive Care Unit, tele-ICU, telemedicine

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USE OF BISPECTRAL INDEX AND THE CRITICAL-CARE PAIN OBSERVATION TOOL FOR THE DETECTION OF PAIN IN NONVERBAL PATIENTS UNDERGO- ING MECHANICAL VENTILATION AFTER CARDIAC SURGERY Submission Author: Arvin Barzanji Arvin Barzanji1, Zahra Faritous2, Rasoul Azarfarin3, Mostafa Alavi4, Saeed Yarahmadi5 1. Department of Anesthesia, Faculty of Para Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran 2. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 3. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 4. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 5. MCs in Health Education and Health Promotion,Kurdistan University of Medical Sciences, Sanandaj, Iran

Background and Aim : Pain assessment is very important in sedated and mechanically ventilated patients, as they are unable to communicate verbally. The aim of this study was to evaluate BIS compared with critical-care pain observation tool (CPOT) for pain assessment during painful procedures in sedated and mechanically ventilated adult ICU patients after cardiac surgery.Meth - ods : 134 patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed in the intubated and sedated patients by using BIS and CPOT. The pain assessments were done at three different times: 1. baseline (immediately before any painful procedure), 2. during painful procedure (including tracheal suctioning or turning, and 3. 15 minutes after the procedure (recovery time). Results : The mean values for CPOT and BIS were significantly different at different times; they were increased during suctioning or turning, and decreased 15 minutes after these procedures (CPOT: 3.92±1.59 during suctioning or changing position,0.70 ± 0.55 at rest and 1.014± 1.02 at recovery time; BIS:59.71 ± 9.75 during suctioning or changing position,76.98 ± 9.90 at rest and 61.73±11.27 at recovery time(P <0.05)). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time. Conclusion: It seems the BIS may be suitable for detecting pain in unco scious patients and can be used more- effi ciently in intubated patients under deep sedation in the ICU. 82 Keywords : BIS, CPOT, Cardiac surgery, Nonverbal patients

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CONFLICT EXPERIENCE IN VISITING IN THE INTENSIVE CARE UNIT Submission Author: Mehri Doosti irani

Mehri Doosti irani1, Batool Alidoost2, Kobra Noorian3, Zahra Tayebi4, Mehri Doosti-Irani5

1. -

2. MSc in nursing, shahrekord university of medical sciences. 3. MSc in nursing, Faculty member, school of nursing and midwifery, alborz university of medical sciences. 4. Assistant professor, school of nursing and midwifery, alborz university of medical sciences. 5. Assistant professor, school of nursing and midwifery, shahrekorduniversity of medical sciences.

Background and Aim : Visiting to the ICU is limited and its related challenges have not been properly discussed. Therefore, in this descriptive-exploratory study, the challenges of visiting are discussed.

Methods : This is a qualitative descriptive-exploratory study conducted through semi-structured deep interview with 35 participants (6 patients hospitalized in ICU, 20 nurses working in this department and 9 patients’ families) in Kashani and Hajar hospitals in Shahrekord in 2017. Written consent was obtained. Data gathering was finished when data saturation was achieved. Data analysis was carried out with a thematic analysis approach.

Results : The main emerged theme was the “Conflict Experience”. Families (patients’ relatives) and patients consider the visiting as an important and necessary need, and this unmet need causes “imbalance between the families’ need and laws” and the “imbalance between the patient’s need and the laws”. Meanwhile, there was another dichotomy that was imbalance between “nurses’ human and scientific beliefs on the patients and families’ need” and “nurse’s belief in the reasons for the forbidden visiting and laws”. In fact, nurses (based on their experiences and rarely based on their scientific studies) found that restricted visiting and the specific area of ICU caused problems such as delirium and etc. In addition to scientific and empirical issues, they placed themselves as a human being in the position 83

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of patients and relatives, and they viewed the phenomenon of visiting from their point of view, and believed that if one day, they or their loved ones were in this position, they needed to meet. In spite of this, they deeply believed that the visiting at the ICU is impossible and there mentioned several reasons for that. That is why the “imbalance between the scientific and human beliefs of nurses and laws” was raised. So there was a contradiction between their beliefs that led to two reactions. Sometimes this contradiction lead to restricted visiting and they suffered (since they consider their action as an unconscientiously activity). But their second reaction was to escape from this unconscientiously action and allow short-time visiting. After providing brief vising on the one hand, they fear of cases such as patient injury, infection in the department and etc. On the other hand, they violate of the law and they may be punished. and this defective cycle was repeated.

Conclusion : Visiting at ICU in Shahrekord hospitals, similar to other parts of the country is limited. Experiencing “conflict” in participants indicate the necessity to find scientific and applicable strategies to address the visiting challenge.

Keywords : Intensive care unit, critical care unit, visiting, descriptive- exploratory study

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A REVIEW OF PROSPECTIVE PAYMENT MECHANISMS FOR INTENSIVE CARE IN SELECTED HIGH INCOME COUNTRIES: LESSONS FOR IRANIAN HOSPITALS Submission Author: Reza Esmaeili

Reza Esmaeili1, Moosa Sajjadi2, abdoljavad khajavi3

1. Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran

2. Department of Medical-Surgical Nursing, School of Nursing, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran

3. Department of Public Health, School of Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran

Background and Aim : Increasing cost of intensive care (IC) is the present and future challenge of health systems around the world. Payment mechanisms is a vital axis in health system reforms and its design and implementation could affect both cost and effectiveness dimensions of IC delivery. Compara- tive analysis of other countries experiences in payment mechanism for IC can trigger the evolving approaches. This review explain the function and impact of payment mechanisms for IC in selected high income countries.

Methods : in this study data were extracted from literature published in PubMed database. Results of the included studies were summarized and presented in comparative tables

Results : Principles and results of DRG implementation in Germany (Insurance-based), England (Tax-based) and Swiss (Social and Private Insurance) health systems were reported. We point out some lessons for Iranian hospitals regarding establishment, function and impact of prospective payment mechanisms in ICUs.

Conclusion : As clinical complexity in ICUs is apparent, the complexity of reimbursement system must be understood to create better value for money. DRGs system is an important necessity for Iranian Hospital

Keywords : Critical Care, DRG, Health Financing 85

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DETERMINING THE USER-INTERFACE PROBLEMS OF A NURSING INFORMATION SYSTEM IN THE ICU OF THE SOCIAL SECURITY HOSPITALS BY USING THINK ALOUD METHOD Submission Author: Fatemeh Farahani

Fatemeh Farahani1, Reza Khajouei2

1. Health Service Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

2. Medical Informatics Research Center, Institute for Futures Studies in Health, Ker- man University of Medical Sciences, Kerman, Iran.

Background and Aim : In spite of the critical role of Nursing Information Systems (NIS) for ICU nursing staff and the frequent use of these systems for documentation of clinical and patient care processes, sometimes the interaction of users with the interface of these systems is difficult. This results in users’ dissatisfaction, system unacceptability and subsequently in medical errors. The purpose of this study was to identify the problems of the ICU Nursing Information System (one of the subsystems of the electronic system of Social Security hospitals) using Think aloud (TA).

Methods : This cross-sectional descriptive study was done on the NIS used in the ICUs of Social Security hospitals in Iran, by participation of 18 novice users consisted of last year undergraduate nursing students. The research was conducted in Payambar-e Azam hospital in fall of 2017. The video and audio of all interactive behaviors of the participants, including their movements and speech, were recorded by Morae when they performed a set of 15 common activities with the system. The usability issues of the system were identified by analyzing the recordings. Eight evaluators were asked to assign a severity score between 0 and 4 to each of the issues. , The final severity scores were determined by calculating the average scores assigned to each problem.

Results : A total of 151 problems with the mean severity of 3.5 were identified and categorized into the following 5 groups based on the usability features proposed by ISO and Nielsen. 1) Satisfaction (n=66), such as presenting extraneous information on the screen and inappropriate design 86 of the pages, especially the home page; 2) Effectiveness (n=13), such as

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran inappropriate design of the main menu and operational buttons, and lack of required user functionalities; 3) Efficiency (n=25), such as the complexity of the steps; 4) Learnability (n=19), such as confusion due to inappropriate screen elements and the need to learn how to work with the system; and 5) Error (n=28), such as the lack of error messages, proper guidance, feedback, and help in the system.

Conclusion : The TA identified a number of problems that users may face in their first encounter with the NIS used in the ICU wards of the Social Security hospitals. Given the identified problems in each group, adherence to the following recommendations can improve the usability of Nursing Information Systems: designing a user-centered home page with a clear main menu to encourage use of the system, removing extraneous information, displaying error messages with practical instructions, providing feedback to user activities, reducing complexity of the system, presenting the information logically, improving the quality of the user interface, simplifying working processes to improve efficiency, and providing required users functionalities.

Keywords : Usability Evaluation, User testing, Think aloud, Nursing Information Systems, Users Interface, ICU(Intensive care unit)

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THE EFFECT OF EDUCATIONAL-SUPPORTING PROGRAM ON ANXIETY, STRESS, AND DEPRESSION IN PATIENTS FAMILY MEMBERS IN THE SURGICAL WAITING ROOM Submission Author: Nasrin Galehdar

Nasrin Galehdar1, Hasanpour Marzieh2, Kazemi Ashraf3, Tarahi Mohammad javad4

1. Ph.D. in Nursing, Assistant Professor of Surgical Technology Department, Faculty of Paramedical, Lorestan University of Medical Sciences, Khorramabad, Iran.

2. PhD in Nursing, NIDCAP Professional School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

3. Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4. Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

Background and Aim : The tensions that affect family members affect the whole family. Hospitalization causes a sudden and severe family members crisis. Surgery is the most stressful time for family members. The amount of stress felt in the family members is equal to the amount of stress that the patient feels. This study aimed to determine the effect of the educational- support program on the level of anxiety, stress, and depression in patient’s Family members undergoing surgery

Methods : This study was a randomized clinical trial. The present study was conducted to evaluate the effect of the educational-supportive program on depression, stress, and anxiety in the waiting room. For the intervention group, a pre-designed preschool education program was held in the 6-day attendance in the waiting room, and the control group received routine care. Levels of depression, stress and anxiety were measured using the DASS-21 scale. Finally, the variables were assessed and compared before and after the intervention by SPSS software. The significance level was 0.05.

Results : The results showed that there was no significant difference between the control and intervention groups before intervention (P> 0.05). 88 In the intervention group, there was a significant difference between the

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran mean of anxiety, stress, and depression in the family members before and after the intervention (p <0.0001). There was no significant difference between the mean anxiety, stress and depression in the family members before and after the intervention (P <0.05).

Conclusion : The results of this study, while presenting the educational and support needs of the family members of patients in the waiting room, showed the effect of the program on the mental health of the family. Therefore, it is suggested that educational support programs in the waiting room for the family of patients should be part of the duties of the medical personnel, so that they will support them while educating them and increase their mental health and satisfaction with the therapeutic system.

Keywords : Family, Educational Support, Program, Waiting room, DASS

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THE IMPACT OF LIAISON NURSE ON SATISFACTION AND PERCEIVED SOCIAL SUPPORT OF THE FAMILY MEMBERS OF SURGICAL PATIENTS IN THE WAITING ROOM Submission Author: Nasrin Galehdar

Nasrin Galehdar1, Hasanpour Marzieh2, Kazemi Ashraf3, Tarahi Mohammad javad4

1. Ph.D. in Nursing, Assistant Professor of Surgical Technology Department, Faculty of Paramedical, Lorestan University of Medical Sciences, Khorramabad, Iran

2. PhD in Nursing, NIDCAP Professional School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3. Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

4. Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

Background and Aim : Family is the most important supportive institution for each person. Patient’s family needs support during the patient’s presence in the operating room, but it does not seem to be enough attention in the treatment centers. Therefore, the present study aimed at determining the effect of interface nurse on the satisfaction and perceived social support of the family members of patients in the expected room

Methods : This was a randomized clinical trial. In this study, the liaison nurse provided information and support to the patient’s family members ina preconfigured program in the intervention group in the presence ofa caregiver in the waiting room. The control group received routine care. Before and after the intervention, perceived social support was measured by MSPSS scale and satisfaction level using a researcher-made questionnaire. Finally, the variables were analyzed before and after the intervention by SPSS software. The significance level was 0.05.

Results : The family member’s satisfaction score was between 4-14 years. Based on Independent T-test, there was a significant difference between the mean score of family members satisfaction in the control group (29.05 90 ± 11.36) and intervention (128.5 ± 9.59) (p <0.0001). In the analysis of the

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran data, the perceived social support tool was perceived and based on the Independent T-test, there was no significant difference between the mean scores of support from family, friends and significant individuals before the intervention between the two groups (0.05 > P) but after the intervention, this difference was significant (p <0.0001).

Conclusion : : This study showed the need for support in the family members of patients undergoing surgery in the presence of the waiting room. Also, the results showed that by increasing the level of support, the satisfaction level of the family members of patients increased. Therefore, in order to raise the level of satisfaction and increase the productivity of the health system of the country, it is necessary to treat the patient’s family members as a person from the treatment team and to be aware of their support needs.

Keywords : Family members - Perceived Ssupport - Satisfaction-Operative- Nurse liaison

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EFFECT OF USING EYE MASK AND EARPLUGS ON STATUS AND QUALITY OF NIGHT-TIME SLEEP IN CARDIAC INTENSIVE CARE UNIT PATIENTS HOSPITALIZED IN SEYYED ALSHOHADA HOSPITAL OF URMIA, IRAN Submission Author: Chiman Ghaderi

Rahim Baghaei1, Chiman Ghaderi2, Mohammad Ahmadpour3, Mohadese Babaie4, Aram Feizi5

1. PhD in Nursing, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Urmia, Iran

2. PhD Student of nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3. Ph.D Student, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

4. PhD Student of nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5. PhD in Nursing, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Urmia, Iran

Background and Aim : Sleep deprivation is a prevalent issue for patients hospitalized in intensive care units (ICU). The aim of this study was to investigate the effect of using eye mask and earplugs on the status and quality of night-time sleep in cardiac intensive care unit patients.

Methods : A total number of 80 patients hospitalized in cardiac ICU for acute coronary syndrome have been chosen as participants. The patients were randomly divided into four groups of 20 individuals; control, those using eye mask, those using earplugs and those who used both eye mask and earplugs. The data were collected using demographic questionnaire, the Pittsburgh sleep quality index (PSQI), numeric pain scale and the Leeds Sleep Evaluation Questionnaire (LSEQ).

Results : There was no statistically significant difference with respect to the demographic variables between the four groups. The average of the overall sleep score was 4.82±0.5, 5.65±1.1, 6.70±1.1 and 6.13±1.1 in control, 92 earplugs, eye mask and eye mask-earplugs groups, respectively. The overall

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran sleep score was statistically different between the four groups (p< 0.001). There was a significant difference between the control and each of earplugs, eye mask and eye mask - earplugs groups with respected to the sleep score (p< 0.05). Analysis of the data related to the four dimensions of sleep showed statistical differences between the four groups (p? 0.001).

Conclusion : Utilization of eye mask and earplugs, individually and together, improved the overall sleep score in cardiac ICU patients hospitalized for acute coronary syndrome. The satisfaction rate was higher in patients who used eye mask than those used earplugs.

Keywords : sleep quality, ICU, eye mask, earplugs, coronary syndrome

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TRANSITION CARE: BEST PRACTICES BASED ON EVIDENCE Submission Author: Kobra Ghorbanzadeh

Kobra Ghorbanzadeh1

1. P.h.D candidate, Department of Nursing, university of social welfare and Rehabilitation sciences, Tehran,Iran.faculty of khalkhal university

Background and Aim : Transfer and discharge patients from ICU is complex and multiprofessional process that doctors, nurses, managers, ward staff and system support in process involve.Various interventions and Programs in patient transition needed to improve the quality of care, safty and reduce costs so that patients who are admitted to critical condition and are often vulnerable during the transition between care setting and care providers. The purpose of this review study is review the best evidence practice about transition care from ICU.

Methods : In this study, 61 articles were published during the years 2000-2017 on the transitin of patients from ICU. This article has been reviewed by google scholar, Elsevier, pubmed, Jama.The authors used keywords including transfer, post-ICU follow-up, transition, care transition

Results : Interventions that were mentioned in the studies, and somewhat confirmed by their effectiveness, included a comprehensive discharge program, timely and complete communication for information provision, drug combinations, patient and caregiver training based on the training- return method, open communication Service providers have been promoting follow-up visits with outpatient service providers after discharge

Conclusion : We recommend that several strategies be provided for hospitals so that the treatment team is encouraged to implement the most effective interventions among such programs and to prevent advers avants and patients re-admit to the ICU, and ultimately in Health care costs are saved

Keywords : transfer, post-ICU follow-up, transition, transition care

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IMPROVE THE PATIENT’S FLOW PROCESS IN THE HEART’S ICU USING THE BROWNIE LINE MODEL Submission Author: Abas Gomar

Abas Gomar1, Gholamreza Ebrahimi2, Abasat Mirzaei3, Abasat Mirzaei4

1. Graduate student,Islamic Azad University of Medical Sciences, Tehran, Iran

2. Graduate student,Islamic Azad University of Medical Sciences, Tehran, Iran

3. Assistant Professor Department of Health Services Management ,Tehran Medical Sciences Branch, Islamic Azad University, Tehran ,Iran

4. Health Economics policy Research Center , Tehran Medical Sciences Branch, Islamic Azad University, Tehran ,Iran

Background and Aim : The intensive care unit is one of the most important parts of the hospital, with most patients in need of a variety of issues such as flat shortages, thus facilitating the flow of patients in this area is of particular importance. The main goal of this study is to maximize patient flow and minimize costs in the network, taking into account the practical limitations of the hospital.

Methods : This research is form a practical, descriptive point of view is an applied research. Information was collected through observation and questionnaire and analyzed by SPSS24 software.The statistical population of the study was the medical staff working in the ICU of hospital. To improve the patient flow process, the Brownian model is used because this modelis rooted in the theory and maintains the advantage of studying the queuing networks as a whole and comes from a heavy traffic theory. Simulation has been used as a validation tool.

Results : Three policies to increase the capacity of the intensive care unit,and the establishment of a relief care,early clearance and entrance control to the public sector were considered to provide the best results.The data obtained were 81/1% , 13/3% and 23/35% respectively, and 86/7% were opposed to early clearance,which had the greatest effect on capacity building and establishment of palliative care, thus,as a major contributor to the improvement. Meanwhile, taking into consideration an intensive care unit 95

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that is available only when the demand for admission to the intensive care unit has increased unevenly can greatly reduce the pressure on other departments in the hospital.It can also seen that reducing the number of interruptions and reducing the time spent resolving the interruptions has a similar effect on the patient’s flow time.

Conclusion : The number of beds in the hospital’s special departments is directly related to the acceptance or rejection of patients and planning for capacity in patients deaths and lives is effective. In this study, an approach has been proposed that the capacity of the special sectors is determined in such a way that in addition the reducing blockage and improving the flow of patients, hospital costs will also be minimized.

Keywords : Intensive Care Unit, Simulation , Patient Movement

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PREVALENCE OF VITAMIN D DEFICIENCY AND ITS CORRELATION WITH MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT Submission Author: Mohamadreza Habibzade

Mohamadreza Habibzade1, Amir Shafa2

1. Assistant Professor of Anesthesiology, Isfahan University of Medical Sciences

2. Assistant Professor of Anesthesiology, Isfahan University of Medical Sciences

Background and Aim : Vitamin D deficiency is common in pediatric intensive care unit (PICU) and is related with mortality. The aim of current study was evaluation of prevalence and correlation between vitamin D deficiency and mortality in pediatric intensive care unit.

Methods : In this cross-sectional study, 61 pediatrics patients admitted to pediatric intensive care unit were enrolled according to inclusion and exclusion criteria. Serum levels of vitamin D were measured in the patients at onset of study; then, patients were allocated into two groups of vitamin D deficiency (less than 20 ng/ml) and normal (vitamin D of more than 20 ng/ ml). Mortality rate was evaluated in patients according to pediatric risk of mortality III (PRISM III) and pediatric index of mortality 2 (PIM 2)

Results : Both the indexes (PIM 2 and PRISM III) were higher in vitamin D deficiency group (P = 0.020 and P < 0.0001, respectively). There wasno significant correlation between serum level of vitamin D with PIM 2 (P= 0.590) and PRISM III (P = 0.180)

Conclusion : According to our results, the prevalence of mortality was higher in vitamin D deficiency group compared to normal group; but there was no significant correlation between serum levels of vitamin D and mortality rate.

Keywords : Vitamin D deficiency, Mortality, Children, Pediatric intensive care units

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INVESTIGATING THE EFFECT OF USING WIRELESS SENSORS IN PROVIDING GOOD CARE FOR PATIENTS IN INTENSIVE CARE UNITS Submission Author: Ali Hajipourtalebi

Ali Hajipourtalebi1, Nastaran Barmaki2, Mina Hadizadeh3, Fatemeh Zia Bakhsh4, Pouriya Darabian5, Sara Jafaryan6, Sepideh Jafari7

1. BSc Student Health Information Technology, Student Research Committee, Army University of Medical Sciences, Tehran, Iran

2. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

3. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

4. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

5. Student Research Committee, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran

6. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

7. Bachelor of Science in Nursing, Student Research Committee, Faculty of Nursing, Aja University of Medical Sciences, Tehran,IR- Iran

Background and Aim : intensive care unit is considered as a critical unit where cables attached to patients , not only are barriers for nurses to carry out their tasks effectively but also barriers for patients to move freely .with rapid revolution in IT , wireless technologies are the ways to this problem . this study aims to identify the issues such as supervision on patients through monitoring of important medical parameters.

Methods : : current study is a systematic review done by analyzing extent searches in websites such as credible journals, PubMed, SID, Google Scholar, ISC, Scopus and relative books with no time limitation. found 256 articles, 197 of them were involved in study then assessed for their titles, abstracts and full text. Unrelated ones were deleted, 123 relative articles were select- 98 ed to research .

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Results : results showed that using wireless sensors in ICU facilitates patients’ movements in hospital environment, accurate and complete recording of Medical parameter that was a help for accurate diagnose and also barrier for loss of sensitive data of patients in ICU.

Conclusion : Studies have stated that using wireless sensors instead of cable connected to patients in ICU, increase measurement accuracy of critical Medical parameters and quality of life and guarantee security of patients

Keywords : ICU , technology , wireless sensors

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THE IMPACT OF USING EMR ON DOTECH TABLETS ON REDUCING NURSES’ DRUG MISTAKES IN THE INTENSIVE CARE UNIT Submission Author: Ali Hajipourtalebi

Ali Hajipourtalebi1, Fatemeh Zia Bakhsh 2, Nastaran Barmaki 3, sepideh Jafari4, sara jafaryan5

1. BSc Student Health Information Technology, Student Research Committee, Army University of Medical Sciences, Tehran, Iran

2. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

3. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

4. Bachelor of Science in Nursing, Student Research Committee, Faculty of Nursing, AjA University of Medical Sciences, Tehran, IR-Iran

5. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

Background and Aim : Dangerous accidents caused by drug mistakes are one of the biggest challenges in the intensive care unit. Patients in these areas are very sensitive to errors and are not able to withstand the damage caused by these errors. The purpose of this study was to investigate the relationship between the use of electronic medical record recording system on DOTECH tablets and its effect on reducing drug mistakes in intensive care units.

Methods : The present study was presented as a systematic overview with a large search of websites, pubmed, SID, Google scholar, ISC, scopus, and analysis, and the 2014-2017 timeframe for the selection of articles was considered. The articles were found in about 156 articles, of which 110 articles were included in the study, and then these articles were evaluated in terms of title, abstract and full text. After removal of unrelated items, 84 articles related to the research were selected. Became

Results : The results of the review of the articles showed that the most common nurses’ drug mistake was the wrong amount (38.6%). Concern- 100 ing the factors associated with drug errors, 43.5% were related to the

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran transcription factors, 25.5% were communication factors, 17.2% were factors related to working conditions, 11% were related to the packaging and 2.8% % Of the agents were the pharmacy; using these tablets, the transcription errors and misdiagnosis of the drug are significantly prevented, and the benefits of using EMR can be to reduce human errors, especially in educational hospitals.

Conclusion : The results indicate that the use of EMR on DOTECH tablets has a significant effect on the reduction of medication errors by nurses in the intensive care unit.

Keywords : special care, medication errors, EMR

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INVESTIGATING THE IMPACT OF TELE-ICU TECHNOLOGY PARTICIPATION ON THE QUALITY OF PATIENT CARE AND SAFETY Submission Author: Ali Hajipourtalebi

Ali Hajipourtalebi1, Sara Jafaryan 2, Nastaran Barmaki 3, Farhad Sadeghi Kalateh Abdul4

1. BSc Student Health Information Technology, Student Research Committee, Army University of Medical Sciences, Tehran, Iran

2. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

3. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

4. BSc Student Health Information Technology, Student Research Committee, Army University of Medical Sciences, Tehran, Iran

Background and Aim : The use of remote surveillance of patients in the intensive care unit, known as tele-lcu technology, which promotes the efficient use of vital care resources. Although the use of tele-lcu has expanded rapidly, Its benefits are broadly different among studies. And does not recognize tele-lCU features that provide patient care benefits. The purpose of this study is to identify aspects of tele-lCU that positively or negatively contribute to patient care processes and outcomes.

Methods : The present study was a systematic overview with a wide range of websites, pubmed, SID, Google scholar, ISC, scopus, and analysis, and the timeframe 2010-2017 was selected for the selection of articles. The articles were found in about 246 articles, of which 173 articles were included in the study, and then these articles were evaluated in terms of title, abstract, and full text. After removing unrelated cases, 112 articles related to research were selected. Became

Results : The literature review studies showed that the availability of additional resources could reduce mortality and increase the life span that a tele-lCU could serve as an effective factor in improving evidence-based medical admissions. As well as the management of drug support and safety, 102 and the tele-lCU’s warning and surveillance through the camera can help

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran reduce the risk of falling and exodusting.

Conclusion : The results of the studies indicate that tele-lCU doctors can create unpleasant care decisions that cause drug misconduct in the absence of information about the patient. Additionally, Trap-ICU has no effecton patient care processes and outcomes when this technology is not accepted by ICU staff and is not used.

Keywords : tele-icu, intensive care, telemedicine

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QUALITATIVE ASSESSMENT OF THE ONLINE COMMUNICATION OF DIABETIC PATIENTS WITH THE FACEBOOK SOCIAL NETWORK Submission Author: Ali Hajipourtalebi

Ali Hajipourtalebi1, Nastaran Barmaki2, Sepideh Jafari3, Fatemeh Zia Bakhsh4, sara jafaryan5

1. BSc Student Health Information Technology, Student Research Committee, Army University of Medical Sciences, Tehran, Iran

2. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

3. Bachelor of Science in Nursing, Student Research Committee, Faculty of Nursing, Aja University of Medical Sciences, Tehran,IR- Iran

4. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

5. BSc Student Health Information Technology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

Background and Aim : Social networks have shown that they can be effective and effective in improving the condition of the disease andthe health outcomes of the patients, so that when collecting information about medical conditions or treatment, patients are increasingly receiving social networking Look at the data. On Facebook, as one of these social networks, there is the possibility of exchanging information about several specific illnesses online. Facebook is also important for patients with chronic disease as a new source of knowledge for the purpose of supporting and interacting. The purpose of this study was to evaluate the relationship between the relationship between diabetic patients and the Facebook social network.

Methods : The present study was a systematic overview with a large collection of online databases, validated journals, scopus, SIDs, Google scholar, ISC, and related articles in this field. And to search for keywords, Social networking, online medical networks, facebook, diabetes, disease management, and their combination were used and the time range 2012-2017 was considered for the selection of articles. The articles were 104 found in about 90 articles, of which about 60 articles were included in the

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran study, and then these articles were evaluated in terms of title, abstract, and full text. After removing repetitive and unrelated, about 50 related articles Was selected by research.

Results : The results of the review showed that diabetics and other users of Facebook used emotional support for sharing personal information, seeking help and feedback. Based on data collected from the articles studied, roughly two thirds of the posts include indirect contributions to diabetes management strategies, which include: More than 13% of the posts have specific feedback for the information requested by other users. And about 29% of the posts are posted by the poster for the emotional support of the other as community members. Approximately 27% of the posts had a kind of promotional activity generally acknowledged as non-commercial advertising (FAD), and incorrect clinical advice was rare but usually associated with the promotion of a product or service.

Conclusion : Studies have shown that patients make more of their searches on social networks, including Facebook, for communicating with their physicians on health questions, and patients are also seeking to meet and interact with patients with similar problems. Both are for sharing clinical information and support. Facebook is also a community for reporting on personal experiences of questions, receiving direct feedback for people with diabetes. However, advertising and personal information collection, without auditing or validation, is also common

Keywords : social networks, online medical networks, facebook, diabetes, disease management

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RELIABILITY AND PREDICTIVE VALIDITY OF OUTCOME AT DISCHARGE OF GLASCOW COMA SCALE IN AN INTENSIVE CARE UNIT POPULATION Submission Author: Reza Heidarifar

Reza Heidarifar1, dr reza shirvani2, dr sarallah shojaei3, leili falah4, somayeh momenyan5 1. vice-chacellor of research,nekouie-forghani hospital,qom,iran 2. vice-chacellor of research,nekouie-forghani hospital,qom,iran 3. vice-chacellor of research,nekouie-forghani hospital,qom,iran 4. vice-chacellor of research,nekouie-forghani hospital,qom,iran 5. Epidemiology and Biostatistics Department, Qom University of Medical Sciences, Qom, Iran

Background and Aim : The Glasgow coma scale (GCS) score is a commonly used in the initial evaluation of patients with traumatic brain injury (TBI). The GCS has some limitations to evaluate the unconscious patients. This study aims to reliability and predictive validity of outcome at discharge of GCS in an intensive care unit population Methods : : This study is a cross-sectional method in 84 patients with acute brain injury in Shahid beheshti hospital in Qom (Iran). The inter-rater agreement for the GCS scores was evaluated by the weighted kappa. Outcome prediction power of the scales was assessed by the area under the curve (AUC) in the ROC curve Results : : In total, 168 ratings were performed for 84 patients by the GCS score. Inter-rater reliability for GCSC score was excellent. Cronbach’s showed a high degree of internal consistency for the GCS (?=0.82). The inter-rater agreement for each pair of raters was excellent (kw 0.838, 95% CI 0.889 - 0.987). The results show that scale is able to predict in-hospital mortality and poor outcome. The cut of point was 6

Conclusion : : The researchers conclude that the reliability and predictive validity of Persian version of the GCS score is a valid scale. The present study shows that the Persian version of the GCS score is a reliable tool for the measurement of consciousness changes in TBI patients.

Keywords : : Brain Injuries, Glasgow Coma Scale, Consciousness, Intensive 106 Care Units

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PREDICTIVE VALIDITY AND INTER-RATER RELIABILITY OF THE PERSIAN VERSION OF FULL OUTLINE OF UNRESPONSIVENESS AMONG UNCONSCIOUS PATIENTS WITH TRAUMATIC BRAIN INJURY IN AN INTENSIVE CARE UNIT Submission Author: Reza Heidarifar dr reza shirvani1, reza heidarifar2, dr sarallah shojaei3, leili falah4, somayeh momenyan5 1. vice-chacellor of research,nekouie-forghani hospital,qom,iran 2. vice-chacellor of research,nekouie-forghani hospital,qom,iran 3. vice-chacellor of research,nekouie-forghani hospital,qom,iran 4. vice-chacellor of research,nekouie-forghani hospital,qom,iran 5. Epidemiology and Biostatistics Department, Qom University of Medical Sciences, Qom, Iran

Background and Aim : Introduction The Glasgow Coma Scale (GCS) has some limitations when evaluating the unconscious patient. This study aims to validate the Persian version of the FOUR (Full Outline of Unresponsiveness) score as a proposed substitute Methods : Two nurses, two nursing students, and two physicians scored the prepared Persian version of the FOUR and GCS in 84 patients with acute brain injury. The inter-rater agreement for the FOUR and the GCS scores was evaluated by the weighted kappa (jw). The outcome prediction power of the scales was assessed by the area under the curve (AUC) in the ROC curve. Results : The inter-rater agreement of the FOUR was excellent (jw = 0.923, 95 % CI, 0.874–0.971) and comparable with the one of the GCS (jw = 0.938, 95 % CI,0.889–0.987). The area under the curve (AUC) for predicting in-hospital mortality (modified Rankin Scale: 6) was 0.835 for the FOUR (95 % CI, 0.739–0.907) and 0.772 for the GCS (95 % CI, 0.668– 0.856) (P = 0.01). AUC for predicting poor outcome (modified Rankin Scale: 3–6) for the total FOUR score was 0.983 (95 % CI, 0.928–0.999),which is comparable with 0.987 for the total GCS score (95 % CI, 0.934–1.000). Conclusion : The researchers conclude that the Persian version of the FOUR score is a reliable and valid scale to assess unconscious patients with traumatic brain injury and can be substituted for the GCS. Keywords : Full Outline of Unresponsiveness score _Acute brain injury _ Coma scale _ Outcome predictor _ Glasgow Coma Scale _ Persian _ Iran 107

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EFFECT OF LAVENDER AROMATHERAPY ON ANXIETY AND HEMODYNAMIC CHANGES: A RANDOMIZED CLINICAL TRIAL Submission Author: Reza Heidarifar

dr sarallah shojaei1, dr reza shirvani2, reza heidarifar3, dr ali arjmand4, Sey.Mojtaba Mousavi5, leili falah6, mitra amini7, hoda heyatzadeh8 1. vice-chacellor of research,nekouie-forghani hospital,qom,iran 2. vice-chacellor of research,nekouie-forghani hospital,qom,iran 3. vice-chacellor of research,nekouie-forghani hospital,qom,iran 4. Mother hospital, Intensivist, Qom, Iran 5. Qom University of Medical Sciences, Qom, Iran 6. Bachelor of Sciences in nursing,nekouie-forghani hospital,qom,iran 7. vice-chacellor of research,nekouie-forghani hospital,qom,iran 8. vice-chacellor of research,nekouie-forghani hospital,qom,iran

Background and Aim : : Pre-surgery anxiety is a common factor among the individuals referring to the operating room. The present study has been conducted with the objective of investigating the effect of lavender essential oil on the anxiety, hemodynamic changes, and pain using the aromatherapy method.

Methods : This single-blinded clinical trial study was performed on 64 patients candidate for surgery with average anxiety score (46-56). The sam- ples were divided into two equal groups (N=32 in each group). The first group had lavender aromatherapy for 20 min and the second group had aromatherapy with distilled water for 20 min. Finally, the levels of hemodynamic changes, pain, and the state (clear) and trait (hidden) anxiety, were investigated using the Spielberger State-Trait Anxiety (STAI) questionnaire once at the night before surgery and once on the day of surgery after aromatherapy.

Results : In this study, 30 male patients (46.9%) and 34 female patients (53.1%) with the mean age of 28.2±6.4 (minimum 17 and maximum 40 years old) were investigated. Spielberger trait mean score was not significant in control and aromatherapy group before and after the anesthesia. Spielberger state anxiety mean score in control group before and after the anesthesia was respectively obtained 52.1±1.5 and 50.2±2, which was not significantly 108 different, but this mean in aromatherapy group before and after thean-

www.ic3med.ir October 17 - 18, 2018 Shahid Beheshti University International Conference Center, Tehran, Iran esthesia was respectively 51.9±3.8 and 45±2, the difference of which was significant (p=0.03). The mean pain score during exit from recovery in control and aromatherapy groups was, respectively, 45.3 and 29.5, the difference of which was significant (Z=-2.55, p=0.01).

Conclusion : : Considering the reduction of pain and anxiety in the recovery before and after aromatherapy by the Lavender essential oil, especially in subjects with moderate anxiety, it seems that use of this plant before surgery is effective in the reduction of anxiety.

Keywords : Aromatherapy; Lavandula; State-trait anxiety; Spielberger Questionnaire; A Randomized Clinical Trial.

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DESIGN AND LOCALIZATION OF SOFTWARE FOR RECORDING AND REPORTING DRUG-DRUG INTERACTIONS Submission Author: Maryam Idani

Maryam Idani1

1. MA Student critical care nursing, Ahwaz Jundi Shapor University of Medical Sciens, Ahvaz,Iran

Background and Aim : This software is using modern technologies to improve hospital services and increase the level of drug safety of patients.

Methods : The aim of this study was to design a software for recording and reporting drug interactions. The research population included physicians and nurses. This study was carried out in four phases; in the first three steps, the software was used to collect the required software data, Delphi review, and focused group sessions, and the fourth phase of the software was designed.

Results : The software for recording and reporting drug- drug interactions was designed over a period of 9 months. Its main components included the entry and registration of information, drug- drug interactions management system, warning system, drug bank, typing, reporting and technical capabilities. The most important feature of this software than Android is its ability to run on a desktop computer, as well as the ability to check multiple medications simultaneously. The software was implemented for one week in ICU of Abadan Shaheed Beheshti Hospital, and interactions were record and surveyed for patients.

Conclusion : The software for recording and reporting drug-drug interactions was designed and implemented. For the final implementation of the comments of its users will be used.

Keywords : Drug-Drug interactions ,Software, ICU

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COMPARISON BETWEEN LIFE SATISFACTION AND BURNOUT AMONG NURSES IN INTENSIVE CARE UNIT AND GENERAL UNIT Submission Author: Maryam Janatolmakan

Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3, Fatemeh Kahrizi4

1. MSc,Of Medical Surgical, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 2. Associate Professor, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 3. BSc, of Mathematics, Razi University of Kermanshah 4. Ph.D. student of Razi University of Kermanshah

Background and Aim : Job burnout is one of the main factors in reducing the efficiency and loss of manpower. Therefore, considering the many stressful factors in the intensive care unit, it is necessary to pay attention to the factors that reduce the burnout and increase thelife satisfaction of nurses in the community. The purpose of this study was to compare life satisfaction and burnout among nurses in intensive care units and general care units.Methods : The current research is descriptive-comparative. The statistical population of this study was 250 nurses who were selected by multistage cluster sampling in Kermanshah hospitals. The research tool was Satisfaction with Life Scale (SWLS), Meshach Burnout Inventory (MBI), and Demographic Information Form. The reliability coeffi- cient of the questionnaires was calculated using Cronbach’s alpha (0/85). Results : The results showed that burnout of nurses in intensive care units were higher than nurses in general units. Satisfaction with the life of nurses in ICUs is lower than nurses in the public units. (p<0/001). Also, the findings showed that there was no significant difference in the demographic variables in the two groups.

Conclusion : Due to the stressful situations of intensive care units that increase nursing burnout and decrease in life satisfaction in this group, the attention of nurses is necessary from the managers.

Keywords : Special Care Unit, Life Satisfaction, Burnout 111

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RELATIONSHIP BETWEEN COMMUNICATION SKILLS OF NURSES WITH PATIENTS’ SAFETY STATUS IN INTENSIVE CARE UNITS Submission Author: Maryam Janatolmakan

Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3, Fatemeh Kahrizi4 1. MSc,Of Medical Surgical, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 2. Associate Professor, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 3. BSc, of Mathematics, Razi University of Kermanshah 4. Ph.D. student of Razi University of Kermanshah

Background and Aim : Focusing on patient safety in ICUs is an important issue in which communication skills between nurses and patients are one of the important factors in providing patient safety. The aim of this study was to determine the relationship between nurses’ communication skills and patient safety in the intensive care units of hospitals in Kermanshah.

Methods : This study was descriptive-correlation. Out of 220 nurses working in the intensive care units of Kermanshah educational hospitals were selected by census. The instrument of this study was a researcher-made questionnaire. The data were analyzed using 16spss software.

Results : Communication skills of nurses in intensive care units were reported at the desired level (%98/2). Patient safety in the intensive care unit was at a good level (89%). Significant relationship was found between the communication skills and patient safety (p<0/001)

Conclusion : According to the results of this study, nurses can improve the patient’s safety status in intensive care units by utilizing appropriate communication skills.

Keywords : Communication skills, nurse, patient safety

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QUALITY OF CARE IN PEDIATRIC INTENSIVE CARE UNIT FROM THE PERSPECTIVE OF NURSES: QUALITATIVE STUDY Submission Author: Maryam Janatolmakan

Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3, Fatemeh Kahrizi4

Background and Aim : Nurses are an ideal reference for the quality of nursing care and use their views on assessing the quality of nursing care as a valid indicator. The purpose of this study was to explain the quality of care in the pediatric ward of nurses.

Methods : The present study is a qualitative and purposeful sampling method. 15 participants at Imam Reza Hospital (Kermanshah) were interviewed during the years 2017-2018.The main method of data collection was semi-structured interviews. Interviews were recorded digitally and immediately written in word and analyzed by content analysis method.

Results : By analyzing the findings from the total of the themes extracted, the main theme of “effective nursing management” was abstracted. The subclasses included “adequate and effective human resources”, “personal relationships”, “and nurse performance organization “,” equipment desirability “,” infrastructure standards”.

Conclusion : The results of this study explain the experiences of nurses working in pediatric intensive care unit on the quality of nursing care in this unit. Having effective nursing management to provide trained human resources is one of the essential elements for maintaining and improving the quality of nursing care in the pediatric care unit.

Keywords : Nursing care quality, Pediatric care unit, Nurses 113

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COMPARISON OF KNOWLEDGE AND SKILLS OF NURSES IN THE FIELD OF MEDICINE IN THE PEDIATRIC INTENSIVE CARE UNIT AND ADULT INTENSIVE CARE UNIT Submission Author: Maryam Janatolmakan Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3, Fatemeh Kahrizi4 1. MSc,Of Medical Surgical, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 2. Associate Professor, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 3. BSc, of Mathematics, Razi University of Kermanshah 4. Ph.D. student of Razi University of Kermanshah Background and Aim : Drug calculation is one of the most important duties of nurses, and its failure can lead to serious dangers for thepa- tient. To this end, this study was conducted to determine the pharmacological knowledge and medication skill of nurses working in the pediatric intensive care unit and adult intensive care unit and compare them. Methods : In this cross-sectional study, 150 nurses working in the pediatric intensive care unit and adolescent intensive care unit of Kermanshah in 2017 were randomly selected. The data collection tool was demographic information and a researcher-made questionnaire based on knowledge of pharmacology and pharmaceutical calculations. Content validity and- re liability were 88% with Cronbach’s alpha. The data were analyzed using SPSS16 software.Results : The results showed that nurses’ knowledge of pediatric intensive care unit (50%) and adult intensive care unit (49.5%) were good in the field of drug effect mechanism, which did not have a significant difference. In the pharmacological category, nurses in the pediatric intensive care unit (65%) and adult intensive care unit (63%) were in good condition, with no significant difference. The level of familiarity with the medication calculations of the nurses of the intensive care unit (68%) and the adult intensive care unit (54%) was good and there was a significant statistical difference (p <0.001), which indicates the better situation of the nurses in the care unit Special for children. There was no statistically significant difference in terms of demographic information in the two groups Conclusion : According to the results of this study, the high sensitivity of the pediatric intensive care unit has led nurses to have more knowledge and skills in understanding the drug calculations, which points to 114 the need for attention of nursing managers to other intensive care units. Keywords : : Nursing, Medication calculus, Intensive Care Unit

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ASSESS THE QUALITY OF SERVICES PROVIDED IN THE INTENSIVE CARE UNIT USING THE SERVQUAL MODEL Submission Author: Maryam Janatolmakan Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3 1. MSc,Of Medical Surgical, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 2. Associate Professor, Clinical Research Development Center, Imam Reza Hospital, Kermanshah 3. BSc, of Mathematics, Razi University of Kermanshah Background and Aim : One of the factors contributing to increasing the competitiveness of organizations is to improve the quality of service. Provid- ing superior service through maintaining high quality is an introduction to success in all organizations. The SERVQUAL model is one of the most commonly used tools for measuring service quality satisfaction. Therefore, the purpose of this study was to evaluate the quality of services provided in the emergency care unit of Imam Reza Hospital through the SERVQUAL model. Methods : The present study was a descriptive-analytic study conducted in 1396. The statistical population of the study was all patients who were alert and needed care in the intensive care unit Using Cochran Table, the sample size was 280 the main tool of this study was the questionnaire of 22 questions, the SERVQUAL model. Data were analyzed by SPSS software version 16, using descriptive statistics and descriptive statistics. In order to explain the research hypotheses, parametric inferential methods were used. Results : The findings showed that there is a direct relationship between perceived service and patient satisfaction (P=0/001). From the dimension of empathy (relaxation of the place), from the response dimension (high speed of accountability), the reliability dimension (employee’s punc- tuality) from the dimension of physical factors (having an appropriate space for waiting) from the reassurance aspect (providing accurate- infor mation to patients) has the greatest impact in the satisfaction ofthepa- -�tients. Also among the components of reliability (r =0/61 ، P=0/001), Re assure (r =0/49 ، P=0/001), Sympathy(r =0/40 ، P=0/001) , responsiveness r =0/42 ، P=0/001), And physical factors (r =0/44 ، P=0/001), Perceived) .Quality of Services (r =0/41 ، P=0/001) there was a significant relationship Conclusion : Significant relationship The quality of providing perceived services with patient satisfaction shows that in order to increase patient satisfaction, attention should be paid to the dimensions of the- qual ity of service, including reliability, accountability, reassurance, empathy, and physical factors, in order to increase the satisfaction of patients, the motivation necessary To continue to use the health center service also. 115 Keywords : Quality of Service, Patient Satisfaction, SERVQUAL Model, ICU

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EVALUATION OF THE STANDARDS OF INTENSIVE CARE UNITS OF KERMANSHAH HOSPITALS Submission Author: Maryam Janatolmakan

Maryam Janatolmakan1, Alireza Khatony2, Fatemeh Janatolmakan3, Fatemeh Kahrizi4

1. MSc,Of Medical Surgical, Clinical Research Development Center, Imam Reza Hospital, Kermanshah

2. Associate Professor, Clinical Research Development Center, Imam Reza Hospital, Kermanshah

3. BSc, of Mathematics, Razi University of Kermanshah

4. Ph.D. student of Razi University of Kermanshah

Background and Aim : The intensive care unit in the hospitals with special equipment and experts is welcoming the sick patients. The new caring equipment and techniques have made the unit a specialized unit for patient care, and the need for standardization in this unit is always evident. This study was conducted to determine the current status of the standards of the intensive care unit and its compliance with the standards in the national evaluation program of hospitals in Iran

Methods : This descriptive cross-sectional study was conducted in all parts of Kermanshah hospitals in 2018.The data collection tool was the National In-patient Surveillance Scoreboard (ICU).The checklist was completed with the help of observation, review of documentation and interviews and data were analyzed using SPSS software.

Results : The findings showed that compliance with the required standards in the intensive care unit was related to 87% CCU,ICU85%,PICU82% and Nicu79%

Conclusion : The results of the study showed that adult intensive care units had a higher score. There are various causes that remind us of further research in this regard.

116 Keywords : Special Care Unit, Evaluation, Standard

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APPLICATION OF MANAGEMENT DASHBOARDS IN INTENSIVE CARE UNIT Submission Author: Mohamad Jebraeily

Mohamad Jebraeily1, Mohamad Amin Valizad Hasanlooie2, Bahlol Rahimi3, Saeide Saidi4

1. Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran 2. Fellowship in Intensive Care, Urmia University of Medical Sciences, Urmia, Iran 3. Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran 4. Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran

Background and Aim : Because of the complexity of patient conditions and the variety of care services, the intensive care unit (ICU) is one of the essential and vital parts of hospitals. For optimal management of resources and improvement in quality of care in the ICUs, consistent monitoring of key performance indicators is essential. Today, there are different tools and methods for evaluating the, one of which is the management dashboards. In fact, the dashboard is an information management tool that displays on a single screen the most important information needed to identify, explore, and communicate problems are as that need corrective action. The purpose of this study was identifying the application of management dashboards in ICU. Methods : We conducted a literature search of databases including PubMed, Web of Sciences and Science Direct which were investigated from 2005 through 2018. The search was performed using a combination of the following terms: dashboard, key performance indicators, and intensive care unit, critical care. Finally, 14 reviewed articles met the inclusion criteria. Results : The results of researches showed that the most common applications of management dashboards in ICU include: patient safety, waiting time, management of bed, referral process of patient, identification of clinical parameters, collaboration among care team members, warning to identify patients at risk, ventilator management. Conclusion : The management dashboards with having capabilities of the real-time display and root cause analysis can be useful in quick evaluation of interventions and timely identification of problems and errors. Therefore, it seems necessary to take effective steps by creating the infrastructures for developing appropriate dashboards and culture-making in order to use managers and health service providers Keywords : dashboard, key performance indicators, and intensive care unit, critical care 117

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THE EFFECT OF FAMILY-BASED CARE ON SATISFACTION OF THE FAMILY OF PATIENTS ADMITTED TO INTENSIVE CARE UNITS Submission Author: Zahra Mohebbi dehnavi

Zahra Mohebbi dehnavi1

1. MSc, Instructor, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Background and Aim : Patient Satisfaction, Parents and Counseling have been introduced as a Health Care Quality Index. Spiritual support and involvement of the family of patients hospitalized in the intensive care unit in the decision-making process on the patient play an important role in their satisfaction. The family of patients admitted to the intensive care unit under- goes many stresses with their hospitalization. Family-based care is an innovative approach to planning, implementing and evaluating health care that builds on the benefits of two-way partnerships between patients, families and healthcare providers. In a family-centered model, each patient and patient family form a care unit. The aim of this study was to determine the effect of family-based care on satisfaction of the family of patients admitted to intensive care units. Methods : This study was performed on 30 patients admitted to intensive care units in Isfahan Hospitals in 2018. Data were collected by questionnaire on days 3 and 7 of hospitalization. Finally, the information gathered by SPSS software version 22 was investigated

Results : The results showed that the mean score of satisfaction at the beginning of the study in the intervention group was 48.35 ± 9.32 and in the control group and 46.31 ± 8.67 in the control group, which was not significantly different (p = 0.32). At the end of the study, the mean score of the satisfaction of the intervention group was 58.30 ± 10.21 and in control group 47.62 ± 8.88, which was significant (p = 0.001).

Conclusion : Based on the results, family-based care can increase the family satisfaction of patients admitted to intensive care units. It seems that getting help from families of patients admitted to intensive care can play an important role in patient care.

Keywords : Care, Family-centered, Satisfaction, Special Care 118

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PARENTERAL NUTRITION IN NEONATES AND PEDIATRICS: A REVIEW Submission Author: Seyed maryam Mousavi

Seyed maryam Mousavi1, Toktam Etezadi2

1. M.Sc. Pediatric Nursing, Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

2. M.Sc. of Nursing, Akbar Hospital, Mashhad University of medical sciences

Background and Aim : Parenteral nutrition (PN) is a vital therapeutic modality for neonates, children for a number of indications used in a variety of setting especially in ICU. Appropriate use of this complex therapy maximizes clinical benefit while minimizing the potential risk for adverse events. Complications occur both because of the PN admixture itself and the process within it is used. One of the most challenging issue in context of PN is making decision about the type of total nutrient admixture (TNA). TNA may be delivered via a 2-in-1 system (one solution containing amino acids , dextrose, electrolytes, vitamins, minerals, and fluids and one solution containing intravenous fat emulsions[IVFEs] or via a 3-in-1 system (all nutrients mixed in one container). while the use of 3-in-1 PN solution have certain benefits such as reduce the risk of contamination, ease of administration, cost saving, reduced IVFE wast- age, but it is essential to consider which if either is better in terms of stability, lipid globule size, sterility, the potential for increased microbial growth/ infectious complications, the need to use a large filter size, precipitation and compatibility risks and increased chance of catheter occlusion. This review outlines the unique issues and challenges to be considered when formulating neonate and pediatric 3-in-1 PN admixture.

Methods : This study is an integrated review. Elsevier, PubMed and Google Scholar Databases were searched by keyword of parenteral nutrition, total nutrient admixture, neonate and pediatrics. Of the 73679 eligible articles, 60 articles. Were selected. Finally, the data were classified, summarized and, analyzed.

Results : Analysis results showed that TNA is compatible and stable at recommended concentrations, and since the IVFE is in the TNA, it is infused at slower rates, allowing for better fat clearance. Unfortunately, the TNA 119

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is not without concern.at low macronutrient concentrations (lower that recommended), the formulation compromised. Greater divalent and monovalent cation amounts and increase concentrations of phosphate and calcium may destabilize the TNA or result in precipitation. With the addition of IVFE in the TNA catheter occlusion is greater without irrigation and the large pore size filters are necessary, resulting in less microbial elimination.

Conclusion : Implementation of an appropriate TNA for an institution requires a recognition of the advantages and disadvantages of the TNA as well as on understanding of the institution’s patient population and their nutrition requirements. Anyway, the benefits of PN solutions must outwight the risks in our patients.

Keywords : Parenteral nutrition, Total nutrient admixture, Neonate, Pediatrics

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EFFECT OF AIRWAY PRESSURE RELEASE VENTILATION MODE ON INTRACRANIAL PRESSURE AND CEREBRAL HEMODYNAMIC IN PATIENTS WITH TRAUMATIC BRAIN INJURIES Submission Author: Aliyeh Pasandideh Aliyeh Pasandideh1, Javad Malekadeh2, Mohamad Abouee3

1. MSc in Critical Care Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2. Instructor of Nursing, Department of Medical Emergency, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 3. Assistant in Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Background and Aim : This study aimed at compare influences of airway pressure release ventilation (APRV) and Synchronized Intermittent Mechanical Ventilation (SIMV) on cerebral hemodynamic and intracranial pressure in patients with traumatic brain injuries. After severe brain trauma, inflammatory processes will cause secondary brain damage and dysfunction of the others, lungs often have the greatest impact in the process (2). Cerebral edema, hypoxia and ischemia are the most important secondary brain injuries that occur following initial injury and require rapid intervention and management. Secondary cerebral secondary diseases in TBI patients, due to impairment of self-regulating properties of the brain, increase intracranial pressure and decrease brain perfusion Which can ultimately exacerbate brain damage and increase mortality in these patients, Our goal in this study is to select an appropriate mechanical ventilation method with less side effects for the vulnerable brain of these patients.. Methods : A clinical trial was carried out in 40 patients with traumatic brain injuries in the intensive care unit in Kamyab neurosurgery Hospital, Mashhad, Iran from January2016 to May 2016. The patients meeting the study inclusion criteria were randomly assigned into two groups; intervention (APRV, n= 20) and control (SIMV, n= 20). The ICP, CPP, MAP, pulse pressure and heart rate in both groups were measured before and after conditioning. Analysis of data was done using independent t-test in SPSS V.22. Results : The mean ICP remained unchanged in both groups (P= 0.421). After the intervention, the CPP, MAP, heart rate, and pulse pressure in APRV group were not significantly different compared with those in the two groups before the intervention (P> 0.05). 121

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Conclusion : The results showed APRV as a safe mode that can be beneficial in patients with traumatic brain injury without concerns for increased intracranial pressure and hemodynamic disorders.

Keywords : traumatic brain injury, intracranial pressure, airway pressure release ventilation, cerebral perfusion pressure

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PHARMACEUTICAL MANAGEMENT PROJECT IN CRITICAL CARE UNIT USING THE MEDICATION MANAGEMENT AND USE Submission Author: Fatemeh Rahimi

Fatemeh Rahimi1, Mohamad Vaseghi2, Azam Karimi3, Fatemeh Gholami4, Shiva Siyamaki5, Maryam Ahangar6

1. in Critical Care Nursing ( BScN,MScN) Clinical Research Development Unit Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

2. computer engineer,Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

3. Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

4. Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

5. Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

6. Shahid Rajaei , Educational & Medical Center ,Alborz University of Medical Sciences, Karaj,Iran.

Background and Aim : With the advancement and development In Critical Care unit of the recent years and the growth of new nurses’ roles, drug management in specialist departments for nurses is necessary. The knowledge of pharmacology and drug management forms an important part of nursing clinical practice. The concept of pharmacovigilance in the Critical Care unit and with the development of the intensive care unitin hospitals, there is a need to empower nursing staff in these sectors, in addition to having sufficient knowledge about the various medicines In Critical Care unit; sufficient knowledge and skills in the fieldDrug management as well. Studies have shown that, on average, nurses spend 40 percent of their time on drug therapies. It is also a basic nursing skill that requires the use of the necessary skill and skill, and attention to improvements in patient’s health and safety. Effective and safe administration of drugs requires knowledge in a variety of areas, including theoretical and clinical knowledge of prescribing drugs, pharmacological 123

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knowledge, and the ability to calculate clinical drugs. Knowledge about drug management in the specialty is one of the factors that increase the quality of nursing care in the pharmaceutical management process comes.

Methods : This cross-sectional descriptive study (Cross-Sectional) In Critical Care unit in the hospitals of Karaj after obtaining informed consent was conducted. The instrument used in this study demographic information , Drug Compliance Questionnaire. MMU Index , With the clinical audit process. Researcher and colleagues have completed.And using SPSS version 16 software data analysis has been done.

Results : The results of this study, the average of 60% management standards and more than 40% of nurses had a “moderate” or “weak” status in calculating drug doses. Compliance with the 5 positions of the90% medication, Automatic Stop Order & standing order 40%, the abilityto calculate the drug 60% of the high-risk and starred drugs 65%, the anti-drug and 80% poisoning, according to the international standards MMU.3.2 (70% ) And MMU.4 (60%) MMU.4.2 (90%), MMU.4.3 (90%), MMU.6.2 (90%), MMU.7 (40%), MMU.7.1 (70%) .

Conclusion : Nurses play a very important role in managing drug therapy. Nurses, as owners of health care, who spend a lot of time in interacting with patients, should have sufficient knowledge of pharmacology to provide safe and high quality care, given the sensitivities of using special medications in critical situations performed by nurses. And the effect of some of the specific nutrients on the low dose and the low difference between the minimum and maximum doses of drugs is not a high error for the nurses and the loss of responsibility can also help increase the amount of drug errors. Since the level of knowledge and skills of nurses in the special department plays an important role, it is suggested that planning and implementation of specialized sections of nurses’ knowledge and skills should be planned and implemented.

Keywords : Pharmaceutical Management, Critical Care, Medication Management

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SURVEY OF POSTOPERATIVE CARES IN SELECTED HOSPITALS IN QOM IN 2018 Submission Author: Arefeh Ranjbar

Arefeh Ranjbar1, Gholamreza Sharifirad2

1. Medical student , Islamic Azad University , Qom branch , Iran

2. Professor of health education, Islamic Azad University, Qom branch, Iran

Background and Aim : Proper care of the patient has a major and undeniable role in maintaining and improving the health status and also preventing complications such as disability . these cares in surgeries are devided into 2 stages : 1. Immediately after surgery 2. After surgery until recovery . the aim of this study was to determine the status of medical cares immediately after surgery .

Methods : In this cross_sectional study , patients undergoing surgery in selected hospitals in Qom , are examined for one month . the tools used in this study include a checklist prepared on the basis of the General Medical School approved by the sixty_second session of the Supreme Council for the Planning of Medical Science . data were collected in 6 sections include the general principles of patient care , prescription medication , nutrition , vital measures , patient rehabilitation and complementary and alternative medicine(traditional) and analyzed after entering the SPSS software .

Results : The results of this study showed that in the general principles of patient care , the present situation indicates the relative satisfaction of patients . also in different aspects of general principles of patient care , the results indicate that %80 of the cares are done . also in the field of prescribing medication and nutrition , up to %85 of the standard cases are observed .

Conclusion : The care done is quantitatively satisfactory , but qualitatively , although satisfactory , but still far from reaching the standards .

Keywords : postoperative care _ hospital _ Qom

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FAMILY EXPERIENCE SURVEY IN THE INTENSIVE CARE UNIT: A INTEGRATIVE REVIEW Submission Author: Yaser Saeid

Yaser Saeid1, Seyed Tayeb Moradian2, Mohammad Mahdi Salari3, Abbas Ebadi4

1. Phd Student in Nursing education, Students’ Research Committee and Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran.

2. Assistant Professor, Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

3. Assistant Professor, Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

4. Professor, Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

Background and Aim : Today, due to the aging population, the demand for admission of patients in the intensive care unit is increasing and the long-term consequences of chronic and critical illnesses are increasing. On the other hand, family involvement in the care and treatment process is inevitable. So, in addition to focusing on family-based care, general care in the care process is another reason to pay attention to the family. However, the results of studies indicate the prevalence of various psychological disorders in the family of patients in the intensive care unit. This Integrative review was conducted with the aim of analyzing and combining the results of studies on the experienced family of patients admitted to the intensive care unit.

Methods : The databases of Cochran Library bases, CINAHL, Science Direct, Scopus, ProQuest, Ovid were searched for literature of March/ April 2004 containing the keywords of ‘‘intensive care unit’’, ‘‘family’’, ‘‘anxiety’’, ‘‘depression’’and ‘‘post traumatic stress disorder’’ combined. Search criteria were further limited to peer reviewed, research articles in English and Persian yielding 114 results. Abstracts were read for relevance, Only research studies regarding Family experience survey in the intensive care unit were included. In total, 50 articles were examined.

Results : The majority of research provided evidence falling within the 126 following five themes: Anxiety, Depression, Posttraumatic Stress,

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Complicated Grief, Stress. The global focus of the studies was on the importance of family-center care and health disorders in the family of patients admitted to the intensive care unit. In some studies, the incidence of these disorders was highlighted in the concept of Post-Intensive Care Syndrome-Family and emphasized the need for attention and specialized evaluation.

Conclusion : Considering the high prevalence of psychological disorders in the family of patients in the intensive care unit and the importance of family-center care, this issue should be addressed more closely by health care workers and future applied research. It is also necessary to design and use specialized tools to evaluate disturbances in the concept of Post- Intensive Care Syndrome-Family.

Keywords : PTSD, Depression, Anxiety, Family, Intensive Care Unit, Post– Intensive Care Syndrome-Family

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A COMPARATIVE STUDY ON THE EFFECTS OF OPEN AND CLOSED ENDOTRACHEAL SUCTION SYSTEMS ON ARTERIAL BLOOD GAS PARAMETERS OF CHILDREN IN PEDIATRIC INTENSIVE CARE UNIT Submission Author: Amir Shafa

Amir Shafa1, Mohammad Reza Habibzade2

1. Assistant Professor of Anesthesiology, Isfahan University of Medical Sciences

2. Assistant Professor of Anesthesiology, Isfahan University of Medical Sciences

Background and Aim : Ventilators are commonly used for patients in intensive care units (ICUs). Under such conditions, children’s oxygenation is critical and enhanced through endotracheal suction systems. This study aimed to compare the effects of open and closed endotracheal suction systems on arterial blood gas (ABG) parameters of children admitted to ICUs

Methods : This double-blind clinical trial recruited 64 patients from the pediatric ICU (PICU) of Imam Hussein Hospital, Isfahan, Iran. The patients were divided into two groups of open or closed suctioning. ABG parameters were analyzed before and one, five, and 15 minutes after each suctioning episode.

Results : The open and closed suctioning groups showed no significant differences in the mean HCO3, PaCO2, and pH (P > 0.05). PaO2 increased after suctioning by both the open and closed techniques (P < 0.001 and < 0.05, respectively). SaO2 showed significant differences before and after suctioning by both close and open techniques. Similar differences were also observed between different minutes after the procedures (P < 0.001).

Conclusion : ABG disturbances were lower in the closed endotracheal suction system than in the open system. Therefore, the use of closed endotracheal suctioning is suggested to ensure lower effects on ABG parameters in patients admitted to PICUs .

Keywords : endotracheal suction; arterial blood gas; pediatric intensive care unit 128

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EFFECT OF FAMILY MEMBERS’ VOICE ON LEVEL OF CONSCIOUSNESS OF COMATOSE PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT Submission Author: Manijeh Shahriary kalantary

Manijeh Shahriary kalantary1

1. MSc in Critical Care Nursing, Department of Nursing, School of Medical science, Islamic Azad University, Yazd, Iran

Background and Aim : Coma is one of the most important complications of brain injury. Comatose patients in the intensive care units are exposed to sensory deprivation. This study aims to survey the effect of family members’ voice on the level of consciousness of comatose patients hospitalized in the intensive care units

Methods: In this singleblind randomized controlled trial, 40 comatose patients with brain injury with the acute subdural hematoma in intensive care units were randomly assigned into two groups. The intervention group was stimulated twice a day each time 515 min witha recorded MP3 from family members’ voice for 10 days. The patients’ level of consciousness was measured with Glasgow Coma Scale before and after auditory stimulations. In the control group, GCS was measured without auditory stimulation with the same time duration like intervention group.Data analysis in software SPSS version 15 and using Chisquare test, independent ttest, paired t-test and analysis of variance with repeated measures was done Results : On the first day before the intervention, there was no a statistically significant difference between the mean of GCS in both groups (P = 0.89), but on the tenth day after the intervention, there was a significant difference (P = 0.0001) between the mean GCS in both control and intervention groups. Also, there was a significant difference between the mean daily GCS scores in two groups (P = 0.003). The findings during ten days showed the changes in the level of consciousness in the intervention group from the 4td day of the study were more in the mean daily GCS scores than the control group. Conclusion : This study indicated that family members’ voice can increase the level of consciousness of comatose patients with the acute subdural hematoma. Keywords : Auditory stimulation, brain injury, coma, family members’ voice, level of consciousness 129

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EFFECT OF AMINOPHYLLINE ON RENAL FUNCTION OF BRAIN INJURY PATIENTS WITH ACUTE RENAL FAILURE ADMITTED TO THE INTENSIVE CARE UNIT Submission Author: Manijeh Shahriary kalantary

Manijeh Shahriary kalantary1

1. MSc in Critical Care Nursing, Department of Nursing, School of Medical science, Islamic Azad University, Yazd, Iran

Background and Aim: Acute renal failure is a common complication in the brain injury patients. released adenosine in injury can reduce renal glomerular filtration. aminophylline is an inhibitor of releasing adenosine. So, this study aimed to evaluate the effect of intravenous aminophylline on renal function of brain injury patients with acute renal failure admitted to the intensive care unit

Methods: In this the doubleblind randomized controlled trial, 50 brain injury patients with ARF in the intensive care unit were randomized in two intervention and placebo groups. They randomized to receive 0.2 mg/kg/h intravenous aminophylline or 0.2 mg/kg/h placebo (normal saline). urine output and serum BUN and Cr were measured at 24 hours before and after administration of aminophylline or placebo. Data analysis in by SPSS version 22 software and with using Chisquare test, independent ttest, Mann- Whitney and Wilcoxon tests was done

Results : There was a significant difference between urine output and serum BUN and Cr at 24 hours after the study in both groups (P< 0.001). in the intervention group, there was a significant difference between urine output and serum BUN and Cr before and after the intervention (P< 0.001) and in the control group, there was no significant difference between the mean of urine output and Cr (p=0/06) and serum BUN (p=0/08) before and after the study

Conclusion: This study indicated that aminophylline can improve the renal function in the brain injury patients with acute renal failure. Also, the Aminophylline can increase urine output and reduce BUN and Cr in ARF patients Keywords : Aminophylline, Acute Kidney Injury, Brain Injuries, intensive care 130 unit

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IMPROVEMENT OF FUZZY EXPERT SYSTEM USING PARTICLE SWARM OPTIMIZATION ALGORITHM FOR DIAGNOSIS OF CHRONIC KIDNEY DISEASE Submission Author: Mohadeseh Shahsavand

Mohadeseh Shahsavand1, Mehrnaz Behrooz2, Hamidreza Shahabi Haghighi3

1. Student at Amirkabir Univesity of Technology

2. Student at Amirkabir Univesity of Technology

3. Faculty member at Amirkabir Univesity of Technology

Background and Aim: Due to the importance of critical care in hospitals, the availability of relevant rooms and equipment is vital. One of the congestion control methods in this unit, is to focus on diagnostic methods, so that treatment is started earlier and that part of patients requiring critical care after surgeries is reduced.Since the kidney plays an important role in the health, its diseases are of interest in the health system and it is always important to prevent and diagnose early detection. A common kidney disease is chronic kidney disease, which leads to kidney failure and even early death. Therefore, the development of an expert system capable of detecting the disease based on individual or laboratory factors willbe effective in preventing the growth and complications of the disease. this paper attempts to use a data-set for chronic kidney disease to develop a basic fuzzy expert system and then improve its parameters by using the learning rules in the evolutionary particle swarm algorithm (PSO), and finally provide a better system with less errors to diagnose chronic kidney disease. Methods: Before developing the expert system, it is needed to complete missing data. we used the K-nearest neighborhood algorithm in this phase.Then, in order to reduce the dimension and make a more accurate database,the fuzzy c-means algorithm is used and having the degree of membership of each data to each cluster, an new database is built. This way, our 24 initial inputs are reduced to 17. In the development of the diagnostic system, after developing the primary fuzzy expert system by the Takagi-Suge- no method in MATLAB, we improved the results and reduced the system error. Optimization of the parameters of the primary fuzzy system was implemented using the PSO algorithm. This algorithm has shown good performance among other evolutionary algorithms to learn the process and produce optimal 131 outputs.

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Results: The root-mean-square error (RMSE) in the primary diagnostic expert system was 0.36. After applying PSO this error was reduced to 0.22. So we were able to reduce detection error 38.8%. This shows that our system can diagnose 230 sample correctly through the total training set that was 235 patients. It means the system’s ability to generate accurate output is over 97%.

Conclusion: Since diagnosis of kidney disease is one of the requirements for preventing disease progression and the occurrence of irreparable complications for the patient, To reduce the congestion of patients in the critical care unit and make it available for more risky diseases, In this research, we attempted to design an expert system using of fuzzy logic to diagnose chronic kidney disease.

Keywords: Critical care, Chronic Kidney disease, fuzzy c-means, Fuzzy Expert System, PSO,

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THE EFFECTS OF MANUAL LUNG HYPERINFLATION ON PULMONARY FUNCTION AFTER WEANING FROM MECHANICAL VENTILATION AMONG PATIENTS WITH ABDOMINAL SURGERIES Submission Author: Mahboube Yazdani

Mahboube Yazdani1, Javad Malekzadeh2, Alireza Sedaghat3, Seyed Reza Mazlom4, Alieh Pasandideh khajebeyk5

1. MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2. Evidence Based Care Research Centre, Instructor of Nursing, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3. Associate Professor of Anesthesiology and Critical Care, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4. Evidence Based Care Research Centre, Instructor of Nursing, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

5. MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Background and Aim : After abdominal surgeries, patients are disconnected from mechanical ventilation and provided with oxygen therapy via a T-piece. In this phase, they are at great risk for respiratory complications.This study aimed to evaluate the effects of manual hyperinflation (MHI) on pulmonary function after weaning from mechanical ventilation among patients with abdominal surgeries.

Methods : This single-blind two-group randomized controlled trial was done from September 2015 to April 2016. participants were forty patients who had undergone abdominal surgeries and were receiving oxygen¬ via a T-piece. They were selected from the intensive care units of two hospitals, Mashhad, Iran, and randomly allocated to a MHI and a control group. Patients in the MHI group were provided with three twenty-minute manual hyperinflation rounds using the Mapleson¬C while patients in the control group received routine cares. Tidal volume(Vt), the ratio of respiratory rate 133

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to tidal volume(RSBI), and the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (P/F¬ratio) were measured before, five, and twenty minutes after the intervention. Atelectasis prevalence was assessed before and 24 hours after the intervention. Data were analyzed in the SPSS software.

Results : The means of participants’ ¬age in the MHI and the control groups were 66.7±8.3 and 67.5±9.0, respectively. At baseline, the groups did not differ significantly respecting Vt, RSBI, P/F ratio, and atelectasis rate (P>0.05). Besides, 24 hours after the intervention, no difference was found between the groups regarding atelectasis rate (P = 0.49). However, at both posttests, Vt, RSBI, and P/F ratio in the MHI group were significantly better than the control group (P < 0.001).

Conclusion : In patients with spontaneous breathing, manual hyperinflation improves oxygenation and ventilation and promotes pulmonary function.

Keywords : manual hyperInflation ,Atelectasis, complication

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DIMENSION OF FUTILITY AT THE END OF LIFE: NURSES’ EXPERIENCES IN INTENSIVE CARE UNITS Submission Author: Leili Yekefallah Leili Yekefallah1, tahereh ashktorab2, human manoochehri3, hamid alavi majd4, fereshteh yekefallah5, leila dehghankar6

1. PhD of nursing, Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran 2. professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3. Assistant professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4. Associate professor, Faculty of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Ira 5. msc of public health ,savojbolagh,alborz University of Medical Sciences 6. Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran Background and Aim : The concept and meaning of futile care depends of the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. In Iran, futile care has become a challenge for nurses working in intensive care units (ICUs). Considering the differences observed in defining futile care based on the patients’ conditions andthe nurses’ personal values, we aimed to define the dimension of futility at the end of life from the viewpoints of nurses working in intensive care units (ICUs). Methods : This qualitative phenomenological study was done to understand the experiences of nurses working in ICUs with respect to the dimension of futility. The statistical population of this study included nurses working in the ICUs of 11 education hospitals and hospitals affiliated to the Social Secu- rity Organization in Qazvin province, northwest Iran. Personal interviews and observations were used for data collection. All interviews were recorded and codes and themes were extracted using Van Manen’s analysis method. Results : 25 nurses working in ICUs were selected for personal interviews. Ini- tially 80 codes were extracted. During data analysis and comparison, the codes were reduced to 65. Ultimately, one themes and 2 sub-themes, and 5 category was emerged: “futile medical orders, futile diagnostic procedures, and category of nursing was futile nursing interventions and irrelevant duties to nursing”. Conclusion : Considering that nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for compiling useful care giving and educational programs in ICUs. Keywords : Futility, end of life, Nurses, Intensive care unit, Phenomenological study 135

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FREQUENCY OF FUTILE CARE IN VIEWPOINT OF ICU NURSES IN PROVINCE OF QAZVIN Submission Author: Leili Yekefallah

Leili Yekefallah1, tahereh ashktorab2, human manoochehri3, hamid alavi majd4, fereshteh yekefallah5, leila dehghankar6

1. PhD of nursing, Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran

2. professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3. Assistant professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4. Associate professor, Faculty of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Ira

5. msc of public health ,savojbolagh,alborz University of Medical Sciences

6. Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran

Background and Aim : Futile care is provided many complicated challenges for nursing in intensive care units in Iran. Objective: This study aimed to study prevalence of futile care from the viewpoints of nurses that working ICU. Methods: This descriptive-analytic study was conducted on totally 210 nurses working in all ICU of academic, public, and private hospitals of Qazvin city in 2014. Data were analyzed using Chi-square, independent t-test, one-way ANOVA and Friedman tests. Results : Most prevalence of providing futile care was in teaching hospital (51.98±23.2), and the least prevalence was in charity hospital (37.3±12.77). There was significant difference between mean of futile care in different hospitals (P<0.007).

Conclusion : As the key role of nurses in the managing futile care, awareness about prevalence of this kind of care, could be initial step for providing benefit care plans in ICU.

Keywords : Futile care, Nurses’ attitude, Intensive care unit, Prevalence 136

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DEVELOPING TOOL FOR EVALUATION OF CAUSES OF FUTILE CARE IN ICUS Submission Author: Leili Yekefallah

Leili Yekefallah1, tahereh ashktorab2, human manoochehri3, hamid alavi majd4, fereshteh yekefallah5, leila dehghankar6

Background and Aim : Background: In Iran, futile care has become a challenge for intensive care nurses. The aim of the study was to develop a tool for assessing the reasons of futile care at ICUs. Methods : A sequential mixed method in three stages was applied. In the first stage, a phenomenological study was performed with van Manen’s method by interviewing 25 nurses at ICUs of 11 hospitals in Qazvin. To extract the items of the tool in the second stage, the concept of futile care in ICUs and its reasons were defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test-retest reliability. Results : The initial tool had 119 questions. After validation, 39 items remained in the final questionnaire. Five extracted factors were as follows: professional competence (14 items), organizational policy (9 items), socio-cultural factors (7 items), personal beliefs and values (4 items), and legal issues (5 items). Cronbach’s alpha for the whole questionnaire was 0.91 (range: 0.7771-0.8796). The test - retest reliability was 0.87 (P<0.0001). Conclusion : Nursing managers and clinical nurses can use this tool to identify the causes of futile care and reduce it in their clinical settings. Policy makers can use this tool for improving the management of ICUs. Keywords : Futile care, Tool, Psychometric properties, Nurses, Intensive care unit. 137

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EFFECT OF TACTILE STIMULATION ON CONSCIOUSNESS AND VITAL SIGNS OF HEAD TRAUMA PATIENTS IN INTENSIVE CARE UNITS Submission Author: Leili Yekefallah

Leili Yekefallah1, fatemeh aghaee2, jalil azimian3, mahmood alipur4

1. PhD of nursing, Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran

2. M.Sc. of Intensive Care Nursing, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran

3.PhD of nursing, Faculty member, Ghazvin University of Medical Sciences, Ghazvin, Iran

4. Assistant Professor of Biostatistics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

Background and Aim: Objectives: This study aimed to investigate the Effect of tactile stimulation on consciousness and vital signs of traumatic head injury patients in intensive care units Methods: the current clinical trial was conducted on 60 patients with brain trauma hospitalized to ICUs in Qazvin, Iran, in 2016. The subjects were selected by the convenience sampling method and assigned into 2 groups of intervention and control. Hands, wrists, and palms were touched for3 minutes twice a day, and the GCS and vital signs of the patients were recorded immediately from the day 1 to 5 of admission. Data were analyzed using SPSS version 21 by the paired and independent t tests. Setting: intensive care units Results: Main Outcome Measures: according to the results of the current study, tactile stimulation increased the level of consciousness (P=0.001), decreased systolic blood pressure level (P=0.0001), diastolic blood pressure (P <0.05), and respiration rate (P <0.05) in the intervention group and had no significant effect on the body temperature of the patients (P >0.05).

Conclusion: it is recommended to employ tactile stimulation methods on patients admitted to ICUs.

Keywords: tactile stimulation, vital signs, level of consciousness, brain trauma, sensory deprivation 138

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USABILITY EVALUATION OF CRITICAL CARE INFORMATION SYSTEMS IN BOHLOOL HOSPITAL IN 2018: EVALUATION OF THE SYSTEM USABILITY SCALE Submission Author: Azam Zanganeh

Azam Zanganeh1, halimeh jamal2, mohsen saheban maleki3

1. MSc Student of Health Information Technology, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran

2. MSc Student of Health Information Technology, Shohada Hospital, Gorgan University of Medical Sciences, Bandar Gaz, Iran

3. Assistant Professor of Anesthesiology and critical Care, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran

Background and Aim: The critical care information system is one of the hospital information subsystems designed to facilitate management of medical information and to improve quality of care and reduce costs. Usability is necessity for the success and acceptability of systems and can enhance the quality of provided care and given the intensive care units have a complex and sensitive environment, therefore, hospitalized patients in these areas, we need to manage and accurately monitor the physiological information. The purpose of this study is to evaluate the usability of critical care information system. Methods: This descriptive, analytical study was conducted in 2018. The population consisted of 26 users of system in Bohlool hospital affiliated with Gonabad University of Medical Sciences. Simple random sampling was used to select the interviewees. We used the International Organization for Standardization (ISO) 9241-11 standard .Data was collected by System Usability Scale (SUS). The collected data was analyzed using descriptive statistics. Results: Most participants were female (76.9%) and were nurse(88.5%) and had a bachelor’s degree (84.6%).The average SUS score was 58.9, indicating marginal range system usability.

Conclusion : Assessing usability of the system after its implementation is very important. The SUS tool can evaluate user satisfaction and system usability. This study could be an example of applied studies in health information systems.

Keywords : critical care information systems ,System Usability Scale,Evaluation 139

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Comparison of the Quality of Physician-Nurse Relations of the Nurses in APACHI-II and M-score Groups

Mitra Nourbakhsh1, Hosein Mahjobipoor2

1. Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2. Assistant Professor, Department of Anesthesiology and Critical Care, Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Corresponding Author: Hosein Mahjobipoor Phone: +989131130419 Address: Amin Hospital, Isfahan, Iran.

Email: [email protected]

Abstract

Background: Appropriate professional collaboration between doctors and nurses can be effective on the quality of health care given to patients. This study was performed to compare the effect of APACHI II and Mscore on the quality of physicians-nurses relationship. Methods: In this cross-sectional study, 100 nurses from Intensive Care Unit of Amin hospital, Isfahan were participated. Attitudes toward physicians-nurses professional collaboration questionare (Jefferson) was used for collecting data. SPSS version23 was used for analyzing data. Paired t test and Wilcoxon test were used for analyzing data. Meaningful level was considered 0/05 in the tests. Results: Results showed that the mean score of physicians- nurses relationship in mscore group was significantly higher than APACHI II group (p<0/001). But overall the attitudes toward physicians-nurses collaboration were positive in both scoring systems. Conclusion: According to the results of the study attitudes of the nurses toward doctor-nurse relationship in Mscore group was significantly more positive than APACHI II group, so using mscore scoring system instead of APACHI II system is recommended in the intensive care unit of the country’s hospitals.

Keywords: Physician-Nurse Relations, Nurses, Communication 140