الفهرس 
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Abstract
Critically ill children are those that are at high risk of life-threatening health problems which may result in permanent deficits or even death. Children with surgical problems are admitted to pediatric surgical intensive care unit. It provides close and constant attention by a trained health team professional. Nurses who are working in the PSICU are responsible to ensure that this critically ill children and families receive optimal care without errors and ensure safety among those children.
Children safety refers to prevention of errors and adverse effects to children associated with health care. It is also a central concern of current health-care delivery systems which is an important indicator of health care quality. Basically, patient safety means how hospitals and other health care organizations protect their patients from errors, injuries, accidents, and infections. It has become a major focus of attention by health care consumers, providers of care and administrators of health care institutions.
This study was conducted at Pediatric Surgical Intensive Care Unit of Alexandria University Children’s Hospital at El –Shatby.
All nurses working in Pediatric Surgical Intensive Care Unit who are responsible for providing direct care for children are included in the study was 35 nurses.
Nurses’ Application of Children’s Safety Measures Observational Checklist was developed by the researcher and guided by National Patient Safety Goals (2016) to assess nurses’ application of safety measures in Pediatric surgical intensive care unit. It was used to assess nurses’ application of such guidelines. It included four parts namely; universal infection control measures, medication administration safety measures and endotracheal suctioning safety measures as well as feeding safety measures.
Every nurse was observed three times during the morning and afternoon shifts for each procedure (two observations in the morning and one in the afternoon).
The main results of the present study revealed the following:
• More than half of nurses (54.3%) of the nurses were in the age from 25 to less than 30 years old. Moreover, 17.1% of them were in the age from 20 to less than 25 years old.
• About half (54.3%) of nurses had nursing diploma. While, 14.3% of nurses had technical diploma.
• It was found that, 42.9% of them had 10 and more years of experience.
• All observation showed that pediatric nurses adjusted water to right temperature, wet hands and wrists under running water and applied soap or detergent to the palms of hands, rinsed wrists and hands completely and dried hands thoroughly with paper towels.
• Only 22.9% of observation showed that nurses rolled sleeves to elbow and washed hands for one minute and rinsed it thoroughly
• Small proportion (9.5%) of observation revealed that nurses closed the water supply source using elbow.
• The majority of observation (91.4%) revealed that nurses cleaned the trolley using soap and water or disinfectant solution, put on sterile gloves and washed their hands after dressing.
• Around three quarters of observations (71.4%, 77.1%) showed that nurses started from clean area and move out to unclean area with normal saline during wound dressing and applied providing iodine on the wound in one direction respectively.
• All of observations showed that nurses did not wear thick and house hold gloves (100% each).
• All of nurses collected contaminated equipment and washed equipment under running water by water force (100% each).
• Only (21%) of the nurses’ observation cleaned equipment gently using soft brush.
• All observations of nurses discarded papers and non-infected wastes in white container, infected wastes and body fluids in red isolation plastic bags, needles and sharps in safety box and discarded needles without recapping (100% each).
• In addition, only small percentage of observations (1%, 1.9%, and 3.8%) nurses did not place the used clothes in appropriate laundry containers, did not place containers for disposed needles besides each bed and did not replace sharp containers when it became up to three quarters full.
• Large proportion of the nurses’ observations (100%) revealed that nurses checked medication rights, checked expired date of medication and checked vital signs before drug administration.
• Moreover, 84.4% of nurses’ observation showed that they washed their hands before administering the drug.
• Unfortunately, only half of the nurses’ observation (56.2%) showed that nurses wear gloves before drug administration.
• Only 18.1% of nurses’ observation revealed that nurses holded cup at eye level and poured liquid to desired level.
• Moreover, 43.8% of nurses’ observation showed that nurses observed the child response to the medication within 30 minutes.
• It was found that, the majority of nurses’ observations (93.3% and 96.2%) revealed that nurses opened bottle cap and ensured that child swallow the medication respectively.
• The majority of nurses’ observations (91.4% and 92.4%) showed that nurses flushed the cannula with normal saline and documented the amount of medication given, time and child reaction respectively.
• In addition, high percentages of nurses’ observations (86.7% and 87.6%) showed that they disinfected the insertion site by sponge with alcohol, kept area to dry and disposed all sharps into sharp container respectively.
• Only 9.5% and 14.3% of nurses did not check rate and the amount of intravenous infusion and did not label IV solution with the drug name, dose, date, and time and nurses’ signature.
• It was found that (87.6%) checked IV solution against the doctor order.
• The majority of nurses’ observations (90.5%, 98.1%, 91.4%) prepared needed supply and equipment, checked IV line for swelling or signs of extravasation and washed their hands after the procedure respectively.
• It was found that, 6.7% of them removed peripheral cannula after blood transfusion.
• Large proportion of nurses’ observations (89.5%, 86.7% and 87.6%) assessed the child needs for suction, wears gloves and opened suction catheter following aseptic technique respectively.
• Unfortunately, small percentages of nurses’ observations (2.9%, 6.7and 5.7%) showed that nurses explained suctioning procedure to the child, wear face mask and put on gown respectively.
• Almost equal percent (88.6%, 86.7%) of nurses’ observations showed that nurses suctioned the oropharyngeal secretion from the child’s mouth and withdraw the suction catheter while applying the negative pressure respectively.
• 33.3% of nurses’ observation showed that nurses inserted the suction catheter without applying pressure.
• Unfortunately, none of nurses’ observation discarded the tube immediately after the procedure.
• The majority of nurses’ observations (92.4%, 91.4%) showed that nurses cleaned the catheter with distal water, disconnected the catheter from suction tubing, washed their hands after the procedure and disposed the gloves and respectively.
• It was found that, 75.2% of nurses inserted the catheter gently into nostril without application of suction.
• Only 20% of nurses’ observation revealed that nurses maintained the negative pressure off during catheter insertion.
• Moreover, one quarter of nurses’ observation (26.7%) documented the child response to the suctioning, type, amount and color.
• Fortunately, all observations of nurses showed that they disconnected the catheter from suction tubing and discarded the tube immediately after the procedure (100% each).
• The majority of nurses’ observations (93.3%, 92.4% and 96.2%) disconnected the child from ventilator, inserted the catheter into the endotracheal tube gently using aseptic technique, washed their hands and cleaned the catheter with distal water.
• Throughout of 74.3% of nurses’ observation showed that they inserted catheter 3 paths during every suction intervention.
• One half of nurses’ observation (52.4%) showed that every suction path should not exceed 10-15 second. On the other hand, during the nurses’ observation it was found that none of them hyper-oxygenated the child by increasing FIO2 from 10-20% above base line data.
• The majority of nurses’ observations (93.3%, 92.4%, 98.1%) revealed that nurses placed all used equipment except rubber in sterilizer and boiled them for 10 minutes, placed nipple and rubber equipment in the sterilizer and boiled it for 3 minutes, boiled water in a pan for 5 minutes and tested temperature &flow of milk by letting a few drops fall on the inner side of the wrist respectively.
• In addition, only 21.9% of nurses’ observation induced sucking reflex by placing the nipple over infant’s lips.
• Unfortunately, 1% of nurses’ observation eructated the infant during feeding. Moreover, none of nurses’ observation showed that they wear gown cap and face mask.
• Throughout nurses’ observations 100% of nurses washed their hands, marked with a water proof marker or with tabe, lubricated the tube with child’s saliva and closed the tube probably to avoid entering air throughout the procedure.
• On the other hand, 67.6% of nurses’ observation showed that nurses poured formula and allowed it to flow by gravity until the right amount has been fed.
• More than half of nurses (56.2%) had good total score of practices regarding safety measures and 39% of them had satisfactory practices.
• Meanwhile, only 4.8% of nurses had unsatisfactory total score of practices regarding safety measures.