Critical Care Newsline — March 4, 2010

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by our clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

March 4, 2010

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1. EVIDENCE Multidisciplinary teams reduce ICU mortality, study reports
2. NEWS AACN to host free webinar, “Assessing the Health of Your Work Environment”
3. NEWS Web-based preceptor, palliative care courses for individual nurses
4. EVIDENCE Healthcare-associated sepsis, pneumonia impose substantial costs
5. EVIDENCE No link between nursing knowledge and clinical performance
6. EVIDENCE Hospital stays cause cognitive decline in older adults, study says
7. EVIDENCE Aspirin used with ACEIs, ARBs doesn’t harm patients with heart failure
8. EVIDENCE Links between cost and quality of care, mortality inconsistent
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES NTI certification exam deadline is April 7

1. EVIDENCE Multidisciplinary teams reduce ICU mortality, study reports
“Daily rounds by a multidisciplinary team are associated with lower mortality among medical ICU patients,” states a population-based retrospective cohort study of 112 Pennsylvania acute care hospital admissions in the Feb. 22 Archives of Internal Medicine. The study credits survival rate to intensivist physician staffing and reports consistent effects across key subgroups: patients with sepsis, those who require invasive mechanical ventilation and patients in the highest quartile of illness severity. Read the abstract for “The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality."

2. NEWS AACN to host free webinar, “Assessing the Health of Your Work Environment”
AACN and VitalSmarts — a provider of corporate training and organizational performance products and services in Provo, Utah — will host a free webinar Tuesday, March 9, 11 a.m. to noon MST. “Assessing the Health of Your Work Environment” promises to be particularly interesting to anyone who uses or plans to use the new AACN Healthy Work Environment Assessment, a Web-based tool that aligns any clinical environment with the six HWE standards.

3. NEWS AACN offers Web-based courses on precepting and palliative care
AACN now offers individual nurses access to two of its most popular Web-based courses, “The Preceptor Challenge” and double-award-winning “Excellence in Palliative & End-of-Life Care.” At the AACN Learn Center, nurses may purchase six-month access to “The Preceptor Challenge” for $100 and “Promoting Excellence in Palliative & End-of-Life Care” for $50. “The Preceptor Challenge,” a three-module course, uses virtual tools to enable nurses to identify best practices. “Excellence in Palliative & End-of-Life Care” allows nurses to apply theory-based practice without the risk of harm to patients or families.

4. EVIDENCE Healthcare-associated sepsis, pneumonia impose substantial costs
Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia” appears in the Feb. 22 Archives of Internal Medicine. The abstract notes that “healthcare-associated sepsis and pneumonia impose substantial clinical and economic costs.”

5. EVIDENCE No link between nursing knowledge and clinical performance
The relationship between knowledge and clinical performance in novice and experienced critical care nurses,” published online Feb. 23, 2009 by Heart & Lung, questions the inextricable link between nursing knowledge and performance. The study finds that “experienced nurses possessed highly superior knowledge when compared with novice nurses.” It shows “a lack of reliable differences in actual clinical performance among nurses considered solely on the basis of experience.”

6. EVIDENCE Hospital stays cause cognitive decline in older adults, study says
A study in the Feb. 24 Journal of the American Medical Association compares the risk of cognitive decline and dementia among non-hospitalized older individuals to those hospitalized for acute or critical care illness. “Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults” screened patients without dementia at baseline every two years for an average of six years. Older adults without dementia at baseline hospitalized for acute care and critical illness “had a greater likelihood of cognitive decline compared with those who had no hospitalization,” concludes the study, which significantly associates dementia with non-critical illness hospitalization.

7. EVIDENCE Aspirin used with ACEIs, ARBs doesn’t harm patients with heart failure
Aspirin with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) doesn’t increase mortality in heart failure (HF) patients 60 to 90 days after hospital discharge, reports February’s American Heart Journal. “When combined with ACEI or ARB, ASA had no demonstrable adverse effect on intermediate-term post-discharge outcomes for patients with ischemic or nonischemic HF,” the abstract concludes.

8. EVIDENCE Links between cost and quality of care, mortality inconsistent
A Feb. 22 Archives of Internal Medicine article calls the associations between hospitals’ cost of care and quality of care and between the cost of care and mortality rates inconsistent. “Most evidence did not support the penny-wise and pound-foolish hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care,” concludes “Hospital Cost of Care, Quality of Care, and Readmission Rates.”

9. CLINICAL PRACTICE RESOURCES

Patient Safety
On Feb. 2, the U.S. Food and Drug Administration (FDA), Silver Spring, Md., extended to 18 months the total recommended time to transition from Steris Corp.’s modified System 1 processor used in surgical and endoscopy suites for reprocessing to a legally marketed alternative.

On Feb. 18, the FDA issued a safety announcement for the use of long-acting beta-agonists (LABAs) for the treatment of asthma. An FDA meta-analysis shows higher risk of severe exacerbation of asthma symptoms leading to pediatric and adult hospitalizations and death. The FDA, which requires manufacturers to evaluate the safety of LABA with inhaled corticosteroids, lacks sufficient data to conclude if LABA with inhaled corticosteroids reduces or eliminates asthma-related hospitalizations or death. Read the list of safe practices.

The FDA issued a safety announcement requiring all Erythropoiesis-Stimulating Agents (ESAs) to be prescribed and used under a risk management program known as a risk evaluation and mitigation strategy (REMS). ESAs increase the risk of tumor growth and reduce survival in patients with cancer. They also increase the risk of heart attack, heart failure, stroke or blood clots among patients who use these drugs for other conditions.

Evidence
A February 2010 American Heart Journal study examines the influence of dedicated heart failure (HF) clinics on the delivery of guideline-recommended therapies for cardiology practice outpatients with HF and reduced left ventricular ejection traction. The study found greater use of cardiac resynchronization therapy and HF education but not guideline-recommended therapies among dedicated HF clinics, which varied in cardiology outpatient practices.

Guidelines
The abstract for “Optimizing antimicrobial therapy in sepsis and septic shock” in October 2009’s Critical Care Clinics contains evidence-based recommendations.

Resource
In December 2009, the National Association of Clinical Nurse Specialists’ Board of Directors approved “Clinical Nurse Specialists – Practitioners Contributing to Primary Care.


10. AACN RESOURCES

NTI
Early bird registration for the 2010 National Teaching Institute & Critical Care Exposition (NTI), Saturday, May 15 through Thursday, May 20, Washington, D.C., ends Wednesday, April 7. Visit the NTI page on the AACN Web site to register for this premier high acuity and critical care conference.

AACN will offer all certification exams at the 2010 NTI, Washington, D.C., Monday, May 17. Nurses must use a special NTI application to preregister for the exam. Exam fee payment and the completed NTI exam application must be postmarked no later than Wednesday, April 7.

Facebook
With 2010 designated the International Year of the Nurse, AACN wonders: What made you become a nurse? Join a robust discussion on Facebook, or type #AACNchat in your Twitter response.

New AJCC OnlineFirst Articles Now Available
New Publish Ahead of Print articles are now live on the American Journal of Critical Care (AJCC) Web site. Click the OnlineFirst logo to read about the effect of certification on nurses’ feelings of empowerment and their intent to leave their current position or the profession, and a study to determine the prevalence and predictors of postoperative delirium after colorectal surgery in older patients. Log-in is required to read the articles; abstracts are free access.

Looking for an AJCC article to discuss in your journal club? The March issue has an engaging piece that evaluates the usefulness of morbidity and mortality conferences in the ICU. It’s followed by a related evidence-based review and discussion guide.

Critical Care Nurse March OnlineFirst Articles Now Available
Two new Publish Ahead of Print articles are now live on the Critical Care Nurse Web site. Riddle, et al discuss alcohol withdrawal in critically ill patients, and Evanson and colleagues report on cardiac monitoring at the bedside. Member log-in is required to read the articles.

AACN’s ‘Response to Haiti Earthquake’ Web Page
Visit “Response to Haiti Earthquake” on the AACN Web site to find information about the massive earthquake that devastated Haiti on Tuesday, Jan. 12. Response to Haiti Earthquake contains links to U.S. government agencies monitoring the earthquake and global relief organizations providing volunteer and financial support.

Healthy Work Environment
Access the new AACN Healthy Work Environment Assessment, a free Web-based tool to help nurse managers and leaders align hospital unit performance with the AACN Standards for Establishing and Sustaining Healthy Work Environments (HWEs). The online tool — developed with VitalSmarts, a provider of corporate training and organizational performance products and services in Provo, Utah — aligns the performance of any clinical environment, from single hospital units to entire healthcare organizations, with the six HWE standards. They include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership. Register for AACN’s and VitalSmarts’ free webinar “Assessing the Health of Your Work Environment."


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