Critical Care Newsline — August 28, 2008

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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 AACN. Every week, our expert clinical practice staff reviews hundreds of journals and Web sites, choosing only the most pertinent information for Critical Care Newsline. 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 on a variety of topics to keep you informed on issues that affect nurses and the nursing profession.


Aug.28, 2008

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1. EDUCATION TeamSTEPPS Offers Free Training to Healthcare Providers
2. EVIDENCE Silver-Coated Endotracheal Tubes Reduce VAP Risk (Abstract)
3. EVIDENCE Better Assessment Could Reduce Ventilator-Induced Lung Injury (Abstract)
4. EVIDENCE Dying From Injuries: Trauma Professionals and the Public Prefer Palliative Care (Abstract)
5. EVIDENCE Younger Patients Have Priority for Trauma Center Transport (Abstract)
6. EVIDENCE New Screening Guidelines: Men Over 75 Don’t Need PSA Test (Free Full Text)
7. EVIDENCE Healthcare Peer Support Counteracts Emotional Effects of Adverse Medical Events (Abstract)
8. EVIDENCE Screening Seniors for Delirium: HELP is on the Way
9. Clinical Practice Resources
10. AACN Resources
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1. EDUCATION TeamSTEPPS Offers Free Training to Healthcare Providers
The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense have created free training opportunities for hospital and other healthcare providers through TeamSTEPPS, an evidence-based teamwork system that optimizes patient outcomes by improving communication and teamwork skills among healthcare professionals. The program includes a comprehensive set of ready-to-use materials and a training curriculum that can be used in any healthcare system to successfully integrate teamwork principles. Free two-and-a-half day training courses are being held throughout the year at four Project Training Resource Centers: Duke Medical Center, Durham, N.C.; Carilion Clinic, Roanoke, Va; University of Minnesota Fairview Medical Center, Minneapolis, Minn; and Creighton University Medical Center, Omaha, Neb. Participants will join a network of master trainers, who will in turn offer TeamSTEPPS training to frontline providers in hospitals and other healthcare settings nationwide. For more information, e-mail tsteppstrainingapps@air.org, call 877-678-3777 or click here.

Don’t have time to attend a training course? Take advantage of learning opportunities offered through the free TeamSTEPPS Webinar series. The next Webinar, Using the AHRQ Hospital Survey on Patient Safety Culture, will be held Sept. 17 from noon to 1:30 p.m. EDT.

The TeamSTEPPs program includes a host of free resources that aid individuals and organizations in implementing the AACN Standards for Establishing and Sustaining Healthy Work Environments.

2. EVIDENCE Silver-Coated Endotracheal Tubes Reduce VAP Risk (Abstract)
Silver-coated catheters are already being used in hospitals to effectively reduce urinary tract infections; now silver-coated endotracheal tubes have been shown to reduce a patient’s risk of developing Ventilator Associated Pneumonia (VAP) or delay onset of the condition by preventing bacterial colonization and biofilm formation, according to a recent study. Researchers found that patients who received the silver-coated tube either did not get VAP or developed the condition later than those who received an uncoated tube. This study shows promise in decreasing the incidence of VAP at a time when hospitals are actively searching for ways to reduce such hospital-acquired infections.

Want more information about this topic? Read the AACN Practice Alert on Ventilator Associated Pneumonia.

3. EVIDENCE Better Assessment Could Reduce Ventilator-Induced Lung Injury (Abstract)
Ventilator-induced lung injury may contribute to prolonged respiratory failure or death among patients with Acute Respiratory Distress Syndrome (ARDS). Even patients with previously healthy lungs who require temporary mechanical ventilation after surgery are at risk. Although the incidence of these injuries has been reduced significantly, a new study indicates there is still much to be done. According to the study, accurately assessing patients' lung stress and strain could mean the difference between life and death. “If we could decrease, with more refined measurements, the mortality rate due to mechanical ventilation by 4-5 percent this could save up to 7,500 lives in the U.S., if we accept that ALI/ARDS has an incidence of 150,000/year,” the researchers report.

For more about this topic, read the CE article in our free online CE center.

4. EVIDENCE Dying From Injuries: Trauma Professionals and the Public Prefer Palliative Care (Abstract)
Most trauma professionals and members of the general public say they would prefer palliative care following a severe injury if physicians determined aggressive critical care would not save their lives, according to a recent study. However, trauma care professionals and other individuals differ in their opinions regarding patients' rights to demand care and the role of divine intervention in recovery from an injury. "The findings of the surveys pose challenges for trauma professionals, hospital administrators, insurers and society as a whole," the authors conclude. "Issues need to be discussed in the clinical and public arenas and within the curricula of health professional education. Rich and sensitive dialogue is needed so that all dying trauma patients and their families receive quality end-of-life care."

Improving palliative and end-of-life care is one of AACN’s major initiatives. To provide optimal, quality care, the science and skills for prolonging life, as well as palliative therapies must be embedded into the management of critically ill patients. For patients to receive quality care, palliation must be included throughout the trajectory of illness. Click here to find more resources that will help you improve palliative care for your patients.

5. EVIDENCE Younger Patients Have Priority for Trauma Center Transport (Abstract)
Elderly trauma patients are less likely than younger patients to be transported to a trauma center, possibly because of unconscious age bias among emergency medical services personnel, a recent study reports. “Evidence-based clinical practice guidelines strongly recommend that elderly trauma patients be treated as aggressively as non-elderly patients," the authors write. "However, some studies have suggested that age bias may still exist in trauma care, even in the prehospital phase of that care." The researchers also noted that elderly trauma patients do, in fact, return to productive lives after their injury, which “can eliminate the perception of futility of care that may be used consciously or subconsciously to justify age bias.” Have you noticed this problem in your hospital? If so, what can you and your colleagues do to help change this age bias?

6. EVIDENCE New Screening Guidelines: Men Over 75 Don’t Need PSA Test (Free Full Text)
Men older than age 75 should no longer have the prostate-specific antigen (PSA) test to screen for prostate cancer and younger men should discuss potential risks and benefits with their healthcare provider before being tested, according to new recommendations from the U.S. Preventive Services Task Force. The task force noted that although nearly one-third of all men in the U.S. over the age of 75 are still having PSA tests, the risks outweigh the benefits in this age group, which have an average life expectancy of approximately 10 years and are more likely die from heart disease or stroke. "Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm," the task force reports.

7. EVIDENCE Healthcare Peer Counteracts Emotional Effects of Adverse Medical Events (Abstract)
Healthcare professionals know how emotionally devastating it can be when an adverse medical event occurs in their workplace. In the past, these events were rarely acknowledged openly. Thanks to the patient safety movement, the need to support the human side of adverse medical events through peer support in conjunction with evidence-based improvement initiatives is becoming commonplace. A recent study describes the development of a confidential, voluntary peer support service for physicians to help alleviate their distress following an adverse medical event. The study’s authors also found that the peer support service provided a safe environment where healthcare providers could share the emotional impact of adverse events and build a foundation for open communication and a renewal of compassion in the workplace.

Moral distress is a critical, frequently ignored, problem in healthcare work environments. Unaddressed, it restricts nurses’ ability to provide optimal patient care and to find job satisfaction. AACN asserts that every nurse and every employer are responsible for implementing programs to address and mitigate the harmful effects of moral distress in the pursuit of creating a healthy work environment. Click here to download a moral distress toolkit and read more about AACN’s position on this issue.

AACN has long been an advocate of healthy work environments, which include skilled communication and true collaboration. Click here to learn more about the AACN Standards for Establishing and Sustaining Healthy Work Environments.

8. EVIDENCE Screening Seniors for Delirium: HELP is on the Way
The Hospital Elder Life Program (HELP), developed by Yale New Haven Hospital, reduced the risk and severity of delirium in elderly patients, lowered hospital and nursing home costs and generated revenues by freeing up bed capacity, according to a recent report. The program screens patients over age 70 for six risk factors of delirium: cognitive impairment, sleep deprivation, immobility, dehydration, and vision and hearing impairment. Patients who show signs of delirium are treated by an interdisciplinary team using interventions to reduce their risk of developing the disorder. Team members also coordinate with local agencies that serve the elderly (home health agencies, voluntary nursing agencies and nursing homes) and follow up with patients to ease their transition from the hospital. The innovative program is now being implemented in other healthcare institutions with similar results. To find out if this program might benefit your hospital, read more.

For more information on delirium, click here.

9. Clinical Practice Resources

PATIENT SAFETY ISSUES
Vivitrol (naltrexone) Alcohol Dependence Drug Can Cause Adverse Injection Site Reactions

Patient Safety Links:
Joint Commission
Medline Plus
National Patient Safety Foundation
Institute for Safe Medication Practices Newsletter
AHRQ Patient Safety Network

NEW GUIDELINES
Modifications in endoscopic practice for pediatric patients

The following are from a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction
2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction.

NEW EVIDENCE-BASED PRACTICE
Nesiritide Improves Hemodynamics in Children with Dilated Cardiomyopathy: A Pilot Study (Abstract)

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