Critical Care Newsline — December 11, 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’s 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.

Dec 11, 2008

NOTE: Critical Care Newsline will not be published during the remainder of 2008 but will resume in January 2009. Have a safe, happy holiday season.

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1. NEWS 'Hospital of the Future' Report Urges Major Changes
2. CALL FOR COMMENT 2009 National Patient Safety Goals
3. NEWS TRENDS Paper and Pencil Certification Exams Application Deadline Just Around the Corner
4. EVIDENCE Consensus Statement on Heart Failure Clinics Issued (Abstract)
5. EVIDENCE Link Between Depression, Cardio Events May Result From Health Behavior Changes (Abstract)
6. EVIDENCE Use of Inhaled Corticosteroids for COPD May Increase Pneumonia Risk (Abstract)
7. RESOURCE Clearing the Path to the DNP
8. Clinical Practice Resources
9. AACN Resources
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1. NEWS 'Hospital of the Future' Report Urges Major Changes
A report released by The Joint Commission offers guiding principles and actions for the hospital of the future to meet the daunting challenges of older and sicker patients, patient safety and quality of care, economics and the work force. As these challenges escalate, hospitals can lead the effort to meet these demands. “ Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future” contends that hospitals must respond in new ways as escalating health care costs are hitting record highs and the conditions and care needs of hospitalized patients are growing more complex. The report is the work of an expert panel comprising hospital executives and clinical leaders, as well as experts in technology, health care economics, hospital design and patient safety. The roundtable analyzed how socio-economic trends, technology, the physical environment of care, patient-centered care values and
ongoing staffing challenges will impact the hospital of the future. The report recommends action in five core areas: Economic Viability, Technology Adoption, Patient-Centered Care, Staffing and Hospital Design.

2. CALL FOR COMMENT 2009 National Patient Safety Goals
The Joint Commission invites your comments on the revisions of the 2009 National Patient Safety Goals. Your feedback is essential to improving patient safety. Please take a few moments to review the goals and submit your comments. Remarks will be accepted during the first three weeks of December.

3. NEWS TRENDS Paper and Pencil Certification Exams Application Deadline Just Around the Corner
Is 2009 the year for you to enhance your skills and knowledge with a new credential? Here’s the perfect opportunity: Paper and pencil exams for the CCRN, PCCN, CCNS, ACNPC, CMC, CSC, and CNML will be given at the spring Trends conference in Philadelphia on March 27, 2009. The deadline to submit Trends exam applications to AACN is February 6, 2009.

4. EVIDENCE Consensus Statement on Heart Failure Clinics Issued (Abstract)
The Heart Failure Society of America has released a consensus statement on heart failure (HF) clinics, which have been established to reduce mortality and rehospitalization rates and improve quality of life for HF patients through individualized patient care. The statement identifies components of HF clinics, focusing on systems and procedures most likely to contribute to the consistent application of guidelines and, consequently, optimal patient care. The report covers disease management, functional assessment, quality of life assessment, medical therapy and drug evaluation, device evaluation, nutritional assessment, follow-up, advance planning, communication, provider education and quality assessment.

5. EVIDENCE Link Between Depression, Cardio Events May Result From Health Behavior Changes (Abstract)
The increased risk of cardiovascular events for patients with coronary heart disease and symptoms of depression may be largely explained by a change in health behaviors, especially a lack of physical activity, according to a recent study. The study’s researchers found that participants with depressive symptoms had a 50 percent greater risk of cardiovascular events, They also noted that patients with depressive symptoms are less likely to adhere to dietary, exercise and medication recommendations, and poor health behaviors can lead to cardiovascular events. “These findings raise the hypothesis that the increased risk of cardiovascular events associated with depression could potentially be preventable with behavior modification, especially exercise,” the authors reported. “Given the relatively modest effects of traditional therapies on depressive symptoms in patients with heart disease, there is increasing urgency to identify interventions that not only reduce depressive symptoms but also directly target the mechanisms by which depression leads to cardiovascular events.”

6. EVIDENCE Use of Inhaled Corticosteroids for COPD May Increase Pneumonia Risk (Abstract)
Inhaled corticosteroids used to treat chronic obstructive pulmonary disease (COPD) does not improve the rate of survival for COPD patients after one year, but does increase risk of pneumonia for these patients, according to an analysis of randomized trials. No pharmacotherapy and few interventions, other than smoking cessation and supplemental oxygen, have been shown to improve the rate of death in patients with COPD. Recent studies on the use of inhaled corticosteroid (ICS) therapy for managing stable COPD have yielded conflicting results regarding survival and risk of adverse events. “Recognizing the adverse events associated with ICS use is especially important, since clinicians may increase ICS therapy from moderate to high doses in patients who are not responding. Our data suggest that increasing to higher ICS doses may place patients at greater risk for pneumonia. Until studies can confirm an unequivocal benefit of ICS therapy in a group of patients with COPD, patients should receive the lowest effective ICS dose to minimize potential adverse effects,” the authors wrote.

7. RESOURCE Clearing the Path to the DNP
There’s been quite a bit of confusion surrounding the certification path for clinical nurse specialists and nurse practitioners nurses who have attained the DNP degree. With the recent release of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (July 2008) and the simultaneous growth in the number of academic programs offering a Doctor of Nursing Practice (DNP) degree, there’s even more uncertainty for nurses with this degree. In response, AACN and AACN Certification Corporation developed an issue brief to provide clarification for our constituents. We want you to know that we are committed to ongoing advocacy in the complex, multifaceted system of advanced practice education, licensure, certification and practice.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Hospital-wide Code Rates and Mortality Before and After Implementation of a
Rapid Response Team

Deaths Due to Bloodborne Infections and Their Sequelae Among Health-Care Workers

GUIDELINES
Urinary Incontinence (UI) in Older Adults Admitted to Acute Care. In: Evidence-based Geriatric Nursing Protocols for Best Practice

PATIENT SAFETY ISSUES
Terumo Cardiovascular Systems Tenderflow Pediatric Arterial Cannulae Recalled Due to Reports of Difficulty Retracting the Introducer From the Cannula
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