Critical Care Newsline — November 20, 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.


PLEASE NOTE: Critical Care Newsline will not be published next week. Have a HAPPY THANKSGIVING!

Nov 20, 2008

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1. LAST CALL Submit Nominations for the 2010 Distinguished Research Lecturer; Deadline Is Dec.1, 2008
2. EVIDENCE Gastric Residual Volumes: A Predictor of Aspiration in Gastric Tube Feedings? (Abstract)
3. EVIDENCE Delirium Assessments and Sedation in the ICU: Nursing Practice and Perceptions (Abstract)
4. EVIDENCE Delirium After Heart Surgery: Who’s at Risk? (Abstract)
5. NEWS Right to Know End-of-Life Options Act (AB 2747) First Law of Its Kind in the Nation
6. NEWS Clostridium Difficile Much More Prevalent in Hospitals Than Previously Thought, Survey Shows
7. RESOURCE AACN President’s Theme Creates Confidence, Empowerment
8. Clinical Practice Resources
9. AACN Resources
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1. LAST CALL Submit Nominations for the 2010 Distinguished Research Lecturer; Deadline Is Dec.1, 2008
Only ten days remain before the Dec. 1 deadline to nominate candidates for the 2010 Distinguished Research Lecturer. The recipient will receive a plaque and present the Distinguished Research Lecture at 2010 NTI in Washington, D.C. The award is sponsored by Philips Medical Systems and consists of a $1,000 honorarium and an additional $1,000 for NTI expenses. Here are criteria for the ideal candidate: 1) nationally recognized for publications, presentations, and/or mentorship in research relevant to acute and/or critical care clinical practice, 2) viewed as a consultant in his or her area of expertise 3) known for significant contributions to acute and critical care nursing practice through research 4) a dynamic and interesting speaker (nominators should cite an example of nominee's expertise in public speaking). For more information click here or e-mail research@aacn.org.

2. EVIDENCE Gastric Residual Volumes: A Predictor of Aspiration in Gastric Tube Feedings? (Abstract)
Bedside assessment of gastric residual volume as a predictor of aspiration is a significant issue in critical care; effectiveness of the practice is consistently under scrutiny in the healthcare community. In results of a recent study, researchers evaluated gastric residual volumes and aspiration of gastric contents in a group of critically ill patients receiving gastric tube feedings. The study’s authors reported that “No consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high. “

3. EVIDENCE Delirium Assessments and Sedation in the ICU: Nursing Practice and Perceptions (Abstract)
Practice and perceptions of delirium assessment vary widely among critical care nurses despite the presence of institutional sedation guidelines that encourage delirium assessment, according to a recent study. The study’s authors surveyed 331 nurses and found that only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment but more common among nurses who worked in medical intensive care units and at academic medical centers.

How much do you know about delirium? Test your skill level and bridge any knowledge gaps with AACN’s free Palliative and End-of-Life Care Self Assessment. The content features the self assessment plus resources for palliative care and end-of-life symptom management, airway management, dyspnea, delirium and pain management.

4. EVIDENCE Delirium After Heart Surgery: Who’s at Risk? (Abstract)
Although delirium after cardiac surgery is a common complication in cardiovascular intensive care units, the condition’s prevalence and risk factors that cause it have not been fully explored, according to a recent study. The study’s authors reviewed charts on 288 patients who had open heart surgery in a Taiwanese hospital and found that 41.7% of the patients experienced postoperative delirium. The researchers also noted that four postoperative factors--hematocrit less than 30%, cardiogenic shock, hypoalbuminemia and acute infection--were significant independent predictors of postoperative delirium. “The results of this study can be used to develop a revised checklist of 29 preoperative, intraoperative and postoperative risk factors for delirium, with special attention to the 4 predictive postoperative factors,” researchers noted. “Use of such a checklist may facilitate the ability to prevent or detect delirium early and provide suitable treatment.”

5. NEWS Right to Know End-of-Life Options Act (AB 2747) First Law of Its Kind in the Nation
California Gov. Arnold Schwarzenegger recently signed into law a bill that requires doctors, nurse practitioners, and physician assistants to provide terminally ill patients with a full disclosure of, and counseling about, all available end-of-life care options accepted in law and medicine. The Terminal Patients’ Right to Know End- of-Life Options Act, AB 2747 (Berg-Levine) is the first law of its kind in the nation to provide such requirements for providing end-of-life information. When requested, information about hospice care, refusal or withdrawing of life-prolonging treatments, voluntary stopping eating and drinking (VSED), palliative care and palliative sedation will be discussed with the patient. The act also requires that healthcare providers who do not wish to comply with a particular patient’s choice must refer or transfer the patient to another provider.

6. NEWS Clostridium Difficile Much More Prevalent in Hospitals Than Previously Thought, Survey Shows
The life-threatening bacterium that causes diarrhea and more serious intestinal conditions, Clostridium difficile (CDI), is sickening many more patients than previously estimated, according to a new study released by the Association for Professionals in Infection Control and Epidemiology (APIC). The APIC survey, the largest, most comprehensive of its kind, presents a one-day snapshot of the prevalence of CDI in American hospitals. Results showed that 13 out of every 1,000 inpatients were either infected or colonized with CDI. Based on this rate, it is estimated that there are at least 7,178 inpatients on any one given day in American healthcare institutions with CDI at an associated cost of $17.6 to $51.5 million. That rate is 6.5 to 20 times greater than previous incidence estimates, according to the survey. "This study shows that CDI infection is an escalating issue in our nation's healthcare facilities," the authors report. "Clearly, preventing the development and transmission of CDI should be a top priority for every healthcare institution."

For more on HAIs , read the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals or view the related Web cast.

7. RESOURCE AACN President’s Theme Creates Confidence, Empowerment
AACN President Caryl Goodyear-Bruch says, “I chose ‘With Confidence’ as the theme for my presidential year because I want to encourage acute and critical care nurses to recognize and embrace the power they have. ‘With Confidence’ affirms the value of your everyday contributions and empowers you to create the workplace you envision for you and your patients.” To find out more click here, where you’ll find all things related to the theme in one convenient location.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
A Protocolized Approach to Identify and Manage Hyperglycemia in a Pediatric Critical Care Unit (Abstract)

Alternating Antipyretics: Antipyretic Efficacy of Acetaminophen Versus Acetaminophen Alternated With Ibuprofen in Children (Abstract)

GUIDELINES
Guidelines for Evaluation of New Fever in Critically Ill Adult Patients: 2008 Update from the American College of Critical Care Medicine and the Infectious Disease Society of America. (This updates a previously published guideline summary.)

Recommendations for End-of-life Care in the Intensive Care Unit: A Consensus Statement by the American Academy of Critical Care Medicine. (This updates a previously published guideline summary.)

Recommendations for the Diagnosis and Management of Corticosteroid Insufficiency in Critically Ill Adult Patients: Consensus Statements From an International Task Force by the American College of Critical Care Medicine.

PATIENT SAFETY ISSUES
Update Regarding Atrial Fibrillation With Bisphosphonates
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