Critical Care Newsline — October 30, 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.


Oct. 30, 2008

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1. EVIDENCE Results Show Point-of-care Glucose Tests May Be Unreliable in Critically Ill Patients
2. EVIDENCE Early Mobility for ICU Patients Better Than Bed Rest (Abstract)
3. NEWS Researchers Downplay MRSA Screening as Effective Infection Control Intervention
4. RESOURCE AHRQ Health Care Innovations Exchange Enhances Patient Care Delivery
5. ADVISORY Screen Heart Patients for Depression, New Guidelines Urge (Free Full Text)
6. EVIDENCE Depression After Heart Attack Raises Risk of Readmission, Death Sevenfold (Abstract)
7. CALL FOR COMMENT Draft Report: Endorsing a Framework and Preferred Practices for Measuring and Reporting Cultural Competency
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Results Show Point-of-care Glucose Tests May Be Unreliable in Critically Ill Patients
Determining accurate glucose testing in critically ill patients who are receiving intensive insulin therapy is essential to administering the correct insulin dose. In a recent study, three point-of care testing devices used to obtain glucose readings from ICU and non-ICU patients produced inaccurate results. The study’s researchers noted, ”among intensive care unit patients, inaccurate glucose readings were falsely elevated, resulting in misinterpretation of high glucose values with subsequent inappropriate insulin administration or masking of true hypoglycemia.”

2. EVIDENCE Early Mobility for ICU Patients Better Than Bed Rest (Abstract)
Routinely keeping ICU patients deeply sedated and on bed rest can lead to muscle weakness. To counteract that condition, it’s probably best to get patients up and moving shortly after ICU admission, according to a recent research report. Based on a review of studies of ICU patients with sepsis, prolonged mechanical ventilation and multiple organ failure, the report found that 46 percent of 1,421 patients had neuromuscular dysfunction associated with extended use of mechanical ventilation and longer stays in the ICU. Other studies showed that physical medicine and rehabilitation therapy given to patients while they were still on life support allowed them to become mobile more quickly. As a result, they spent less time on a ventilator and fewer days in the ICU.

3. NEWS Researchers Downplay MRSA Screening as Effective Infection Control Intervention
A team of internationally acclaimed epidemiologists are downplaying the value of mandatory universal nasal screening of patients for MRSA, arguing that proven, hospital-wide infection control practices can prevent more of these potentially fatal infections. Using epidemiological principles and focusing on bloodstream infections, the team modeled a focused-screening program that was assumed to be effective in reducing MRSA rates by 50 percent and compared it to a hospital-wide program designed to reduce the rates of all infections by half. According to the researchers, MRSA causes only 14 percent of hospital infections, and investing huge resources into their control would be less effective than implementing programs to reduce the rate of all infections by 50 percent. They also noted the MRSA screening was inferior to general infection control programs and produced false positives, which lead to the isolation of patients who are non-MRSA carriers, and false negatives, which miss some real carriers. In addition, the cost of nasal swabbing tests for all patients in a screening program was estimated to be two to three times as much as adding additional infection control nurses for a broad infection control program. Some states, including Pennsylvania, Illinois, California and New Jersey, are mandating universal nasal screening for MRSA in hospitalized patients. The authors contend that a focused screening program would have made more sense in the late 1980s and early 1990s when MRSA was the key in antibiotic-resistant pathogen; now hospitals are facing threats from multiple resistant bacteria.

4. RESOURCE AHRQ Health Care Innovations Exchange Enhances Patient Care Delivery
The Health Care Innovations Exchange is an Agency for Healthcare Research and Quality program designed to support health care professionals in sharing and adopting innovations that improve the delivery of care to patients. Explore this site to find innovative strategies and quality-related tools, learn how to improve your organization's ability to innovate and adopt new ideas, and interact with innovators and adopters. Browse the Innovations Exchange by Subject, Find Innovations and Quality Tools classified by disease or clinical category, patient population, stage of care and setting of care.

5. ADVISORY Screen Heart Patients for Depression, New Guidelines Urge (Free Full Text)
Heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery and overall health, according to a scientific advisory recently released by the American Heart Association. Although there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory states that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life. The statement suggests that it is also "possible that biological changes associated with depression such as reduced heart rate variability and increases in blood factors that encourage clot formation could increase risk". Depression is approximately three times more common in people with heart complications than in the general population and as many as 20 percent of heart patients meet the criteria for major depression. The advisory recommends that heart patients initially be evaluated with a simple two-item assessment. If even one of the questions generates a "yes" response, a more in-depth screening should be done. Heart patients found to be suffering from depression can benefit from a number of treatment options, including behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs, or combinations of these treatments.

6. EVIDENCE Depression After Heart Attack Raises Risk of Readmission, Death Sevenfold (Abstract)
Previous research has shown that people who develop depression following a heart attack or chest pain have an elevated risk of cardiac death or hospital readmission during the following year. But in a new study, researchers report that depression occurring after the coronary event—not prior or existing at the time of hospitalization--was associated with a substantially higher risk of cardiac-related morbidity and mortality. After controlling for traditional cardiac risk factors such as age, gender and smoking status, depression that developed in the month after the coronary event increased the odds of cardiac readmission or death seven times. The study’s authors noted, "If confirmed, [this finding] has the potential to greatly enhance the ability of health professionals to identify and allocate resources to those patients who are at the greatest risk. This finding also has the potential to shed light on the mechanisms by which post-ACS depression is associated with reduced survival; an area that is still very poorly understood."

7. CALL FOR COMMENT Draft Report: Endorsing a Framework and Preferred Practices for Measuring and Reporting Cultural Competency
The National Quality Forum (NQF) is seeking comment from NQF members and the general public on a draft report to establish a framework for culturally competent healthcare. The project aims to promote culturally competent care and to reduce disparities by endorsing a comprehensive framework for measuring and reporting cultural competency and by endorsing preferred practices to provide culturally competent care. Without the provision of culturally accurate and appropriate services, medical errors, misunderstandings and a lack patient compliance may increase as a result of differences in language or culture. Public comments are due by Nov. 5, 2008; NQF members have until Nov.12 to respond.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Pulmonary-Vein Isolation for Atrial Fibrillation in Patients With Heart Failure (Abstract)

GUIDELINES
Delirium: Prevention, Early Recognition, and Treatment. In: Evidence-based Geriatric Nursing Protocols for Best Practice

PATIENT SAFETY ISSUES
Thoratec HeartMate II Left Ventricular Assist System- Device Correction: Wear and Fatigue of the Percutaneous Lead Connecting the Blood Pump With the System Controller May Cause Serious Injury or Death
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