Critical Care Newsline — September 4, 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.


Sept 4, 2008

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1. EVIDENCE Red Blood Cell Transfusions Affect Disease and Death Rates in ICU Patients (Abstract)
2. EVIDENCE Paying the Price for Quality Nursing Care (Free Full Text)
3. EVIDENCE Challenging Tight Glucose Control Practice for Critically Ill Patients (Abstract)
4. RESOURCE New Tool Helps Hospitals Evaluate Disaster Drills
5. CALL TO ACTION Medicare Fee-for-service Town Hall Meeting/Teleconference Important for APRNs
6. EDUCATION Free CE: Popular NTI '08 Certification Session Now Online
7. CALL TO ACTION Take the Flu Vaccination Challenge to Protect Your Patients and Your Colleagues
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Red Blood Cell Transfusions Affect Disease and Death Rates in ICU Patients (Abstract)
Red blood cell (RBC) transfusions are common in intensive care unit, trauma and surgical patients but the hematocrit for each patient may be difficult to determine and may ultimately affect morbidity and mortality. Many studies have been done to evaluate the appropriateness and frequency of red blood cell transfusions in ICU patients, especially with the scarcity of blood resources available. The authors of this study reviewed current literature and found that in adult, intensive care unit, trauma and surgical patients, RBC transfusions were associated with increased morbidity and mortality. As a result, the authors suggest that current transfusion practices may need to be reevaluated.

Read an AACN article about red blood cell transfusions.

2. EVIDENCE Paying the Price for Quality Nursing Care (Free Full Text)
It costs money to improve the quality of nursing care through work environment changes or increases in staffing but those costs may be offset through improved nursing satisfaction and patient outcomes, according to a series of articles published in special issue of Policy, Politics & Nursing Practice. The authors explore the economic issues and policies needed to provide quality nursing care and concluded that: "Improving the quality of nursing care through work environment changes or increases in staffing is viewed by many as an added cost, but the benefits in terms of money saved through improved nursing satisfaction and patient outcomes are not considered." Access to the articles is free for a limited time.

AACN believes that all workplaces can be healthy if nurses and employers are resolute in their desire to address not only the physical environment, but also less tangible barriers to staff and patient safety. We know that this change won’t happen without an understanding of the factors contributing to unhealthy work environments and a commitment to embrace solutions, such as appropriate staffing. For more ways to transform your workplace, check out the AACN Standards for Establishing and Sustaining Healthy Work Environments.

3. EVIDENCE Challenging Tight Glucose Control Practice for Critically Ill Patients (Abstract)
An analysis of randomized trials indicates that for critically ill adults, tight glucose control does not significantly reduce a patient’s risk of dying in the hospital but does increase the risk of hypoglycemia, calling into question the recommendation by many professional societies that the practice be used in these patients, according to an article in the August 27 issue of JAMA. Although initially used for cardiac surgery patients, tight glucose control has become commonplace in other critical care populations. The authors suggest that those investigating the practice “should take a step back and address the fundamental questions of defining quality standards for tight glycemic control, finding affordable methods of frequent and highly accurate measurement of blood glucose in the ICU, and conduct multicenter efficacy studies to determine if tighter glycemic control can reduce mortality under optimal conditions.” Staying current on this topic is a must for nurses who provide care for these patients.

For more on the topic, read this Practice Resource Network article from AACN News.

4. RESOURCE New Tool Helps Hospitals Evaluate Disaster Drills
Hospitals can now identify the strengths and weaknesses in their disaster response plans using a new tool from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). The Tool for Evaluating Core Elements of Hospital Disaster Drills is a series of evidence-based modules that provide standardized checklists to document observations during a disaster drill. Using the observations, hospitals can identify areas for improvement, make appropriate changes and set benchmarks to track those changes over time.

5. CALL TO ACTION Medicare Fee-for-service Town Hall Meeting/Teleconference Important for APRNs
The Centers for Medicare & Medicaid Services (CMS) will hold a "Medicare Provider Feedback Group (MPFG) Town Hall Meeting" and teleconference Sept. 22 from 2-4 (EDT) in Baltimore, Md. If you are an APRN who uses Medicare fee-for-service (FFS) billing, here’s an excellent opportunity for to voice your concerns and learn more about current policies. Topics covered include 5010 HIPAA standards, Medicare Administrative Contract Transitions, Recovery Auditing and how to improve communications to better serve Medicare providers; a question and answer session will follow. Prior registration is required; the deadline to register is Sept 17. To register, click here. For more information, contact Colette Shatto (410) 786-6932; or e-mail MFG@cms.hhs.gov .

6. EDUCATION Free CE: Popular NTI '08 Certification Session Now Online
“Intensive Power Units: Healthy Work Environments That Promote Certification,” a popular certification session from NTI 2008, is now online and offers one free contact hour of CE. The session outlines how healthy work environments empower nurses and provide the encouragement they need to pursue specialty certification.

Certification validates nurses’ knowledge and skills, demonstrates their commitment to patient safety and gives them the confidence to handle any crisis. Find out more.

7. CALL TO ACTION Take the Flu Vaccination Challenge to Protect Your Patients and Your Colleagues
Did you know that only 42 percent of healthcare workers currently receive flu shots? That percentage isn’t high enough to protect patients, according to Joint Commission Resources (JCR). In response, the organization has launched a Flu Vaccination Challenge beginning this month to underscore the responsibility that hospitals have to help keep their employees and patients healthy this flu season. In past years, flu infections have been documented in health care settings and health care workers have been implicated as the potential source of these infections. Register your healthcare institution to take the challenge; hospitals that achieve a vaccination rate of 43 percent or more will be recognized for their dedication to enhancing patient safety. Take the challenge.

To learn more about this year’s flu vaccine, click here.

8. Clinical Practice Resources

PATIENT SAFETY ISSUES
Alaris SE Pump (a.k.a. Signature Edition Infusion System) Recall Information

Pacific Consolidated Industries Mobile Oxygen Storage Tank- Class I Recall Because the Device's Pressure Gauge May Rupture and May Catch Fire

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
Relative reliability of the auditory evoked potential and Bispectral Index for monitoring sedation level in surgical intensive care patients

A survey of staff attitudes immediately post-resuscitation to family presence during resuscitation

Dosing ketamine for pediatric procedural sedation in the Emergency Department

Increased mortality of ventilated patients with endotracheal Pseudomonas aeruginosa without clinical signs of infection

The effect of tracheostomy timing during critical illness on long-term survival

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