Critical Care Newsline — April 16, 2009

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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.

April 16, 2009

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1. EVIDENCE The Complex Nature of Pain Experienced by ICU Patients (Free Full Text)
2. EVIDENCE Managing Pain in Critically Ill Patients (Free Full Text)
3. EVIDENCE Functional Decline Differs in Older Patients After Hospitalization for Surgery, Illness
4. REMINDER It’s Not Too Late to Register for NTI 2009 in New Orleans
5. EVENT Free Webinar Series on 2009 Safe Practices Begins April 23
6. RESOURCE Helping Spanish-Speaking Patients Stay Healthy
7. REMINDER Only Ten Days Left to Vote Online in AACN’s Annual Election; Voting Closes April 25
8. Clinical Practice Resources
9. AACN Resources
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Today is National Healthcare Decisions Day. Do you have an advance directive?


AACN Collaborates With Other Critical Care Experts to Develop New Report, ‘Pain in the ICU'
Managing pain in the ICU is an ongoing and significant challenge for the critical care team. However, new reports suggest that taking a comprehensive approach to pain management may be the key to managing pain in the ICU and even decreasing the incidence of preventable pain. The reports, Evaluation of Pain in ICU Patients and Pain Management Principles in the Critically Ill, are part of a series of five papers developed by critical care experts from AACN, the Critical Care Institute of the ACCP and the American Society of Health-System Pharmacists. The article series reviews the complex nature of pain experienced by a critical care patient and details the benefits of taking a comprehensive approach to pain management—one that combines pharmacotherapy with behavioral, social and communication strategies, interdisciplinary teams and family involvement. Following are highlights from the first two reports and links to full text versions.

1. EVIDENCE The Complex Nature of Pain Experienced by ICU Patients (Free Full Text)
Critically ill patients may suffer disproportionately compared with other patients; they often experience intense pain from a life-threatening illness or injury, and pain from simple procedures, such as endotracheal suctioning or the removal of a chest tube. In addition, they may not be able to effectively communicate pain to their caregivers, making it difficult to assess and manage pain sufficiently. These characteristics are often significantly challenging for the critical care team. "An interdisciplinary critical care team who uses standard and alternative methods of pain assessment, evaluation and management is essential for optimal patient care," the authors concluded, adding that family members are an integral part of the treatment process and may help assess a loved one’s level of pain.

2. EVIDENCE Managing Pain in Critically Ill Patients (Free Full Text)
Organ failure, sepsis and other medical complications can make it difficult to manage pain in critically ill patients. The use of opioids or related medications is the standard method of acute pain control, and the choice of which opioid to use is carefully selected based on the uniqueness of each patient's pain management issues, as well as potential side effects and drug interactions. According to the report’s authors, much of the research on pain medications has been conducted outside the ICU, making it necessary for critical care practitioners to apply the data to ICU patients, who often have tenuous, rapidly changing clinical conditions that complicate decisions on pain medication treatment. "Although pain in the ICU is inevitable, there are a number of unique interventions that critical care professionals can use to anticipate, manage and even prevent pain from occurring," the authors noted. “Physicians, nurses, pharmacists and other members of the extended critical care team should continue to make effective pain assessment and management a priority in the ICU."

3. EVIDENCE Functional Decline Differs in Older Patients After Hospitalization for Surgery, Illness
Motivation and expectation are essential to helping older adults regain lost functional ability after hospitalization, according to findings of a recent study. The study’s researchers discovered that patients hospitalized for surgery returned to normal baseline function more quickly and more completely than did patients hospitalized for illness. On average, patients hospitalized for surgery had a sharp decline in life-space scores immediately after surgery but returned to or exceeded pre-surgical scores within one year. Patients hospitalized for illness or other medical reasons experienced a lower post-hospitalization decline but did not return to pre-hospitalization scores, experiencing a marked functional decline following hospitalization even after two years. The study’s authors noted that score differences may result from higher expectations of recovery for surgical patients.

4. REMINDER It’s Not Too Late to Register for NTI 2009 in New Orleans
Still thinking about attending NTI 2009? Here’s some encouragement from past NTI participants and a special message from the New Orleans Visitors Bureau. NTI is a great opportunity to learn, network, re-energize and renew your spirit. Won’t you join us?

5. EVENT Free Webinar Series on 2009 Safe Practices Begins April 23
This month, the National Quality Forum (NQF) launches a Webinar series to help healthcare providers implement this year’s updates to the NQF Safe Practices. Each 90-minute session will be include a 10-minute briefing on the practices and Leapfrog Survey questions, a 50-minute roundtable discussion of implementation issues, and a 30-minute Q&A period. The first session is April 23 from 1-2:30 p.m. EDT.

6. RESOURCE Helping Spanish-Speaking Patients Stay Healthy
AHRQ's Superheroes Web site provides Spanish-speakers with tips on staying healthy and talking with their doctor; recommendations on preventive testing; help in understanding prescriptions; a glossary of medical terms; and links to other resources that provide health information. The Web site is part of a public service campaign that urges Hispanics to stay healthy for their loved ones by visiting their doctor for regular screenings.

7. REMINDER Only Ten Days Left to Vote Online in AACN’s Annual Election; Voting Closes April 25
Please vote today to help select AACN’s leadership. Voting online is quick and easy. You will need your member ID number located on your member card. All current AACN members as of January 31, 2009 who have Active, Emeritus, International or Lifetime membership are eligible to vote. Need a paper ballot or have a question about the election? Call 800-394-5995 ext. 331 or e-mail volunteers@aacn.org.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
CDC, HICPAC Issue Guidelines to Treat Carbapenem-Resistant Klebsiella Pneumoniae in Acute Care Facilities

GUIDELINES
ISMP Guidelines for Use of Automated Dispensing Cabinets

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

PATIENT SAFETY ISSUES
Preventing Misconnection Errors – Medical Device Safety Calendar

Ceftriaxone: Update to Previous Alert Regarding Interaction of Ceftriaxone With Calcium-containing Products

ZOLL AED Plus Defibrillator Recalled Because of Failure to Deliver Defibrillation Energy

FDA Statement on the Voluntary Withdrawal of Raptiva From the U.S. Market

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