Critical Care Newsline — August 13, 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 our 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.


Aug. 13, 2009

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1. NEWS Saying “sorry” for mistakes saves money
2. NEWS FDA approves new drug for Type 2 diabetes
3. NEWS Rapid sequence intubation in neonates: safe, effective, yet little used
4. EVIDENCE Low birth weight linked to increased respiratory illness as an adult
5. EVIDENCE AHRQ reports uncertain benefits of vitamin D and calcium
6. CLINICAL PRACTICE RESOURCES
7. AACN RESOURCES
8. REMINDERS
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1. NEWS Saying “sorry” for mistakes saves money
Apologizing for mistakes up front and offering compensation, as appropriate, saves money according to risk management personnel at the University of Michigan Health System. Key components of the program, which reduced legal costs and claims processing time, include communication, full disclosure, and learning from experiences. (http://www.med.umich.edu/news/newsroom/mm.htm) (http://www.med.umich.edu/news/newsroom/mm.htm#summary)

2. NEWS FDA approves new drug for Type 2 diabetes
The Food and Drug Administration approved saxagliptin (Onglyza), a dipeptidyl peptidase-4 (DPP-4) inhibitor, used to treat Type 2 diabetes. Common side effects of the once-daily oral drug include upper respiratory tract infection, urinary track infection and headache. DPP-4 inhibitors stimulate the pancreas to make more insulin after a meal.

3. NEWS Rapid sequence intubation in neonates: safe, effective, yet little used
Rapid sequence intubation (RSI), a safe, effective way to intubate infants, needs wider clinical use according to an article in Advances in Neonatal Care. RSI, used as a premedication to the sedative atropine and neuromuscular blocker before intubation, facilitates quicker intubation with fewer heart rate changes.

4. EVIDENCE Low birth weight linked to increased respiratory illness as an adult
Very low or moderately low birth weight increases the risk of adult respiratory illness hospitalization according to a 2009 study that includes 4,674 case patients and 18,444 control subjects. Researchers report that as birth weight decreased, risk of adult hospitalization increased.

5. EVIDENCE AHRQ reports uncertain benefits of vitamin D and calcium
Inconsistent methodologies makes it difficult to link vitamin D, calcium or a combination of the two to various health outcomes according to a 2009 Tufts Evidence-based Practice Center report supported by an Agency for Healthcare Research and Quality grant. Calcium supplementation lowered systolic by 2 to 4 mm Hg but not diastolic blood pressure in adults with hypertension according to the study, which included 165 primary articles and 11 systematic reviews.

6. CLINICAL PRACTICE RESOURCES

EVIDENCE-BASED PRACTICE
Importance and prevalence of new-onset anemia after myocardial infarction

Fresh frozen plasma associated with increased risk of multiple organ failure and acute respiratory distress syndrome

GUIDELINES
Pulse oximetry in examining newborns for congenital heart disease


PATIENT SAFETY
ADVISORY Propylthiouracil may cause fatal liver injury
In August, the U.S. Food and Drug Administration issued an alert that the anti-thyroid drug propylthiouracil used to treat Graves’ disease may cause serious and fatal liver injury, particularly in children. Clinicians should use the drug only for patients who can’t take methimazole, the first-line treatment for Graves, and monitor liver function closely. (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=89#2)

ADVISORY Neuropsychiatric events connected to leukotriene-modifying drugs
Leukotriene-modifying drugs used to treat asthma and allergic rhinitis may cause neuropsychiatric events such as agitation, aggression, anxiousness, irritability, sleep disturbances, depression and even suicide. The U.S. Food and Drug Administration (FDA) advises manufacturers of zafirlukast (Accolate) and zileuton (Zyflo, and Zyflo CR),to include a drug label precaution. Clinicians also should tell patients to report neuropsychiatric symptoms, advises the FDA. (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=89#2)

ADVISORY Philips Respironics recalls infant apnea monitors
Philips Respironics recently issued a recall for certain Smart Monitor 2 infant apnea monitors because of a possible alarm failure. Recalled monitors include models 4002 and 4003 with serial numbers 3000033364 through 3000038740. (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=89#2)
 

Patient Safety Links:

Joint Commission
Medline Plus
National Patient Safety Foundation
Institute for Safe Medication Practices Newsletter
AHRQ Patient Safety Network

9. AACN Resources
For information about AACN's many resources for acute and critical care nurses, click here.

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Reminders:

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