Critical Care Newsline — February 26, 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.

Feb. 26, 2009

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1. EVIDENCE Catheter-related MRSA Bloodstream Infections Drop by Half, CDC Study Shows
2. NEWS Elder Abuse Act Receives Congressional Support
3. EVIDENCE General ICU Vs. Specialty ICU: Is One Better for Survival?
4. EVIDENCE Penicillin Skin Testing in the ED Assesses Patients Who Are Truly Allergic (Free Full Text)
5. RESOURCE Innovative Transport Tool Gives Patients a Ticket to Ride
6. REMINDER Mark Your Calendar: National Healthcare Decisions Day Is April 16, 2009
7. RESOURCE AACN President’s Theme Creates Confidence, Empowerment
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Catheter-related MRSA Bloodstream Infections Drop by Half, CDC Study Shows
In contrast to the perception that methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections resulting from catheter use is increasing in ICU patients, the incidence of MRSA CA-BSIs decreased by nearly 50 percent, according to recent study. The authors suggest that the drop may be related to efforts by healthcare facilities to improve adherence to CDC’s evidence-based prevention guidelines, to the improvements in central line insertion and care practices and to increasing success in preventing MRSA transmission between patients. “The overall decline in incidence stands in sharp contrast to trends in percent MRSA, which give an incomplete picture of changes in the magnitude of the MRSA problem over time and may have led to a misperception that the MRSA central line–associated BSI problem in ICUs has been increasing,” the authors noted. They added that significant declines in all types of central line–associated BSIs, which included regular staph and drug-resistant staph (MRSA) in all major non-neonatal ICUs, also suggest that general central line–associated BSI prevention efforts are succeeding and may have contributed to the declining MRSA trends.

For more information on this topic, read AACN’s Practice Alert on Preventing Catheter Related Bloodstream Infections.

2. NEWS Elder Abuse Act Receives Congressional Support
The House of Representatives last week passed a bill that funds elder abuse prosecution and establishes education and therapy programs for victims and their families. The Elder Abuse Victims Act (H.R. 448) allows the attorney general's office to conduct research into current state and local elder abuse prevention programs. The legislation also provides funding for elder abuse prosecution at local, state and federal levels, as well as law enforcement training and nurse-investigators to identify and evaluate elder abuse cases. Passage of the bill is particularly good news for advanced practice forensic nurses, who ensure that systems are in place to screen patients for abuse or neglect; provide training and education on the subject; review and support related research; and identify health policy to reduce incidents of abuse.

3. EVIDENCE General ICU Vs. Specialty ICU: Is One Better for Survival?
Patients who were treated in general ICUs were as likely to survive as those treated in specialty ICUs for conditions except pneumonia but less likely to survive when admitted to non-ideal specialty ICUs, according to a recent study. There was no consistent effect of specialization on length of stay, either for the total number of patients studied or for ICU survivors. “We examined 84,182 patients admitted to specialty and general ICUs with an admitting diagnosis or procedure of acute coronary syndrome, ischemic stroke, intracranial hemorrhage, pneumonia, abdominal surgery or coronary-artery bypass graft surgery. After adjusting for important confounders, we found there were no significant differences in risk-adjusted mortality between general versus ideal specialty ICUs for all conditions other than pneumonia. Risk-adjusted mortality was significantly greater for patients admitted to non-ideal specialty ICUs,” the authors concluded.

4. EVIDENCE Penicillin Skin Testing in the ED Assesses Patients Who Are Truly Allergic (Free Full Text)
Can emergency department (ED) skin testing of patients who report penicillin allergy identify a group who do not have a true allergy? Yes, according to a recent study. In 150 patients reporting penicillin allergy, a 30-minute skin prick and intracutaneous test performed in the ED found that 91% of patients who claimed to be allergic did not have a true immunoglobulin E-mediated penicillin allergy. If skin testing for penicillin allergy can be done in the ED, emergency physicians may have more appropriate antibiotic treatment options for patients who are not truly allergic to drug.

5. RESOURCE Innovative Transport Tool Gives Patients a Ticket to Ride
An intra-hospital transport ticket, called Ticket to Ride, is streamlining patients’ hospital journeys from the unit to diagnostic and procedure areas. The ticket standardizes intra-hospital inpatient transport by providing critical patient information and a checklist of steps to protect patient safety during transport and ensure accurate care at each destination. The program has led to fewer off-unit adverse events and resulted in higher levels of patient satisfaction.

6. REMINDER Mark Your Calendar: National Healthcare Decisions Day Is April 16, 2009
AACN is proud to be participating again this year in National Healthcare Decisions Day (NHDD) to promote advance care planning nationwide and we invite you to join us. The NHDD Initiative, now in its second year, is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their healthcare decisions In its first year (2008), NHDD enjoyed participation by 76 national organizations and approximately 400 state and local organizations. As a result, hundreds of thousands of people learned more about—and took action—on advance directives.

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
Transfusion Principles in Children

Aetiology and Outcome of Paediatric Cardiopulmonary Arrest

Trauma and Burns in Children

Failed Intravenous Access in Children

Perioperative Fluid and Electrolyte Balance in Children

GUIDELINES

The following are from the American College of Chest Physicians Evidence-based Clinical Practice Guidelines (8th edition):

Prevention of Venous Thromboembolism

Antithrombotic Therapy for Venous Thromboembolic Disease

Treatment and Prevention of Heparin-induced Thrombocytopenia

PATIENT SAFETY ISSUES
CellCept (Mycophenolate Mofetil) - Medication Guide to be Distributed to Every Patient Who Fills a CellCept Prescription


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