Critical Care Newsline — January 8, 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.

Jan 8, 2009

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1. ADVISORY CMS Clarifies Standing Orders for Hospitals
2. RESOURCE CDC Releases Revised Guidelines for Disinfection and Sterilization
3. NEWS Rise in Hospital Stays for Pressure Ulcers, AHRQ Reports
4. EVIDENCE What's the Best Treatment for Pressure Ulcers?
5. RESOURCE The Working Nights Health & Safety Guide
6. NEWS National Healthcare Decisions Day April 16, 2009
7. CALL TO ACTION Volunteers Needed for National Healthcare Decisions Day
8. Clinical Practice Resources
9. AACN Resources
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1. ADVISORY CMS Clarifies Standing Orders for Hospitals
"The use of standing orders must be documented as an order in the patient’s medical record and signed by the practitioner responsible for the care of the patient, but the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances," according to a memorandum released last fall by The Centers for Medicare & Medicaid Services (CMS). The document supersedes a previous CMS memorandum on the use of standing orders in hospitals to more closely align with The Joint Commission’s view on providing timely treatment of certain patients, particularly those who need medications not previously ordered to be administered quickly. The most significant change: removing a requirement to obtain patient-specific practitioner approval for standing orders that meet the CMS’ criteria prior to treatment; without this requirement, patients can be treated immediately and standing orders can be signed by the physician at a later time. "This approach provides the safest, most expeditious way to provide timely care and treatment to patients," The Joint Commission reports.

2. RESOURCE CDC Releases Revised Guidelines for Disinfection and Sterilization
The Centers for Disease Control and Prevention (CDC) has released updated guidelines for cleaning, disinfecting and sterilizing medical devices and for cleaning and disinfecting the environment. The last version was published more than two decades ago in 1985. The 2008 revision contains significant changes reflecting the evolution of the medical field: disinfection technology for complex medical equipment, effectiveness of cleaning products on recently discovered pathogens, and the development of new disinfection products. The report found no evidence to indicate that disinfectants are becoming resistant to organisms—a common problem in antibiotic use.

3. NEWS Rise in Hospital Stays for Pressure Ulcers, AHRQ Reports
Hospital stays involving patients with pressure ulcers rose nearly 80% from 1993 to 2006, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). In most cases, the patients were elderly and the condition was not the primary reason for the stay. More than half of the patients were discharged to long-term care.

4. EVIDENCE What's the Best Treatment for Pressure Ulcers?
Although many treatments are available, "little evidence supports the use of a specific support surface or dressing over other alternatives for pressure ulcers," according to authors of a systematic literature review of 21 randomized controlled trials on the topic. The researchers also noted a lack of evidence to support routine nutritional supplementation (such as protein supplements) or adjunctive therapies (including electric current, ultrasound, light therapy and vacuum therapy) compared with standard care.

5. RESOURCE The Working Nights Health & Safety Guide
If you work the night shift, this is the guide for you. The Working Nights Health & Safety Guide contains years of shift work wisdom in 34 easy-to-read pages. The booklet covers major areas of interest for shift workers: work performance and job safety, sleep, health problems and solutions, family and social life, and understanding individual circadian rhythms. Individual booklets are $5.50; discounts are available for those ordering certain quantities. Take advantage of this great training and wellness tool for all your shift workers.

6. NEWS National Healthcare Decisions Day 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. CALL TO ACTION Volunteers Needed for National Healthcare Decisions Day
Want to make a real difference in advance planning awareness in your community? NHDD event organizers are seeking volunteers to serve as state liaisons for the event April 16. This is a wonderful opportunity to work collaboratively with other healthcare organizations and a great chance to gain increased recognition for your organization. Want to volunteer? Sign up here.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Catheter-related Bloodstream Infections in Children

A Critical Review of Daily Sedation Interruption in the Intensive Care Unit

GUIDELINES
Adult Weight Management Evidence-based Nutrition Practice

Critical Illness Evidence-based Nutrition Practice

Pediatric Weight Management Evidence-based Nutrition Practice

PATIENT SAFETY ISSUES
20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection, USP: Recall of One Lot Due to Possible Incorrect Bar Code for 5% Dextrose Injection, USP

Gravity Compensating Accessory by Integra NeuroSciences Recalled Because Devices May Leak Cerebrospinal Fluid

SunMed Greenline/D MacIntosh No. 3 Laryngoscope Blades Recalled Due to Potential to Break During Use

Weight Loss Pills Contain Undeclared, Active Pharmaceutical Ingredients That May Put Consumers' Health at Risk

Innohep (Tinzaparin Sodium) Dear Healthcare Professional Letter Issued re: Increased Risk of Death in Renal Impaired Elderly

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