Critical Care Newsline — January 15, 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. 15, 2009

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1. NEWS: Online Registration for NTI 2009 Now Open; Join Us in New Orleans May 16-21
2. ADVISORY New Healthcare Technology Not a Cure-all
3. NEWS Extensive Review of National Patient Safety Goals
4. EVIDENCE Hope, Truth and Preparing for Death: Perspectives of Surrogate Decision-makers
5. EVIDENCE Discussing Uncertain Prognosis Unavoidable, Surrogates Say
6. EVIDENCE Multi-faceted Strategy Improves Nutritional Support but Not Outcomes for ICU Patients
7. RESOURCE AHRQ Issues Emergency Evacuation Planning Model
8. Clinical Practice Resources
9. AACN Resources
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1. NEWS: Online Registration for NTI 2009 Now Open; Join Us in New Orleans May 16-21
With the click of a mouse, you can register to attend NTI sessions, exhibits and events; book your hotel; and download the conference brochure. Save money, too, if you register by April 1.

2. ADVISORY New Healthcare Technology Not a Cure-all
A new Joint Commission Sentinel Event Alert warns that the implementation of technology and related devices is not a guarantee for success and may actually jeopardize the quality and safety of patient care. The alert urges greater attention to understanding when a technology may (or may not) be applicable, choosing the right technology, understanding the impact technology can have on the quality and safety of patient care and attempting to quickly fix technology when it becomes counterproductive. The alert makes clear that the overall safety and effectiveness of technology in healthcare ultimately depend on its human users, and that any form of technology can have a negative impact on the quality and safety of care if it is designed or implemented improperly or is misinterpreted.

3. NEWS Extensive Review of National Patient Safety Goals
During 2009, the current National Patient Safety Goals (NPSGs) will undergo an extensive review. As a result, no new NPSGs will be developed for 2010. Responding to concerns about the challenge some goals represent and the need for information about effective approaches to addressing these challenges, The Joint Commission and its Patient Safety Advisory Group (formerly the Sentinel Event Advisory Group), which helps develop the NPSGs, will thoroughly evaluate the goals and their development process. The NPSGs highlight serious patient safety issues that need to be addressed by healthcare organizations.

4. EVIDENCE Hope, Truth and Preparing for Death: Perspectives of Surrogate Decision-makers
Most surrogates of critically ill patients do not view withholding prognostic information as an acceptable way to maintain hope, because timely discussions about prognosis help families begin to prepare emotionally, existentially and practically for the possibility that a patient will die, according to results of a recent study. Although physicians caring for critically ill patients are often reluctant to discuss poor prognoses with family members, they should not withhold this information solely to preserve surrogates’ hope.

5. EVIDENCE Discussing Uncertain Prognosis Unavoidable, Surrogates Say
Many physicians are reluctant to discuss a patient's prognosis when there is significant prognostic uncertainty but most patient surrogates view this discussion as unavoidable and an acceptable part of the palliative care process. In fact, in many cases they expect such a conversation. Prognostic uncertainty is inherent in caring for many critically ill patients. Insights derived from this study may contribute to the goal of improving physician–surrogate communication, according to the study’s authors.

Test your skill level and bridge any knowledge gaps with AACN’s free Palliative and End-of-Life Care Self Assessment. The content features the self assessment plus resources for palliative care and end-of-life symptom management, airway management, dyspnea, delirium and pain management.

6. EVIDENCE Multi-faceted Strategy Improves Nutritional Support but Not Outcomes for ICU Patients
A strategy to change practice in ICUs was effective in implementing earlier nutritional support for critically ill patients, but the change did not result in a reduced risk of death or reduced length of stay in the ICU, according to a recent study. Previous studies have found that early nutritional support, provided within 24 hours of injury or ICU admission is a key component in the treatment of critically ill patients and may reduce the risk of death. But early nutritional support varies widely between ICUs, and up to 40 percent of eligible patients may remain unfed after 48 hours in the ICU, according to the article. "We achieved significant practice change in the complex environment of the ICU through the use of a multifaceted, multilevel practice-change strategy, leveraged by educational outreach visits. Although the successful implementation of the guideline resulted in significant practice change, it did not result in reduced hospital mortality in critically ill patients," the authors conclude.

7. RESOURCE AHRQ Issues Emergency Evacuation Planning Model
The Agency for Healthcare Research and Quality (AHRQ) has released an online tool to help emergency planners estimate how much time is needed to evacuate healthcare facilities in a disaster area. The Mass Evacuation Transportation Planning Model addresses patient transfer time, number of vehicles to execute transfers in the allotted time and how healthcare facilities’ attributes affect evacuation plans. The model was developed with funding from the departments of Homeland Security and Health and Human Services; the pilot program was tested in New York and Los Angeles.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Treatment of Fibromyalgia Syndrome With Antidepressants: A Meta-analysis

Weaning and Extubation Readiness in Pediatric Patients

High-alert Medications in the Pediatric 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
Singulair (Montelukast): Updated Information to March 2008 Early Communication

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