Critical Care Newsline — July 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 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.


July 16, 2009

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1. ADVISORY FDA Strengthens Warnings for Pain Medications Containing Propoxyphene
2. EVIDENCE Delirium in Hospital Patients: Situation Critical, No Relief in Sight
3. EVIDENCE Delirium Is a Predictor of Mortality in Hospitalized Patients
4. EVIDENCE Monitoring Seizures in Critically Ill Patients: Continuous EEG Enhances Vigilance
5. EVIDENCE Air Traffic Control Tracking Method Reduces Errors in Trauma Management
6. REMINDER AACN Circle of Excellence Awards Nomination Deadline Is Aug 1
7. NEWS Scholarships Available for Nurse in Washington Internship (NIWI)
8. Clinical Practice Resources
9. AACN Resources
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1. ADVISORY FDA Strengthens Warnings for Pain Medications Containing Propoxyphene
The U.S. Food and Drug Administration (FDA) is taking action to reduce the risk of overdose in patients using pain medications containing propoxyphene. In response to data linking propoxyphene and fatal overdoses, the agency is requiring manufacturers of propoxyphene-containing products to change the label, including the boxed warning, to emphasize the potential for overdose. Manufacturers must also provide a medication guide to patients stressing the importance of using the drugs as directed. In addition, the FDA is requiring a new safety study assessing unanswered questions about the effects of propoxyphene on the heart when the drug is taken at doses exceeding recommended levels.

2. EVIDENCE Delirium in Hospital Patients: Situation Critical, No Relief in Sight
Despite the fact that as many as seven million adults annually in the U.S. experience delirium during hospitalization, there are currently no effective ways to prevent or treat the condition, according to a recent literature review. Researchers found that only 13 randomized controlled studies on promising drugs for delirium were conducted from January 1966 to October 2008. These studies identified and evaluated 15 drugs including first and second generation antipsychotics currently prescribed by most physicians to treat delirium. The researchers found that neither older agents nor newer, more expensive medications were effective in preventing delirium. "Having delirium prolongs the length of a hospital stay, increases the risk of post-hospitalization transfer to a nursing home and doubles the risk of death. We need to identify a safe and effective drug to prevent and treat delirium. With our review we are challenging the scientific community to come up with new therapeutic options," the authors said.

3. EVIDENCE Delirium Is a Predictor of Mortality in Hospitalized Patients
When patients develop delirium in a post-acute hospital setting, the condition is detrimental to their survival rate, according to recent research. The study is the first to link subtypes of delirium with disease severity. Researchers found that patients with severe, hypoactive delirium, characterized by slowing or lack of movement and unresponsiveness, have the worst six-month survival rate of any class of the disease. "Our data reinforce the need to systematically assess patients for delirium at post-acute care admission, while considering dementia status," the authors noted.

4. EVIDENCE Monitoring Seizures in Critically Ill Patients: Continuous EEG Enhances Vigilance
Continuous electroencephalography monitoring of patients in the medical intensive care unit (MICU) effectively detects subtle seizures often impossible to observe visually, according to a recent study. Using continuous EEG monitoring, the researchers found that seizures and nearly continuous spikes related to seizures, were common among patients in the MICU, especially those with sepsis. Most of the seizures were non-convulsive, not visible to an observer and could only be detected by continuous EEG. These abnormal brain wave patterns were linked to death and severe disability. “Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients,” the authors conclude.

5. EVIDENCE Air Traffic Control Tracking Method Reduces Errors in Trauma Management
A method used by air traffic controllers may be more effective in tracking patient data and lead to fewer errors compared with current methods used in similar medical settings, primarily in military trauma. Currently, there is no standard practice for tracking the movement of patients from emergency rooms to the radiology suite, operating rooms, the intensive care unit, inpatient rooms or the discharge area. Researchers compared the air traffic control model and the traditional casualty tracking method of paper and clipboard during mass casualty training. The air traffic control method tracked where patients were at given times and kept patient information in one location. Plus, medical site administrators easily determined current capacity with the air traffic method, allowing them to redirect resources and manage the triage process. “The ATC model more effectively tracked patient data with fewer errors when compared with the clipboard method. Application of these principles can enhance trauma management and can have application in civilian and military trauma centers and emergency rooms,” the study’s researchers concluded.

6. REMINDER AACN Circle of Excellence Awards Nomination Deadline Is Aug 1
Only two weeks remain until the deadline to submit nominations for the 2010 Circle of Excellence Awards. Up to 25 individuals who exemplify excellence in the care of acutely and critically ill patients and their families will be chosen to receive the 2010 awards; recipients will become part of the Circle of Excellence Society. Learn about the awards, review the criteria and fill out a nomination form at www.aacn.org/awards.

7. NEWS Scholarships Available for Nurse in Washington Internship (NIWI)
Looking for a way to influence healthcare legislation? Attend the Nurse in Washington Internship (NIWI). Participants learn from health policy experts and government officials, network with other nurses and visit members of Congress. NIWI is open to any RN or nursing student who is interested in learning more about the legislative process. NIWI 2010 will be held in Washington, D.C. March 14-16. Scholarship applications are now being accepted. The deadline to apply is Oct. 9, 2009.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock

GUIDELINES
Critical Care in Pregnancy

PATIENT SAFETY
Immunosuppressant drugs: Required labeling changes to add stronger warnings about the risk of BK virus-associated nephropathy

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:

Visit AACN’s Online CE Center – AACN Members Get Unlimited Free CE Credits
Online Certification Exam Registration Available

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