Critical Care Newsline — July 30, 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 30, 2009

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1. NEWS FDA Approves Opioid Pain Reliever with Required Risk Reduction Plan
2. EVIDENCE Multidisciplinary approach to adverse drug events in pediatric trauma patients reduces medication events
3. EVIDENCE Therapeutic hypothermia after cardiac arrest in cardiac surgery: A meaningful pursuit?
4. EVIDENCE Intra-operative trans-esophageal echocardiography in congenital heart disease
5. NEWS Now available, this month's AJCC OnlineFirst articles
6. CALL FOR RESPONSE: The 21st Annual International Conference of the Society
7. AACN RESOURCES: Deadline for Circle of Excellence Awards Nominations Extended to August 17
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES
10. REMINDERS
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1. NEWS FDA Approves Opioid Pain Reliever with Required Risk Reduction Plan
The U.S. Food and Drug Administration approved Onsolis to manage breakthrough pain for opioid-tolerant patients, such as cancer patients, who need and can safely use high doses of an additional opioid medicine. Onsolis delivers the opioid fentanyl via the mouth’s mucous membranes. FOCUS, a restricted distribution program, will make Onsolis available to registered prescribers, patients and pharmacies. FOCUS provides training and education to prescribers and pharmacy personnel and a counseling call to patients before dispensing.

2. EVIDENCE Multidisciplinary approach to adverse drug events in pediatric trauma patients reduces medication events
Medication administration to children in adult trauma centers can be complex and fraught with errors. A multidisciplinary team -- consisting of a pediatric hospitalist, pediatric care coordinator, pediatric nurse, pharmacist and trauma service -- managed pediatric trauma patients from admission to discharge and mandated collective decision-making for medication dosing and administration, weight documentation, error report systems and an education-based pediatric trauma patient care model to identify and decrease adverse medication events. They found that instituting a multidisciplinary approach to pediatric trauma patient care can be practical and significantly decrease adverse medication events.

3. EVIDENCE Therapeutic hypothermia after cardiac arrest in cardiac surgery: A meaningful pursuit?
The return of spontaneous circulation (ROSC) after cardiac arrest resuscitation may not assure successful cerebral resuscitation. Current investigative modalities don’t allow clinicians to predict cerebral outcome resulting in anxiety about post-ROSC cerebral status. Despite inadequate evidence about outcome, clinicians try neuroprotective treatment in a desperate attempt to “do something.” Therapeutic hypothermia, not commonly practiced in cardiac surgical units, may produce short term benefits.

4. EVIDENCE Intra-operative trans-esophageal echocardiography in congenital heart disease
Intra-operative trans-esophageal echocardiography (TEE), a unique, but important monitoring and diagnostic repair tool used during congenital heart disease surgery, provides intra-cardiac anatomic information before and after surgery. Before intra-operative TEE, significant residual abnormalities went undetected causing substantial post-operative morbidity and mortality and the need for re-operation. New practice guidelines indicate that TEE significantly improves the clinical outcomes. It also confirms diagnosis, spots additional lesions and provides a baseline for comparison after the surgical correction.

5. NEWS Now available, this month's AJCC OnlineFirst articles
This month's Publish Ahead of Print articles are now live on the American Journal of Critical Care Web site, www.ajcconline.org. Click the OnlineFirst logo to read about the effect of implementing an oral and dental care system and protocol on rates of VAP in patients admitted to a 10-bed MICU and the case of a 27-year-old woman with spontaneous primary peritonitis caused by group A streptococci. Users must log-in to read articles; abstracts are free access.

6. CALL FOR RESPONSE
The 21st Annual International Conference of the Society for the Arts in Healthcare announced its call for papers! Hosted by the University of Minnesota, the conference -- which shares best practices, model programs and cutting-edge research -- takes place Wednesday, April 28 to Saturday, May 1, 2010 in Minneapolis. Submit a paper, panel, workshop or poster presentation here.

7. AACN RESOURCES: Deadline for Circle of Excellence Awards Nominations Extended to August 17

Nominations for individuals and chapters for the 2010 Circle of Excellence Awards will be extended to August 17. Up to 25 individuals who exemplify excellence in the care of acutely and critically ill patients and their families will receive the 2010 award and corresponding $1000 honorarium. Learn about the awards, review the criteria and fill out a nomination form here.

8. CLINICAL PRACTICE RESOURCES

EVIDENCE-BASED PRACTICE
Structured Approaches to Pain Management in the ICU
http://amedeo.com/p2.php?id=19497902&s=crc&pm=0e1f4e1a88c9736

Correlation between the Sedation-Agitation Scale and the Bispectral Index in Ventilated Patients in the Intensive Care Unit
http://www.ncbi.nlm.nih.gov/pubmed/19577705

GUIDELINES
Critical Care in Pregnancy
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=14179

PATIENT SAFETY
Teva Pharmaceuticals USA issues a voluntary user-level nationwide recall of Propofol Injectable Emulsion 10 mg/mL 100 mL vials, lot numbers 31305429B and 31305430B
http://www.fda.gov/Safety/Recalls/ucm172474.htm

Recall: Prevnar Pneumococcal 7-valent Conjugate Vaccine, Wyeth
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/Recalls/ucm172378.htm

Omalizumab (marketed as Xolair): Early communication about an ongoing safety review
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm172406.htm


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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