Critical Care Newsline — June 4, 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.


June 4, 2009

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1. EVIDENCE Acid-Suppressive Medication Use Increases Risk of Hospital-Acquired Pneumonia
2. EVIDENCE Preoperative Briefing Protocol Streamlines Cardiovascular Surgery Disruptions
3. EVIDENCE Common Antibiotics May be Best First Treatment for Children With MRSA-related Infections
4. ADVISORY Commission on Accreditation: BLS, Other Courses Not Awarded Contact Hours
5. RESOURCE Team Training Tool for Hospital Rapid Response Systems
6. RESOURCE Newsletter Provides Patient Information on Taking Coumadin
7. NEWS Circle of Excellence Nominations Now Open; Deadline Is Aug. 1
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Acid-Suppressive Medication Use Increases Risk of Hospital-Acquired Pneumonia
Hospitalized patients who received acid-suppressive medication were 30% more likely to contract hospital-acquired pneumonia, according to results from a large, hospital-based pharmacoepidemiologic cohort study. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use. The use of acid-suppressive medication has been steadily increasing, particularly in the inpatient setting, despite lack of an accepted indication in the majority of these patients,” the researchers noted, adding that in the study, “acid-suppressive medication was ordered in 52% of admissions and hospital-acquired pneumonia occurred in 2,219 admissions (3.5%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication than in the unexposed group.”

2. EVIDENCE Preoperative Briefing Protocol Streamlines Cardiovascular Surgery Disruptions
Specialty-specific preoperative briefings decrease surgical flow disruptions and improve patient safety in the operating room, according to findings from a recent study. Although these findings demonstrate the feasibility of creating have been adopted in many high consequence environments, they have not been widely accepted in medicine, according to the authors.

3. EVIDENCE Common Antibiotics May be Best First Treatment for Children With MRSA-related Infections
Penicillin and other antibiotics in the beta-lactam family work as well as other antibiotics to treat MRSA (methicillin-resistant Staphylococcus aureus) infections in the skin and soft-tissue of children and may help prevent further resistance to antibiotic treatment, according to a new study funded by the Agency for Healthcare Research and Quality. The study compared treatment outcomes for three antibiotics – beta-lactams (which include penicillin, cephalosporins, carbapenems and monobactams), clindamycin and trimethoprim-sulfamethoxazole (TMP -SMZ). Researchers concluded that children treated with clindamycin for skin and soft tissue infections potentially caused by MRSA did not show greater improvement compared to those treated with beta-lactam therapy. Children treated with TMP-SMZ were less likely to show improvement.

4. ADVISORY Commission on Accreditation: BLS, Other Courses Not Awarded Contact Hours
The Commission on Accreditation recently announced that contact hours may not be awarded for BLS and other basic “canned” courses or for renewal of ACLS, PALS and other advanced “canned” courses after June 1, 2011. Awarding contact hours for initial ACLS, PALS and other advanced “canned” courses is still permitted. E-mail marymoon.allison@ana.org with questions.

5. RESOURCE Team Training Tool for Hospital Rapid Response Systems
AHRQ and the Department of Defense have released a new TeamSTEPPS module on Rapid Response Systems. Designed for use by hospital teams, the module can be used to help implement team training principles that can improve care delivery and patient safety. The new module includes vignettes and customizable educational slides that provide insight into the core concepts of teamwork relevant to Rapid Response Systems. After implementing the system, hospitals have experienced a decrease in the number of cardiac arrests, deaths from cardiac arrest, the number of days in the intensive care unit and the hospital overall following heart attacks, and inpatient death rates.

6. RESOURCE Newsletter Provides Patient Information on Taking Coumadin
Patients taking Coumadin (warfarin) will want to read this easy-to-understand guide to the medication in a recent newsletter from the Vascular Disease Foundation. Included is information on how the drug works, side effects to watch for and signs severe enough to call a healthcare provider.

7. NEWS Circle of Excellence Nominations Now Open; Deadline Is Aug. 1
AACN’s Circle of Excellence Awards program will recognize up to 25 individuals who exemplify excellence in the care of acutely and critically ill patients and their families each year. Guidelines for the program, nomination forms and evaluation criteria are posted on the AACN Web site. Nominations will be accepted through Aug. 1, 2009 for the 2010 awards.

8. Clinical Practice Resources

COMPREHENSIVE H1N1 FLU INFORMATION

IDENTIFYING AND TREATING PATIENTS WITH H1N1

EVIDENCE-BASED PRACTICE
Bacterial Contamination of Stethoscopes on the Intensive Care Unit

Impact of Emergency Intubation on Central Venous Oxygen Saturation in Critically Ill Patients: a Multicenter Observational Study

GUIDELINES
Strategies to Prevent Transmission of Methicillin-resistant Staphylococcus Aureus in Acute Care Hospitals

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