Critical Care Newsline — June 18, 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 18, 2009

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1. EVIDENCE Daily Baths With Chlorhexidine Reduces Risk of MRSA, VRE, BSIs in ICU Patients
2. EVIDENCE Cardiomyopathy Unit (CMU) Saves Costs, Provides Optimal Care for Heart Failure Patients
3. EVIDENCE Alcoholic Liver Disease, Hepatitis C Affect Liver Transplant Patients’ Survival
4. CALL FOR COMMENT Proposed Requirements for Communication, Diversity, Safety
5. NEWS Check Out This Month's AJCC OnlineFirst Articles
6. CALL FOR RESPONSE Submit Nominations for the Circle of Excellence Awards; Deadline Is Aug. 1
7. NEWS Electronic Medical Records Systems Top the List of Technologies Impacting Hospital Leaders
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Daily Baths With Chlorhexidine Reduces Risk of MRSA, VRE, BSIs in ICU Patients
ICU patients who receive daily baths with chlorhexidine are less likely to become infected with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), according to results of a recent study. Researchers noted “this approach is simple to implement and inexpensive, and it may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated bloodstream infections (BSI).” During the six-month study, ICUs at four academic centers measured MRSA and VRE bacteria colonization and incidence of BSI in patients bathed daily either with soap or chlorhexidine solution. In the chorlhexidine group, the MRSA infections dropped 32% and VRE infections decreased 50%, leading to fewer BSIs.

2. EVIDENCE Cardiomyopathy Unit (CMU) Saves Costs, Provides Optimal Care for Heart Failure Patients
A unit that provides specialized care for advanced decompensated heart failure patients also benefits the hospital’s bottom line, according to a recent study. Patients with this condition are usually treated in an ICU or progressive care unit, where staff members must care for patients with a wide range of critical and acute illnesses. However, the CMU treats only decompensated heart failure patients; when the nursing staff focuses on that patient population, they increase their efficiency in treating these patients, learn which medications and treatments are optimal for the condition, and intervene sooner when a patient’s condition worsens. “The inpatient CMU may offer a lower cost and higher contribution margin alternative for the management of advanced heart failure patients requiring hemodynamic monitoring without other major inpatient procedures” the study’s authors concluded.

3. EVIDENCE Alcoholic Liver Disease, Hepatitis C Affect Liver Transplant Patients’ Survival
Patients with Hepatitis C awaiting a liver transplant were less likely to survive until a transplant and more likely to die soon after a transplant than those without the infection, according to a recent review of a comprehensive liver transplant registry. In contrast, alcoholic liver disease did not impact pre- or post-transplant survival, the researchers noted.

4. CALL FOR COMMENT Proposed Requirements for Communication, Diversity, Safety
The Joint Commission is seeking feedback on its proposed hospital requirements aimed at advancing effective communication, cultural competence and patient-centered care. Comments will be accepted for the next six weeks. “While effective communication is necessary for patient safety, it can be inhibited by language, culture, hearing or visual impairment, health literacy, cognitive impairments, and disease or disability,” according to the report’s authors. “In addition, racial and ethnic health disparities are linked to poorer health outcomes and lower quality care. As the diversity of our nation continues to grow, there is a need to provide hospitals with more robust guidance to address the needs of the populations they serve.”

5. NEWS Check Out 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. Click the OnlineFirst logo to read about how nurses evaluated the medical emergency team (rapid response team) in an academic hospital in Canada, and what physiological and situational variables influence nurses' judgments about managing secondary brain injury in critically ill patients with TBI. Log-in is required to read articles; abstracts are free access.

6. CALL FOR RESPONSE Submit Nominations for the Circle of Excellence Awards; 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 AACN’s Web site. Submit your nomination no later than Aug. 1, 2009 for the 2010 awards.

7. NEWS Electronic Medical Records Systems Top the List of Technologies Impacting Hospital Leaders
The ECRI Institute, a nonprofit research firm, has released its top 10 list of health technologies for hospital
c-suite executives (those in primary leadership positions) for 2009. ECRI compiled the list taking into account the convergence of critical economic, patient safety, reimbursement and regulatory pressures facing hospitals today. First on the list: establishing an electronic medical records system. Next-generation MRIs, premium slice CTs, robotic assisted systems for surgery and proton therapy devices for radiation oncology also made the top ten.

8. Clinical Practice Resources

COMPREHENSIVE H1N1 FLU INFORMATION

IDENTIFYING AND TREATING PATIENTS WITH H1N1

EVIDENCE-BASED PRACTICE
Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial

Written Information That Relatives of Adult Intensive Care Unit Patients Would Like to Receive: A Comparison to Published Recommendations and Opinion of Staff Members

Recognition of a Kawasaki Disease Shock Syndrome

PATIENT SAFETY
Propylthiouracil (PTU) associated with risk of serious liver injury, including liver failure and death

Sirolimus (marketed as Rapamune): clinical trial suggests increased mortality in stable liver transplant patients after conversion from CNI-based immunosuppressive regimen to sirolimus

Zoll AED Plus Defibrillator recalled due to defective batteries

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