Critical Care Newsline — March 12, 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.

March 12, 2009

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1. EVIDENCE Plavix, PPI Combo May Be Deadly for Heart Attack Patients
2. EVIDENCE Drug Resistant Influenza A Virus Potentially Serious To High-Risk Patients (Free Full Text)
3. EVIDENCE Reining in Pain: The Challenges of Pain Assessment (Free Full Text)
4. RESOURCE AHRQ Recommendations for a National Emergency Evacuation System
5. CALL FOR RESPONSE Survey on Nurses’ Satisfaction With Supply Chain Management
6. REMINDER FOR CHAPTER LEADERS Register Now for the Leadership Development Workshop
7. RESOURCE ECRI Institute Offers Free Article on Best Practices for Working With a Patient Safety Organization
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Plavix, PPI Combo May Be Deadly for Heart Attack Patients
Heart attack patients given the blood thinner Plavix (clopidogrel) plus a proton pump inhibitor (PPI) such as Prilosec or Nexium to prevent gastrointestinal bleeding may be at increased risk of death or another heart attack, according to a recent study. PPIs are often prescribed prophylactically to prevent GI bleeding. The researchers found that 29.8 percent of patients given a PPI and Plavix died or were re-hospitalized, compared with 20.8 percent of the patients given Plavix alone. The combination of Plavix plus a PPI was associated with a 25 percent increase in risk of dying or being re-hospitalized, compared to the use of Plavix alone. The study’s authors concluded that a PPI should only be prescribed to patients who have had a stomach bleed, since they are at higher risk of another bleed.

2. EVIDENCE Drug Resistant Influenza A Virus Potentially Serious To High-Risk Patients (Free Full Text)
A mutation of the influenza A (H1N1) virus resistant to the drug oseltamivir (Tamiflu) may pose a serious health threat to hospitalized patients who have a weakened immune system, according to a new study. "Early identification and prolonged isolation precautions appear prudent in the care for infected immunocompromised patients to prevent [hospital] influenza virus outbreaks. This study confirmed that circulating H274Y-mutated A (H1N1) viruses can retain significant pathogenicity and lethality, as shown in elderly or immunocompromised patients with lymphocytopenia, underlining the urgency for the introduction of new effective antiviral agents and therapeutic strategies," the authors wrote, adding that because the study consisted of a small number of patients, the findings require careful interpretation and further research to determine the extent of the problem.
Read more about this topic in these free, full-text articles: Infections With Oseltamivir-Resistant Influenza A (H1N1) Virus in the United States and The Evolution of Influenza Resistance and Treatment.

3. EVIDENCE Reining in Pain: The Challenges of Pain Assessment (Free Full Text)
The gold standard of pain assessment is the patients’ self-report; they know best where and how much they hurt. But when patients can’t speak for themselves, healthcare professionals have customary assessment tools, the Hierarchy of Importance of Pain Measures, to assess pain level. These include: attempting to obtain self-report using a variety of techniques, making appropriate assumptions about the presence of pain, observing behaviors, evaluating physiologic indicators, and conducting an analgesic trial. The information gleaned from this comprehensive approach helps clinicians develop an effective plan to treat pain in patients who are unable to communicate.

4. RESOURCE AHRQ Recommendations for a National Emergency Evacuation System
A new report, Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System, proposes a coordinated multi-jurisdictional evacuation system that builds on existing resources and procedures available at the state, local, and federal level. The document includes guidelines for establishing a national data tracking system for patients and evacuees leaving disaster areas and for preparing an inventory of key resources such as available hospital beds and ambulances.

5. CALL FOR RESPONSE Survey on Nurses’ Satisfaction With Supply Chain Management
Owens & Minor is teaming up with AACN, the Association of Healthcare Resource & Materials Management, the Association of PeriOperative Registered Nurses, the Association of Nurse Executives and the Marquette University Colleges of Nursing & Business Administration to conduct a national survey of nurses’ perspectives and satisfaction level with their healthcare supply chain. Survey results will be presented in the trade media and at industry conferences to initiate positive dialogue and facilitate potential improvements that meet the needs of nurses with supply chain leaders and other key stakeholders. The survey takes about 10 minutes. The deadline is May 31.

6. REMINDER FOR CHAPTER LEADERS Register Now for the Leadership Development Workshop
April 30 is the deadline to register for the Chapter Leadership Development Workshop at NTI 2009. This year’s LDW will be held on Sunday, 5/17/09 from 7:30 a.m. to 4:30 p.m. at the Hilton New Orleans Riverside Hotel. Seating is limited.

7. RESOURCE ECRI Institute Offers Free Article on Best Practices for Working With a Patient Safety Organization
In honor of National Patient Safety Awareness Week, March 8-14, 2009, ECRI Institute is providing free access to best practices for working with a patient safety organization (PSO). Healthcare professionals can download the full resource, "PSOs Bring New Opportunities for Learning and Safety Improvement," from ECRI Institute Patient Safety Center Web site. The article is free but registration is required.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
A Randomized Controlled Trial of Nurse-led Care for Symptomatic Moderate-Severe Obstructive Sleep Apnea

Vasopressin for In-hospital Pediatric Cardiac Arrest: Results From the American Heart Association National Registry of Cardiopulmonary Resuscitation

Efficacy of Sedation Regimens to Facilitate Mechanical Ventilation in the Pediatric Intensive Care Unit: A Systematic Review

GUIDELINES

The following are from the American College of Chest Physicians Evidence-based Clinical Practice Guidelines (8th edition):

Prevention of Venous Thromboembolism

Antithrombotic Therapy for Venous Thromboembolic Disease

Treatment and Prevention of Heparin-induced Thrombocytopenia

PATIENT SAFETY ISSUES
Shiley 3.0PED Cuffless Pediatric Tracheostomy Tube by Covidien Inc. Class 1 Recall of Specific Lots


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