Critical Care Newsline — April 1, 2010

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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.

April 1, 2010

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1. CALL TO ACTION AACN 2010 election, vote today
2. CALL TO ACTION Advance directives, National Healthcare Decisions Day April 16
3. EVIDENCE Arterial and central venous catheters carry similar risks for infection
4. EVIDENCE Most ICU family members physically, emotionally distressed
5. EVIDENCE ICU family support coordinator increased satisfaction
6. EVIDENCE New therapies may improve outcomes for cranial-hemorrhage patients
7. EVIDENCE Early goal-directed therapy and antibiotics lower mortality in sepsis patients
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES NTI certification exam deadline is April 7

1. CALL TO ACTION AACN 2010 election, vote today
The AACN 2010 election is under way. This is your opportunity to select leaders for AACN who best represent your interests and vision for the future of acute and critical care nursing. Your single act of voting strengthens our community and is an invaluable contribution to our profession. Voting closes April 26 at 11:59 p.m. EST. Cast your vote now.

2. CALL TO ACTION Advance directives, National Healthcare Decisions Day April 16
On April 16, in honor of National Healthcare Decisions Day (NHDD), join Americans across the country in talking to others about future healthcare decisions and completing your advance directive. NHDD is a collaboration of national, state and community organizations committed to ensuring adults have information and the opportunity to communicate and document healthcare decisions. “All adults can benefit from thinking about what their healthcare choices would be if they are unable to speak for themselves,” states the NHDD Web site. “These decisions can be written down in an advance directive.”

3. EVIDENCE Arterial and central venous catheters carry similar risks for infection
Infection risk doesn’t differ between arterial and central venous catheters (CVCs), indicating arterial catheter use should receive the same precautions as CVC use, states a trial of seven ICUs in April’s Critical Care Medicine. The study, “Infectious risk associated with arterial catheters compared with central venous catheters,” which included 3,532 catheters and 27,541 catheter days, found the daily risk of infection constant over time for CVC after the fifth catheter day but increased significantly for arterial catheters after the seventh day.

4. EVIDENCE Most ICU family members physically, emotionally distressed
April’s Critical Care Medicine states most family members of ICU patients at high risk of dying experience physical symptoms, including fatigue, and psychological distress such as anxiety and depression, although families cope and function well. The abstract for “Symptom experiences of family members of intensive care unit patients at high risk for dying,” which sampled 74 family members of 74 ICU patients, found “the only patient factor significantly associated with symptom severity was younger age.”

5. EVIDENCE ICU family support coordinator increased satisfaction
A full-time family support coordinator in the surgical ICU increased families’ satisfaction with communication of all surgical ICU team members and improved their perceptions of the care and treatment they receive during the stay of their family member, finds a study published online March 11 by Critical Care Medicine. The abstract for “The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit” states further research is needed to “determine whether intervention refinement could produce lower length-of-stay and costs.”

6. EVIDENCE New therapies may improve outcomes for intracranial-hemorrhage patients
March’s Critical Care Medicine includes the review article “Management of acute intracranial and intraventricular hemorrhage,” which states new therapies “designed to stabilize hematoma growth and reduce hematoma burden may improve outcomes.”

7. EVIDENCE Early goal-directed therapy and antibiotics lower mortality in sepsis patients Qualifying patients for early goal-directed therapy and administering antibiotics within an hour of emergency department (ED) triage reduces mortality in patients with severe sepsis and septic shock, states a study in April’s Critical Care Medicine. “Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department,” a single-center cohort study, sampled 261 patients undergoing early goal-directed therapy in an ED.

8. CLINICAL PRACTICE RESOURCES
Patient Safety
Boston Scientific, Boston, Mass., notified U.S. Food and Drug Administration (FDA), Silver Spring, Md., that it issued a voluntary recall of all of its implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators that have not been implanted, because manufacturing changes weren’t submitted to FDA as required. In the March 19 announcement, FDA advises practitioners not to use the devices until it reviews and approves the changes.

On March 19, FDA announced that a review of data from a large clinical trial and other sources found patients taking the highest approved dose of the cholesterol-lowering drug Zocor (simvastatin), manufactured by Merck & Co., Whitehouse Station, N.J., have a higher risk for rhabdomyolysis than those taking lower doses. The risk may extend to other “statin” drugs, states the announcement, which advises practitioners to follow dose limitation guidelines for Zocor.

FDA recommends a temporary stop to using the vaccine Rotarix, manufactured by GlaxoSmithKline, Research Triangle Park, N.C., while it investigates the presence of DNA from porcine circovirus type 1. Because there is no evidence of a safety risk, the March 22 announcement states those already vaccinated don’t need medical follow-up.

Read how to prevent errors when administering drugs through an enteral feeding tube, the danger of cutting medication patches and other stories in the March issue of Nurse Advise-ERR from the Institute for Safe Medication Practices, Horsham, Pa.

Guidelines
Download “A.S.P.E.N. Clinical Guidelines: Nutrition Support of the Critically Ill Child,” published May/June 2009 in the Journal of Parenteral and Enteral Nutrition by A.S.P.E.N. (American Society for Parenteral and Enteral Nutrition), Silver Spring, Md. Free registration required.

Resources
April’s Critical Care Medicine reports deficiencies in quality of care in 8 to 45 percent of trauma patients 18 years or younger. More research is needed to “develop and evaluate patient-centered pediatric-specific” quality indictors for trauma care, states the abstract for “A systematic review of quality indicators for evaluating pediatric trauma care,” which reviewed 12 studies that evaluated quality of care.

The number of RNs in the U.S. is now 3.1 million, a gain of more than 5 percent from 2004 to 2008, according to newly released findings in a U.S. Department of Health and Human Services report by Health Resources and Services Administration (HRSA), Washington, D.C. “Initial Findings: 2008 National Sample Survey of Registered Nurses” states since 2004, workforce diversity has increased, more nurses have higher degrees and most RNs — 84.8 percent, the highest in the history of the survey — actively practice nursing. Since 1980, HRSA has conducted eight RN workforce surveys, one every four years; a final report on the latest will be published this summer.

9. AACN RESOURCES
E-Learning
AACN now offers individual nurses access to two of its most popular Web-based courses, “The Preceptor Challenge” and double-award-winning “Promoting Excellence in Palliative & End-of-Life Care.” Nurses may purchase six-month access to “The Preceptor Challenge” for $100 and “Promoting Excellence in Palliative & End-of-Life Care” for $50 at the AACN LearnCenter. “The Preceptor Challenge,” a three-module course, uses virtual tools to enable nurses to identify best practices. The groundbreaking “Promoting Excellence in Palliative and End-of-Life Care” allows nurses to apply theory-based practice without the risk of harm to patients or families.

Certification
AACN will offer all its certification exams at the 2010 National Teaching Institute & Critical Care Exposition (NTI), Washington, D.C., on Monday, May 17. Nurses must preregister for the exam using a special NTI application. AACN must receive exam fee payment and a completed NTI exam application postmarked no later than Wednesday, April 7.

Healthy Work Environment
Access the new AACN Healthy Work Environment Assessment, a free Web-based tool to help nurse managers and leaders align hospital unit performance with the AACN Standards for Establishing and Sustaining Healthy Work Environment (HWEs). The online tool — developed with VitalSmarts, a provider of corporate training and organizational performance products and services in Provo, Utah — aligns the performance of any clinical environment, from single hospital units to entire healthcare organizations, with the six HWE standards. They include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership.

Access a recording of the live webinar “Assessing the Health of Your Work Environment.” Available on the AACN Web site, the webinar — a joint venture between AACN and VitalSmarts, Provo, Utah — promises to be of particular interest to users of the new AACN Healthy Work Environment Assessment, a Web-based tool that aligns any clinical environment with the six HWE Standards. NOTE: Video portion of recording loads slowly.

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