Critical Care Newsline — April 8, 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 8, 2010

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1. CALL TO ACTION AACN 2010 election, vote today
2. CALL TO ACTION Urge your senators to support nurse education funding
3. CALL TO ACTION Comment on The Joint Commission’s proposed safety goal
4. CALL TO ACTION Advance directives, National Healthcare Decisions Day April 16
5. EVIDENCE Advance directives effective, states New England Journal of Medicine study
6. EVIDENCE Study profiles adrenal insufficiency in critically ill children
7. EVIDENCE VAP carries high economic burden, study shows greater need for prevention
8. EVIDENCE Review doesn’t support lactic acidosis concern in certain patients on metformin
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES New AJCC OnlineFirst articles now available

1. CALL TO ACTION AACN 2010 election, vote today
The AACN 2010 election is under way. 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 Urge your senators to support nurse education funding
Ask your U.S. senator to sign the “Dear Colleague” letter that Sen. Barbara Mikulski, D-Md., and Sen. Olympia Snowe, R-Maine, are circulating to support $267.3 million in funding for Nursing Workforce Development programs — Title VIII — in Fiscal Year 2011, by Monday, April 12. Find your senator’s name at the AACN Legislative Action Center.

3. CALL TO ACTION Comment on The Joint Commission’s proposed safety goal
The Joint Commission, Oakbrook Terrace, Ill., is asking for comments on proposed revisions to the Medication Reconciliation National Patient Safety Goal, which highlights specific risk points that are critical and readily achievable. Read more and submit comments by May 11, preferably by April 30.

4. 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 the information and 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.”

5. EVIDENCE Advance directives effective, states New England Journal of Medicine study
Patients with advance directives “received care that was strongly associated with their preferences,” according to a study of 3,746 adults 60 years or older in April 1’s New England Journal of Medicine. “Advance Directives and Outcomes of Surrogate Decision Making before Death” reports that 83.2 percent of those who had requested limited care and 97.1 percent of those who had requested comfort care “received care consistent with their preferences.” The abstract concludes, “These findings support the continued use of advance directives.”

6. EVIDENCE Study profiles adrenal insufficiency in critically ill children
Adrenal insufficiency (AI) occurs in many disease conditions in critically ill children and is associated with increased catecholamine use and fluid boluses, according to “A Prospective Multi-Center Study of Adrenal Function in Critically Ill Children,” published online March 18 by the American Journal of Respiratory and Critical Care Medicine. In the cohort study of 381 patients in seven tertiary-care pediatric ICUs, patients with AI had higher baseline cortisol levels and were significantly older than those without AI. More research is needed to determine “which of these critically ill children are truly cortisol deficient before any treatment recommendations can be made,” the abstract states.

7. EVIDENCE VAP carries high economic burden, study shows greater need for prevention
Ventilator-associated pneumonia (VAP) increases hospital costs, hospital length of stay and the need for respiratory and other services according to the retrospective study “Economic burden of ventilator-associated pneumonia based on total resource utilization,” published online March 19 by Infection Control & Hospital Epidemiology. The matched cohort analysis found that median total charges for those with VAP was $198,200 compared with $96,540 for matched control patients. The abstract states the findings “underscore the need for bundled measures to prevent VAP.”

8. EVIDENCE Review doesn’t support lactic acidosis concern in certain patients on metformin
A data review failed to support concerns about the risk of lactic acidosis in patients who receive metformin and have renal impairment or heart failure or have procedures requiring iodinated contrast, indicates January’s Heart. The abstract for “Metformin: safety in cardiac patients” states that in patients with heart failure “existing evidence suggests that metformin use is associated with improved outcome rather than increased risk.”

9. CLINICAL PRACTICE RESOURCES
Evidence
April’s Intensive Care Medicine contains abstracts of Chapter 7, Critical care triage, and Chapter 9, Educational process, in “Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster,” a report from a European Society of Intensive Care Medicine task force.

Guidelines
Read “Clinical Practice Guidelines for Clostridium difficile infection in adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA),” published electronically March 22 by Infection Control & Hospital Epidemiology.

Resources
Access a new audio series and other materials with evidence-based health information for consumers as part of the Healthcare 411 en Español program from the Agency for Healthcare Research and Quality, Rockville, Md.

10. AACN RESOURCES
Journals
New Publish Ahead of Print articles are now live on the American Journal of Critical Care (AJCC) Web site. Click the OnlineFirst logo to read about the general public’s attitudes toward alternative consent models for clinical trial participation and a study that evaluates the validity and reliability of measuring chronic heart failure patients’ depressive symptoms with the Patient Health Questionnaire–8. Member login is required to read articles; abstracts are free access.

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 & End-of-Life Care” allows nurses to apply theory-based practice without the risk of harm to patients or families.

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 Environments (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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