Critical Care Newsline — April 29, 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 websites that will keep you informed on issues affecting nurses and the nursing profession.

April 29, 2010

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1. NEWS HHS to develop visitation rights regulations
2. NEWS California Acuity-Adaptable Care Delivery Pilot Program bill to be pulled
3. EVIDENCE Sepsis patients suffer long-term ill effects
4. CALL TO ACTION Participate in a mechanical ventilator research study
5. EVIDENCE PPIs, histamine-2 receptors to prevent upper GI bleeding carry similar risks
6. EVIDENCE CPR may influence autoresuscitation
7. CALL TO ACTION Comment on TJC’s proposed National Patient Safety Goal
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES AACN Protocols for Practice price reductions

1. NEWS HHS to develop visitation rights regulations
To help advance-directive proxies access patients, President Barack Obama requests Kathleen Sebelius, secretary of the U.S. Department of Health & Human Services, Washington, D.C., to develop regulations requiring hospitals to respect a patient’s right to designate non-family members as visitors. In his April 15 memorandum, President Obama outlines three steps, which include initiating appropriate rulemaking “to ensure that hospitals that participate in Medicare and Medicaid respect the rights of patients to designate visitors” and ensuring patients’ representatives have the right to make informed decisions about patient care.

2. NEWS California Acuity-Adaptable Care Delivery Pilot Program bill to be pulled
On April 8, the North County Times reports that Assemblyman Nathan Fletcher, R-San Diego, plans to pull a bill that proposes the Acuity-Adaptable Care Delivery Pilot Program — to allow more time to address nurse-staffing concerns. The program described in AB 2194 allows one to five acute care hospitals in California — with at least one in San Diego County — to use ICU beds “as stepdown and medical surgical beds interchangeably, based on the acuity of the patient.”

3. EVIDENCE Sepsis patients suffer long-term ill effects
Patients with sepsis continue to die “up to two years and beyond after the standard 28-day inhospital mortality end point” and experience decreased quality of life after discharge, states May’s Critical Care Medicine. “Future studies should include longer-term end points to better-understand” sepsis and the effects of interventions on patient morbidity, mentions the abstract for “Long-Term Mortality and Quality of Life in Sepsis: A Systematic Review.”

4. CALL TO ACTION Participate in a mechanical ventilator research study
A research survey from George Mason University, Fairfax, Va., will evaluate nurses’ satisfaction with mechanical ventilator weaning protocols. The deadline to participate in the five-minute survey is May 3.

5. EVIDENCE PPIs, histamine-2 receptors to prevent upper GI bleeding carry similar risks
A meta-analysis in April’s Critical Care Medicine finds no difference in the risk of pneumonia and mortality between proton pump inhibitors (PPIs) and histamine-2 receptors when used to prevent stress-related upper gastrointestinal (GI) bleeding. “Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted,” states “The Efficacy and Safety of Proton Pump Inhibitors vs Histamine-2 Receptor Antagonists for Stress Ulcer Bleeding Prophylaxis Among Critical Care Patients: A Meta-Analysis,” which involved 936 ICU patients in seven randomized trials.

6. EVIDENCE CPR may influence autoresuscitation
“A Systematic Review of Autoresuscitation After Cardiac Arrest” in May’s Critical Care Medicine, suggests providing CPR may influence autoresuscitation, which was not reported in the absence of CPR because it “may apply to controlled organ donation after cardiac death after withdrawal of life-sustaining therapies.” The review failed to support or refute a recommended waiting period to establish death after cardiac arrest, because of inconsistencies in the reporting of 32 autoresuscitation cases, the abstract states.

7. CALL TO ACTION Comment on TJC’s proposed National Patient Safety Goal
The Joint Commission, Oakbrook Terrace, Ill., requests comments by April 30 on proposed revisions to the Medication Reconciliation National Patient Safety Goal, which highlights specific risk points that are critical and readily achievable.

8. CLINICAL PRACTICE RESOURCES
Patient Safety
The U.S. Food and Drug Administration, Silver Spring, Md., reports on April 22 that Physio-Control, Inc., Redmond, Wash., recalled LIFEPAK 15 Monitor/Defibrillator models distributed between March 26 and Dec. 15, 2009, because of unreliable power switches.

In a study to determine risk factors and potential harm associated with medication errors, results show more than one-third of 651 patients experienced 309 order errors; 85 percent of patients had errors originate in medication histories; and almost half were omissions, states May’s Journal of General Internal Medicine. Clinicians “should help patients utilize and maintain complete, accurate and understandable medication lists,” states “Results of the Medications at Transitions and Clinical Handoffs (Match) Study: An Analysis of Medication Reconciliation Errors and Risk Factors at Hospital Admission.”

Evidence
Chronic kidney disease (CKD), common in patients with heart failure and left ventricular dysfunction, is not independently associated with adherence to guideline-recommended therapy in outpatient cardiology practices, states April’s American Journal of Cardiology. The abstract for “Influence of Renal Function on the Use of Guideline-Recommended Therapies for Patients With Heart Failure,” which involved 13,164 patients, concludes the exception is the occurrence of “angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy.”

9. AACN RESOURCES
AACN Protocols for Practice price reductions
Several AACN Protocols for Practice are now available at reduced prices in AACN’s Online Bookstore. The list includes “Palliative Care and End-of-Life Issues in Critical Care,” “Non-Invasive Monitoring, 2^nd Ed.,” “Creating Healing Environments, 2^nd Ed.,” “Care of the Mechanically Ventilated Patient, 2^nd Ed.” and “Monitoring Technologies in Critically Ill Neuroscience Patients.”

E-Learning
AACN 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 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). Developed with VitalSmarts, a provider of corporate training and organizational performance products and services in Provo, Utah, the online tool 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 website, 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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