Critical Care Newsline — August 26, 2010

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.

August 26, 2010

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1. NEWS AACN joins CCSC to support relief to Pakistan flood victims
2. NEWS NICHE announces October Leadership Training Program
3. NEWS Submit AACN grant proposals in September
4. EVIDENCE CRNAs deliver safe, effective care without physician supervision
5. EVIDENCE Factors that affect survival of cardiac-death donor kidneys
6. EVIDENCE Study compares working conditions of Magnet and Non-Magnet hospitals
7. NTI Submit poster abstracts and certification best practices for NTI 2011
8. CALL TO ACTION Give TJC feedback about two patient-safety efforts
9. CALL TO ACTION Comment on CMS 30-minute rule impact, visitation ruling
10. CLINICAL PRACTICE RESOURCES
11. AACN RESOURCES Learn at home with E-Learning

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1. NEWS AACN joins CCSC to support relief to Pakistan flood victims
Widespread flooding in northern parts of Pakistan has affected more than 17 million people who need life-saving humanitarian assistance. The Critical Care Societies Collaborative — including AACN, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine — encourages members to volunteer or donate to first responder relief organizations that work with World Health Organization’s Pakistan Health Cluster, among them are the American Red Cross, CARE USA, Save The Children and Doctors Without Borders. Access resources and information to help disaster victims here.

2. NEWS NICHE announces October Leadership Training Program
On Aug. 6, Nurses Improving Care for Healthsystem Elders (NICHE) announced its next Leadership Training Program will be Oct. 4. The NICHE team facilitates the six-week Web-based program — the first step to prepare staff for leadership in geriatric care. Register online.

3. NEWS Submit AACN grant proposals in September
Submit proposals for AACN 2011 grants from Sept. 1-30. New this year is the AACN Impact Research Grant, designed to support experienced clinicians and researchers in inquiry and systematic research and generate new knowledge.

4. EVIDENCE CRNAs deliver safe, effective care without physician supervision
No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians” in August’s Health Affairs found no difference in patient mortality or complications between certified registered nurse anesthetists (CRNAs) who were supervised by a physician and those who weren’t. “Based on our findings, we recommend that CMS (Centers for Medicare and Medicaid Services) allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist,” the study concludes. The American Medical Association, Chicago, refutes the study on the Health Affairs blog.

5. EVIDENCE Factors that affect survival of cardiac-death donor kidneys
Analysis of Factors That Affect Outcome After Transplantation of Kidneys Donated After Cardiac Death in the UK: A Cohort Study” lists factors for decreased graft survival that include older ages of donor and recipient, repeat transplantation and cold ischemic time for more than 12 hours. Kidneys from cardiac-death donors “provide good graft survival and function up to five years in first-time recipients and are equivalent to kidneys from brain-death donors,” states the study, published online Aug. 18 by The Lancet.

6. EVIDENCE Study compares working conditions of Magnet and Non-Magnet hospitals
“Working conditions reported by nurses working in Magnet and non-Magnet hospitals varied little,” concludes a study in July/August’s Journal of Nursing Administration. “A Comparison of Working Conditions Among Nurses in Magnet and Non-Magnet Hospitals” included 837 nurses at 171 hospitals. Magnet-designated hospitals must meet criteria from the American Nurses Credentialing Center, Silver Spring, Md.

7. NTI Submit poster abstracts and certification best practices for NTI 2011
Submit poster abstracts for the 2011 National Teaching Institute & Critical Care Exposition (NTI), April 30-May 5, Chicago, in three categories: Research, Evidence-based Solutions, which replaces Creative Solutions, and Chapter Best Practice. Read Poster Abstract Submission Guidelines before submitting your abstract online. Deadline Sept. 15.

If your hospital, unit or chapter has successfully implemented certification best practices — strategies to encourage, recognize and reward certification — submit your certification story online by Sept. 30. AACN will select the two most innovative practices for panel presentation during the “Creating a Culture of Certification: Best Practices Roundtable” at the 2011 National Teaching Institute & Critical Care Exposition (NTI), April 30-May 5, Chicago. AACN Certification Corporation accepts best-practice submissions, which it posts online, year-round.

8. CALL TO ACTION Give TJC feedback about two patient-safety efforts
The Joint Commission’s (TJC’s) Division of Standards and Survey Methods seeks effective methods to execute the National Patient Safety Goal (NPSG), “Implement Evidence-based Practices for Preventing Surgical Site Infections.” Upon project completion, accredited hospitals receive a free NPSG implementation guide to highlight successful implementation methods for this NPSG. Submit your methods.

TJC wants to know the effect of the changes on patient care and internal processes. Complete a 10-minute survey on the Universal Protocol revisions implemented in January. Deadline Sept. 10.

9. CALL TO ACTION Comment on the CMS 30-minute rule impact, visitation ruling
Respond by Aug. 31 to an online survey about the 30-minute rule from the Centers for Medicare & Medicaid Services (CMS), Baltimore. The CMS rule, which requires medications to be administered within 30 minutes before or after their scheduled times, may be causing unintended consequences that affect medication safety. CMS has agreed with a position statement from the American Association for Respiratory Care, Irving, Texas, that states respiratory medications may be given within 60 minutes of their scheduled times. The Institute for Safe Medication Practices, Horsham, Pa., is conducting the survey.

The Centers for Medicare & Medicaid Services (CMS), Baltimore, requests comments by Aug. 27 on a proposed ruling that requires hospitals participating in Medicare and Medicaid programs to have written policies and procedures on patients’ visitation rights. The president’s directive instructed the U.S. Dept. of Health and Human Services, Washington, D.C., to propose that a “participating hospital not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.” It suggests that rule-makers consider allowing participating hospitals to “restrict visitation in medically appropriate circumstances.” Read more in the April 29 Critical Care Newsline.

10. CLINICAL PRACTICE RESOURCES
Patient safety
On Aug. 13, the U.S. Food and Drug Administration, Silver Spring, Md., announced a recall of 6 French Engage Introducers from St. Jude Medical, Inc., St. Paul, Minn., because of “the potential for separation of the shaft (sheath) from the hub or for a break in the hub assembly.”

August’s Nurse Advise-ERR, published by the Institute for Safe Medication Practices (ISMP), Horsham, Pa., discusses how to safely administer Exalgo, a controlled substance for pain. Other topics include a neuromuscular blocker mix-up in the pharmacy, alerts on Lovenox unit dose syringes and generic enoxaparin syringes, and questionable safety with continuous inhalation albuterol infusion setup. Subscribe to the free monthly newsletter. Please read the archives, updated monthly.

Evidence
Door-to-balloon times (DBTs) less than or equal to 90 minutes “are associated with a lower mortality rate in patients with early presentation but have less impact on the mortality rate in patients presenting later,” states “When Is Door-to-Balloon Time Critical? Analysis From the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) and CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) Trials,” in the July 27 Journal of American College of Cardiology. “These data may be helpful in designing triage strategies for reperfusion therapy in patients presenting to non-percutaneous coronary intervention hospitals,” the study concludes.

Resources
Access two guides from the Agency for Healthcare Research and Quality, Rockville, Md.: “Adding ACEIs and/or ARBs to Standard Therapy for Stable Ischemic Heart Disease: Benefits and Harms” — a clinician’s guide with level-of-confidence ratings for possible benefits and harms — and “ACE Inhibitors and ARBs to Protect Your Heart?,” a guide for patients.

The Aug. 18 Journal of the American Medical Association includes “Does This Patient Have Delirium?” — a review of 25 studies that describes the use of 11 delirium bedside instruments. The review states that “the best evidence” supports the use of the Confusion Assessment Method for assessing delirium in adults.

11. AACN RESOURCES
Learn at home with E-Learning
Develop your clinical knowledge, anytime, anywhere, with the three AACN E-Learning courses, available for individual purchase. “The Preceptor Challenge” and the award-winning “Promoting Excellence in Palliative & End-of-Life Care” feature simulations of real-life experiences. “Essentials of Nurse Manager Orientation” helps new and experienced managers expand their management competencies. More information and pricing.

Stand Tall
Be proud of what you do.” — Kristine Peterson, AACN President 2010-2011

Healthy Work Environment
Access AACN’s Healthy Work Environment tools.

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