Critical Care Newsline — December 2, 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.

December 2, 2010

********************************************
1. CALL TO ACTION HHS-CCSC HAI Award Applications Open
2. CALL TO ACTION Nurses needed for tube-feeding practices survey
3. NEWS Unsafe injection practices, ‘ongoing threat to patient safety,’ study states
4. EVIDENCE Delirium duration predicts mortality in ventilated, sedated ICU patients
5. EVIDENCE Noninvasive BP monitoring common despite lack of accuracy evidence
6. EVIDENCE Automated drug-dispensing system reduces ICU med errors
7. EVIDENCE Elevated troponin predicts morbidity, mortality
8. CALL TO ACTION Comment on TJC draft for cardiac arrest performance measures
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES Speak boldly with AACN Practice Alerts

********************************************
1. CALL TO ACTION HHS-CCSC HAI Award Applications Open
Apply now for national awards recognizing long-term reduction or elimination of healthcare-associated infections (HAI), a leading cause of death in the U.S. Sponsored by the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Health, Office of Healthcare Quality and Critical Care Societies Collaborative (CCSC), the new awards recognize sustained improvements in HAI prevention, specifically in critical care. Applications are due by Saturday, Jan. 29. Visit AACN’s award site for complete details on eligibility, selection criteria and application requirements.

2. CALL TO ACTION Nurses needed for tube-feeding practices survey
Nurse researchers Norma Metheny and Andrew Mills, St. Louis University, request that all registered nurses, including AACN members, participate in “A Survey of Tube Feeding Practices by Nurses Working in Adult Intensive Care Units.” Completely anonymous, the 22-question online survey takes 10 minutes to finish and will give researchers a larger sample size on which to draw conclusions about current safe practices for safe tube feeding. Nurses who completed an earlier survey, mailed to 1,909 participants, should not respond to this one. Questions should be directed to the St. Louis University Institutional Review Board at (314) 977-7744 or Norma Metheny at (314) 977-8941 or methenna@slu.edu.

3. NEWS Unsafe injection practices, ‘ongoing threat to patient safety,’ study states
Although most clinicians report injection practices consistent with current recommendations, “unsafe injection practices represent an ongoing threat to patient safety” according to “Injection Practices Among Clinicians in United States Health Care Settings.” These practices include using single-dose/single-use vials for more than one patient, reusing a syringe but changing the needle for a second patient and reusing a syringe to enter a multidose vial, state survey results in December’s American Journal of Infection Control.

4. EVIDENCE Delirium duration predicts mortality in ventilated, sedated ICU patients
“Delirium Duration and Mortality in Lightly Sedated, Mechanically Ventilated Intensive Care Patients” in December’s Critical Care Medicine states duration of delirium was “the strongest independent predictor of death, ventilation time, and intensive care unit stay” in 354 patients from 68 ICUs in five countries.

5. EVIDENCE Noninvasive BP monitoring common despite lack of accuracy evidence
Intensivists commonly use noninvasive blood pressure measurement to make decisions despite the “paucity of evidence validating its accuracy” according to “Results of a Survey of Blood Pressure Monitoring by Intensivists in Critically Ill Patients: A Preliminary Study.” The report in December’s Critical Care Medicine calls for “accuracy and precision validation studies comparing noninvasive blood pressure measurement with intra-arterial blood pressure measurement in critically ill patients.”

6. EVIDENCE Automated drug-dispensing system reduces ICU med errors
An “Automated Drug Dispensing System Reduces Medication Errors in an Intensive Care Setting” according to December’s Critical Care Medicine. Nurses favored the new system, which reduced errors related to “picking, preparation and administration of drugs.”

7. EVIDENCE Elevated troponin predicts morbidity, mortality
The degree of troponin elevation predicts morbidity and mortality according to “Quantitative Troponin and Death, Cardiogenic Shock, Cardiac Arrest and New Heart Failure in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS): Insights From the Global Registry of Acute Coronary Events.” Each approximate 10-fold increase in the troponin ratio increases cardiac arrest, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), cardiogenic shock, new heart failure and mortality, states the study of more that 16,000 patients published online Nov. 12 by Heart.

8. CALL TO ACTION Comment on TJC draft for cardiac arrest performance measures
Share your thoughts on The Joint Commission’s, Oakbrook Terrace, Ill., Sudden Cardiac Arrest Performance Measures by Dec. 3. A Sudden Cardiac Arrest Initiative panel developed the nine measures that include timeliness of first defibrillation attempt and initiation of therapeutic hypothermia.

9. CLINICAL PRACTICE RESOURCES
Patient safety
On Nov. 9, the U.S. Food and Drug Administration (FDA), Silver Spring, Md., announced that it found no evidence of excess radiation with correctly used scanners. Its investigation into reports of radiation overexposure from CT brain perfusion scans identified improvements that the industry could make to increase safety and reduce the likelihood of overexposure. The FDA advocates “the universal adoption of two principles of radiation protection: appropriate justification for ordering each procedure, and careful optimization of the radiation dose used during each procedure.”

Guidelines
Access Pressure Ulcer Prevention and Treatment: Health Care Protocol, a guideline from the Institute for Clinical Systems Improvement, Bloomington, Minn.

10. AACN RESOURCES
Speak boldly with AACN Practice Alerts
Access AACN Practice Alerts — concise, action-oriented and evidence-based statements about acute and critical care nursing practices — to help nurses carry their bold voices to the bedside. Each Practice Alert includes the expected practice, scope and impact of the problem, supporting evidence, nursing actions and references. Download the accompanying PowerPoint presentation and Audit Tools to facilitate implementation. Topics include ST segment monitoring, ventilator associated pneumonia and verification of feeding tube placement.

Exceptional nurses. Exceptional bestsellers.
Find these and more popular resources at AACN’s Online Bookstore.
Do you take care of kids? www.aacn.org/bestsellers1
Do you need fast facts at your fingertips, pocket cards? www.aacn.org/bestsellers2
Are you a nurse manager or leader? www.aacn.org/bestsellers3
Are you a nurse educator? www.aacn.org/bestsellers4
Getting ready for certification? www.aacn.org/bestsellers5

Stand Tall: AACN Bold Voices
Is standing tall something to do or a way to be? — Kristine Peterson, AACN President 2010-2011

******************************************************************************

If you do not wish to receive e-mail updates from AACN, please reply to unsubscribe@aacn.org.
Do you have a comment, question or story idea for Critical Care Newsline? Send your e-mail to enewsletter@aacn.org.

UPDATE YOUR OWN INFORMATION ONLINE
Did you know you can update your demographic profile, including your e-mail address, online? Simply log in using your membership or customer identification number. Go to:
http://www.aacn.org/DM/CustomerProfile/UpdateCustomerProfile.aspx