Critical Care Newsline — December 16, 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 16, 2010

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1. NEWS TJC approves revised NPSG medication reconciliation
2. EVIDENCE Etomidate use in sepsis does not increase mortality
3. EVIDENCE Structured meetings with families have no effect on ICU LOS
4. CALL TO ACTION TJC invites comments on proposed NPSGs
5. CALL TO ACTION Apply for HHS-CCSC HAI Award
6. CALL TO ACTION Metheny, Mills’ tube-feeding practices survey request
7. CLINICAL PRACTICE RESOURCES
8. AACN RESOURCES This holiday season, share inspiration.

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1. NEWS TJC approves revised NPSG medication reconciliation
On Dec. 7, The Joint Commission (TJC), Oakbrook Terrace, Ill., announced approved revisions to the National Patient Safety Goal (NPSG) on medication reconciliation. The new version — developed in response to complaints about implementation difficulties with the 2009 version — focuses on critical risk points in the medication reconciliation process.

2. EVIDENCE Etomidate use in sepsis does not increase mortality
December’s CHEST states that giving a single dose of etomidate to facilitate rapid sequence intubation in patients with sepsis doesn’t increase mortality, vasopressor use, ICU length of stay or the number of ventilator days. Although patients were more likely to receive subsequent steroids, there was no difference in outcomes, concludes “Outcomes of Etomidate in Severe Sepsis and Septic Shock.”

3. EVIDENCE Structured meetings with families have no effect on ICU LOS
Structured, regular family meetings have no effect on length of stay (LOS), aggressiveness of care or treatment limitation decisions, according to “Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients.” Medical ICU exploratory analysis associates intervention “with a lower prevalence of tracheostomy among patients who died or had do-not-attempt-resuscitation orders in place,” states October’s CHEST. “The negative findings of the main analysis, in combination with preliminary evidence of differences among types of unit, suggest that further examination of the influence of patient, family, and unit characteristics on the effects of a system of regular family meetings may be warranted,” concludes the study of 346 patients from five ICUs.

4. CALL TO ACTION TJC invites comments on proposed NPSGs
The Joint Commission (TJC), Oakbrook Terrace, Ill., invites comments on proposed National Patient Safety Goals (NPSGs) for ventilator-associated pneumonia and catheter-associated urinary tract infections. Comment by Jan. 27, 2011.

5. CALL TO ACTION Apply for HHS-CCSC HAI Award
AACN recently told you about new national awards recognizing long-term reduction or elimination of healthcare-associated infections (HAIs) — a leading cause of death in the U.S. Apply by Saturday, Jan. 29. Visit AACN’s award site for complete details on eligibility, selection criteria and application requirements. AACN, a member of the Critical Care Societies Collaborative (CCSC), and U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Health, and Office of Healthcare Quality sponsor these sustained improvement and prevention awards for critical care. The American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine partner with AACN in the collaborative.

6. CALL TO ACTION Metheny, Mills’ tube-feeding practices survey request
Complete an anonymous 22-question online survey and give nurse researchers Norma Metheny and Andrew Mills, St. Louis University, a large sample size to draw conclusions about current safe practices for tube feeding. “A Survey of Tube Feeding Practices by Nurses Working in Adult Intensive Care Units” takes a mere 10 minutes to finish. Nurses who completed the paper survey mailed to 1,909 participants should not respond to this online request. Direct questions about the survey to the St. Louis University Institutional Review Board at (314) 977-7744 or Norma Metheny at (314) 977-8941 or methenna@slu.edu.

7. CLINICAL PRACTICE RESOURCES
Evidence
In most patients with paroxysmal atrial fibrillation (AF) and normal left ventricular function, circumferential pulmonary vein isolation results in stable sinus rhythm with a low incidence of chronic AF, according to “Long-Term Results of Catheter Ablation in Paroxysmal Atrial Fibrillation: Lessons From a 5-Year Follow-Up,” published online Nov. 22 by Circulation.

On Dec. 7, the Agency for Healthcare Research and Quality, Rockville, Md., released the evidence-based review “Transition of Care for Acute Stroke and Myocardial Infarction Patients From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention.”

Guidelines
Access “Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association,” published online Dec. 6 by Stroke.

9. AACN RESOURCES
This holiday season, share inspiration.
Gifts under $20. Buy them online at www.aacn.org/under20.

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 severe sepsis, verification of feeding tube placement and family presence during resuscitation and invasive procedures.

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

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