Critical Care Newsline — February 11, 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.

Feb. 11, 2010

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1. NEWS AACN to host free webinar, “Assessing the Health of Your Work Environment”
2. EVIDENCE PTSD, depression common among family after ICU patient death
3. EVIDENCE Procalcitonin-based algorithm reduces antibiotic use
4. EVIDENCE Scandinavian journal study advises patients, staff about MRSA
5. EVIDENCE Family issues most common reason nurses refer patients to chaplains
6. EVIDENCE U.K. study reports harmful effects of pediatric opioid infusion
7. NEWS New tool for assessing patients’ decision-making capacity in an emergency
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES AACN launches “Response to Haiti Earthquake” Web page

1. NEWS AACN to host free webinar, “Assessing the Health of Your Work Environment”
AACN and VitalSmarts — a provider of corporate training and organizational performance products and services in Provo, Utah — will host a free webinar Tuesday, March 9, 11 a.m. to noon MST. “Assessing the Health of Your Work Environment” promises to be particularly interesting to anyone who uses or plans to use the new AACN Healthy Work Environment Team Assessment, a free Web-based tool that aligns any clinical environment with the six HWE Standards.

2. EVIDENCE PTSD, depression common among family after ICU patient death

“Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU,” states “Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU.” The study in February’s CHEST reports post-traumatic stress disorder and depressive symptoms among 14 percent and 18 percent of survey respondents respectively. “Characteristics associated with symptoms may help target interventions to reduce these symptoms,” the abstract states.

3. EVIDENCE Procalcitonin-based algorithm reduces antibiotic use
A multicenter study published online Jan. 22 by Lancet reports that a procalcitonin-based algorithm reduces antibiotic use in ICU patients with no adverse outcomes. Reduced antibiotic exposure may “contain the emergence of multidrug-resistant bacteria,” the abstract states.

4. EVIDENCE Scandinavian journal study advises patients, staff about MRSA
A Jan. 11 Scandinavian Journal of Caring Sciences study reports that “patients who contract methicillin-resistant Staphylococcus aureus (MRSA) need information about what the MRSA contagion involves” and that an increased awareness of how the contagion spreads will allay fears of MRSA among staff and patients. “Source isolation should be as short as possible to minimize the feeling of confinement.”

5. EVIDENCE Family issues most common reason nurses refer patients to chaplains
Survey results reported in the January/February issue of Holistic Nursing Practice indicate family issues are the most likely reason nurses refer patients to chaplains. Treatment issues ranked between slightly and moderately likely reasons to refer patients to chaplains, states “When Do Nurses Refer Patients to Professional Chaplains.”

6. EVIDENCE U.K. study reports harmful effects of pediatric opioid infusion
One in 10,000 opioid infusions cause serious harm to children according to a United Kingdom audit published online Nov. 3, 2009 by Pediatric Anesthesia. Contributing factors include overgenerous dosing in infants and concurrent sedatives or opioids by different routes. Patients with specific risk factors — including age or neurodevelopmental, respiratory or cardiac comorbidities — should be monitored at least every two hours, the abstract states.

7. NEWS New tool for assessing patients’ decision-making capacity in an emergency
February’s CHEST reports the development of a mnemonic device that assesses patients’ decision-making capacity in emergency situations by physicians and bioethicists at Johns Hopkins, Baltimore. CURVES (Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) may be used with or substituted for longer assessment tools when time is critical, the abstract states. Read the CURVE questions.

8. CLINICAL PRACTICE RESOURCES

PATIENT SAFETY
On Jan. 29, Thomas Medical Products, Malvern, Pa., issued a recall of SafeSheath Coronary Sinus Guide Sheath Introducer because of reports that tip fragmentation inside the blood vessel could cause embolization and death.

Significant fluid imbalance and potential overrides of fluid balance alarms prompted the Food and Drug Administration, Silver Spring, Md., and Edwards Lifesciences, Irvine, Calif., on Feb. 3 to recall Aquarius Hemodialysis System, distributed in the U.S. by Baxter International, Deerfield, Ill.

On Jan. 29, Lilly, Indianapolis, and the FDA notified healthcare professionals of changes to prescribing information for Zyprexa to treat adolescents 13 to 17 years old with schizophrenia and bipolar disorder. “Clinicians should consider the increased potential for weight gain and hyperlipidemia,” states the FDA information. Zyprexa should be an integral part of a total treatment program for pediatric patients with schizophrenia and bipolar disorder. Read “Zyprexa (olanzapine): Use in Adolescents.

EVIDENCE
“Both off- and on-pump coronary artery bypass grafting can be performed in high-risk patients with low short-term complications” reports a study in the Feb. 2 Circulation. “Observational studies indicate that off-pump surgery may provide more benefit in high-risk patients,” states “No Major Differences in 30-Day Outcomes in High-Risk Patients Randomized to Off-Pump Versus On-Pump Coronary Bypass Surgery.”

February’s Seminars in Respiratory and Critical Care Medicine reviews the use of ICU protocols. Read “Using Protocols to Improve Patient Outcomes in the Intensive Care Unit: Focus on Mechanical Ventilation and Sepsis.

An article in the January/February Holistic Nursing Practice describes a unitary-caring model that transforms national standards of palliative care into a values-based praxis for healing and caring. Read A Unitary-Caring Conceptual Model for Advanced Practice Nursing in Palliative Care.

The Jan. 20 Clinical Advisor provides an overview of antibiotics to manage urinary tract infections (UTI). Read How to select the right drugs for UTI.

H1N1
Visit AACN’s H1N1 Influenza Resource Center for up-to-date information about H1N1 etiologies, symptoms and treatments, educational Web tools and journal resources. The site includes links to flu.gov from U.S. Health & Human Services, updates from the Centers for Disease Control, podcasts and more.

GUIDELINE
Access evidence-based guidelines, “Preventing Hospital-Acquired Conditions,” from the U.S. Health and Human Services, Washington. Medicare no longer pays hospitals for increased cost of care resulting from HACs. Hospitals can’t bill beneficiaries for the difference between lower and higher payment rates, the guidelines state.

9. AACN RESOURCES

RESPONSE TO HAITI EARTHQUAKE
Visit Response to Haiti Earthquake on the AACN Web site to find information about the massive earthquake that devastated Haiti Tuesday, Jan. 12. Response to Haiti Earthquake contains links to U.S. government agencies monitoring the earthquake and global relief organizations that provide volunteer and financial support.

CERTIFICATION
Preregister for paper and pencil certification tests to be offered at the 2010 National Teaching Institute & Critical Care Exposition, Washington, D.C., Monday, May 17. Payment must accompany the NTI exam application and be postmarked no later than Wednesday, April 7, 2010.


HEALTHY WORK ENVIRONMENT
Access the new AACN Healthy Work Environment Team 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.

JOB SEARCH AND CAREERS
Search for new career opportunities at NursePath.com, AACN’s official job marketplace.


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