Critical Care Newsline — February 25, 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. 25, 2010

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1. NEWS AACN to host free webinar, “Assessing the Health of Your Work Environment”
2. RESOURCES AACN offers Web-based courses on precepting and palliative care
3. EVIDENCE Evidence-based interventions reduce bloodstream infections for 36 months
4. EVIDENCE Transradial vs. transfemoral arterial access for PCI in STEMI patients
5. EVIDENCE Evidence-based guidelines cut NICU rates for CLABSI, late-onset sepsis
6. CLINICAL PRACTICE RESOURCES
7. AACN RESOURCES NTI certification exam deadline is April 7

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 Web-based tool that aligns any clinical environment with the six HWE standards.

2. RESOURCES AACN offers Web-based courses on precepting and palliative care
AACN now offers individual nurses access to two of its most popular Web-based courses, “The Preceptor Challenge” and double-award-winning “Excellence in Palliative & End-of-Life Care.” At the AACN Learn Center, nurses may purchase six-month access to “The Preceptor Challenge” for $100 and “Promoting Excellence in Palliative & End-of-Life Care” for $50. The Preceptor Challenge,” a three-module course, uses virtual tools to enable nurses to identify best practices. “Excellence in Palliative & End-of-Life Care” allows nurses to apply theory-based practice without the risk of harm to patients or families.

3. EVIDENCE Evidence-based interventions reduce bloodstream infections for 36 months
According to a study, published Feb. 4 by BMJ, ICUs participating in Michigan’s Keystone Project sustained catheter-related bloodstream infection reductions for 36 months using a conceptual model that increased evidence-based interventions. “Reduced rates of catheter related bloodstream infection achieved in the initial 18-month post-implementation period were sustained for an additional 18 months,” states the study, which concludes “broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.” Read “Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.”

4. EVIDENCE Transradial vs. transfemoral arterial access for PCI in STEMI patients
Transradial arterial access for percutaneous coronary intervention in patients with acute ST elevation myocardial infarction (STEMI) doesn’t compromise door-to-balloon (D2B) times compared to transfemoral access states a Nov. 25, 2009 online study in Catheterization and Cardiovascular Intervention. Mean case starts took significantly longer, but balloon inflation occurred faster with arterial access. STEMI patients can undergo successful PCI via radial artery approach without compromise in D2B times, the abstract concludes.

5. EVIDENCE Evidence-based guidelines cut NICU rates for CLABSI, late-onset sepsis
Evidence-based guidelines can reduce central line-associated bloodstream infection (CLABSI) and late-onset sepsis rates according to a Jan. 26 online study in Infection Control & Hospital Epidemiology. “A Quality Improvement Initiative to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit” states that “sustainability depends on continued data surveillance, knowledge of medical and nursing literature and timely feedback to staff.” These techniques can be applied to other areas of in-patient care, the abstract notes.

6. CLINICAL PRACTICE RESOURCES

PATIENT SAFETY

A study in the Jan. 15 American Journal of Respiratory and Critical Care Medicine reports at least one medical error (ME) among 27 percent of 1,369 patient participants. Fifteen percent of errors caused clinical consequences that required at least one procedure or treatment. Insulin administration caused the most common ME. “The impact of medical errors on mortality indicates an urgent need to develop prevention programs.”

The February issue of Nurse Advise-ERR from the Institute for Safe Medication Practices, Horsham Pa., includes stories about fatal outcomes after inadvertent injection of topical epinephrine; purple is not the standard for enteral feeding equipment or PICC lines and others.

EVIDENCE
Intensive care unit-acquired weakness: risk factors and prevention,” a study in the October 2009 Critical Care Medicine, calls prolonged mechanical ventilation and delayed physical self-sufficiency “the main clinical sign of critical illness neuromyopathy.” Avoid unnecessary deep sedation and excessive blood glucose levels, and promote early mobilization and careful use of corticosteroids to “reduce the incidence and severity of intensive care unit-acquired weakness.”


GUIDELINES
Expanding ICUs into other hospital areas and establishing a management system with facility control groups are key recommendations in a Feb. 5 Intensive Care Medicine article titled “Recommendations for intensive care unit and hospital preparation for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster.”

Access liver biopsy guidelines from the American Association for the Study of Liver Diseases.


7. AACN RESOURCES

CERTIFICATION
AACN will offer all its certification exams at the 2010 National Teaching Institute & Critical Care Exposition, Washington, D.C., Monday, May 17. Nurses must preregister for the exam using a special NTI application.

Completed applications with fee payment must be postmarked no later than Wednesday, April 7.

The Kentucky Board of Nursing recognizes AACN Certification Corporation as a national certifying body for APRN exams and approves the ACNPC and CCNS for APRN licensure.

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.

RESPONSE TO HAITI EARTHQUAKE
Visit “Response to Haiti Earthquake” on the AACN Web site to find information about the massive earthquake that devastated Haiti on 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.


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