Critical Care Newsline — January 14, 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.

Jan. 14, 2010

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1. EVIDENCE Glucose variability increases ICU mortality
2. EVIDENCE Short preop erythropoietin therapy reduces blood transfusion
3. CALL TO ACTION Joint Commission invites effective practice submissions for new guide
4. EVIDENCE Therapeutic mild hypothermia feasible for pediatric cardiac arrest
5. EVIDENCE Noninvasive mechanical ventilation reduces intubation in chest trauma
6. EVIDENCE Remote ICU monitoring doesn’t reduce mortality, length of stay
7. EVIDENCE No mortality difference between early-, late-onset ARDS
8. NEWS Submit research online to ANA’s NDNQI
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES AACN to host HWE webinar in March

1. EVIDENCE Glucose variability increases ICU mortality
Frequent glucose level changes increase mortality in ICUs and hospitals according to a retrospective study of 5,728 patients published online Dec. 23, 2009 by Critical Care Medicine. Patients with high variability and mean values for glucose showed the highest ICU mortality, while “low variability seemed protective even when mean glucose levels remained elevated,” the abstract states.

2. EVIDENCE Short preop erythropoietin therapy reduces blood transfusion
Administering erythropoietin for a short time before surgery is safe, easy and reduces blood transfusions according to a randomized trial of 320 patients published online Dec. 28, 2009 by the Journal of Thoracic and Cardiovascular Surgery.

3. CALL TO ACTION Joint Commission invites effective practice submissions for new guide
The Joint Commission, Oakbrook Terrace, Ill., seeks examples of effective practices used by hospitals to engage patients and families in safety and quality for possible inclusion in a new national guide, Advancing Patient and Family Engagement: Developing a Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting. E-mail effective practices to APFE@jointcommission.org. Read submission guidelines for the project —supported by the Agency for Healthcare Research and Quality, Rockville, Md., and led by the American Institutes for Research, Washington, D.C.
http://www.air.org/projects/projects_health_PFengagement.aspx

4. EVIDENCE Therapeutic mild hypothermia feasible for pediatric cardiac arrest
Use of therapeutic mild hypothermia during pediatric cardiac arrest is feasible, states a retrospective cohort study of 181 patients, the largest of its kind, in January’s Pediatric Critical Care Medicine. “Temperature below target range (32 degrees) was associated with increased mortality,” the study states. “Prospective study is urgently needed to determine the efficacy of therapeutic hypothermia in pediatric patients after cardiac arrest.”

5. EVIDENCE Noninvasive mechanical ventilation reduces intubation in chest trauma
Noninvasive mechanical ventilation rather than a high-flow oxygen mask reduces the need for intubation in patients with hypoxemia from chest trauma according to a randomized clinical trial in January’s CHEST.

6. EVIDENCE Remote ICU monitoring doesn’t reduce mortality, length of stay
Remote patient monitoring doesn’t reduce ICU or hospital mortality or length of stay, states an observational study of six ICUs in Dec. 23, 2009’s JAMA.

7. EVIDENCE No mortality difference between early-, late-onset ARDS
A study in January’s CHEST reports no difference in mortality for patients with early- or late-onset Acute Respiratory Distress Syndrome (ARDS). Late-onset patients have longer lengths of stay, the abstract states.

8. NEWS Submit research online to ANA’s NDNQI
The American Nurses Association (ANA), Silver Spring, Md., recently established the National Database of Nursing Quality Indicators (NDNQI) Review Council, which allows research proposals to be submitted online. The 15-member council reviews and scores proposals to determine if they meet criteria for the NDNQI database, a program of ANA’s advocacy group, the National Center for Nursing Quality (NCNQ). More than 12,000 nursing units report data to the NDNQI in any given quarter, which helps to determine links between nursing staff levels and skill mixes and patient outcomes. Survey information from the database measures nurse satisfaction and practice environments.

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

The Society of Critical Care Medicine introduces a FREE Web-based training program to prepare non-intensivists to assist with care of critically ill patients including those with H1N1. Available to all healthcare professionals, the comprehensive course allows participants to work with and under the supervision of experienced critical care professionals. Funded by the U.S. Dept. of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, Washington, “Critical Care Cross Training for Hospital-based non-ICU Health Care Professionals (CCXT)” can be accessed 24 hours a day.

EVIDENCE
Cleaning a patient’s skin with chlorhexidine-alcohol rather than povidone-iodine reduces the risk of incisional infections in clean-contaminated surgeries according to a study in The New England Journal of Medicine’s Jan. 7 issue.

Factors contributing to the burden of care of ICU patients after hospital discharge depend on patient characteristics, states a January study in CHEST. These factors may change over time, it adds.

According to a survey, 310 physicians from 22 institutions characterized 583 diagnostic errors as major (28 percent), moderate (41 percent) or minor/insignificant (31 percent). Failure to order, report and/or follow up on laboratory tests represent the most common errors states the survey in the Nov. 9, 2009 Archives of Internal Medicine.

According to an abstract in January’s Pediatric Critical Care Medicine, prophylactic treatment may prevent upper gastrointestinal bleeding in pediatric ICU patients. “High-quality evidence to guide clinical practice is still limited,” the abstract states.

GUIDELINE
The Eastern Association for Surgery of Trauma and American College of Critical Care Medicine issued a new guideline for red blood cell transfusion in adult trauma and critical care in December 2009’s Critical Care Medicine. Read the abstract and a guideline article.

10. AACN RESOURCES
JOURNALS
This month’s Publish Ahead of Print article is now live on the Critical Care Nurse Web site, www.ccnonline.org. Click the OnlineFirst logo to read about the impact of a no-interruption zone on medication safety in ICUs. Member log-in is required to read articles; abstracts are free access.

HEALTHY WORK ENVIRONMENT
Visit www.hweteamtool.org to 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.

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 using or planning to use the new AACN Healthy Work Environment Team Assessment, a Web-based tool launched with VitalSmarts at www.hwetool.org. Click here to register for the free webinar.

EDUCATION
AACN’s Web-based e-learning course “Promoting Excellence in Palliative & End-of-Life Care” recently won a 2009 Gold Brandon Hall Excellence in Learning Award for Best Custom Content, its second industry honor. In July 2009, it won a gold-level “Best of Training Category Horizon Interactive Award,” an industry Oscar, for outstanding achievement in interactive media production. Visit www.aacn.org to purchase “Promoting Excellence in Palliative & End-of-Life Care” priced at $50 per user plus the cost of a one-, two- or three-year institutional site license.

AACN offers FREE online, self-paced course, “Best Practices for Elder Care
Visit the AACN Web site to access “Best Practices for Elder Care,” a FREE online, self-paced course that addresses complex issues specific to older patients and promotes a healthy work environment. This Web-based resource includes four units of instructional content and interactive case studies and a 17-question self-assessment unit. AACN members earn four FREE hours of continuing nursing education for completing this program. Nonmembers pay a nominal fee for the four CNE hours.

Register to participate in a free webcast of a first-of-its-kind survey, “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions.” The survey, conducted by Gallup Consulting on behalf of the Robert Wood Johnson Foundation, will be presented at a press conference Wednesday, Jan. 20 at 9 a.m. EDT.


CERTIFICATION
The CCRN Adult Self-Assessment Exam (SAE) for candidates planning to test after Jan. 13, 2010, can be purchased for $50. The newly revised SAE, based on the new CCRN Adult Test Plan, provides automatic rationale for correct and incorrect answers. Candidates can access the program 90 days from the date of purchase. The 60-item CCRN SAE may be used one time by CCRNs renewing with a passing score of 70 percent or more on Category A Continuing Education Recognition Points (CERPs). Candidates may earn CERPs but not CE credit. Technical requirements include a computer with Internet access, a Web browser (version 4.0 or greater), cookies enabled and a current e-mail account.


CORRECTION: Last week, Critical Care Newsline reported a published-ahead-of-print abstract about elevated international normalized ratio in patients with chronic liver disease. Published-ahead-of-print items are embargoed until they appear in the print edition of CHEST. AACN regrets the error.

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