Critical Care Newsline — June 10, 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.

June 10, 2010

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1. NEWS TJC issues sentinel-event alert on violence in healthcare institutions
2. EMERGING EVIDENCE Avoidable and unavoidable pressure ulcers in all care settings
3. NEWS WHO designates June 14 as World Blood Donor Day
4. EVIDENCE AACN endorses initiative to prevent Torsades de Pointes
5. CALL TO ACTION Share your thoughts about AACN’s quest for excellence
6. CALL TO ACTION NLM announces resource grants to reduce health disparities
7. EVIDENCE Vascular closure devices, bivalirudin lower bleeding risk after PCI, JAMA says
8. EVIDENCE JAMA study associates arterial hyperoxia and mortality after cardiac arrest
9. EVIDENCE Incidence of S. aureus infection varies significantly with surgery type
10. CALL TO ACTION Tell your nursing story in photos
11. CALL TO ACTION Premier Safety Institute launches injection-practices survey
12. CLINICAL PRACTICE RESOURCES
13. AACN RESOURCES Updated CNS scope and standards

1. NEWS TJC issues sentinel-event alert on violence in healthcare institutions
On June 3, The Joint Commission (TJC), Oakbrook Terrace, Ill., issued “Preventing Violence in the Health Care Setting,” a sentinel-event alert urging healthcare facilities to control access and implement prevention measures that protect patients, staff and visitors from crimes such as assault, rape and murder. “As criminal activity spills over from the streets onto the campuses and through the doors, providing for the safety and security of all patients, visitors and staff … requires increasing vigilant attention …” states the alert, which lists high-risk areas and crime-prevention strategies.

2. EMERGING EVIDENCE Avoidable and unavoidable pressure ulcers in all care settings
At a consensus conference convened in February, the National Pressure Ulcer Advisory Panel unanimously agreed that some patient situations create unavoidable pressure ulcers. Panelists cited examples such as patients who refuse to participate in their care or the hemodynamically unstable patient unable to tolerate repositioning and agreed that in these situations, the condition of “skin failure” occurs. A full report will be accessible at http://www.npuap.org. Access current guidelines and resources for free.

3. NEWS WHO designates June 14 as World Blood Donor Day
The World Health Organization (WHO) selects June 14 as World Blood Donor Day, recognizing blood donors and those who motivate others to donate. This year’s slogan, “New blood for the world,” focuses on young donors. “Young people can make an important contribution by donating blood and by recruiting other young people to become donors,” states WHO information.

4. EVIDENCE AACN endorses initiative to prevent Torsades de Pointes
AACN endorses “Prevention of Torsades de Pointes (TdP) in Hospital Settings,” a scientific statement from the American Heart Association, Dallas, and American College of Cardiology Foundation, Washington, D.C. The statement recommends at-risk TdP patients receive continuous ECG monitoring and provides guidance for managing drug-induced long Q-T syndrome and immediate treatment for TdP. AACN member Barbara J. Drew chaired the writing committee for the statement, published in Circulation and the Journal of the American College of Cardiology.

5. CALL TO ACTION Share your thoughts about AACN’s quest for excellence
This year’s Annual Membership Forum at the National Teaching Institute & Critical Care Exposition joined audience members and board members in focused discussions about AACN, to explore three questions: 1) What is the most innovative practice you’ve seen recently? 2) What can we, the AACN community, do to spread the word about these best practices to let other nurses know about them? 3) As a nurse, what gives you the greatest cause for optimism in the current environment? Respond to these questions at info@aacn.org or at NTI Voices Online.

6. CALL TO ACTION NLM announces resource grants to reduce health disparities
The National Library of Medicine (NLM), Bethesda, Md., seeks resource grant applications for projects that bring “useful, usable health information to health disparity populations and the health care providers who care for those populations.” Proposed projects must leverage computer and information technology capabilities and health sciences libraries that “bring health-related information to consumers and their health care providers.” Preference is given to applications that strongly involve health sciences libraries or minority-serving institutions. Letters of intent are due June 14. Applications are due by July 14.

7. EVIDENCE Vascular closure devices, bivalirudin lower bleeding risk after PCI, JAMA says
A data analysis of a national percutaneous coronary intervention (PCI) registry, published in the Journal of the American Medical Association (JAMA), June 2, shows that vascular closure devices and bivalirudin decrease bleeding rates, “particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients,” states “Association Between Use of Bleeding Avoidance Strategies and Risk of Periprocedural Bleeding Among Patients Undergoing Percutaneous Coronary Intervention.”

8. EVIDENCE JAMA study associates arterial hyperoxia and mortality after cardiac arrest
A multicenter cohort study in June 2’s Journal of the American Medical Association (JAMA), “Association Between Arterial Hyperoxia Following Resuscitation From Cardiac Arrest and In-Hospital Mortality,” states, “Among patients admitted to the ICU following resuscitation from cardiac arrest, arterial hyperoxia was independently associated with increased in-hospital mortality compared with either hypoxia or normoxia.”

9. EVIDENCE Incidence of S. aureus infection varies significantly with surgery type
Cardiothoracic surgical procedures had a higher risk of bloodstream S. aureus infection than orthopedic, neurosurgical and plastic surgical procedures, “comprising almost three-quarters of the invasive S. aureus infections after these procedures,” while neurosurgical procedures had the highest rate — 80 percent of invasive infections after any of the procedure types — of surgical site infections, states “Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure.” The retrospective study that evaluated 81,267 patients undergoing 96,455 procedures, published in July’s Infection Control & Hospital Epidemiology, recommends targeting the highest-risk procedures for “ongoing preventative interventions” of S. aureus infection.

10. CALL TO ACTION Tell your nursing story in photos
Submit your original photos portraying 21st century nursing to the Center to Champion Nursing in America, Washington, D.C., and contribute to a photo repository that displays nurses across various roles and settings. One winning photograph will appear in an AARP print or Web publication. The submission deadline is June 25.

11. CALL TO ACTION Premier Safety Institute launches injection-practices survey
A short survey from Premier Safety Institute, Washington, D.C., helps identify practices of clinicians who prepare or administer parenteral and injectable medications. Aggregate results will be shared with the Centers for Disease Control and Prevention, Atlanta, the U.S. Food and Drug Administration, Silver Spring, Md. and professional groups to guide research, outreach and education related to reducing risks to patients. The deadline to participate is June 18.

12. CLINICAL PRACTICE RESOURCES
Patient Safety
On June 4, Baxter BioScience, Deerfield, Ill., and the U.S. Food and Drug Administration, Silver Spring, Md., announced a precautionary recall of GammaGard Liquid, Immune Globulin IV (Human) because of an increased number of allergic reaction reports for two product lots.

Evidence
Risk Factors for Surgical Site Infection After Cardiac Surgery in Children” includes pediatric patients less than 1 year old who undergo longer procedures and need more blood transfusions during surgery, states a matched, case-control study in June’s Annals of Thoracic Surgery.

13. AACN RESOURCES
Updated CNS scope and standards
Visit the AACN Online Bookstore to buy the updated “AACN Scope and Standards of Acute and Critical Care Clinical Nurse Specialist Practice.” It includes standards of practice and professional performance, competency criteria and suggestions for implementing the standards in the acute and critical care environment.

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

Healthy Work Environment
Access AACN Healthy Work Environment 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). Developed with VitalSmarts, a provider of corporate training and organizational performance products and services in Provo, Utah, the online tools 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.

Access a recording of the webinar “Assessing the Health of Your Work Environment.” Available on the AACN website, the webinar — a joint venture between AACN and VitalSmarts, Provo, Utah — is of particular interest to users of the AACN Healthy Work Environment Assessment, a Web-based tool that aligns any clinical environment with the six HWE standards. NOTE: Video portion of recording loads slowly.

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