Critical Care Newsline — March 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.

March 11, 2010

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1. NEWS ECRI offers free, Web-based resources to improve communication, patient safety
2. EVIDENCE Tight glycemic control fails to prevent death, infections in ICU patients
3. NEWS AHRQ to publish evidence-based report for healthcare decision-making
4. EVIDENCE No mortality difference between dopamine, norephinephrine, NEJM reports
5. EVIDENCE New tool helps to predict infections after pediatric cardiac surgery
6. EVIDENCE VNS valid, reliable tool to gauge acute pediatric pain
7. EVIDENCE Resuscitation journal identifies ways to monitor patient deterioration
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES NTI certification exam deadline is April 7

1. NEWS ECRI offers free, Web-based resources to improve communication, patient safety
In honor of National Patient Safety Awareness Week, March 7-13, ECRI Institute, a nonprofit dedicated to improving patient care, makes available free, online resources to guide communications in healthcare settings and improve patient care. ECRI cites communication “as the root cause in nearly 70 percent of reported sentinel events, surpassing other commonly identified issues such as staff orientation and training, patient assessment and staffing.”

2. EVIDENCE Tight glycemic control fails to prevent death, infections in ICU patients
No evidence supports use of intensive insulin therapy among patients in general medical-surgical ICUs who are fed according to current guidelines, states “Toward Understanding Tight Glycemic Control in the ICU: A Systematic Review and Metaanalysis.” The recent CHEST study associates tight glycemic control with a high incidence of hypoglycemia and increased mortality in patients who don’t receive parenteral nutrition. Tight glycemic control failed to reduce 28-day mortality rates or bloodstream infections among the 11,425 patients studied in the prospective randomized clinical trials, the abstract states.

3. NEWS AHRQ to publish evidence-based report for healthcare decision-making
The Agency for Healthcare Research and Quality, Rockville, Md., plans to release an evidence-based report that addresses four key questions about clinical decision support systems. “Enabling Healthcare Decisionmaking through Clinical Decision Support and Knowledge Management” is scheduled for release in late 2010.

4. EVIDENCE No mortality difference between dopamine, norephinephrine, NEJM reports
The March 4 New England Journal of Medicine reports no significant difference in mortality rates for patients with shock at 28 days between dopamine as a first-line vasopressor agent and norephinephrine. “Comparison of Dopamine and Norepinephrine in the Treatment of Shock” — a trial that included 1,679 patients, 858 of whom received dopamine and 821 norephinephrine — associates dopamine with “a greater number of adverse events.”

5. EVIDENCE New tool helps predict infections after pediatric cardiac surgery
March’s Annals of Thoracic Surgery reports that a new bedside model helps to predict major infections after pediatric cardiac surgery in a study of 30,078 children from 48 centers. Children at risk of infection may be studied in future clinical trials to develop targeted interventions, states the abstract of “Major Infection After Pediatric Surgery: A Risk Estimation Model.”

6. EVIDENCE VNS valid, reliable tool to gauge acute pediatric pain
An in-press study of 202 children published online Feb. 26 in PAIN calls the verbal numeric scale (VNS) valid and reliable for evaluating acute pain in children, 8-17 years old, but not interchangeable with the Visual Analogue Scale. Read the abstract of “Validation and properties of the verbal numeric scale in children with acute pain.

7. EVIDENCE Resuscitation journal identifies ways to monitor patient deterioration
Identifying the hospitalised patient in crisis – A consensus conference on the afferent limb of Rapid Response Systems,” published online Feb. 9 in Resuscitation, answers questions about the best ways to use monitoring systems to detect patient deterioration. Vital sign abnormalities predict risk, and “monitoring patients more effectively may improve outcome,” the abstract states.

8. CLINICAL PRACTICE RESOURCES

Patient Safety
The U.S. Food and Drug Administration (FDA), Silver Spring, Md., reports that LifeScan, Inc., Milpitas, Calif., initiated a voluntary recall of eight lots of OneTouch SureStep Test Strips, which may give false low results for glucose levels higher than 400 mg/dL. Read more in the announcement, issued Feb. 26.

Evidence
Save Our Skin” — a comprehensive program at OSF Saint Francis Medical Center, Peoria, Ill. — reduces pressure ulcers from 9 to 2 percent and saves an estimated $3 million annually. Key elements of the program include “upgrading mattresses, clarifying staff roles and protocols and improving measurement and communication of pressure ulcer performance data.”

A comprehensive skin care program at Georgia’s Children’s Healthcare of Atlanta reduced by 59 percent the number of ICU pressure ulcers. Education, use of the pediatric Braden scale and early preventive therapy represent major program elements.

Guidelines
Men should discuss the benefits and risks of prostate screening with healthcare providers according to guidelines from the American Cancer Society, Atlanta.

Resource
The board of directors for the National Association of Clinical Nurse Specialists, Harrisburg, Pa., approved “Clinical Nurse Specialists — Practitioners Contributing to Primary Care.”


9. AACN RESOURCES
Certification exam deadline is April 7
AACN will offer all certification exams at the 2010 National Teaching Institute & Critical Care Exposition, Washington, D.C., Monday, May 17. Nurses must use a special NTI application to preregister for the exam. AACN must receive exam fee payment and the completed NTI exam application postmarked no later than Wednesday, April 7.

E-learning
AACN now 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.” 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. 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.

AACN’s ‘Response to Haiti Earthquake’ Web Page
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 and global relief organizations providing volunteer and financial support.

Healthy Work Environment
Access the new 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). 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.

CORRECTION: Previous issues of Critical Care Newsline mistakenly reported the single-user prices for “The Preceptor Challenge” and “Promoting Excellence in Palliative & End-of-Life Care,” available at the AACN Learn Center. “The Preceptor Challenge” costs $100 and “Promoting Excellence in Palliative & End-of-Life Care” costs $50. AACN regrets the error.
 

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