Critical Care Newsline — May 27, 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 websites that will keep you informed on issues affecting nurses and the nursing profession.

May 27, 2010

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1. NEWS AACN President-Elect Kristine Peterson asks members to ‘Stand Tall’
2. CALL FOR ABSTRACTS Submit abstracts by June 1 for the 2011 NTI/API
3. CALL TO ACTION Submit evaluation forms for CNE and CERP credit by June 4
4. CALL TO ACTION Share your thoughts about AACN’s quest for excellence
5. CALL TO ACTION Sample all catheter lumens to check for CRBSI, study suggests
6. EVIDENCE U.S. hospitals fall short in VTE prophylaxis
7. CALL TO ACTION Participate in survey of hand-offs between CRNAs and SICU nurses
8. CALL TO ACTION Premier Safety Institute launches survey of injection practices
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES AACN Protocols for Practice price reductions
1. NEWS AACN President-Elect Kristine Peterson asks members to ‘Stand Tall’

On May 19, AACN President-Elect Kristine Peterson, clinical nurse specialist at Aspirus Wausau Hospital, Wausau, Wis., announced the 2010-2011 theme, “Stand Tall,” at AACN’s 2010 National Teaching Institute & Critical Care Exposition (NTI). “Let’s be proud of what we do,” Peterson said. “Let’s speak up as individuals and as a community because when we do things together, we can do a lot more.” AACN President Beth Hammer passed the vision to Peterson, who becomes AACN President in the new fiscal year starting July 1. This year’s NTI, Washington, D.C., May 15-20, hosted more than 7,500 nurse attendees.

2. CALL FOR ABSTRACTS Submit abstracts by June 1 for the 2011 NTI/API
The 2011 National Teaching Institute & Critical Care Exposition (NTI), including the Advanced Practice Institute (API), seeks speaker abstracts. NTI/API features the latest advances in research practice, technology and healthcare delivery and offers six full days of learning opportunities and collaborative exchange. Read submission guidelines.

3. CALL TO ACTION Submit evaluation forms for CNE and CERP credit by June 4
If you attended this year’s National Teaching Institute & Critical Care Exposition (NTI), submit evaluation forms online for CNE and CERP by June 4. “After that, AACN will make the certificate available for print only,” says clinical practice specialist Rose Faber. Submit your forms online.

4. CALL TO ACTION Share your thoughts about AACN’s quest for excellence
The Annual Membership Forum at the National Teaching Institute & Critical Care Exposition, which joins audience members with board members in focused discussions about AACN, explored three questions: 1) What is the most innovative practice you've seen recently? 2) What can we, as 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 greatest cause for optimism in the current environment? Respond to these questions at info@aacn.org or at NTI Voices Online.

5. CALL TO ACTION Sample all catheter lumens to check for CRBSI, study suggests
A retrospective study, published May 10 online by Clinical Infectious Diseases, recommends drawing blood cultures from all catheter lumens to determine catheter-related bloodstream infection (CRBSI). Eliminating two cultures for triple lumen catheters would have resulted in 37.3 percent missed CRBSIs, states “How Many Lumens Should Be Cultured in the Conservative Diagnosis of Catheter-Related Bloodstream Infections?

6. EVIDENCE U.S. hospitals fall short in VTE prophylaxis
The rate of using heparin or compression devices to prevent venous thromboembolism (VTE) is “substantially below” The Joint Commission’s recommendations, states “Venous Thromboembolism Prophylaxis among Medical Patients at US Hospitals,” a retrospective cohort study of 351,535 patients with moderate to high risk for VTE published in June’s Journal of General Internal Medicine.

7. CALL TO ACTION Participate in survey of hand-offs between CRNAs and SICU nurses
Nurses in the nurse anesthesia program at Georgetown University, Washington, D.C., ask nurses with surgical intensive care unit (SICU) or combined medical and surgical ICU experience to participate in a short survey a bout the hand-off process between certified registered nurse anesthetist (CRNA) and SICU nurses. The deadline to participate is June 4.

8. CALL TO ACTION Premier Safety Institute launches survey of injection practices
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.

9. CLINICAL PRACTICE RESOURCES
Patient Safety
May’s Nurse Advise-ERR, published by the Institute for Safe Medication Practices, Horsham, Pa., provides strategies to prevent borrowing or loaning medications between patients, clarifies the correct way to measure liquids in oral syringes and reminds nurses not to withdraw insulin from insulin pen cartridges.

On May 12, the U.S. Food and Drug Administration (FDA), Silver Spring, Md., and GlaxoSmithKline, Collegeville, Pa., notified healthcare professionals that Promacta (eltrombopag) is not indicated for treating thrombocytopenia in patients with chronic liver disease. The action stemmed from the ELEVATE study, which was terminated after “the identification of an imbalance of thrombosis of the portal venous system in the patients treated with eltrombopag versus matching placebo,” the announcement states.

On May 17, Sagent Pharmaceuticals, Inc., Schaumburg, Ill., voluntarily recalled all lots of the IV antibiotic metroniadazole injection, USP 500 mg/100 mL, manufactured by Claris Lifesciences Inc., North Brunswick, N.J., and distributed by Sagent between Feb. 18 and May 4, because “of the discovery of non-sterility in two lots of metroniadazole injection,” the announcement states.

Evidence
June’s Current Opinion in Critical Care contains two review articles regarding cardiopulmonary monitoring. “Coupling Microcirculation to Systemic Hemodynamics” says “Microvascular alterations frequently occur in critically ill patients and these may be implicated in the development of organ failure and are associated with poor outcome.” The abstract for the second article, “Evolving Approaches to Assessing and Monitoring Patient Ventilator Interactions,” suggests monitoring diaphragmatic electrical activity “comes closest to representing the ideal in ventilator monitoring.”

Guidelines
American Journal of Respiratory and Critical Care Medicine, May 15, contains a report from a consensus conference on acute renal failure in the ICU patient, which included the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, the Society of Critical Care Medicine and the Société de Réanimation de Langue Française. Conclusions include new definitions, the importance of adequate volume repletion to prevent renal failure and use of crystalloids for fluid resuscitation. “Careful management is essential for improving outcome,” states “An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient.
http://ajrccm.atsjournals.org/cgi/content/abstract/181/10/1128
Download a revised comparison of guidelines for managing obstructive sleep apnea from the American Academy of Sleep Medicine, Westchester, Ill., and the Institute for Clinical Systems Improvement, Bloomington, Minn., from the National Guideline Clearinghouse.

Resource
Taking Care of Myself: A Guide for When I Leave the Hospital,” developed by the Agency for Healthcare Research and Quality, Rockville, Md., provides a method for patients to track their medications, upcoming medical appointments, and important phone numbers.

10. AACN RESOURCES
AACN Protocol for Practice price reductions
Visit the AACN Online bookstore to buy AACN Protocols for Practice resources at reduced prices. The list includes “Palliative Care and End-of-Life Issues in Critical Care,” “Non-Invasive Monitoring, 2nd Ed.,” “Creating Healing Environments, 2nd Ed.,” “Care of the Mechanically Ventilated Patient, 2nd Ed.” and “Monitoring Technologies in Critically Ill Neuroscience Patients.”

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 Environment (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 Web site, 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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