Critical Care Newsline — November 11, 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.

November 11, 2010

1. NEWS New AJCC co-editor says nurses are essential to advance critical care
2. NEWS Applications open for new Beacon Award for Excellence
3. HAPPY VETERANS DAY ‘Let’s Get Certified’
4. RESOURCE Key recommendations of new PALS guidelines
5. EVIDENCE Same admission nonurgent cardiac cath and surgery increase risks of AKI
6. EVIDENCE PCS viable for mechanically ventilated patients
7. CALL TO ACTION Nominations open for AACN’s Distinguished Research Lectureship
8. CALL TO ACTION TJC welcomes activities to improve safety
9. CALL TO ACTION Submit examples of safety activities to TJC
10. CALL TO ACTION Survey relates perceived empowerment to moral distress
12. AACN RESOURCES Exceptional nurses. Exceptional bestsellers.
13. JOIN THE DISCUSSION Is your unit too noisy? Why more ICU deaths on weekends?

1. NEWS New AJCC co-editor says nurses are essential to advance critical care
In his first editorial as physician co-editor of AACN’s American Journal of Critical Care, Dr. Richard Savel, says, “Nurses’ involvement in and contributions to the critical care literature are paramount if our field is to advance as a whole.” He shares his passion for “helping ICU teams become great” in “The Multidisciplinary Nature of Critical Care: Living the Dream.” Are you part of a great multidisciplinary team? Comment on Facebook.

2. NEWS Applications open for new Beacon Award for Excellence
AACN is now accepting applications for the new Beacon Award for Excellence. The program introduces a three-year designation with gold, silver and bronze levels that allow all hospital units to track their journey to excellence. Visit the Beacon Award for Excellence website for tools and archived webcasts — including the Beacon Award for Excellence Application Handbook and Beacon Audit Tool — to start validating your unit’s journey.

3. HAPPY VETERANS DAY ‘Let’s Get Certified’
U.S. Department of Veterans Affairs (VA) nurses receive AACN discounts on exams, membership, review courses and recognition products as part of the VA’s “Let’s Get Certified Campaign.” U.S. Department of Defense nurses in the U.S. Army, Navy, Air Force and Public Health Corps qualify. The campaign — now in Phase III — started on June 1, 2008 and lasts through May 31, 2011. Access discounts.

4. RESOURCE Key recommendations of new PALS guidelines
New pediatric advance life support (PALS) guidelines recommend: defibrillating initially at 2 to 4 J/kg for ventricular fibrillation or pulseless ventricular tachycardia; monitoring capnography/capnometry to confirm proper endotracheal tube placement; titrating oxygen delivery levels down once circulation has been restored; and compressing at least one third of the anterior-posterior dimension of the chest. Review these and other recommendations in “Part 10: Pediatric Basic and Advanced Life Support.”

5. EVIDENCE Same admission nonurgent cardiac cath and surgery increase risks of AKI
Patients who have cardiac catheterization and nonurgent cardiac surgery in the same hospital stay are more likely to develop acute kidney injury (AKI), according to November's Annals of Thoracic Surgery. “Same Admission Cardiac Catheterization and Cardiac surgery: Is There an Increased Incidence of Acute Kidney Injury?” recommends discharging patients after catheterization and readmitting them for surgery because “such an approach might reduce the risk of AKI.”

6. EVIDENCE PCS viable for mechanically ventilated patients
“Patient-Controlled Sedation (PCS): A Novel Approach to Sedation Management for Mechanically Ventilated Patients” reports patients and nurses were satisfied with PCS as a method of sedation, although one quarter of patients had mild negative physiological effects. “PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients,” concludes the pilot study in November’s CHEST.

7. CALL TO ACTION Nominations open for AACN’s Distinguished Research Lectureship
Nominate colleagues for the 2010 AACN Distinguished Research Lectureship by Dec. 1. Eligible nominees are nationally known researchers who have made significant contributions to acute and critical care nursing through research.

8. CALL TO ACTION TJC opens comments on draft for cardiac arrest performance measures
Comment on The Joint Commission’s (TJC’s), Oakbrook Terrace, Ill., Sudden Cardiac Arrest Performance Measures by Dec. 3. A Sudden Cardiac Arrest Initiative panel developed the nine measures, which include timeliness of first defibrillation attempt and initiation of therapeutic hypothermia.

9. CALL TO ACTION TJC welcomes activities to improve safety
Submit your organization’s examples of effective safety-related activities to improve processes and outcomes for both patients and health care workers to The Joint Commission (TJC), Oakbrook Terrace, Ill. The National Occupational Research Agenda Healthcare and Social Assistance Sector Council, sponsored by the National Institute of Occupational Safety and Health, Washington, D.C., will select processes for discussion at an upcoming invitational roundtable meeting and inclusion in a free educational monograph.

10. CALL TO ACTION Survey relates perceived empowerment to moral distress
Complete a survey about the relationship between perceived empowerment and its relationship to moral distress among critical care nurses who care for adults at the end of life. AACN calls moral distress a “serious problem in nursing.” It occurs when, “You know the ethically appropriate action to take, but are unable to act upon it,” or, “You act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.”

Patient safety
On Nov. 4, the U.S. Food and Drug Administration, Silver Spring, Md., announced a recall of Symbiq One-Channel and Two-Channel Infusers, manufactured by Hospira, Lake Forest, Ill., because of “motor encoder failures” that cause the infusers to stop operating.

November’s American Journal of Critical Care contains two evidence-based articles related to patient safety:

“Sound Intensity and Noise Evaluation in a Critical Care Unit” reports that increasing the output level of an alarm in a patient’s room doesn’t necessarily make the alarm audible in an adjacent room. The study also found high peak ambient noise during both day and night.

Among “Strategies Used by Critical Care Nurses to Identify, Interrupt, and Correct Medical Errors” are ways to identify errors. For example, double-checking; interrupting errors, including offering assistance; and correcting errors, such as involving another nurse or physician. “These results reflect the pivotal role that critical care nurses play in the recovery of medical errors and ensuring patient safety,” concludes the study of 20 nurses from five critical care units.

Pediatric ICU nurses believe language barriers and parental discomfort in withholding or withdrawing mechanical ventilation are the two greatest obstacles to end-of-life care for children, according to November’s American Journal of Critical Care. The most supportive behavior is allowing family members to have time alone with the child after death, states “Pediatric Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care.”

“The Epidemiology of Pain During the Last 2 Years of Life” found more than one quarter of older adults have pain during this time, with pain prevalence increasing in the last four months of life. “Arthritis is strongly associated with pain at the end of life,” states the observational study of 4,703 adults in Nov. 2’s Annals of Internal Medicine.

A fall prevention tool kit with software that tailors intervention to specific patient risks “significantly reduced” the rate of falls according to Nov. 3’s Journal of the American Medical Association. “Fall Prevention in Acute Care Hospitals” found the tool kit to be “particularly effective” with patients 65 years or older.

The number of hospital admissions for medication and illicit drug-related conditions doubled between 1997 and 2008 among Americans ages 45 and older according to a new report, “HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008,” from the Agency for Healthcare Research and Quality, Rockville, Md. Three types of conditions drove the increase in discharges: drug-induced delirium; “poisoning” or overdose from codeine, meperidine and other opiate-based pain drugs; and withdrawal from narcotic or non-narcotic drugs.

Access the “VTE [venous thromboembolism] Toolkit: A Guide for Health Care Professionals” from the Venous Disease Coalition, Lakewood, Colo. Free registration required.

Exceptional nurses. Exceptional bestsellers.
Find these and more popular resources at AACN’s Online Bookstore.

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New procedure manual is ‘gold standard’
Access comprehensive information — illustrations, special considerations and icons for Joint Commission and Centers for Disease Control protocols — for 139 procedures in the 6th edition of the “AACN Procedure Manual for Critical Care.” Written by critical care nursing experts, the new compendium documents rationales, evidence levels and expected outcomes. The comprehensive, easy-to-use manual is the “gold standard for proper technique and procedure for critical care nursing skills” according to a review on AACN members receive a discount for this critical care go-to guide available at the AACN Online Bookstore.

Access E-Learning programs
Learn at your own pace with AACN’s E-Learning courses that let you access material from any computer with broadband Web access. “The Preceptor Challenge” and the award-winning “Promoting Excellence in Palliative & End-of-Life Care” feature realistic, interactive scenarios. “Essentials of Nurse Manager Orientation” covers business management skills, leadership skills, and professional development for aspiring and experienced managers. More information and pricing.

Stand Tall in November’s AACN Bold Voices
“Show me the evidence.” — Kristine Peterson, AACN President 2010-2011

Healthy Work Environment
Access AACN’s Healthy Work Environment tools.

• Is your unit too noisy? How does your hospital approach noise abatement?
• Why more ICU deaths on weekends? What is it about being admitted to an ICU during a weekend that increases the mortality rate among patients?

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