Critical Care Newsline — November 18, 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 18, 2010

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1. NEWS AACN endorses IO vascular access in certain settings
2. NEWS AACN, others appeal NQF-proposed ICU measures
3. EVIDENCE Harmful hyperthermia common after pediatric cardiac arrest
4. EVIDENCE ‘ABCDE bundle’ may reduce ICU delirium
5. CALL TO ACTION Applications open for new Beacon Award for Excellence
6. NEWS PNCB CEO Janet Wyatt transitions to consultant role
7. CALL TO ACTION Nominate colleagues for AACN’s Distinguished Research Lectureship
8. CALL TO ACTION Comment on TJC draft for cardiac arrest performance measures
9. CLINICAL PRACTICE RESOURCES
10. AACN RESOURCES Exceptional nurses. Exceptional bestsellers

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1. NEWS AACN endorses IO vascular access in certain settings
Recognizing that IV use is not always optimal for providing patients with fluids and medications, AACN endorses “Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Healthcare Settings: A Consensus Paper.” The consensus paper in November/December’s Journal of Infusion Nursing proposes IO vascular access as an alternative to peripheral or central IV access in the ICU; on high acuity/progressive care floors; on the general medical floor; in pre-procedure surgical settings where the lack of vascular access may delay surgery; and in chronic and long-term care settings, where patient morbidity or mortality can occur. The paper will appear online Dec. 1 in AACN’s Critical Care Nurse.

2. NEWS AACN, others appeal NQF-proposed ICU measures
On Nov. 3, the Consensus Approval Committee of the National Quality Forum (NQF) Washington, D.C., proposed standardized mortality ratios and length of stay ratios as two new measures of ICU outcomes. Expressing concerns about the recommendations, leaders of the Critical Care Societies Collaborative — which includes AACN, the American College of Chest Physicians, Northbrook, Ill., and the American Thoracic Society, New York — signed an Oct. 20 letter that states, “These measures reflect process of care that are independent of quality and can be easily manipulated.” NQF awaits final decisions on the two measures by its board.

3. EVIDENCE Harmful hyperthermia common after pediatric cardiac arrest
“Temperature Patterns in the Early Postresuscitation Period After Pediatric Inhospital Cardiac Arrest” in November’s Pediatric Critical Care Medicine reports that hyperthermia commonly occurs in the first 24 hours after cardiac arrest. It associates the condition with “unfavorable neurologic outcomes.”

4. EVIDENCE ‘ABCDE bundle’ may reduce ICU delirium
November’s CHEST calls for adoption of an “ABCDE bundle” — Awakening and Breathing Coordination, Delirium monitoring and Exercise/early mobility — to reduce delirium in ICU patients. The evidence-based bundle could help improve “cognitive and functional outcomes for ICU survivors,” concludes “Reducing Iatrogenic Risks: ICU-Acquired Delirium and Weakness — Crossing the Quality Chasm.”

5. CALL TO ACTION Applications open for new Beacon Award for Excellence
Submit applications for the new Beacon Award for Excellence. The program introduces a three-year designation with gold, silver and bronze levels that allows all hospital units to track their journey to excellence. Visit www.aacn.org/beacon for tools and archived webcasts — including the Beacon Award for Excellence Application Handbook and the Beacon Audit Tool — and start validating your unit’s journey.

6. NEWS PNCB CEO Janet Wyatt transitions to consultant role
On Feb. 1, 2011, after 13 years as CEO for the Pediatric Nursing Certification Board (PNCB), Gaithersburg, Md., Janet Wyatt becomes a consultant to the organization and founding executive director to its new Institute of Pediatric Nursing. “Through Jan’s leadership, the PNCB has experienced unprecedented growth and achieved national and international acclaim for its certification and continuing education programs,” says PNCB president Arlene Sperhac. Margaret Harrison, former executive vice president for pediatric nursing programs and chief operating officer, becomes PNCB’s new CEO.

7. CALL TO ACTION Nominate colleagues for AACN’s Distinguished Research Lectureship
Nominate colleagues for the 2012 AACN Distinguished Researcher 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 Comment on TJC draft for cardiac arrest performance measures
Share your thoughts about The Joint Commission’s, Oakbrook Terrace, Ill., Sudden Cardiac Arrest Performance Measures by Dec. 3. A Sudden Cardiac Arrest Initiative panel developed nine measures that include timeliness of first defibrillation attempt and initiation of therapeutic hypothermia.

9. CLINICAL PRACTICE RESOURCES
Patient safety
On Nov. 10, The Joint Commission, Oakbrook Terrace, Ill., announced the launch of its Lending Practice Library, a complimentary tool available only to Joint Commission-accredited or -certified organizations and accessible via the organization’s Joint Commission Connect extranet. The library includes real-life solutions implemented by accredited organizations and a tutorial on how to use the tool. E-mail questions.

Evidence
Hypoglycemia is common in critically ill children and is associated with increased mortality and “worsening organ function” according to a retrospective study of 899 patients without diabetes in November’s Pediatric Critical Care Medicine. “Hypoglycemia may merely be a marker of severity of illness,” states “Relationship Between Hypoglycemia and Mortality in Critically Ill Children,” which concludes that more research is needed “to establish the mortality risk with hypoglycemia due to insulin compared to spontaneous hypoglycemia.”

Surrogate decision-makers prefer to have “significantly more control” over “value-sensitive” decisions, such as discontinuing life support, compared to technical decisions, such as choice of antibiotics, states a study published online Oct. 29 by the American Journal of Respiratory and Critical Care Medicine. “Low trust in physicians is associated with surrogates preferring more control of life-support decisions,” concludes “An Empirical Study of Surrogates’ Preferred Level of Control Over Value-Laden Life Support Decisions in Intensive Care Units.”

10. AACN RESOURCES
Exceptional nurses. Exceptional bestsellers.
Find these and other popular resources at AACN’s Online Bookstore.
Do you take care of kids? www.aacn.org/bestsellers1
Do you need fast facts at your fingertips, pocket cards? www.aacn.org/bestsellers2
Are you a nurse manager or leader? www.aacn.org/bestsellers3
Are you a nurse educator? www.aacn.org/bestsellers4
Getting ready for certification? www.aacn.org/bestsellers5

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
How healthy is your work environment? Find out with AACN’s Healthy Work Environment tools.

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