Critical Care Newsline — November 4, 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 4, 2010

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1. NEWS Applications open for new Beacon Award for Excellence
2. NEWS Certification linked to higher workforce empowerment
3. CALL TO ACTION Submit abstract to SHEA by Nov. 7
4. RESOURCE Key recommendations in new ALS guidelines
5. EVIDENCE Effects of severe sepsis in older patients
6. EVIDENCE Pediatric CAM-ICU effective in diagnosing delirium
7. JOIN THE DISCUSSIONS on Facebook
8. NEWS Free scientific meeting on acetaminophen-related liver injury set for Nov. 10
9. CALL TO ACTION Participate in survey about perceived empowerment, moral distress
10. CALL TO ACTION Comment on FAA’s proposed safety rules for air ambulances
11. CALL TO ACTION Join new Nurses’ Health Study
12. CLINICAL PRACTICE RESOURCES
13. AACN RESOURCES New procedure manual is critical care go-to guide
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1. NEWS Applications open for new Beacon Award for Excellence
On Monday, Nov. 1, AACN began accepting 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 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.

2. NEWS Certification linked to higher workforce empowerment
Units with more certified nurses reported higher overall workplace empowerment according to a survey of 866 nurses from 25 ICUs in November’s AACN American Journal of Critical Care. Although the survey finds no significant relationship between certification and patient outcomes, “the association between workplace empowerment and the proportion of certified nurses on a unit underscores the importance of organizational factors in the promotion of nursing certification,” concludes “Nursing Specialty Certification and Nursing-Sensitive Patient Outcomes in the Intensive Care Unit.”

3. CALL TO ACTION Submit abstract to SHEA by Nov. 7
Submit an abstract for The Society for Healthcare Epidemiology of America’s (SHEA’s) Annual Scientific Meeting, by Sunday, Nov. 7. The meeting — which takes place Friday, April 1 to Monday, April 4, 2011 at the Hilton Anatole, Dallas — will include current research, evidence and advances in healthcare epidemiology and infection prevention.

4. RESOURCE Key recommendations in new ALS guidelines
New advanced life support (ALS) guidelines recommend (1) using continual capnography to confirm and monitor tracheal tube placement; (2) treating blood glucose values higher than 180 mg/dL; (3) considering therapeutic hypothermia for comatose survivors of cardiac arrest associated with nonshockable rhythms; and (4) considering organ donation for adults who experience brain death. “Many of the accepted predictors of poor outcome in comatose survivors of cardiac arrest are unreliable, especially if the patient has been treated with therapeutic hypothermia,” states “Part 8: Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.”

5. EVIDENCE Effects of severe sepsis in older patients
Oct. 27’s Journal of the American Medical Association reports that new cognitive impairment and functional disability increase in older patients who survive severe sepsis, with declines persisting for “at least” eight years. “The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients’ ability to live independently,” concludes “Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis,” a prospective, cohort study of 1,194 patients.

6. EVIDENCE Pediatric CAM-ICU effective in diagnosing delirium
A study of 68 children published online Oct. 14 by Critical Care Medicine calls pCAM-ICU a “highly reliable and valid instrument” for diagnosing delirium in children at least 5 years old. Use of this method “may facilitate earlier diagnosis of delirium and referral to psychiatric specialists,” states “Diagnosing Delirium in Critically Ill Children: Validity and Reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU).”

7. JOIN THE DISCUSSIONS on Facebook
• How does your hospital retain experienced nurses?
• Are you part of a great multidisciplinary team?
• Why relate the “doing” of nursing care to evidence and science?

8. NEWS Free scientific meeting on acetaminophen-related liver injury set for Nov. 10
The American Pain Foundation, Baltimore, opened registration for its free scientific meeting, “Seeking Solutions: Advancing Our Understanding of the Safe Use of Acetaminophen,” which takes place Wednesday, Nov. 10 in Bethesda, Md. Topics include how to reduce morbidity and mortality of liver injury caused by acetaminophen.

9. CALL TO ACTION Participate in survey about perceived empowerment, moral distress
Complete a survey about the relationship between perceived empowerment and moral distress in critical care nursing staff who care for adults at the end of life. AACN defines moral distress as discomfort or internal conflict related to ethical dilemmas when constraints prevent one from following the course of action one believes to be right.

10. CALL TO ACTION Comment on FAA’s proposed safety rules for air ambulances
Comment on the new safety rules for air ambulances, which the Federal Aviation Administration (FAA), Washington, D.C., proposes by Jan. 10, 2011. The new rules would “require stricter flight rules and procedures, improved communications and training, and additional on-board safety equipment,” the FAA states. Send comments online.

11. CALL TO ACTION Join new Nurses’ Health Study
Join Nurses’ Health Study (NHS) III, a new study designed to learn about how women’s lifestyles, including exercise, diet and birth control, during their 20s, 30s and 40s, can influence health throughout their lives. NHS III builds on the two previous Nurses’ Health Studies that show lifestyle factors “can powerfully promote better health,” NHS states.

12. CLINICAL PRACTICE RESOURCES
Patient safety
On Oct. 19, the U.S. Food and Drug Administration (FDA), Silver Spring, Md., approved Pradaxa capsules (dabigatran etexillate), manufactured by Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Conn., for the prevention of stroke and blood clots in patients with atrial fibrillation. Unlike warfarin, Pradaxa doesn’t require periodic blood tests to monitor anticoagulation for dose adjustments.

On Oct. 22, the FDA announced a recall of Fentanyl Transdermal System 25 mcg/h, a product of Actavis Inc., Morristown, N.J., because laboratory testing showed one patch released its active ingredient faster than the approved specification, which could cause adverse effects such as respiratory depression.

On Oct. 23, the FDA announced a recall of Hyland’s Teething Tablets, a product of Standard Homeopathic Co., Los Angeles, because the tablets contain inconsistent amounts of belladonna, which can cause adverse effects in larger doses.

Evidence
Quality training, good communication between clinicians and families, and interdisciplinary team collaboration support quality end-of-life decision making and help clinicians avoid current “substantial” regional variations in how ethical decisions are made, according to Oct. 16’s The Lancet. High-quality decision making can also improve patient and family outcomes and staff retention, states “Ethics and End-of-Life Care for Adults in the Intensive Care Unit.”

Resources
Access the Web-based, interactive Hospital Surge Model, from the Agency for Healthcare Research and Quality, Rockville, Md., which helps hospitals and emergency planners estimate resources needed to treat casualties from 13 scenarios of biological incidents and attacks that range from pandemic influenza to a nuclear explosion.

Access the Toolkit for Making Written Material Clear and Effective, a health literacy resource from the Centers for Medicare & Medicaid Services, Baltimore.

13. AACN RESOURCES
New procedure manual is critical care go-to guide
Access comprehensive information — including evidence-based steps, rationales, special considerations, expected and unexpected outcomes and updated references — for hundreds of procedures in the 6th edition of the “AACN Procedure Manual for Critical Care.” Written by critical care nursing experts, the new edition features 139 entries, starting with Combitube Insertion and Removal and ending with Calculating Medication Doses. The comprehensive, clear, easy-to-use book is the “gold standard for proper technique and procedure for critical care nursing skills,” according to a review on Amazon.com. 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 tools that let you access course 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
“Together we can do more.” — Kristine Peterson, AACN President 2010-2011

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

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