Critical Care Newsline — October 14, 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.

October 14, 2010

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1. EVIDENCE Study identifies risk factors for PICC-associated DVT
2. CALL TO ACTION Critical Care Canada Forum, Nov. 7-10, Toronto
3. EVIDENCE Study identifies morbidity, mortality risk factors after pneumonectomy
4. EVIDENCE Research supports ‘four faces’ scales for assessing children’s pain
5. EVIDENCE Off-pump bypass surgery reduces stroke risk for most patients
6. NEWS New AJCC physician co-editor named
7. NEWS HCC selects seven hospital-based quality improvement programs
8. NEWS AACN selects 2011 Distinguished Research Lectureship award recipient
9. CALL TO ACTION Submit healthcare IT success stories to HIMSS by Oct. 22
10. CALL TO ACTION Register for the first AONE Nurse Manager Institute webinar
11. CALL TO ACTION CNML Review Course offered in November
12. CALL TO ACTION Apply for AACN’s NIWI scholarship by Nov. 1
13. CLINICAL PRACTICE RESOURCES
14. AACN RESOURCES Locate TJC and CDC protocol icons with new procedure manual

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1. EVIDENCE Study identifies risk factors for PICC-associated DVT
A one-year prospective study in October’s CHEST reports that a history of deep vein thrombosis (DVT) and surgery lasting more than one hour identifies patients at increased risk for peripherally inserted central catheter (PICC)-associated DVT. “Risk of Symptomatic DVT Associated With Peripherally Inserted Central Catheters” says “the best-performing predictive model for DVT” was previous DVT, use of double-lumen 5F or triple-lumen 6F PICCs and prior surgery duration of more than one hour. It concludes, “Rates of PICC-associated DVT may be reduced by improved selection of patients and catheter size.”

2. CALL TO ACTION Critical Care Canada Forum, Nov. 7-10, Toronto
Register for the Critical Care Canada Forum, scheduled for Nov. 7-10 in Toronto. The forum focuses on research and management of critically ill patients. Download the advance program.

3. EVIDENCE Study identifies morbidity, mortality risk factors after pneumonectomy
Predictors of Major Morbidity and Mortality After Pneumonectomy Utilizing the Society for Thoracic Surgeons General Thoracic Surgery Database” in September’s Annals of Thoracic Surgery finds independent predictors of “major adverse outcomes” in patients undergoing pneumonectomy include being male, 65 years or older, having congestive heart failure, forced expiratory volume in one second less than 60 percent of predicted, benign lung disease and extrapleural pneumonectomy, according to the study of 1,267 patients. The rate of major adverse effects was 30 percent, and patients with lung cancer who received “neoadjuvant chemoradiotherapy” had higher risk for major morbidity than those without induction therapy, it states.

4. EVIDENCE Research supports ‘four faces’ scales for assessing children’s pain
A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children” reports psychometric data support for four scales: 1) Faces Pain Scale; 2) Faces Pain Scale-Revised; 3) Oucher Pain Scale and 4) Wong-Baker Faces Pain Rating Scale. The Faces Pain Scale-Revised has been recommended for research use but for clinical use, there are “no grounds to switch from 1 faces scale to another when 1 of the scales is in use,” concludes the review of 127 articles published online Oct. 4 by Pediatrics.

5. EVIDENCE Off-pump bypass surgery reduces stroke risk for most patients
Off-pump coronary artery bypass surgery (OPCAB) “was associated with a significantly lower postoperative stroke rate compared with conventional on-pump CABG CCB even for older and higher risk patients,” finds a study in September’s Annals of Thoracic Surgery. Patients, switched from OPCAB to California Coronary Bypass (CCB) during surgery, experienced the highest postoperative stroke rate, adds “Off-pump Bypass Surgery and Postoperative Stroke: California Coronary Bypass Outcomes Reporting Program.”

6. NEWS New AJCC physician co-editor named
AACN recently appointed Richard H. Savel, as physician co-editor of American Journal of Critical Care — AACN’s official interdisciplinary, evidence-based journal. Savel, medical co-director of the surgical intensive care unit at Montefiore Medical Center, Bronx, N.Y., serves as director of critical care education for the center. Board certified in internal medicine, critical care medicine and neurocritical care, he holds an academic appointment as associate professor of clinical medicine and neurology at Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., where he serves as medical director of its critical care physician assistant residency program.

7. NEWS HCC selects seven hospital-based quality improvement programs
The Hospital Care Collaborative (HCC) — an alliance of six leading professional societies with a shared vision of improving hospital-based patient care — recently took initial steps to identify best practices in quality improvement programs with presentations from seven of the most effective programs in the country. HCC member organizations, including AACN, selected seven hospital team leaders from hundreds of submissions to present their hospital-based quality improvement programs, each employing teams of multiple health professionals.

8. NEWS AACN selects 2011 Distinguished Research Lectureship award recipient
AACN recently selected Marjorie “Marge” Funk, a professor at Yale University School of Nursing, New Haven, Conn., as the 30th recipient of the prestigious Distinguished Research Lectureship award. Established in 1982 and now funded by a grant from Philips Healthcare, Andover, Mass., the award recognizes nurses whose research programs significantly influence high acuity and critical care. Funk’s research focuses on the wise use of technology in the care of critically ill patients with heart disease. She presents her groundbreaking research during AACN’s National Teaching Institute & Critical Care Exposition in Chicago, Saturday, April 30, through Thursday, May 5, 2011.

9. CALL TO ACTION Submit healthcare IT success stories to HIMSS by Oct. 22
Submit success stories that discuss the use of information technology (IT) to improve patient safety for possible inclusion in Stories of Success, sponsored by Healthcare Information and Management Systems Society (HIMSS), Chicago; American Society for Quality, Milwaukee; the National Committee for Quality Assurance, Washington, D.C. and the National Patient Safety Foundation, Boston. The program illustrates how IT helps to fulfill The Joint Commission’s, Oakbrook Terrace, Ill., national patient safety recommendations put forth by the National Priorities Partnership and National Patient Safety Goals. Read past case studies. Submission deadline Oct. 22.

10. CALL TO ACTION Register for the first AONE Nurse Manager Institute webinar
Register for the first Nurse Manager Institute webinar series from the American Organization of Nurse Executives (AONE), Chicago, which takes place Oct. 21 from 11 a.m. to 3 p.m. Topics include How to Manage and Resolve Conflict in a Health Environment; Conversations With Difficult Employees; Finances and the Nurse Manager — Making the Business Case; and Situational Leadership — Matching Your Leadership to the Needs of Your Staff.

11. CALL TO ACTION CNML Review Course offered in November
Join fellow nurse managers and leaders for the CNML Review Course, Monday and Tuesday, Nov. 1-2, at the Hilton Chicago O’Hare Airport. Presented by AACN and the American Organization of Nurse Executives (AONE), the 11-hour course includes case studies and dialogue. AACN and AONE members receive discounted tuition. Learn more or contact cnmlreview@aacn.org.

12. CALL TO ACTION Apply for AACN’s NIWI scholarship by Nov. 1
For the second year, AACN offers scholarships for the Nurse in Washington Internship (NIWI) program — sponsored by the Nursing Organizations Alliance — Sunday, March 13, to Tuesday, March 15, 2011, in Washington, D.C. The three-day internship teaches healthcare professionals how to advance healthcare agendas on local, state and national levels through legislative processes. Applicants must be AACN members and accepted by the NIWI program. The deadline is Nov. 1. Learn more at www.nursing-alliance.org and www.aacn.org/niwi.

13. CLINICAL PRACTICE RESOURCES
Patient safety
On Oct. 8, Abbott Laboratories, Abbott Park, Ill., and the U.S. Food and Drug Administration, Silver Spring, Md., announced voluntary withdrawal of Meridia (sibutramine) — an obesity drug — because data from the Sibutramine Cardiovascular Outcomes Trial indicated an increased risk of heart attack and stroke.

ICU staff estimates of patient weight are often inaccurate, but estimations of height are usually “adequate,” finds a prospective study in September’s Anaesthesia and Intensive Care. “Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution,” states “Accuracy of Weight and Height Estimation in an Intensive Care Unit.”

Evidence
“Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies,” according to the Aug. 15 American Journal of Respiratory and Critical Care Medicine. Rising costs of chronic critical illness in the U.S. exceed $20 billion, states “Chronic Critical Illness,” which suggests defining chronic critical illness, advocating for the creation of a research network that encompasses a broad range of venues for care and highlighting areas for future study of the comparative effectiveness of different treatment venues and approaches.”

September’s Critical Care Medicine contains “Difficulties in Managing the Surgical Patient Who Is Morbidly Obese,” which discusses sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections and other complications for critically ill patients who are morbidly obese.

Resource
Access flu vaccine information from the Centers for Disease Control and Prevention, Atlanta.

14. AACN RESOURCES
Locate TJC and CDC protocol icons with new procedure manual
Access updated advanced-practice scope and standards and locate protocol icons for The Joint Commission, Oakbrook Terrace, Ill., and the Centers for Disease Control and Prevention, Atlanta in the 6th edition of the “AACN Procedure Manual for Critical Care.” Written by critical care nursing experts, this new compendium documents reference and evidence levels for practice procedures. AACN members receive a discount for this critical care go-to guide available on the AACN Online Bookstore.

Top-selling mobile pocket cards, 30 percent off
Buy six top-selling pocket cards for your iPhone or iPod Touch at a 30 percent discount at AACN’s Mobile Resource Center. These mobile pocket cards provide a ready reference at the point of care and include Cardiac Medications Pocket Reference, Cardiovascular Assessment Pocket Reference, Hemodynamic Management Pocket Reference, Laboratory Values Pocket Reference, Patient/Family Guide Conference Pocket Reference and Sepsis Management Pocket Reference. Offer ends Oct. 31.

Learn at home with E-Learning
Develop your clinical knowledge, anytime, anywhere, with the three AACN E-Learning courses, available for individual purchase. “The Preceptor Challenge” and the award-winning “Promoting Excellence in Palliative & End-of-Life Care” feature simulations of real-life experiences. “Essentials of Nurse Manager Orientation” helps new and experienced managers expand their management competencies. More information and pricing.

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