Critical Care Newsline — October 28, 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 28, 2010

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1. NEWS Redesigned AJCC and CCN sites launch in November
2. NEWS AACN adds bold voice to hospital leaders calling for medication reconciliation
3. RESOURCE Executive summary of new BLS/ACLS guidelines
4. NEWS AACN endorses Adult-Gerontology CNS Competencies
5. NEWS Free scientific meeting on acetaminophen-related liver injury set for Nov. 10
6. EVIDENCE Nurses need more support, knowledge to provide EOL care
7. EVIDENCE Most high-risk ICU patients have unrelieved and distressing symptoms
8. EVIDENCE Early physical and occupational therapy feasible for ventilator patients
9. PATIENT SAFETY TJC releases hand-off communication solutions
10. CALL TO ACTION Deadline alert: Apply for AACN’s NIWI scholarship by Nov. 1
11. CALL TO ACTION Participate in survey about perceived empowerment, moral distress
12. CALL TO ACTION Complete survey on LGBT patient and family care by Dec. 31
13. CALL TO ACTION Comment on FAA’s proposed safety rules for air ambulances
14. CALL TO ACTION Join new Nurses’ Health Study
15. CLINICAL PRACTICE RESOURCES
16. AACN RESOURCES Order mobile pocket cards while discount lasts

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1. NEWS Redesigned AJCC and CCN sites launch in November
Expect to see newly designed websites for the American Journal of Critical Care (AJCC) and Critical Care Nurse (CCN) in November that improve online functionality and add to membership value. New features include mouse-over citations to pop-up abstracts so you can read articles with less clicking. Both sites feature online-only resources, including rankings of most read and cited articles. The AJCC site features OnlineNOW articles, which are full-text online-only articles, whose abstracts appear in the corresponding print issue.

2. NEWS AACN adds bold voice to hospital leaders calling for medication reconciliation
AACN added its bold voice to hospital healthcare leaders by endorsing a pivotal white paper. “Making Inpatient Medication Reconciliation Patient Centered, Clinically Relevant and Implementable: A Consensus Statement on Key Principles and Necessary First Steps” appears in October’s Journal of Hospital Medicine. Among the organizations endorsing the white paper outlining 10 key areas to progress medication reconciliation: the American Academy of Pediatrics, Elk Grove Village, Ill.; Consumers Advancing Patient Safety, Chicago; Institute for Healthcare Improvement, Cambridge, Mass.; Institute for Safe Medication Practices, Horsham, Pa.; and The Joint Commission, Oakbrook Terrace, Ill.

3. RESOURCE Executive summary of new BLS/ACLS guidelines
Access “Executive Summary: 2010 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations,” which recommends reordering the CPR steps so compressions come first and eliminating atropine as a treatment for pulseless electrical activity.

4. NEWS AACN endorses Adult-Gerontology CNS Competencies
AACN recently endorsed “Adult-Gerontology Clinical Nurse Specialist Competencies,” developed by the American Association of Colleges of Nursing, Washington, D.C., with the Hartford Institute for Geriatric Nursing at New York University, New York, and National Association of Clinical Nurse Specialists, Philadelphia. Focused on the unique practice knowledge, skills and attitudes of adult gerontology, it builds on graduate, APRN and national CNS core competencies.

5. 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 Nov. 10 in Bethesda, Md. Topics include how to reduce morbidity and mortality of liver injury caused by acetaminophen.

6. EVIDENCE Nurses need more support, knowledge to provide EOL care
Critical Care Nurses’ Perceptions of Obstacles, Supports, and Knowledge Needed in Providing Quality End-of-Life (EOL) Care” concludes: 1) “families and patients need clear, direct, and consistent information to make EOL decisions;” 2) “physician-related issues affect nurses’ ability to provide quality EOL care;” 3) “nurses need more knowledge, skill, and a sense of cultural competency to provide quality care;” and 4) “having properly completed advance directives can reduce confusion about the goals of care.” This survey of AACN members in November/December’s Dimensions of Critical Care Nursing also urges nurses to advocate for the integration of palliative and critical care to improve EOL.

7. EVIDENCE Most high-risk ICU patients have unrelieved and distressing symptoms
Symptoms Experienced by Intensive Care Unit Patients at High Risk of Dying” include delirium, fatigue, thirst, fear, pain, confusion and shortness of breath. Most ICU patients have “unrelieved and distressing symptoms” according to a study of 171 patients in November’s Critical Care Medicine, which concludes “symptom assessment in high-risk intensive care unit patients may lead to more focused interventions to avoid or minimize unnecessary suffering.”

8. EVIDENCE Early physical and occupational therapy feasible for ventilator patients
November’s Critical Care Medicine reports physical and occupational therapy for medical ICU patients is “feasible” from the start of mechanical ventilation. “Adverse events are uncommon, even in this high-risk group,” concludes “Feasibility of Physical and Occupational Therapy Beginning From Initiation of Mechanical Ventilation.”

9. PATIENT SAFETY TJC releases hand-off communication solutions
On Oct. 21, The Joint Commission (TJC) Center for Transforming Healthcare, Oakbrook Terrace, Ill., released solutions that improve hand-off communications, including standardized forms, tools and methods, and creating a quiet workspace for sharing patient information. Ten leading hospitals teamed with the center to develop solutions for barriers to effective hand-offs.

10. CALL TO ACTION Deadline alert: 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, which takes place 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.

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

12. CALL TO ACTION Complete survey on LGBT patient and family care by Dec. 31
The Joint Commission (TJC), Oakbrook Terrace, Ill., invites organizations to complete the Human Rights Campaign Healthcare Equality Index 2010 Survey — a self-assessment tool for measuring compliance with best practices related to lesbian, gay, bisexual and transgender (LGBT) patients and families. The Human Rights Campaign, Washington, D.C., recognizes top-performing facilities and awards a logo for use in advertising and marketing. If you are authorized to represent your employer, e-mail HEI@hrc.org to obtain your facility’s unique username and password for the survey. If you aren’t authorized, e-mail the name, position, e-mail and mailing address of the appropriate contact, typically human resources, diversity, staffing, communications or marketing professionals.

13. 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.

14. 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, showing that lifestyle factors “can powerfully promote better health,” NHS states.

15. CLINICAL PRACTICE RESOURCES
Patient safety
On Oct. 15, CareFusion Corporation, San Diego, and the U.S. Food and Drug Administration, Silver Spring, Md., announced a recall of Alaris PC unit model 8015 because, under certain wireless conditions, a communication error can occur that freezes the PC screen, possibly delaying or interrupting therapy.

Evidence
“Use of a pain behavior tool is one strategy to improve assessment of pain experienced by the ventilated adult patient who is unable to provide a self-assessment,” concludes “Comparison of Two Pain Scales for the Assessment of Pain in the Ventilated Adult Patient,” in November/December’s Dimensions of Critical Care Nursing, which examined the Behavioral Pain Scale and the NonVerbal Pain Scale. It adds that results demonstrated “overall adequate validity and reliability” for both pain behavior tools.

For volume resuscitation, use of colloid solutions “significantly” improves hemodynamic status according to “Fluids After Cardiac Surgery: A Pilot Study of the Use of Colloids Versus Crystalloids.” In the study of 237 patients in November’s Critical Care Medicine, nurses used an algorithm based on pulmonary artery catheter data to determine fluid boluses.

Methicillin-resistant Staphylococcus aureus (MRSA) Nasal Colonization Is a Poor Predictor of Intensive Care Unit-acquired Methicillin-resistant Staphylococcus aureus Infections Requiring Antibiotic Treatment” according to October’s Critical Care Medicine. Clinicians should be cautious in using nasal-colonization testing results to determine the need for MRSA treatment, concluded the study of 749 ICU patients.

Resource
Toward an Integrated Research Agenda for Critical Illness in Aging,” in the Oct. 15 American Journal of Respiratory and Critical Care Medicine, identifies knowledge gaps, research opportunities and barriers to research.

16. AACN RESOURCES
Order mobile pocket cards while discount lasts
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.

New procedure manual is a 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,” says a review on Amazon.com. AACN members receive a discount for this critical care go-to guide available through the AACN Online Bookstore.

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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