Critical Care Newsline — September 23, 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.

September 23, 2010

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1. NEWS ISMP report: Nurses call 30-minute rule unsafe, unrealistic and impractical
2. CALL TO ACTION CNML Review Course offered in November
3. CALL TO ACTION AACN grant proposal deadline is one week away
4. NEWS AACN members receive discount on ultrasound course
5. NEWS STTI salutes nurse researchers during September
6. EVIDENCE Early neuromuscular blocker improves ARDS survival rates
7. EVIDENCE Centers’ volume linked to graft survival after heart transplant
8. EVIDENCE Prescription choices for antithrombotics affect bleeding risk
9. EVIDENCE Early treatment of lactate levels reduces mortality
10. CALL TO ACTION Apply for AACN’s NIWI scholarship by Nov. 1
11. NEWS Latest AACN procedure manual expands patient-safety, infection-control coverage
12. NTI Submit certification best practices for NTI 2011
13. CLINICAL PRACTICE RESOURCES
14. AACN RESOURCES Top-selling mobile pocket cards, 30 percent off

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1. NEWS ISMP report: Nurses call 30-minute rule unsafe, unrealistic and impractical
Most of the 17,500 respondents to a survey from the Centers for Medicare & Medicaid Services (CMS), Baltimore, call the 30-minute rule “unsafe, unrealistic, impractical, and virtually impossible,” states a special report from the Institute for Safe Medication Practices (ISMP), Horsham, Pa., in September’s Nurse Advise-ERR. More than half — 59 percent — comply infrequently or only sometimes. Respondents commented that compliance with the rule, which requires administering medication 30 minutes before or after scheduled times, may compel them to take shortcuts that cause errors. Subscribe to the free monthly newsletter. Read the archives, updated monthly.

2. 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 and 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.

3. CALL TO ACTION AACN grant proposal deadline is one week away
Submit proposals for AACN 2011 grants by Oct. 1. New this year is the $50,000 AACN Impact Research Grant, designed to support experienced clinicians and researchers in inquiry and systematic research and generate new knowledge. Other grants range from $1,500 to $10,000 each. Learn more.

4. NEWS AACN members receive discount on ultrasound course
The American Institute of Ultrasound in Medicine (AIUM), Laurel, Md., offers AACN members the AIUM nonphysician member registration rate for “Cutting-Edge Applications for Point-of-Care Ultrasound,” which takes place Nov. 6-7 before AIUM’s Ultrasound Practice Forum 2010, Orlando, Fla. The course focuses on critical care, anesthesia and emergency medicine. AACN will participate in the forum. Learn more and register.

5. NEWS STTI salutes nurse researchers during September
In September, the Honor Society of Nursing, Sigma Theta Tau International (STTI), Indianapolis, salutes nurses dedicated to advancing nursing research. Learn more.

6. EVIDENCE Early neuromuscular blocker improves ARDS survival rates
Administering a neuromuscular blocking agent within 48 hours of severe Adult Respiratory Distress Syndrome (ARDS) onset continuously for 48 hours improved patient survival at 90 days according to a multicenter, double-blind trial of 340 ICU patients in Sept. 16’s New England Journal of Medicine. The therapy also “increased the time off the ventilator without worsening muscle weakness,” states “Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome.”

7. EVIDENCE Centers’ volume linked to graft survival after heart transplant
“Across all recipient-donor pair risk strata, posttransplant graft survival at 1 year was significantly lower at low-volume centers,” states an analysis of 8,029 patients in September’s Circulation. The relationship between volume and outcomes “was strongest in the highest-risk recipient-donor category,” concludes “Post-Heart Transplant Survival Is Inferior at Low-Volume Centers Across All Risk Strata.”

8. EVIDENCE Prescription choices for antithrombotics affect bleeding risk
According to “Emerging Antithrombotic Agents: What Does the Intensivist Need to Know?” — a review article in October’s Current Opinion in Critical Care — the bleeding risk “associated with antithrombotics is not only a function of their inherent biochemical properties but also a reflection of how healthcare professionals choose and dose these agents in individual patients.”

9. EVIDENCE Early treatment of lactate levels reduces mortality
Treating lactate levels equal to or above 3.0 mEq/L in newly admitted ICU patients significantly reduces hospital mortality according to “Early Lactate-Guided Therapy in Intensive Care Unit Patients.” “This study suggests that initial lactate monitoring has clinical benefit,” concludes the multicenter, randomized trial in September’s American Journal of Respiratory and Critical Care Medicine.

10. 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.

11. NEWS Latest AACN procedure manual expands patient-safety, infection-control coverage
The evidence-based “AACN Procedure Manual for Critical Care,” 6th edition, increases focus on patient safety and infection control with an easy-to-use format, intervention rationales, clear identification of advanced practice procedures and new icons that highlight key procedures related to requirements from The Joint Commission, Oakbrook Terrace, Ill., and the Centers for Disease Control and Prevention, Atlanta. Each procedure includes AACN’s levels of evidence and comprehensive references.

12. NTI Submit certification best practices for NTI 2011
If your hospital, unit or chapter has successfully implemented certification best practices — strategies to encourage, recognize and reward certification — submit your certification story online by Sept. 30. AACN will select the two most innovative practices for panel presentation during the “Creating a Culture of Certification: Best Practices Roundtable” at the National Teaching Institute & Critical Care Exposition (NTI 2011) — Saturday, April 30, to Thursday, May 5, 2011, Chicago. AACN Certification Corporation accepts best-practice submissions, which it posts online, year-round.

13. CLINICAL PRACTICE RESOURCES
Patient safety
On Sept. 15, the U.S. Food and Drug Administration, Silver Spring, Md., announced a recall of BagEasy Manual Resuscitation Devices by Westmed, Inc., Greenwood Village, Colo., because “disconnection at the retention ring of the patient port manifold” may occur, making the device inoperable.

On Sept. 10, the U.S. Food and Drug Administration, Silver Spring, Md., announced a recall of Symbiq One-Channel and Two-Channel Infusers from Hospira, Inc., Lake Forest, Ill., because of the “potential for the device to fail to detect air in line at the end of an infusion.”

Evidence
Having an interventional cardiology team available in the hospital to perform primary percutaneous coronary intervention “consistently and significantly” reduces door-to-balloon time, cardiovascular adverse effects and in-hospital and one-year mortality according to “Impact of 24-hr In-hospital Interventional Cardiology Team on Timeliness of Reperfusion for ST-segment Elevation Myocardial Infarction” in June’s Catheterization and Cardiovascular Interventions.

Commentary
September’s Health Affairs includes “Why Diagnostic Errors Don’t Get Any Respect — And What Can Be Done About Them,” which states diagnostic errors don’t receive the same attention as healthcare and medication errors even though they are “common and often serious.” It adds, “Health information technology, better training and increasing acknowledgment of the problem” hold promise as a means for addressing diagnostic errors.

14. AACN RESOURCES
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.

This month’s Bold Voice, Gloria McNeal
Learn more in the September issue of AACN Bold Voices.

Contract protocol for chapters
AACN chapters must submit all contracts, such as those for speakers, caterers, grants, exhibitors and facility rental, to the AACN national office for review and approval before signing them to help ensure the chapter is protected. Learn more.

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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