Critical Care Newsline — August 25, 2011

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.

Aug. 25, 2011

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1. EVIDENCE Study associates dyspnea with anxiety and delayed extubation in ICU patients
2. EVIDENCE Care bundles are best practice for preventing VAP, study states
3. WEIGH IN Mandatory flu shots for hospital workers, the pros and cons?
4. EVIDENCE JAMA study finds race, age mortality differences among dialysis patients
5. CALL TO ACTION AACN grant applications open Sept. 1
6. CALL TO ACTION Submit NTI 2012 poster abstracts by Sept. 19
7. CALL TO ACTION Comment on FDA draft guidelines for mobile medical apps
8. EVIDENCE New guidelines for brain death in infants and children released
9. EVIDENCE ICH more common with carotid stenting than endarterectomy
10. EVIDENCE TeamSTEPPS improves ICU patient outcomes
11. CALL TO ACTION Nominate an ‘Amazing Nurse’ for Johnson & Johnson contest
12. CALL TO ACTION Register for AACN Progressive Care Pathways conference
13. CLINICAL PRACTICE RESOURCES
14. AACN RESOURCES Find jobs at NursePath.com
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1. EVIDENCE Study associates dyspnea with anxiety and delayed extubation in ICU patients
Dyspnea is common, “intense, and strongly associated with anxiety in mechanically ventilated patients,” finds a study in September’s Critical Care Medicine. “Dyspnea in Mechanically Ventilated Critically Ill Patients,” which associates dyspnea with delayed extubation, found that adjusting the ventilator setting improved dyspnea in 35 percent of patients.

2. EVIDENCE Care bundles are best practice for preventing VAP, study states
A review article in September/October’s Nursing in Critical Care associates a ventilator care bundle (VCB) with decreased ventilator-associated pneumonia (VAP). “In the absence of contradictory research, the current evidence suggests that use of the VCB represents best practice for all eligible adult ventilated patients in ICU,” concludes “The Ventilator Care Bundle and Its Impact on Ventilator-Associated Pneumonia: A Review of the Evidence.”

3. WEIGH IN Mandatory flu shots for hospital workers, the pros and cons?
Mandatory flu shots for hospital workers — they’re already mandatory in Maryland. What are the pros and cons? Weigh in on Facebook.

4. EVIDENCE JAMA study finds race, age mortality differences among dialysis patients
A study in Aug. 10’s Journal of the American Medical Association (JAMA) found that black patients on dialysis have a lower risk of death compared to white patients among adults more than 50 years old. However, risk is reversed in patients younger than 50 years with black patients more likely to die, according to “Association of Race and Age With Survival Among Patients Undergoing Dialysis.”

5. CALL TO ACTION AACN grant applications open Sept. 1
AACN invites clinicians and researchers to apply for its grants. Awards range from $1,500 to $50,000. These grants fund priority projects that address gaps in clinical research and support the translation of these findings to bedside nurses. Applications open Sept. 1 and must be submitted online by Nov. 1. Learn more and get started.

6. CALL TO ACTION Submit NTI 2012 poster abstracts by Sept. 19
Be an essential part of the 2012 National Teaching Institute & Critical Care Exposition (NTI), which takes place May 19-24, in Orlando, Fla., as a poster participant. Submit poster abstracts in any of the following categories: chapter best practice, evidence-based solutions and research. Deadline: Sept. 19.

7. CALL TO ACTION Comment on FDA draft guidelines for mobile medical apps
Comment by Oct. 19 on draft guidelines from the U.S. Food and Drug Administration (FDA), Rockville, Md., that would regulate medical apps found on mobile devices. The FDA wants to know what factors to consider when determining risk classification of software that provides clinical-decision-support functionality.

8. EVIDENCE New guidelines for brain death in infants and children released
September’s Critical Care Medicine contains “Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations” from the Society of Critical Care Medicine, Mount Prospect, Ill.; American Academy of Pediatrics, Elk Grove Village, Ill.; and the Child Neurology Society, St. Paul, Minn.

9. EVIDENCE ICH more common with carotid stenting than endarterectomy
A study published online Aug. 11 by Stroke finds “Intracranial Hemorrhage (ICH) Is Much More Common After Carotid Stenting Than After Endarterectomy.” Its conclusion associates carotid angioplasty and stenting “with elevated adverse outcomes, including ICH, in-hospital death, and unfavorable discharges, especially among symptomatic presentations.”

10. EVIDENCE TeamSTEPPS improves ICU patient outcomes
In two ICUs, a customized TeamSTEPPS education program improved staff perceptions of teamwork and communication openness, reduced time for placing patients on extracorporeal membrane oxygenation and lengthened duration of adult surgery rapid response team events, according to “Evaluating Efforts to Optimize TeamSTEPPS Implementation in Surgical and Pediatric Intensive Care Units,” in August’s Joint Commission Journal on Quality and Patient Safety. A three-phase teamwork system for providing higher-quality, safer patient care, TeamSTEPPS is available from the Agency for Healthcare Research and Quality, Rockville, Md.

11. CALL TO ACTION Nominate an ‘Amazing Nurse’ for Johnson & Johnson contest
The Campaign for Nursing’s Future, supported by Johnson & Johnson, New Brunswick, N.J., invites nominations for “amazing nurses” who make a difference in people’s lives. One grand prize winner will receive an all-expense-paid trip for two to Los Angeles and two VIP tickets to attend the 2011 CNN Heroes: All-Star Tribute live broadcast. Johnson & Johnson will also feature the winner in a television commercial. Finalists and semifinalists will appear on the Amazing Nurses contest website. Learn more and nominate by Sept. 11.

12. CALL TO ACTION Register for AACN Progressive Care Pathways conference
Is your clinical unit called stepdown, intermediate, telemetry, transitional, subacute, direct observation or even the emergency department? Is it a med-surg unit that receives patients directly from the ICU. Then register for the AACN Progressive Care Pathways conference, Nov. 9-12, Las Vegas. Conference topics include “The Challenges of Managing Complex Heart Failure” and “Progressive Mobility: Impacting Short and Long Term Outcomes.” Download a brochure and register by Sept. 30 to receive tuition discounts.

13. CLINICAL PRACTICE RESOURCES
Patient safety
August’s Nurse Advise-ERR, published by the Institute for Safe Medication Practices (ISMP), Horsham, Pa., discusses the need for a patient verification process “everywhere, not just at the bedside.” It specifies phases of medication use — including patient registration, prescribing, transcribing, dispensing and monitoring — and provides error-reduction strategies.

Evidence
Deep vein thrombosis (DVT) occurs in 1.6 percent of patients who undergo general surgery, according to Aug. 15’s Archives of Surgery. Most DVTs are catheter-induced, so prevention “should include more attention to the need for a central catheter, limiting the amount of time of a central catheter, and possibly the use of anticoagulation in the presence of a central catheter,” concludes “Deep Venous Thrombosis After General Surgical Operations at a University Hospital: Two-Year Data From the ACS NSQIP.”

Exercise treadmill testing (ETT) costs less and has similar results as myocardial perfusion imaging when used to diagnose coronary artery disease (CAD) in low-risk women, according to a study published online Aug. 15 by Circulation. “ETT with selective follow-up testing should be considered as the initial diagnostic strategy in symptomatic women with suspected CAD,” concludes “Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) Trial.”

Guidelines
Access “Effectiveness-based Guidelines for the Prevention of Cardiovascular Disease in Women — 2011 Update: A Guideline From the American Heart Association.”

14. AACN RESOURCES
Find jobs at NursePath.com
Are you a recent graduate? Or are you a mid- or senior-career acute or critical care nurse looking to change jobs or locations? Visit NursePath.com, AACN’s online career site, to find employment opportunities in high acuity and critical care across the U.S.

AACN Bold Voices
Even When There’s Chaos — Mary Stahl, AACN President 2011-2012

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