Critical Care Newsline — December 15, 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.

Dec. 15, 2011

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1. ALERT Prevention of Aspiration
2. ALERT Catheter-Associated Urinary Tract Infections
3. ALERT Family Visitation in the ICU
4. ALERT Delirium Assessment and Management
5. CALL TO ACTION Comment on proposed TJC standards
6. CALL TO ACTION Apply for HHS-CCSC HAI award by Dec. 19
7. CALL TO ACTION Join world-famous Nurses’ Health Study
8. CALL TO ACTION Submit nominations for AACN President’s Awards for Chapters
9. EVIDENCE Optimal management of shivering during therapeutic hypothermia
10. EVIDENCE No benefit for air transfer of acute ischemic stroke patients, study says
11. EVIDENCE New CLABSI report highlights prevention lessons from four hospitals
12. EVIDENCE Few women benefit from aspirin to prevent CV events, study says
13. BOOKSTORE New products in the online AACN Bookstore
14. CALL TO ACTION Apply for funding to assess point-of-care ultrasound competency
15. MEMBER BENEFIT Deadline to sign up for free enrollment in ChangeAnything.com nears
16. CLINICAL PRACTICE RESOURCES
17. AACN RESOURCES
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1. ALERT Prevention of Aspiration
Critically ill patients, especially those who are tube-fed, may experience micro-aspirations, which greatly increase the risk for pneumonia and other complications. This AACN Practice Alert offers a checklist for aspiration prevention, including head-of-bed elevation, assessment of sedation levels and feeding-tube placement.

2. ALERT Catheter-Associated Urinary Tract Infections
Urinary tract infections account for nearly 40 percent of hospital-acquired infections in acute care hospitals today, leading to increased hospital costs and higher patient morbidity and mortality rates. This AACN Practice Alert stresses the use of pre- and post-catheterization assessments to gauge proper catheter use and to monitor early indications of infection.

3. ALERT Family Visitation in the ICU
The unrestricted presence and participation of patients’ family members and friends has wide-reaching benefits for patients, both medically and psychologically. This AACN Practice Alert outlines administrative and practical considerations for implementing less-restrictive access to the bedside for these “partners in care.”

4. ALERT Delirium Assessment and Management
Studies show that delirium in the ICU often goes undetected and therefore untreated, leading to delirium-associated costs of between $4 billion and $16 billion annually in the United States. While no FDA-approved drugs are available to treat delirium, this AACN Practice Alert explains that implementing early assessment, prevention and detection protocols such as the described ABCDE bundle reduces risk factors.

5. CALL TO ACTION Comment on proposed TJC standards
The Joint Commission (TJC), Oakbrook Terrace, Ill., invites comments on two proposed standards — revisions to its “Patient Flow in the Emergency Department” requirements (response deadline Jan. 20, 2012) and a National Patient Safety Goal addressing overuse of treatments, procedures and tests (response deadline Jan. 24, 2012).

6. CALL TO ACTION Apply for HHS-CCSC HAI award by Dec. 19
Apply by Monday, Dec. 19, for national awards recognizing sustained improvements in reducing or eliminating healthcare-associated infections (HAIs) in critical care. Now in its second year, this awards program — sponsored by AACN and its partnering organizations in the Critical Care Societies Collaborative (CCSC) and U.S. Department of Health and Human Services (Office of Healthcare Quality/Office of the Assistant Secretary for Health) — emphasizes success related to reducing or eliminating central line-associated bloodstream infections and ventilator-associated pneumonia. Access eligibility, selection criteria and application requirements.

7. CALL TO ACTION Join world-famous Nurses’ Health Study
Are you between 20 and 46 years old? If so, join the world-famous Nurses’ Health Study (NHS) 3 to contribute to groundbreaking research on lifestyle, environment, nurses’ work life and women’s health. NHS 3 builds on the two previous Nurses’ Health Studies, which enrolled more than 230,000 women combined. Participation requires only an hour of your time each year. Recruitment continues until 100,000 participants are enrolled. JoAnn Grif Alspach’s editorial in December’s Critical Care Nurse also addresses this study.

8. CALL TO ACTION Submit nominations for AACN President’s Awards for Chapters
Nominate chapters for the 2012 AACN President’s Awards for Chapters, which recognize the chapters that best exemplify the association’s annual theme. Learn more and nominate by Wednesday, Feb. 15, 2012.

9. EVIDENCE Optimal management of shivering during therapeutic hypothermia
Pharmacological methods to control shivering during therapeutic hypothermia include the drug meperidine, which provides the greatest reduction in the shivering threshold. Effective nonpharmacological agents include skin counterwarming techniques in conjunction with medication, according to “Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest,” in December’s Critical Care Nurse.

10. EVIDENCE No benefit for air transfer of acute ischemic stroke patients, study says
Air transport of patients with acute ischemic stroke who were treated with thrombolysis does not provide any benefit over ground transport, according to “Does Helicopter Emergency Medical Service Transfer Offer Benefit to Patients With Stroke?” published online Dec. 8 by Stroke. “Therefore, ground transport should be considered for these patients unless they are being considered for emergency endovascular rescue therapy,” concludes the study of 122 patient transportations.

11. EVIDENCE New CLABSI report highlights prevention lessons from four hospitals
On Dec. 2, The Commonwealth Fund, New York, released “Eliminating Central Line Infections and Spreading Success at High-Performing Hospitals,” a new synthesis report of lessons learned from four hospitals that reported zero central line-associated bloodstream infections (CLABSIs) in their ICUs in 2009. These lessons include following evidence-based protocols; having dedicated teams oversee all central line insertions; participating in statewide, national or regional CLABSI initiatives; and promoting quality, including monitoring infection rates, giving feedback to staff and applying goals.

12. EVIDENCE Few women benefit from aspirin to prevent CV events, study says
In most women, aspirin is ineffective or harmful for reducing the risk of a major cardiovascular (CV) event, according to “Aspirin for Primary Prevention of Vascular Events in Women: Individualized Prediction of Treatment Effects.” The only time aspirin provided a benefit was when the score on a new model, 10-year number-willing-to-treat (NWT) was higher than 50 in women older than 65 and they received prediction-based treatment. When the NWT is 50 or lower, the “optimal net benefit” in preventing CV events in women is to not treat, concludes the study in December’s European Heart Journal.

13. BOOKSTORE New products in the online AACN Bookstore
AACN has several new product offerings, including “ABC of Sepsis.” The importance of early prevention and treatment of sepsis has never been greater. “ABC of Sepsis” provides a much-needed introduction and an invaluable aid in the increasing efforts to reduce hospital infection and improve patient safety.

14. CALL TO ACTION Apply for funding to assess point-of-care ultrasound competency
The American Institute of Ultrasound in Medicine (AIUM), Laurel, Md., invites proposals for studies to assess competency for point-of-care applications of ultrasound. AIUM’s Endowment for Education and Research has allocated up to $50,000 for one or more grants. Learn more and apply by Thursday, March 1, 2012.

15. MEMBER BENEFIT Deadline approaches to sign up for free enrollment in ChangeAnything.com
Take control of the sources of influence that impact your behavior by becoming both the subject and the scientist of your change. In partnership with Change Anything, a division of VitalSmarts, AACN welcomes members to ChangeAnything.com — a social media website based on award-winning research. Sign up by Saturday, Dec. 31 for free one-year premium membership in this unique online resource.

16. CLINICAL PRACTICE RESOURCES
Patient Safety
Download the new Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation from the Agency for Healthcare Research and Quality, Rockville, Md.

On Dec. 7, the U.S. Food and Drug Administration (FDA), Silver Spring, Md., announced a safety review of Pradaxa (dabigatran etexilate mesylate), manufactured by Boehringer Ingelheim, Ridgefield, Conn., because of post-marketing reports of serious bleeding. FDA advises patients to continue taking Pradaxa and clinicians to follow the drug’s label recommendations.

Janssen Pharmaceuticals, Inc., Raritan, N.J., has communicated a reminder about two risks of Xarelto (rivaroxaban) — discontinuing the drug without substituting another anticoagulant increases the risk of thrombotic events such as stroke and not taking the drug with meals can reduce its effectiveness. As part of a Risk Evaluation and Mitigation Strategy (REMS) required by the U.S. Food and Drug Administration, Silver Spring, Md., Xarelto’s REMS webpage has prescribing information, a medication guide and a healthcare professional letter.

Evidence
July’s Archives of Surgery contains the study “Increases in Mortality, Length of Stay, and Cost Associated With Hospital-Acquired Infections in Trauma Patients,” which found significantly higher increases in these measures. 

17. AACN RESOURCES
Buy your holiday gifts online
This holiday season support AACN by purchasing one or more holiday gifts online, such as:
-- “A Daybook for Nurse Educators” to inspire an OR nurse educator
-- AACN pins so nurses can show their pride
-- AACN water bottle for a fitness buff
-- CCRN lunch cooler for a certified nurse colleague

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.

Together. Stronger. Bolder.
From December’s AACN Bold Voices
Embrace Conflict. Really?” — Mary Stahl, AACN President 2011-2012
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