Critical Care Newsline — December 21, 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. 21, 2011

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1. NEWS TJC issues alert on worker fatigue and patient safety
2. ALERT Delirium Assessment and Management
3. ALERT Family Visitation in the ICU
4. ALERT Prevention of Aspiration
5. ALERT Catheter-Associated Urinary Tract Infections
6. EVIDENCE CCN publishes strategies for quality patient-ventilator management
7. EVIDENCE Nurse-led intravenous insulin protocol reduces hypoglycemia
8. CALL TO ACTION U.S. Department of Labor starts acute care nursing survey
9. CALL TO ACTION Participate in ASTM survey on non-sterile isolation gowns
10. CALL TO ACTION Comment on proposed TJC standards
11. CALL TO ACTION Join world-famous Nurses’ Health Study
12. CALL TO ACTION Submit nominations for AACN President’s Awards for Chapters
13. EVIDENCE Critical Care Medicine publishes new studies
14. EVIDENCE JAMA study finds PCI mortality not higher in centers without on-site surgery
15. EVIDENCE Stopping aspirin less than three days before CABGS may decrease stroke risk, study says
16. BOOKSTORE New resource for cardiac arrhythmia management
17. MEMBER BENEFIT Deadline nears to sign up for free enrollment in ChangeAnything.com
18. CLINICAL PRACTICE RESOURCES
19. AACN RESOURCES Buy your holiday gifts online
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1. NEWS TJC issues alert on worker fatigue and patient safety
On Dec. 14, The Joint Commission (TJC), Oakbrook Terrace, Ill., released “Sentinel Event Alert: Health Care Worker Fatigue and Patient Safety,” which states, “Fatigue increases the risk of adverse events, compromises patient safety and increases risk to personal safety and well-being.” The alert includes recommendations for organizations to reduce risk, such as inviting staff input for designing work schedules and implementing a fatigue management plan.

2. 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 U.S. While no FDA-approved drugs are available to treat delirium, this AACN Practice AlertTM explains that implementing early assessment, prevention and detection protocols such as the described ABCDE bundle reduces risk factors.

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 AlertTM outlines administrative and practical considerations for implementing less-restrictive access to the bedside for these “partners in care.”

4. 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 AlertTM offers a checklist for aspiration prevention, including head-of-bed elevation, assessment of sedation levels and feeding-tube placement.

5. 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 AlertTM stresses the use of pre- and post-catheterization assessments to gauge proper catheter use and to monitor early indications of infection.

6. EVIDENCE CCN publishes strategies for quality patient-ventilator management
Achieving Quality Patient-Ventilator Management: Advancing Evidence-Based Nursing Care,” in December’s Critical Care Nurse (CCN), presents suggestions for nurses to gain skill, competence and comfort when caring for critically ill patients receiving mechanical ventilatory support, with a focus on education strategies and building communication skills with these patients.

7. EVIDENCE Nurse-led intravenous insulin protocol reduces hypoglycemia
Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit,” in December’s Critical Care Nurse, states the protocol is safe and effective and markedly reduces the rate of hypoglycemia.

8. CALL TO ACTION U.S. Department of Labor starts acute care nursing survey
Representatives conducting a survey for the Occupational Information Network (O*NET) System, a database of occupational requirements and worker attributes based in the U.S. Department of Labor, will be calling AACN members during the end of December and in January 2012 to gather information for the acute care nursing category. O*NET information facilitates career guidance and supports workforce education and creation of competency models. Contact Traci Davis with questions.

9. CALL TO ACTION Participate in ASTM survey on non-sterile isolation gowns
ASTM International in West Conshohocken, Pa., which develops voluntary consensus standards, invites nurses to participate in a short survey on the use of non-sterile isolation gowns. Results will help in creating a standard for these gowns that meets requirements for personal protection and comfort.

10. 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).

11. 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.

12. 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.

13. EVIDENCE Critical Care Medicine publishes new studies
December’s Critical Care Medicine contains three studies of interest to critical care nurses: 1) “Sedation for Critically Ill Adults With Severe Traumatic Brain Injury: A Systematic Review of Randomized Controlled Trials” found no “convincing evidence” that one sedative agent is better than another for patients with traumatic brain injury, but high bolus doses of opioids have “potentially deleterious effects on intracranial pressure and cerebral perfusion pressure”; 2) “Early Use of Supplemental Parenteral Nutrition in Critically Ill Patients: Results of an International Multicenter Observational Study” concludes that although supplemental parenteral nutrition may provide patients with more calories and protein, it “is not associated with any clinical benefit”; and 3) “Outcomes of Extubation Failure in Medical Intensive Care Unit Patients” found that patients older than 65 years who have chronic cardiac or respiratory disease are at “high risk for extubation failure and subsequent pneumonia and death.” The study also found that rapid worsening in the patient’s clinical condition followed failed or unplanned extubation, “suggesting a direct and specific effect of extubation failure and reintubation on patient outcomes.”

14. EVIDENCE JAMA study finds PCI mortality not higher in centers without on-site surgery
The Dec. 14 Journal of the American Medical Association (JAMA) contains “Percutaneous Coronary Intervention (PCI) at Centers With and Without On-site Surgery: A Meta-Analysis,” which found that centers without on-site surgery do not have a higher incidence of in-hospital mortality or emergency bypass surgery.

15. EVIDENCE Stopping aspirin less than three days before CABGS may decrease stroke risk, study says
Discontinuing low-dose aspirin less than three days before coronary artery bypass graft surgery (CABGS) or not stopping it at all may decrease the risk of stroke without increasing postoperative bleeding, according to “Timing of Preoperative Aspirin Discontinuation and Outcome After Elective Coronary Artery Bypass Graft Surgery.” The findings “suggest that the use of aspirin until the day of elective coronary surgery may be beneficial,” concludes the study published online Dec. 2 by Journal of Cardiothoracic and Vascular Anesthesia.

16. BOOKSTORE New resource for cardiac arrhythmia management
Cardiac Arrhythmia Management: A Practical Guide for Nurses and Allied Professionals” is an excellent resource for nurses and other health professionals who treat patients with cardiac arrhythmias. Sections include Supraventricular Tachycardia: Diagnosis and Management, Implantable Device Management and Care of the Pediatric Arrhythmia Patient. Access this resource and other new titles.

17. MEMBER BENEFIT Deadline nears 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 a free one-year premium membership in this unique online resource.

18. CLINICAL PRACTICE RESOURCES
Patient Safety
Staff-led evidence-based practice councils “have the potential to improve quality of care, job satisfaction, vision and leadership,” according to “Evidence-Based Practice Councils: Potential Path to Staff Nurse Empowerment and Leadership Growth.” To achieve improvements, managers and executives must be “sufficiently prepared to work with and support the councils,” notes the study in the January 2012 Journal of Nursing Administration.

Evidence
A Visit to the Intensive Cares Unit: A Family-Centered Culture Change to Facilitate Pediatric Visitation in an Adult Intensive Care Unit,” in the January/March 2012 Critical Care Nursing Quarterly, describes how changes in practice, including giving a child an informational book and providing staff education on developmental stages, increased staff members’ comfort and eased fears among the children.

19. 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 Critical Care Nurses” to inspire a colleague
-- AACN fleece jackets and pullovers
-- Executive-style pens to show pride in certification
-- Engage and Transform ornament for the giving nurse: a portion of the proceeds supports the AACN Scholarship Endowment

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.

Notable Quote
“The future management of sepsis will most likely involve therapies directed at newer inflammatory targets. Several such molecules are currently under investigation ...” — Ron Daniels and Tim Nutbeam, Eds., “ABC of Sepsis.”

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