Critical Care Newsline — January 13, 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.

January 13, 2011

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1. CALL TO ACTION Register for NTI by March 17 and save
2. CALL TO ACTION Apply for HHS-CCSC HAI Award by Jan. 29
3. CALL TO ACTION Participate in Studies of Practice surveys by Jan. 31
4. EVIDENCE IDSA releases its first MRSA guidelines
5. CALL TO ACTION Register for Adult CCRN Review Course Webinars
6. EVIDENCE Race, ethnicity don’t affect ICU patient outcomes
7. EVIDENCE Warfarin doesn’t affect mortality of select HF patients
8. CALL TO ACTION Survey on ICU nurses and EOL decision making
9. CALL TO ACTION Apply to attend AONE’s Aspiring Nurse Leader Institute
10. EVIDENCE CABG harvest-site discomfort common
11. CLINICAL PRACTICE RESOURCES
12. AACN RESOURCES Happy New You

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1. CALL TO ACTION Register for NTI by March 17 and save
Register for the 2011 National Teaching Institute & Critical Care Exposition (NTI) in Chicago, which takes place Saturday, April 30 through Thursday, May 5. Let’s join together as a community of exceptional nurses to experience more than 500 education sessions, networking and inspirational general sessions. Early-bird registration, which includes a cost savings, ends March 17.

2. CALL TO ACTION Apply for HHS-CCSC HAI Award by Jan. 29
Recognize your hospital’s achievements by applying for new national awards recognizing long-term reduction or elimination of healthcare-associated infections (HAIs). Apply by Saturday, Jan. 29. Visit www.aacn.org/hhs-ccsc-award for complete details on eligibility, selection criteria and application requirements.

3. CALL TO ACTION Participate in Studies of Practice surveys by Jan. 31
Acute care and gerontology nurse practitioners are invited to participate in the ACNPC Study of Practice. CCNSs and adult, gerontology and pediatric CNSs are invited to participate in the CCNS Study of Practice. Each survey takes about 30 minutes to complete. Survey deadline is Jan. 31. Upon completion, you may enter a drawing for one of four regional gift cards and main conference registration for the 2011 National Teaching Institute & Critical Care Exposition, Chicago, which takes place Saturday, April 30 through Thursday, May 5. AACN Certification Corporation will use survey information to update ACNPC and CCNS test plans, inform AACN’s future revisions of Scope and Standards of Practice documents and enhance resources for advanced practice nurses.

4. EVIDENCE IDSA releases its first MRSA guidelines
On Jan. 4, the Infectious Diseases Society of America (IDSA), Arlington, Va., released its first guidelines for treating methicillin-resistant Staphylococcus aureus (MRSA). “Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children,” published online by Clinical Infectious Diseases, includes management of MRSA-related clinical syndromes and vancomycin dosing recommendations.

5. CALL TO ACTION Register for Adult CCRN Review Course Webinars
AACN Certification Reviews Online expands to include Adult CCRN Review Course webinars, which takes place Thursday, Feb. 10 through Thursday, March 3. National content experts Mary Kay Bader, Suzi Burns, Bobbi Leeper and Carol Rauen will present seven live sessions, which award a total of 13.5 contact hours of continuing education credit. Each session features practice questions, live polling and text chat with the presenters. Register now.

6. EVIDENCE Race, ethnicity don’t affect ICU patient outcomes
Race and ethnicity do not affect hospital mortality or ICU length of stay according to a study published online Dec. 23, 2010, by Critical Care Medicine. If ICU disparities exist, “they may be explained by differences in the quality of care provided by hospitals that serve high proportions of minority patients,” concludes “The Effect of Race and Ethnicity on Outcomes Among Patients in the Intensive Care Unit: A Comprehensive Study Involving Socioeconomic Status and Resuscitation Preferences.”

7. EVIDENCE Warfarin doesn’t affect mortality of select HF patients
Warfarin Use and Outcomes in Patients With Advanced Chronic Systolic Heart Failure Without Atrial Fibrillation, Prior Thromboembolic Events, or Prosthetic Valves,” published online Dec. 22, 2010, by the American Journal of Cardiology, finds that, in patients with chronic advanced systolic heart failure (HF) without atrial fibrillation “or other recommended indications for anticoagulation,” there was a high prevalence of warfarin use. But “despite a therapeutic international normalized ratio in those receiving warfarin, its use had no significant intrinsic association with mortality and hospitalization.”

8. CALL TO ACTION Survey on ICU nurses and EOL decision making
Participate in “Nurses’ Involvement in End-of-Life (EOL) Decision-Making in the Intensive Care Unit” — a research study on the prevalence and predictors of ICU nurses’ active involvement in EOL decision making. Complete the online survey and opt to participate in a “thank you” drawing for a $150 Visa gift card.

9. CALL TO ACTION Apply to attend AONE’s Aspiring Nurse Leader Institute
The American Organization of Nurse Executives (AONE) holds its semiannual Aspiring Nurse Leader Institute Monday, June 20 through Thursday, June 23 in Indianapolis. Apply for an AACN Continuing Professional Development Scholarship to attend. Qualified applicants must be current members of both AACN and AONE. Visit AACN’s special interest scholarships page for details on eligibility and application requirements. Learn more about additional AACN special interest scholarships that help members attend evidence-based nursing practice programs.

10. EVIDENCE CABG harvest-site discomfort common
Persistent Sensitivity Disorders at the Radial Artery and Saphenous Vein Graft Harvest Sites: A Neglected Side Effect of Coronary Artery Bypass Grafting Procedures” reports that persistent harvest-site discomfort — chronic pain, numbness, paresthesia and dysethesia — occurs with “astonishing frequency” after Coronary Artery Bypass Grafting (CABG) surgery and affects arms and legs equally. “Harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware,” concludes the study of 123 patients published online Dec. 20, 2010, by the European Journal of Cardio-Thoracic Surgery.

11. CLINICAL PRACTICE RESOURCES
Patient safety
On Jan. 5, the U.S. Food and Drug Administration, Silver Spring, Md., posted the following:

AngioScore, Inc., Fremont, Calif., recalled the AngioSculpt PTA Scoring Balloon Catheter OTW 0.018” Platform because of a design defect causing unintended fracture and peeling, resulting in peeling of the bond and detachment of the distal end of the scoring element.

The Ritedose Corp., Columbia, S.C., voluntarily recalled 0.083 percent Albuterol Sulfate Inhalation Solution, 3 mL in 25, 30 and 60 unit dose vials because the “2.5 mg/3 mL single use vials are embossed with the wrong concentration of 0.5 mg/3 mL and therefore represents a potential significant health hazard,” the announcement states.

Effects of Learning Climate and Registered Nurse Staffing on Medication Errors” — a descriptive study of 279 nursing units in January/February’s Nursing Research — finds a significant negative relationship between learning climate and medication errors. “Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors,” it adds.

Evidence
On Dec. 20, 2010, Annals of Surgery published two studies of prehospital fluid resuscitation, online. “Prehospital Intravenous Fluid Administration Is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis” concludes, “The routine use of prehospital IV fluid administration for all trauma patients should be discouraged.” According to “Out-of-hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock: A Randomized, Placebo Controlled Trial,” hypertonic saline or hypertonic saline/dextran did not improve 28-day survival when compared to normal saline. The study of 853 patients says that “interpretation of these findings is limited by the early stopping of the trial.”

Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending” attributes the savings to reduced hospital stays and emergency department use. The study of patients with four chronic vascular diseases in January’s Health Affairs concludes, “Programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.”

Context and processes of care that could affect ventilator weaning outcomes vary “considerably” across countries, states a randomized control trial in the January issue of AACN’s American Journal of Critical Care. “International Perspectives on the Influence of Structure and Process of Weaning From Mechanical Ventilation” says weaning in Australia, New Zealand, Denmark, Norway, Sweden and the U.K. “is generally a collaborative process between nurses and physicians.” Notable differences in the U.S. were “frequent use of an open structure and inclusion of respiratory therapists” on the ICU’s healthcare team. “Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives,” it adds.

OMEGA, a Randomized, Placebo-Controlled Trial to Test the Effect of Highly Purified Omega-3 Fatty Acids on Top of Modern Guideline-Adjusted Therapy After Myocardial Infarction” in Nov. 23, 2010’s Circulation says, “Guideline-adjusted treatment of acute myocardial infarction results in a low rate of sudden cardiac death and other clinical events within 1 year of follow-up, which could not be shown to be further reduced by the application of omega-3 fatty acids.”

Resource
January’s Pediatric Critical Care Medicine contains “Thrombotic Disease in Critically Ill Children,” a review article that suggests increased awareness of “the recognition and current approaches to management and prevention of thromboembolic disease in children” is necessary to improve outcome of “these life-threatening processes.”

Guidelines
Jan. 1’s American Journal of Respiratory and Critical Care Medicine contains “An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients.”

12. AACN RESOURCES
Happy New You
What are your New Year’s resolutions? Are they to achieve mental balance, get fit, better your work performance or gain more inner strength to handle difficult situations? Wishing you a Happy New You in the New Year! Browse our wellness products at www.aacn.org/newyou.

Speak boldly with AACN Practice Alerts
AACN Practice Alerts are concise, action-oriented and evidence-based statements about acute and critical care nursing practices that help nurses carry their bold voices to the bedside. Learn more or access alerts.

Stand Tall: AACN Bold Voices
Without it you’re a yawn. — Kristine Peterson, AACN President 2010-2011

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