Critical Care Newsline — November 23, 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.

Nov. 23, 2011

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1. NEWS TJC center launches new partnership campaign
2. PATIENT SAFETY FDA revokes approval of Avastin (bevacizumab)
3. EVIDENCE Enoxaparin reduces VTE in morbidly obese patients
4. EVIDENCE JAMA study finds severe sepsis and new-onset AF increases mortality
5. EVIDENCE Statins not associated with higher risk of ICH, study says
6. CALL TO ACTION Comment on AHRQ’s VTE Common Format
7. CALL TO ACTION Apply for HHS-CCSC HAI award
8. CALL TO ACTION Comment on FDA’s proposed opioid training program
9. CALL TO ACTION Participate in survey on providing care when guidelines are lacking
10. EVIDENCE Delays reduce benefits of transfer for primary PCI in MI patients
11. EVIDENCE PedNIHHS useful for pediatric stroke studies
12. EVIDENCE Warfarin dose assessment might be extended to every 12 weeks, study says
13. CALL TO ACTION Submit nominations for AACN President’s Awards for Chapters
14. MEMBER BENEFIT Free enrollment in ChangeAnything.com for one year
15. CLINICAL PRACTICE RESOURCES
16. AACN RESOURCES Find jobs at NursePath.com
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1. NEWS TJC center launches new partnership campaign
On Nov. 16, The Joint Commission (TJC) Center for Transforming Healthcare, Oakbrook Terrace, Ill., launched Healing Healthcare Partnership™, a campaign that brings together accredited healthcare organizations and industry to improve patient safety and lower healthcare costs. TJC encourages organizations to join the campaign and use the center’s resources, including the Targeted Solutions Tool™ for hand hygiene.

2. PATIENT SAFETY FDA revokes approval of Avastin (bevacizumab)
On Nov. 18, the Food and Drug Administration (FDA), Silver Spring, Md., revoked the agency’s approval of Avastin (bevacizumab), manufactured by Genentech, South San Francisco, Calif., for metastatic breast cancer, because “the drug has not been shown to be effective for that use.” Avastin remains on the market for certain types of colon, lung, kidney and brain cancer.

3. EVIDENCE Enoxaparin reduces VTE in morbidly obese patients
Weight-based dosing of enoxaparin reduced the rate of venous thromboembolism (VTE) in 23 morbidly obese surgical ICU patients “below expected levels and no additional adverse effects were reported,” according to “Implementation of an Enoxaparin Protocol for Venous Thromboembolism Prophylaxis in Obese Surgical Intensive Care Unit Patients” in November’s The Annals of Pharmacotherapy.

4. EVIDENCE JAMA study finds severe sepsis and new-onset AF increases mortality
Patients with severe sepsis and new-onset atrial fibrillation (AF) have a higher risk of “in-hospital stroke and death compared with patients with no AF and patients with preexisting AF,” according to “Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis,” published online Nov. 13 by the Journal of the American Medical Association (JAMA).

5. EVIDENCE Statins not associated with higher risk of ICH, study says
Statins and Intracerebral Hemorrhage: Collaborative Systematic Review and Meta-Analysis” found “no evidence” that statins increase risk of intracranial hemorrhage (ICH). “If such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs,” concludes the study in the Nov. 15 Circulation.

6. CALL TO ACTION Comment on FDA’s proposed opioid training program
The U.S. Food and Drug Administration (FDA), Silver Spring, Md., invites comments on the “Draft Blueprint for Prescriber Education for Long-Acting/Extended-Release Opioid Class-Wide Risk Evaluation and Mitigation Strategy.” Deadline: Wednesday, Dec. 7.

7. CALL TO ACTION Apply for HHS-CCSC HAI award
Apply by 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 is sponsored by AACN and its partnering organizations in the Critical Care Societies Collaborative (CCSC), U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, and Office of Healthcare Quality (HHS), emphasizing success related to reducing or eliminating central line-associated bloodstream infections and ventilator-associated pneumonia. Access eligibility, selection criteria and application requirements.

8. CALL TO ACTION Comment on AHRQ’s VTE Common Format
Comment by Wednesday, Nov. 30 on the new Venous Thromboembolism (VTE) Common Format from the Agency for Healthcare Research and Quality (AHRQ), Rockville, Md. Common Formats help healthcare providers collect and submit standardized information on patient safety events.

9. CALL TO ACTION Participate in survey on providing care when guidelines are lacking
You are invited to participate in a series of three confidential online questionnaires about the opinions of critical care nurses regarding care provided when standard practice guidelines are lacking, to meet patient specific care needs. Doctoral student Jodie Gary from the University of Texas at Tyler College of Nursing requests your participation as an expert in your field to find areas of agreement and gaps in knowledge. Read inclusion criteria and participate.

10. EVIDENCE Delays reduce benefits of transfer for primary PCI in MI patients
Benefit of Transferring ST-Segment-Elevation Myocardial Infarction (MI) Patients for Percutaneous Coronary Intervention (PCI) Compared With Administration of Onsite Fibrinolytic (O-FT) Declines as Delays Increase” found that as door-to-balloon/door-to-needle times increase, the mortality advantage of transferring for primary PCI instead of O-FT declines. “PCI-related delays are extensive among patients transferred for (primary) PCI and are associated with poorer outcomes,” notes the study, published online Nov. 7 by Circulation.

11. EVIDENCE PedNIHHS useful for pediatric stroke studies
November’s Stroke contains “Concurrent Validity and Reliability of Retrospective Scoring of the Pediatric National Institutes of Health Stroke Scale (PedNIHHS),” which concludes PedNIHHS “can be used to improve the quality of retrospective pediatric stroke studies.”

12. EVIDENCE Warfarin dose assessment might be extended to every 12 weeks, study says
Warfarin Dose Assessment Every 4 Weeks Versus Every 12 Weeks in Patients With Stable International Normalized Ratios: A Randomized Trial” found that 12-week assessments were safe and “noninferior” to four-week assessments. More research is needed before extended monitoring intervals “can be routinely recommended for practice,” concludes the study in the Nov. 15 Annals of Internal Medicine.

13. 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.

14. MEMBER BENEFIT Free enrollment in ChangeAnything.com for one year
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 Dec. 31 for free one-year premium membership in this unique online resource.

15. CLINICAL PRACTICE RESOURCES
Patient Safety
November’s Nurse Advise-ERR, published by the Institute for Safe Medication Practices (ISMP), Horsham, Pa., discusses the role of culture in patient safety and notes “the two strongest predictors of high-level patient safety behaviors” for healthcare workers are observed behavior of peers and a genuine belief in the safety outcomes of the behavior. The issue also states dolasetron (Anzemet) injection, manufactured by sanofi-aventis, Bridgewater, NJ, shouldn’t be used to prevent chemotherapy-induced nausea and vomiting, and highlights recommendations for detecting clinically significant drug-induced postoperative respiratory depression from a group convened by the Anesthesia Patient Foundation, Indianapolis. Subscribe to the free monthly newsletter or read the archives, which ISMP updates each month.

Evidence
Screening and Prevention of Venous Thromboembolism in Critically Ill Patients: A Decision Analysis and Economic Evaluation,” published online Aug. 25 by American Journal of Respiratory and Critical Care Medicine, states, “Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening” for deep vein thrombosis.

Hospital safety climate is associated with nurse and patient injuries, “suggesting that patient and nurse safety may actually be linked to outcomes,” according to “Do Nurse and Patient Injuries Share Common Antecedents? An Analysis of Associations With Safety Climate and Working Condition,” published online Oct. 19 by BMJ Quality & Safety. “The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries,” the study concludes.

Resource
Access “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals,” a free monograph from The Joint Commission, Oakbrook Terrace, Ill., designed to help hospitals meet patient-centered communication standards scheduled to take effect July 1, 2012.

Guidelines
Download “2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention,” published online Nov. 7 by Journal of the American College of Cardiology.

16. 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.

Notable Quote
“Change happens when we stop looking for off-the-shelf answers to our one-of-a-kind challenges. You are unique. The change plan that will work for you is unique. In order to find it, you’ll have to be both the scientist and the subject of your unique experiment. When you take on this mindset, even bad days become good data. You become progressively smarter at influencing yourself until you evolve a plan that works perfectly for your subject: you.” — Kerry Patterson, Joseph Grenny, David Maxfield, Ron McMillan and Al Switzler, “Change Anything: The New Science of Personal Success.”

Together. Stronger. Bolder.
From November’s AACN Bold Voices
One Size Doesn’t Fit All” — Mary Stahl, AACN President 2011-2012
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