Critical Care Newsline — June 21, 2012

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. Each issue includes links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and websites that will inform you on issues affecting nurses and the nursing profession.

June 21, 2012

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1. NEWS Statins don’t reduce colesevelam’s ability to lower glucose
2. NEWS AACN and ACCP publish joint editorial
3. CALL TO ACTION Review and comment on AACN’s ACNP Scope and Standards by Sunday, July 8
4. CALL TO ACTION Participate in study on moral distress
5. EVIDENCE Article in CCN gives nursing implications of contrast-induced nephropathy
6. CNE ARTICLE Article in CCN discusses neuromuscular blockade
7. EVIDENCE Risk index predicts HF mortality in emergency department
8. EVIDENCE Sleep disruption varies according to sound level and type, and sleep stage
9. PROFESSIONAL DEVELOPMENT Register for multidisciplinary leadership program
10. EVIDENCE Unsafe injection practices are major form of medical errors, study says
11. EVIDENCE CDC reports VTE remains significant problem in U.S.
12. EVIDENCE Off-pump CABG associated with less effective revascularization, study says
13. BOOKSTORE Advance your 12 lead ECG skills
14. CLINICAL PRACTICE RESOURCES
15. AACN RESOURCES Find jobs at NursePath.com
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1. NEWS Statins don’t reduce colesevelam’s ability to lower glucose
Colesevelam significantly reduces hemoglobin A1c and LDL cholesterol levels in adults with type 2 diabetes regardless of statin use, according to results of a post hoc data analysis reported June 6 at the annual meeting of the American Association of Clinical Endocrinologists in Philadelphia. The analysis included 62 patients in the colesevelam group and 75 in the placebo group, who received statin therapy before and during the original study, “Colesevelam Hydrochloride Therapy in Patients With Type 2 Diabetes Mellitus Treated With Metformin: Glucose and Lipid Effects,” in the Oct. 13, 2008 Archives of Internal Medicine

2. NEWS AACN and ACCP publish joint editorial
An editorial jointly published by the American Journal of Critical Care and CHEST proposes interdisciplinary collaboration based on “existing and proven training pathways” as a means to help hospitalists achieve competence in critical care. In the editorial, the American College of Chest Physicians (ACCP), Northbrook, Ill., and AACN propose that solutions to the ongoing critical care workforce shortage must keep patients’ needs at the forefront and consider the perspectives of nurses and allied health professionals.

3. CALL TO ACTION Review and comment on AACN’s ACNP Scope and Standards by Sunday, July 8
AACN invites comments from acute care nurse practitioners (ACNPs) on proposed updates to “AACN Scope and Standards of Practice for the Acute Care Nurse Practitioner,” published in 2006. First read the “Scope of Practice,” “Standards of Clinical Practice” and “Standards of Professional Performance.” Links to these documents are included in the survey. We need to hear from you, as these standards help define the evolving role of ACNPs.

4. CALL TO ACTION Participate in study on moral distress
Participate in a research study on the moral distress of nurses currently working in ICUs and their coping mechanisms. You must be an RN with more than one year of experience working in an ICU. The study is being conducted by Samantha Young, a graduate nursing student at DePaul University, Chicago. Email sahyoung@gmail.com if you have questions.

5. EVIDENCE Article in CCN gives nursing implications of contrast-induced nephropathy
June’s Critical Care Nurse (CCN) contains “Contrast-Induced Nephropathy: Nursing Implications,” which discusses the pivotal role of critical care nurses in identifying patients at risk for contrast-induced nephropathy, a major adverse event.

6. CNE ARTICLE Article in CCN discusses neuromuscular blockade
Residual Neuromuscular Blockade in Critical Care,” a continuing nursing education (CNE) article in June’s Critical Care Nurse (CCN), describes the mechanism of action for, assessment of and factors related to this condition.

7. EVIDENCE Risk index predicts HF mortality in emergency department
Prediction of Heart Failure Mortality in Emergent Care: A Cohort Study,” in the June 5 Archives of Internal Medicine, found that using a multivariate index consisting of routinely collected variables, including heart rate, systolic blood pressure, oxygen saturation, creatinine concentration and troponin levels, “stratified mortality risk” (death within seven days of presentation) with “high discrimination” in patients with heart failure (HF) in the emergency department.

8. EVIDENCE Sleep disruption varies according to sound level and type, and sleep stage
Sleep Disruption Due to Hospital Noises: A Prospective Evaluation,” published online June 12 by Annals of Internal Medicine, finds that arousal varies depending on sound level and type, and sleep stage. Electronic sounds were more arousing than other sounds, and arousal to sounds during rapid eye movement (REM) sleep included a greater and more sustained increase in instantaneous heart rate compared to arousal during non-REM sleep.

9. PROFESSIONAL DEVELOPMENT Register for multidisciplinary leadership program
The Arizona Healthcare Leadership Academy offers a two-tiered multidisciplinary program designed to teach fundamental (Tier I) and advanced (Tier II) leadership skills to frontline and middle managers in healthcare. Download the 2012 schedule and register. AACN Continuing Professional Development Scholarships support this and other programs that help members enrich their career and acquire knowledge and skills beyond traditional academic nursing. Email scholarships@aacn.org with questions.

10. EVIDENCE Unsafe injection practices are major form of medical errors, study says
Patient Notification for Bloodborne Pathogen Testing Due to Unsafe Injection Practices in the US Health Care Settings, 2001-2011,” in April’s Medical Care, finds 35 patient notification events related to unsafe injection practices in at least 17 states, resulting in about 130,198 notifications. “Unsafe injection practices represent a form of medical error that have manifested as large-scale adverse events, affecting thousands of patients in a wide variety of health care settings,” concludes the study, which also calls for increased oversight, attention to basic infection control and research to identify best practices for patient notifications. The One & Only Healthcare Provider Toolkit provides information and resources for healthcare providers about safe injection practices.

11. EVIDENCE CDC reports VTE remains significant problem in U.S.
An estimated average of 547,596 hospitalizations with thromboembolism (VTE) occur each year among those 18 years or older, according to “Venous Thromboembolism in Adult Hospitalizations – United States, 2007-2009,” with 28,726 hospitalized patients with VTE dying each year. “Greater efforts are needed to identify, develop, and implement VTE prevention strategies and to improve surveillance for VTE cases to reduce morbidity and mortality from VTE,” concludes the report in the June 8 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), Atlanta.

12. EVIDENCE Off-pump CABG associated with less effective revascularization, study says
Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization,” in the June 12 Circulation, found that one year after surgery, patients with less effective revascularization had higher adverse event rates.

13. BOOKSTORE Advance your 12 lead ECG skills
Advance your skills with “12 Lead ECG Interpretation: Part 2,” a CD of slides and audio that comprises an advanced 12 lead ECG interpretation course, including bundle branch blocks, fascicular blocks, atrial and ventricular hypertrophy, effects of drug and electrolytes and myocardial infarction mimics. Access new titles in AACN’s Online Bookstore.

14. CLINICAL PRACTICE RESOURCES
Evidence
On June 15, the U.S. Food and Drug Administration, Silver Spring, Md., announced an expanded recall of Spectrum Infusion Pump Model 35700, manufactured by Sigma International in Medina, N.Y., because units may suddenly fail without an alarm sounding, resulting in back flow or over-infusion that may lead to serious injury or death.

Unintended Consequences of a Standard Admission Order Set on Venous Thromboembolism Prophylaxis and Patient Outcomes,” in March’s Journal of General Internal Medicine, found that implementing a standard admission order set “transiently” increased venous thromboembolism pharmacoprophylaxis in patients who might be harmed by it. The success of order sets “should be judged based on the degree to which they successfully target patients likely to benefit from the intervention without inadvertently targeting patients potentially harmed,” the study concludes.

Guidelines
Access the guideline summary for “Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters With an Evidence-Based Literature Review and Meta-Analysis,” published in January’s Sleep.

Access summaries of two sets of guidelines from the American Society of Anesthesiologists: “Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management,” published in February’s Anesthesiology, and “Practice Advisory for Preanesthesia Evaluation: An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation,” published in March’s Anesthesiology.

15. 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
“Eyeballing your patient before sitting down and taking report communicates to the patient that you are there to take care of him or her, not the charts or ICU gadgets.” Elizabeth Simon, “Critical Care Nursing Practice Guide: A Road Map for Students and New Graduates.”

Together. Stronger. Bolder.
From June’s AACN Bold Voices
The Energy of Community” — Mary Stahl, AACN President 2011-2012
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