Best-practice guidelines released by The Joint Commission emphasize the role nurses play in preventing central line-associated bloodstream infections (CLABSI). "The Joint Commission's guidelines underscore the value of investing in nurses and making sure caregivers at the bedside have all the resources they need to keep patients safe," says Patricia Stone, PhD, MPH, RN, FAAN, Centennial Professor of Health Policy in Nursing at Columbia University School of Nursing and a contributor to the new guidelines.
Each year, about 30,000 patients die from CLABSI, according to The Joint Commission. Nurses can help implement catheter insertion checklists, ensure dressing changes at recommended intervals, maintain proper hand hygiene and other infection control standards, and educate patients and colleagues about infection control.
For a complete toolkit designed to prevent CLABSI, visit The Joint Commission's website at http://www.jointcommission.org/topics/clabsi_toolkit.aspx.
Source: Guidelines released by Joint Commission highlight importance of nurses in preventing deadly bloodstream infections. Columbia University School of Nursing. News release. December 3, 2013.
EMERGENCY CARE
"Angel dust" makes an unwelcome comeback
Nationwide, ED visits related to use of the illicit hallucinogenic drug phencyclidine (PCP), also known as angel dust, increased more than 400% between 2005 and 2011 (from 14,825 to 75,538 visits), according to data recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA). PCP is associated with hostile, potentially violent behavior, distorts perceptions of sight and sound, and produces feelings of detachment.
The greatest increase occurred in patients ages 25 to 34, who accounted for nearly half of all ED visits involving PCP. Two-thirds of PCP-related ED visitors were male. "This report is a wake-up call that this dangerous drug may be making a comeback in communities throughout the nation," warns Dr. Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality. The complete report is available at http://www.samhsa.gov/data/2K13/DAWN143/sr143-emergency-phencyclidine-2013.pdf.
Source: PCP-related emergency department visits rose 400 percent over six years. Substance Abuse and Mental Health Services Administration. News release. November 14, 2013.
TREATING COPD
Poor communication undermines effective care
Lack of communication between patients and caregivers remains a major barrier to diagnosis of chronic obstructive pulmonary disease (COPD), according to results of a web-based survey released by the National Institutes of Health. The survey uncovered a dramatic increase in the percentage of current smokers who'd discussed their symptoms with a care provider: from 42% in 2009 to 67% in 2013. But 26% of adults with signs and symptoms of COPD hadn't discussed them with a care provider for various reasons, such as, "I did not think of it," "I've had these problems for years," and "these problems will go away in time." In addition, just 18% of patients who discussed their symptoms with a healthcare provider said that their provider mentioned COPD.
In 2010, COPD exceeded stroke to become the third leading cause of death in the United States, but estimates suggest that half of those affected are undiagnosed. COPD is the only major chronic disease for which deaths are not decreasing. Although most often found in people age 40 and older with a history of smoking, COPD can also affect people who've never smoked, those with alpha-1 antitrypsin deficiency (a genetic disorder), and those who've experienced long-term exposure to dust, fumes, and other pulmonary irritants.
Source: NIH survey identifies barriers to effective patient-provider dialogue about COPD. National Institutes of Health. News release. November 15, 2013.
HEALTH AND SAFETY
Contribute to this health risk appraisal database
How does your health, wellness, and safety on the job compare with your colleagues'? A new web-based appraisal tool offered by the American Nurses Association (ANA) and Pfizer, Inc. can help you find out.
Offered online, the HealthyNurse Survey is a health risk appraisal (HRA) that lets nurses assess their health and workplace risks from factors such as patient lifting and workplace violence. The HRA is compliant with privacy provisions of the Healthcare Insurance Portability and Accountability Act.
The survey, which takes about 20 minutes to complete, is divided into three sections: demographics, work environment, and health/safety/wellness. Results are immediately available to participants, who can then compare their results with national averages (if available) and standards developed from evidence-based sources such as Healthy People 2020. Responses become part of a continually accumulating database that nurses can use to track trends and set policy.
To take the survey, visit the ANA's website at http://www.anahra.org.
In February, celebrate
* Wear Red Day (February 7)http://www.goredforwomen.org
* Age-Related Macular Degeneration/Low Vision Awareness Monthhttp://www.preventblindness.org
* Burn Awareness Week (February 2 to 8)http://www.burnawareness.org
* Perianesthesia Nurse Awareness Week (February 3 to 9)http://www.panaw.com
* Eating Disorders Awareness Week (February 23 to March 1)http://www.nedawareness.org
PRESSURE ULCERS
Mattresses take a turn for the better
A recent study of newer high-density foam mattresses used in long-term-care facilities found no difference in the incidence of pressure ulcers among patients using these mattresses who were turned at 2-, 3-, or 4-hour intervals. The study included 942 long-term-care facility residents age 65 and older who were at moderate to high risk of developing pressure ulcers. Residents were randomly allocated to a 2-, 3-, or 4-hour repositioning schedule for 3 weeks. Their skin was assessed weekly by blinded assessors.
After 3 weeks, researchers found no difference in pressure ulcer incidence when residents were "repositioned consistently and skin was monitored. This finding has major implications for use of nursing staff and cost of [nursing home] care."
Source: Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Turning for ulcer reduction: a multisite randomized clinical trial in nursing homes. J Am Geriatr Soc. 2013;61(10):1705-1713.
HEART FAILURE
RN coaching may not reduce readmissions
A study conducted by researchers at Duke University involved 86 patients with heart failure who were at high risk for poor adherence to drug therapy. Researchers wanted to learn why patients skip their medications and whether a nursing intervention could improve adherence, with the goal of lowering hospital readmission rates among these patients.
Patients were randomly assigned into two groups: those who were periodically contacted and coached by nurses about taking their drugs, and those who were contacted on the same schedule but not coached by nurses.
Nurses asked patients about signs and symptoms, triggers for symptoms, and the patients' typical responses. Many patients reported that they stopped taking their drugs when symptoms persisted, believing that the drugs were ineffective. When symptoms escalated, most patients said they went to an ED.
Coached by nurses at 3-, 6-, and 12-month intervals, patients in the intervention group learned about managing their symptoms, taking their medication on schedule, and developing an action plan for addressing their symptoms. They were encouraged to use healthcare provider offices and clinics rather than EDs.
The good news: Patients who received nurse coaching were four times more likely to adhere to their drug therapy than the comparison group. Despite this dramatic improvement, however, readmission rates didn't differ between the two groups for reasons that are unclear. Researchers are considering whether many of the same social and economic factors that cause health disparities may also contribute significantly to high resource use. They're continuing to investigate.
The findings were presented at the American Heart Association's Scientific Sessions in Dallas.
Source: Staying on medication may not translate to avoiding readmission. Duke Medicine News and Communications. News release. November 27, 2013.
SUDDEN CARDIAC ARREST
Heed the early warning signs
As part of the Oregon Sudden Unexpected Death Study, researchers gathered information on the health histories of 567 men ages 35 to 65 who'd experienced out-of-hospital cardiac arrests in the Portland, Oregon metropolitan area from 2002 to 2012. They found that 53% of these men had experienced symptoms before the arrest, including chest pain (56%), shortness of breath (13%) and dizziness, syncope, or palpitations (4%). Most symptoms (80%) occurred in the period between 4 weeks and 1 hour before the event. Although most of the men had coronary artery disease, only about half had been tested for it before the cardiac arrest.
The study was presented at the American Heart Association's Scientific Sessions 2013 in Dallas, Tex. Similar research on women is now underway.
Source: Many sudden cardiac arrests preceded by warning signs. American Heart Association Meeting Report: Abstract 18987 (Hall F, Core 4, Poster Board: 4051). November 19, 2013.
PEDIATRICS
Kids with severe flu need antiviral drugs
Prompt treatment with neuraminidase inhibitor (NAI) drugs may improve survival of children critically ill with influenza. A recent study involved children younger than 18 treated for influenza in California ICUs between 2009 and 2012. Six percent of children treated with NAIs died from flu compared with 8% of children who weren't treated with NAIs.
Treatment within 48 hours of symptom onset was "significantly" associated with survival. Researchers say that "recent decreased frequency of NAI treatment of influenza may be placing untreated critically ill children at an increased risk of death."
Source: Louie JK, Yang S, Samuel MC, Uyeki TM, Schechter R. Neuraminidase inhibitors for critically ill children with influenza. Pediatrics. 2013;132(6):e1539-e1545.