{"title":"The cold truth about postcardiac arrest targeted temperature management: 33°C vs. 36°C.","authors":"Sara Knippa, Jana Butler, L. Johnson, S. Perman","doi":"10.1097/01.CCN.0000660392.87533.89","DOIUrl":"https://doi.org/10.1097/01.CCN.0000660392.87533.89","url":null,"abstract":"","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000660392.87533.89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49112560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"30 minutes or less","authors":"M. Rolen, Betsy Richter-Gifford, M. Sleutel","doi":"10.1097/01.CCN.0000660412.23959.21","DOIUrl":"https://doi.org/10.1097/01.CCN.0000660412.23959.21","url":null,"abstract":"When it comes to correctional insulin administration in the hospital, the old adage, “Better late than never,” is simply unsafe. Timeliness is important concerning the critical interval between checking a patient’s blood glucose (BG) reading and administering correctional insulin for the result. As the population living with diabetes in America grows, so does the number of people admitted to the hospital with diabetes as a comorbidity. Current best-practice recommendations guide hospitals to use insulin for diabetes management while patients are in the hospital. Insulin is a high-risk medication, with potential for serious harm or even death when errors occur. A 2010 study revealed that the most-common medical errors in critical care patients were insulin administration errors.1 A survey conducted by the Institute for Safe Medication Practices (ISMP) in 2014 surveyed pharmacists and nurses, and showed that subcutaneous insulin ranked ninth among almost 40 drugs and drug classes identified as highalert medications that concerned practitioners.2 Yet, of all the highalert medications, subcutaneous insulin came in last place when pharmacists and nurses were asked to rank how confident they were regarding the effectiveness of hospital-wide precautions to prevent serious errors.2 The survey findings suggest a consensus among pharmacists and nurses that hospitalized patients are vulnerable to errors with subcutaneous insulin, and that more must be done to prevent patient harm with this high-alert medication. Many insulin errors result in serious hypoglycemia, especially when point-of-care BG monitoring is not coordinated well with meals and insulin therapy. Coordinating insulin with meals and glucose monitoring in inpatient settings is a nationwide challenge.3 Studies suggest that the timing of glucose monitoring and insulin administration occur within an acceptable range less than half of the time in hospitalized patients prescribed insulin.4,5 Studies suggest that less than half of patients met the goal of receiving a rapid-acting insulin within 10 to 15 minutes of a meal, and only 35% received glucose monitoring within 1 hour prior to insulin administration.4,5 Timing for meals, BG testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various facilities. Coordinating BG monitoring with correctional insulin administration is a significant challenge in the inpatient hospital setting. BG checks were performed at inconsistent times on the authors’ unit; insulin was not being administered in coordination with BG checks, and the staff was unaware of the ISMP recommendations. This article outlines an intervention aimed at reducing the interval between BG checks and correctional insulin administration, with a target of 30 minutes or less of the BG check as per ISMP best-practice recommendations.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000660412.23959.21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49302798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing noncompressible torso hemorrhage with REBOA.","authors":"M. K. Bartley","doi":"10.1097/01.CCN.0000718320.73469.6c","DOIUrl":"https://doi.org/10.1097/01.CCN.0000718320.73469.6c","url":null,"abstract":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews nursing considerations for patients undergoing REBOA.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44985935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A case for shared governance","authors":"","doi":"10.1097/01.ccn.0000654808.02124.a7","DOIUrl":"https://doi.org/10.1097/01.ccn.0000654808.02124.a7","url":null,"abstract":"","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.ccn.0000654808.02124.a7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49606485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ventilator waveforms","authors":"B. Pruitt","doi":"10.1097/01.CCN.0000654804.24995.ce","DOIUrl":"https://doi.org/10.1097/01.CCN.0000654804.24995.ce","url":null,"abstract":"March l Nursing2020CriticalCare l 29 Mechanical ventilation supports patients in many ways, such as decreasing the work of breathing, supporting and improving gas exchange, and recruiting collapsed alveoli. These benefits are often lifesaving, but mechanical ventilation can also cause harm by opening the door for infection, contributing to muscle atrophy and ventilator dependence, contributing to an increased work of breathing, or damaging the fragile lung tissues, leading to development of complications such as pneumothorax or acute respiratory distress syndrome Abstract: Mechanical ventilation supports patients by decreasing the work of breathing, supporting and improving gas exchange, and recruiting collapsed alveoli. However, mechanical ventilation can cause harm by opening the door for infection, contributing to muscle atrophy and ventilator dependence, contributing to an increased work of breathing, or damaging the fragile lung tissues. This article examines how ventilator waveforms can help achieve the delicate balance of providing ventilatory support while avoiding harm in adults and give clues to how well the patient-ventilator system is functioning.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000654804.24995.ce","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46627659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sally Huey, M. Granitto, L. Brien, Catherine C Tierney
{"title":"E-cigarette, or vaping, product use associated lung injury","authors":"Sally Huey, M. Granitto, L. Brien, Catherine C Tierney","doi":"10.1097/01.ccn.0000654800.17371.09","DOIUrl":"https://doi.org/10.1097/01.ccn.0000654800.17371.09","url":null,"abstract":"","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.ccn.0000654800.17371.09","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48242650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Zimmermann, You “Jay” Chung, Cara Fleming, Jericho Garcia, Yekaterina Tayban, H. J. Alvarez, MaryAnn Connor
{"title":"Implementing real-time sepsis alerts using middleware and smartphone technology","authors":"M. Zimmermann, You “Jay” Chung, Cara Fleming, Jericho Garcia, Yekaterina Tayban, H. J. Alvarez, MaryAnn Connor","doi":"10.1097/01.CCN.0000654832.34404.99","DOIUrl":"https://doi.org/10.1097/01.CCN.0000654832.34404.99","url":null,"abstract":"A s clinical practice continues to evolve and improve, technology has become increasingly integrated into everyday clinical workflow. From alarms and alerts to pointof-care electronic clinical communication tools, the future of healthcare depends on the ability to implement technology to improve quality and safety of patient care.1 Adoption of electronic health records (EHRs) has been found to improve clinicians’ performance by providing access to aggregated patient information such as lab results, nursing notes, and alerts.2 The use of decision support system technology, along with clinical reasoning, can help decrease errors and avoid delays in treatment.3 Real-time alerts and data to and from mobile platforms can lead to early diagnosis and detection, with the opportunity to improve quality of life and reduce healthcare costs.4 However, caution must be taken with these implementations to evaluate and address alert fatigue (often called alarm fatigue) and ensure alerts are clinically actionable and relevant.5 Development of alert algorithms through an EHR should help provide clinical decision support by supplying relevant information, at the time it is needed, to the correct clinician.6 An example of this includes the high-risk scenario of sepsis identification, with alerts triggered from the EHR. Research has shown that sepsis alerts can help improve patient outcomes by assisting with early detection.7,8 A study by Dziadzko and colleagues compared the emergence of smartphones for sepsis alerts to EHR-based notifications and pagers to determine the best method of notification delivery.6 Due to technologic failures and barriers, sepsis smartphone alerts were unsuccessful, and clinicians continued to use pagers and EHR-based alerts.6 Continued research and development were identified as needs to better evaluate the efficacy of smartphone alerts in a clinical setting.6 Since May 2013, the New York State Department of Health (NYSDOH) has regulated that hospitals maintain sepsis protocols that use explicit algorithms and/ or alert systems to assist in the early identification of patients with severe sepsis and septic shock.9,10 However, in January 2017, regulatory changes necessitated real-time, prospective identification of sepsis and standardized clinician documentation.11 This documentation was needed to record an initial assessment, and recognition of sepsis signs and symptoms as well as verifying reassessment of the patient’s sepsis signs and symptoms within 6 hours of management. At Memorial Sloan Kettering Cancer Center (MSKCC), the alert algorithm was initially set so that patients with three simultaneous abnormal vital signs, new (in a 24-hour period) altered mental status, or rigors in the presence of two abnormal vital signs triggered an alert. MSKCC has a unique population of oncology patients, and patient signs and symptoms or treatment adverse reactions could often be similar to sepsis indicators. Sepsis alerts were put in place to hel","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000654832.34404.99","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41766332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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