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Use of Rapid Response Teams to Expedite Imaging and Treatment for Inpatients With Acute Stroke. 使用快速反应小组加快急性中风住院病人的成像和治疗。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-12-15 DOI: 10.4037/aacnacc2025924
Kathrina B Siaron, Theresa Heineman, Julie Earnest, Lillian Otieno-Watta, Cara Pulliam, Norma Sonier, Emerson B Nairon, DaiWai M Olson, Mark Johnson, Leah A Cohen
{"title":"Use of Rapid Response Teams to Expedite Imaging and Treatment for Inpatients With Acute Stroke.","authors":"Kathrina B Siaron, Theresa Heineman, Julie Earnest, Lillian Otieno-Watta, Cara Pulliam, Norma Sonier, Emerson B Nairon, DaiWai M Olson, Mark Johnson, Leah A Cohen","doi":"10.4037/aacnacc2025924","DOIUrl":"10.4037/aacnacc2025924","url":null,"abstract":"<p><p>In-hospital strokes carry high long-term morbidity and mortality rates, but treatment pathways for inpatient strokes are not as well studied as those for community-onset strokes. This single-center, retrospective study of in-hospital Code Strokes extracted data from a database maintained by stroke nurse coordinators at an urban academic institution (January 2017 to March 2023). The objective was to explore the benefits of a rapid response team-driven Code Stroke model. Of 900 Code Stroke activations, 836 were driven by the rapid response team and 64 were not driven by the rapid response team. Patients with codes activated by the rapid response team received imaging faster than did those with codes not activated by the rapid response team (mean [SD] time, 15.7 [13.7] minutes vs 23.2 [23.1] minutes; P = .03). More Code Strokes were activated in the intensive care units and cardiovascular units than in other areas.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 4","pages":"317-324"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716357","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}
引用次数: 0
Mechanical Ventilation: Modes, Settings, and Clinical Considerations. 机械通气：模式、设置和临床考虑。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-12-15 DOI: 10.4037/aacnacc2025722
John J Gallagher, Jennifer Lynn Adamski
{"title":"Mechanical Ventilation: Modes, Settings, and Clinical Considerations.","authors":"John J Gallagher, Jennifer Lynn Adamski","doi":"10.4037/aacnacc2025722","DOIUrl":"10.4037/aacnacc2025722","url":null,"abstract":"<p><p>Since its initial use during the polio epidemic in the 1950s, positive pressure mechanical ventilation has become an indispensable therapy to support critically ill patients in the intensive care unit. Over the past 70 years, ventilators have increased in technical sophistication and capability. Although these advances have increased our ability to support complex conditions such as acute respiratory distress syndrome, the development of new modes and applications, often assigned manufacturer-specific trade names, can cause confusion among clinicians who must use them. This article will review the classification of ventilator modes, initial ventilator settings, alarms, and clinical considerations when using mechanical ventilation. From these basics, we will explore more advanced modes that may be used for lung protection and recruitment to improve oxygenation and ventilation. Additionally, we will discuss potential complications of mechanical ventilation and strategies to mitigate them.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 4","pages":"356-373"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716337","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}
引用次数: 0
Beyond Monitors: Intravenous Smart Pump Alarm Fatigue As a Safety Concern. 超越监视器：静脉注射智能泵报警疲劳作为安全问题。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025136
Brenda Abena Nyarko, Karen K Giuliano
{"title":"Beyond Monitors: Intravenous Smart Pump Alarm Fatigue As a Safety Concern.","authors":"Brenda Abena Nyarko, Karen K Giuliano","doi":"10.4037/aacnacc2025136","DOIUrl":"10.4037/aacnacc2025136","url":null,"abstract":"<p><p>Intravenous smart pump alarm fatigue remains a persistent and underrecognized patient safety concern in acute and critical care settings. Although alarm fatigue has been traditionally associated with physiological monitors, intravenous smart pumps are also a frequent source of alarms for hospitalized patients that contribute substantially to alarm fatigue. This article synthesizes current evidence on intravenous smart pumps and related alarm fatigue, identifies knowledge gaps, and proposes short-term and long-term interventions. Inconsistencies in alarm design and inadequate human-centered design have led to the development of intravenous smart pump systems that create an unacceptably high number of technical alarms that are unrelated to changes in patient status. Data-driven strategies are discussed as mechanisms to reduce burden and enhance alarm effectiveness. A systems-level approach combining human factors engineering, intelligent algorithm development, and clinical partnerships with manufacturers is essential for reducing alarm-related risk, decreasing nursing workload, and improving patient outcomes.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"252-257"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001638","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}
引用次数: 0
Critical Care Antineoplastic Infusions: Safety and Practice Essentials. 重症护理抗肿瘤输液：安全和实践要点。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025932
Karen Meade, Elizabeth Clark, Michele L Weber
{"title":"Critical Care Antineoplastic Infusions: Safety and Practice Essentials.","authors":"Karen Meade, Elizabeth Clark, Michele L Weber","doi":"10.4037/aacnacc2025932","DOIUrl":"10.4037/aacnacc2025932","url":null,"abstract":"<p><p>Oncology care is rapidly evolving due to the continual emergence of new treatment. Despite the shift toward outpatient cancer care, many patients still need inpatient hospitalization for antineoplastic infusion therapies because of a variety of factors. Acute and critical care nurses may be responsible for administering complex intravenous therapies to treat cancer. This task requires careful attention to both patient and nurse safety. Nurses must be knowledgeable about hazardous drug handling, safe medication delivery, prompt recognition and management of adverse effects, and the unique challenges of infusion therapy in critically ill patients. This article outlines key nursing practice considerations and best practices for the administration of oncology infusions in critical care settings, emphasizing strategies to optimize patient outcomes and minimize risks associated with infusion therapy.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"258-271"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001646","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}
引用次数: 0
Optimizing Patient Safety: Intravenous Smart Pump Usability in Acute and Critical Care. 优化患者安全：静脉注射智能泵在急性和危重症护理中的可用性。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025998
Karen K Giuliano, Peggy McDaniel, Dian Baker
{"title":"Optimizing Patient Safety: Intravenous Smart Pump Usability in Acute and Critical Care.","authors":"Karen K Giuliano, Peggy McDaniel, Dian Baker","doi":"10.4037/aacnacc2025998","DOIUrl":"10.4037/aacnacc2025998","url":null,"abstract":"<p><p>Large-volume intravenous (IV) smart pumps are used in acute and critical care to deliver IV fluids and medications with safety-enhancing features such as dose error reduction systems. Although these technologies offer improvements over manual administration, IV smart pumps are associated with high rates of medication errors, programming challenges, and usability issues. Alarm fatigue, interface complexity, and workarounds are common, with studies showing high error rates. The Elaine Marieb Center for Nursing and Engineering Innovation at the University of Massachusetts Amherst addresses these concerns through interdisciplinary research focused on IV smart pump usability, safety, and innovation. Real-world studies, US Food and Drug Administration recalls, and post-market issues underscore the urgent need for improved user-centered design and regulatory oversight. Collaboration between clinicians, engineers, and manufacturers is crucial for developing safer, more intuitive devices. This article synthesizes current evidence and highlights opportunities for advancing IV smart pump safety and usability to improve patient outcomes.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"230-239"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001687","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}
引用次数: 0
Secondary Infusion Underdelivery: Risks and Rewards of Common Workarounds. 二次输液输送不足：常见解决方案的风险和回报。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025893
Jeannine W C Blake, Robert Butterfield, Tiffany Hopper, Nathaniel M Sims
{"title":"Secondary Infusion Underdelivery: Risks and Rewards of Common Workarounds.","authors":"Jeannine W C Blake, Robert Butterfield, Tiffany Hopper, Nathaniel M Sims","doi":"10.4037/aacnacc2025893","DOIUrl":"10.4037/aacnacc2025893","url":null,"abstract":"<p><p>Secondary medication delivery using large-volume smart pumps offers important workflow and safety benefits. However, the widely used linear peristaltic large-volume smart pumps rely on sufficient head-height differential for accurate secondary infusion, leading to underdelivery risks. This article outlines common clinician workarounds used to mitigate these risks, including delivering secondary medications via primary mode, programming excess volume to be infused, clamping primary lines, and using short-set primary delivery. Although intended to ensure full medication delivery, these strategies introduce safety risks, increase alert burden, and heighten cognitive load. In contrast, cassette-based large-volume smart pumps use valve-controlled fluid delivery, eliminating the need for head-height differential and reducing the potential for human error. This review evaluates the risks and rewards of these workarounds and offers guidance to support informed decision-making while advocating for long-term technology solutions that improve safety, reduce clinician burden, and align with best practices in infusion therapy.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"240-251"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001603","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}
引用次数: 0
Diagnostic Error: An Overview. 诊断错误：概述。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025978
Mary Mescher Benbenek
{"title":"Diagnostic Error: An Overview.","authors":"Mary Mescher Benbenek","doi":"10.4037/aacnacc2025978","DOIUrl":"10.4037/aacnacc2025978","url":null,"abstract":"<p><p>Diagnostic error is increasingly identified as a concern in health care. The purposes of this article are to provide an understanding of diagnostic error and its contributing factors and to briefly review strategies to reduce errors. A literature review provided a definition of diagnostic error, a synopsis of diagnostic error prevalence and settings, systemic and individual factors contributing to diagnostic error, and cognitive biases and errors in diagnostic reasoning. Strategies to address diagnostic error are discussed. Diagnostic errors are prevalent across clinical settings, may result in harm, and are preventable. Enhancing the education of health care professionals related to diagnostic reasoning and metacognition, using clinical decision-making tools, and advocating for strong communication practices may reduce diagnostic errors in practice settings.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"123-130"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188242","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}
引用次数: 0
Diagnostic Reasoning for APRN Learners: Overview of Teaching Strategies. APRN学习者的诊断推理：教学策略概述。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025341
Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy
{"title":"Diagnostic Reasoning for APRN Learners: Overview of Teaching Strategies.","authors":"Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy","doi":"10.4037/aacnacc2025341","DOIUrl":"10.4037/aacnacc2025341","url":null,"abstract":"<p><p>Diagnostic error is a critical issue in health care. To reduce diagnostic error and enhance practice safety of new graduates, advanced practice registered nurse (APRN) learners need intentional preparation in diagnostic reasoning. It is imperative that APRN programs integrate diagnostic reasoning into all program curricula. This article provides an overview of teaching strategies aimed at promoting skill development in diagnostic reasoning, specifically related to knowledge development, differential diagnosis, and reflective practices. The article reviews foundational information related to dual-process thinking and teaching strategies for APRN primary and acute care curricula. Knowledge development is supported by illness scripting and problem representation activities. Skills in differential diagnosis and diagnosis prioritization are supported by the use of grids and lists. Cognitive debiasing and reflective practice are supported through self-explanation and structured reflection. Implementation of tailored teaching strategies can effectively prepare learners for clinical practice as diagnosticians.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"131-142"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188245","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}
引用次数: 0
Diagnostic Reasoning Competency Assessment Tools: An Integrative Review. 诊断推理能力评估工具：综合回顾。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025683
Leah Burt, Patricia B Griffith, Margaret Bavis, Rebecca Raszewski
{"title":"Diagnostic Reasoning Competency Assessment Tools: An Integrative Review.","authors":"Leah Burt, Patricia B Griffith, Margaret Bavis, Rebecca Raszewski","doi":"10.4037/aacnacc2025683","DOIUrl":"10.4037/aacnacc2025683","url":null,"abstract":"<p><p>Diagnostic errors are the most common cause of medical mistakes in the United States. Nurse practitioners (NPs) are critical in reducing the incidence of diagnostic errors, because diagnosis is a common competency for NPs. Although strategies for teaching diagnostic reasoning in NP education have been studied, little research has been conducted on evaluating diagnostic reasoning competencies among NP students. This integrative literature review was performed to identify and synthesize diagnostic reasoning competency assessment strategies in NP education. Data were evaluated for quality and synthesized to provide a comprehensive, actionable overview for NP educators. Although most assessments have been implemented among medical learners, most are also based on processes common to interprofessional diagnostic reasoning competencies. A small number were developed or implemented with NP learners. Current assessment methods may be used in NP education in various settings (eg, simulation education, clinical rotations) with varying reliability and validity.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"174-186"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188244","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}
引用次数: 0
Secondary Headache: Learning Diagnostic Reasoning in Complex Cases. 继发性头痛：学习复杂病例的诊断推理。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025295
Sarah McCarthy, Sheila Smith
{"title":"Secondary Headache: Learning Diagnostic Reasoning in Complex Cases.","authors":"Sarah McCarthy, Sheila Smith","doi":"10.4037/aacnacc2025295","DOIUrl":"10.4037/aacnacc2025295","url":null,"abstract":"<p><p>Acute care nurse practitioners (ACNPs) provide care in a variety of settings and for a wide range of patient acuities. Flexible use of both analytic and nonanalytic thinking is necessary for safer and efficient diagnostic reasoning (DR). The purpose of this article is to review the diagnostic thought process required of ACNPs, provide a case-based example of DR in a complex secondary headache scenario, and identify key tools to help ACNP learners develop strong DR skills. Multiple strategies for developing or advancing DR competencies can be used by ACNP learners at all levels using learner-driven approaches. Statistically significant improvement in DR performance can be achieved with intentional, learner-driven activities and metacognitive exercises. ACNP learners have the opportunity to master DR using various system 1, system 2, and metacognitive processes to ensure safe and effective DR, even in the most complex of cases.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"143-157"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188252","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}
引用次数: 0
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