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Critical Care Nursing Quarterly

Janet T Crimlisk, Gintas P Krisciunas, Margie H Sipe, Michael R Winter, R Mauricio Gonzalez, Gregory A Grillone
Patients in an acute care hospital who experience a difficult airway event outside the operating room need a specialized emergency airway response team (EART) immediately. This designated team manages catastrophic airway events using advanced airway techniques as well as surgical intervention. Nurses respond as part of this team. There are no identified difficult airway team documentation instruments in the literature, and the lack of metrics limits the quality review of the team response. This study identified EART documentation criteria and incorporated them into a nursing documentation instrument to be completed by a nurse scribe during the event...
October 2018: Critical Care Nursing Quarterly
Yelena Ignatyeva, Albert Phan Nguyen, Ulrich Schmidt, Ron Barak, Ravi Agarwal, Judy E Davidson
Intra-hospital transport (IHT) of intensive care unit (ICU) patients is associated with a 30% to 60% incidence of adverse events (AEs). This prospective observational study collected data from 200 patient transports from a 24-bed cardiovascular intensive care unit (ICU) between July 2017 and December 2017. Phase 1 of the study focused on identifying and correcting deficiencies in nurses' knowledge regarding IHT. Phase 2 observed the occurrence and type of AEs during the IHT of ICU patients with and without physician accompaniment...
October 2018: Critical Care Nursing Quarterly
Kim Bartolowits
Operational Excellence is about allowing the system to put the correct processes in place to empower all staff members to make change. These processes will evolve into continuous quality improvement, allowing the best outcomes to be achieved. At Allegheny Health Network, Pittsburgh, the right structures are in place to incorporate continuous process improvement by using an Operational Excellence board. This article discusses how the Operational Excellence concept and board was used in a busy cardiothoracic intensive care unit to affect employee safety and empowerment as well as improvements in patient safety and care quality...
October 2018: Critical Care Nursing Quarterly
Susan Leininger
Stress-induced hyperglycemia can occur after cardiac surgery unless the patient is carefully managed. Postoperative hyperglycemia is typically associated with surgical site infections and mediastinitis, resulting in a longer length of stay and escalated costs for the hospitalization. The American Association of Clinical Endocrinologists recommend keeping the intraoperative and postoperative blood glucose levels below 180 mg/dL to avoid postoperative infections. This article describes the effectiveness of a Glucose Management Team tasked with ensuring that blood glucose levels are maintained within these recommended guidelines, starting with day of admission and extending through the first postoperative day...
October 2018: Critical Care Nursing Quarterly
Alex Calhoun
Extracorporeal membrane oxygenation (ECMO) is used for both cardiac and pulmonary failure when conventional measures are no longer substantial in supporting life. ECMO is not a permanent device. It is used as a temporary measure to allow the lungs and heart, as well as other organs to recover. If recovery is not possible, it may also be used as a bridge to a more permanent device such as the left ventricular assist device or heart or lung transplantation. This is a detailed description of the differences between venovenous ECMO and venoarterial ECMO and the nursing care that is associated with the two...
October 2018: Critical Care Nursing Quarterly
Kari Mohney
The heart transplant nurse coordinator plays a key role in educating and supporting the postoperative heart transplant patient to achieve the best outcomes for a long and healthy life. The time leading up to transplantation, wait-list candidates will hear vital information regarding life after they have received their life-sustaining heart transplant. Unfortunately, at times, the information is minimally retained. The first few days to weeks following surgery are a crucial period of time for education of patients to be discharged from the hospital setting to home where they will need to care for themselves independently...
October 2018: Critical Care Nursing Quarterly
Samantha Hoy, Jason Frisbee
Heart failure or congestive heart failure remains a major public health concern on the global scale. End-stage heart failure is a severe disease where the heart is unable to pump enough oxygen and nutrients to other tissues and organs of the body. When the lines of treatment of heart failure such as lifestyle adjustments, medical management, and device therapy fail, a patient may be deemed a candidate for heart transplantation. This article reviews the history of heart transplantation, complications post-heart transplantation, and nursing management considerations for the immediate period after heart transplant surgery...
October 2018: Critical Care Nursing Quarterly
Ashley Blair
Heart failure is one of the most common diagnoses in patients requiring multiple hospitalizations. The use of mechanical circulatory support (both temporary and durable), especially left ventricular assist devices (LVADs), in this patient population has evolved over the last decade. There are thousands of durable LVADs implanted in the United States annually as bridge to transplantation, destination therapy, or bridge to recovery. LVAD therapy, just like cardiac transplantation, takes a multidisciplinary team approach to achieve success...
October 2018: Critical Care Nursing Quarterly
Rebecca Pirozzi
Heart transplantation is a viable option for many patients with end-stage heart failure. An extensive evaluation by specialists and in-depth testing are done to determine the risks of advanced therapies including the left ventricular assist device, since most patients need one to safely make it to transplant. A multidisciplinary approach is the most effective approach to successfully progressing a patient to transplant safely and helping him or her prosper after transplant.
October 2018: Critical Care Nursing Quarterly
Diane Berger
Transcatheter aortic valve replacement (TAVR) is quickly becoming the new standard of care for high- and intermediate-risk patients requiring aortic valve replacement. From May 2012 through April 2018, 1850 patients were evaluated for severe aortic valve stenosis, and over 900 TAVR procedures were performed at the author's institution, Allegheny General Hospital, Pittsburgh. Efficient screening processes, comprehensive review of data, and the less invasive delivery of care have made the TAVR program a viable and sustainable treatment option for patients with severe symptomatic aortic valve stenosis...
October 2018: Critical Care Nursing Quarterly
Laurie Weatherby
Coronary artery bypass grafting remains a viable and successful option for treating high-grade coronary artery stenosis. The postoperative recovery is individual for each patient, but when following long-standing guidelines and physician orders, outcomes are generally positive.
October 2018: Critical Care Nursing Quarterly
Rita Schwab, Molly Kosoglow, Frances Hite Philp, Erin Suydam
The decision to develop a formal Bloodless Medicine Program to attract and effectively care for patients who decline blood transfusion was made in 1998 by clinical and administrative leaders at our flagship hospital, Allegheny General Hospital, part of the Allegheny Health Network. The Bloodless Medicine Program has more than 20 years of experience in caring for this sometimes challenging patient population and with this experience has provided extensive insight into best practices related to effective, safe, patient blood management...
October 2018: Critical Care Nursing Quarterly
Susan Leininger, Kim Bartolowits
No abstract text is available yet for this article.
October 2018: Critical Care Nursing Quarterly
Deborah L Totzkay
Reduction in nursing staff injuries has occurred with the use of an evidence-based approach to safe patient handling and mobility. Parts of the evidence-based practice initiative include having the appropriate equipment, such as mechanical patient-lifting devices, a no-lift policy, and the use of peer coaches. The combination of the implementation of a culture of safety can sustain evidence-based, safe patient-handling practices that reduce patient-handling injuries. Patient-handling programs should include adaptations for an aging nursing workforce...
July 2018: Critical Care Nursing Quarterly
Katie Parchem, Amanda Peck, Katherine Tales
Research has shown that patients who are mechanically ventilated or immobile for greater than 7 days are at increased risk for deconditioning and muscle atrophy. Immobility impacts length of stay as well as patients' ability to return to their prior level of function. As part of the safe patient-handling initiative created at Michigan Medicine, a special team of nurses and therapists was assembled to adapt an adult mobility framework for the pediatric population. The pediatric mobility model determines each patient's specific mobility "phase" based on detailed criteria...
July 2018: Critical Care Nursing Quarterly
Danielle Van Damme, Heidi Flori, Tonie Owens
Physical activity in acute and critical care has been recognized as a successful method of improving patient outcomes. Challenges lie, however, in mobilizing pediatric critically ill patients and establishing consensus among health care providers about the safety and feasibility. The challenge of mobilizing pediatric patients is balancing developmental level, functional ability, and level of acuity; therefore, a mobility guideline was developed for use in the pediatric intensive care unit (PICU). The unique population and challenges in the PICU led to the development of a PICU-specific set of medical criteria within a PICU mobility guideline...
July 2018: Critical Care Nursing Quarterly
Tonie Owens, Christopher Tapley
Due to improvements in biomedical sciences and clinical expertise, childhood mortality has decreased. Pediatric patients experience similar complications from inactivity as adults, such as hospital-acquired conditions and delirium. Interdisciplinary collaboration is imperative to improve functional and developmental outcomes of children who suffers from either a chronic illnesses or an acute illness that results in a prolonged hospitalization. Pediatric nursing assessments should include gross motor function related to mobility...
July 2018: Critical Care Nursing Quarterly
Chris J Dickinson
No abstract text is available yet for this article.
July 2018: Critical Care Nursing Quarterly
Renee Havey, Cassandra Aebersold, Jason Terrasi
Nelson and Baptiste noted that a standard approach to safe patient handling and mobility (SPHM) cannot be generalized to all patient care areas because the unique, high-risk tasks of each area require specific intervention. Matching the SPHM program to the setting, tasks, and roles is important in developing a program that will prevent harm. However, there is little evidence related to the use of SPHM programs in nontraditional care environments, such as emergency departments (EDs). A such, there is no standardized method for training ED nurses in safe patient handling...
July 2018: Critical Care Nursing Quarterly
Twanda Gillespie, Sarah Lane
The health care team must be able to mobilize bariatric patients efficiently and safely. It is challenging to find the proper equipment of sufficient variety to meet the need. Patients can feel self-conscious when staff are struggling to provide care, and staff can be injured when trying to mobilize patients without the proper equipment. This can result in feelings of humiliation for the patient and frustration for staff. Furthermore, staff often experience compassion fatigue when dealing with their frustration around this...
July 2018: Critical Care Nursing Quarterly
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