Bold Voices - January 2012 - (Page 12)
CERTIFICATION PRACTICE ALERT
AACN Issues Four New Evidence-Based Practice Alerts
AACN adds four new Practice Alerts — which help standardize practice, inform nurses on the latest advances and issues of concern, and ensure a safe work environment — to its extensive collection of evidence-based clinical practice resources. “Practice Alerts are important because they give you clear direction for speciﬁc actions to: ‘Stop doing, start doing, or we don’t have enough evidence to say.’ They are written by content experts who can distill the research and translate it into appropriate activities for the bedside nurse,” says Linda Bell, AACN clinical practice specialist. Catheter-Associated Urinary Tract Infections (CAUTIs) — One of the most common healthcare-associated infections in the U.S., CAUTIs are associated with increased morbidity and mortality; up to 80 percent of urinary tract infections are linked to an indwelling urinary catheter, the alert notes. Since the Centers for Medicare and Medicaid Services considers them a reasonably preventable complication of hospitalization, no additional payment is given to hospitals for CAUTI treatment-related costs. To manage CAUTIs, a 2012 national patient safety goal set by The Joint Commission, AACN’s recommendations include unit guidelines for urinary catheterization, training programs and daily review of the need for catheter use. Family Visitation in the Adult ICU — Evidence suggests family visitation improves patient and family satisfaction as well as safety of care, particularly in the ICU, where patients are often intubated and cannot speak for themselves, this Practice Alert notes. It also recommends unrestricted 24-hour ICU visitation with a support person, according to patient preference, and expected practice includes ensuring the facility has approved written practices. CAUTI, family visitation, delirium, Delirium Assessment and Management — Delirium, which often goes undetected, affects up to 80 percent of ICU aspiration prevention join the patients and is associated with increased length of ICU and Practice Alert collection. hospital stays. AACN’s Practice Alert recommends delirium assessment at least once per shift and developing a protocol with early progressive mobility for all critically ill patients. Expected practice includes strategies to decrease delirium risk factors, including early exercise, and incorporating evidence-based strategies into daily care. Prevention of Aspiration — Approximately half of critically ill, mechanically ventilated patients receiving tube feedings experienced frequent micro-aspirations, according to a study referenced in this alert. Since no bedside tests are available to detect micro-aspirations, minimizing or preventing aspiration takes on added importance. AACN’s expected practice includes maintaining head-of-bed elevation at 30 to 45 degrees, unless contraindicated, using sedatives sparingly and maintaining endotracheal cuff pressures at an appropriate level. Read the Practice Alert about CAUTIs on page 13 of this issue of AACN Bold Voices, or online with references at www.aacn.org/practicealerts. Full text of the other new alerts will be published in future issues. Access all of them now at www.aacn.org/practicealerts.
12 www.aacnboldvoicesonline.org JANUARY 2012
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