Tag: American Association of Critical-Care Nurses (AACN)

Rapid Telehealth Consults Improve Care for Rural Patients With Stroke

Newswise — Minutes matter when a patient may have had a stroke, but being far from a physician with advanced training in neurology no longer needs to be a barrier to rapid diagnosis and intervention.

Telestroke programs are designed to improve access to the limited number of specialists, regardless of the geographic isolation of patients who may have experienced a stroke. Telestroke, or stroke telemedicine, is a form of telehealth in which physicians with advanced training in stroke care use technology to provide immediate consultation to a local healthcare professional to recommend diagnostic imaging and treatment for patients with stroke at an originating site. Patients who present within 4.5 hours of when they were last known to be well may be eligible for thrombolytic drug therapy or endovascular intervention, often measured as door-to-needle time.

After launching a telestroke consultation program, Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin and North Dakota, increased the percentage of patients receiving thrombolytics in less than 60 minutes and decreased the average door-to-needle time.

“Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms” describes how Essentia Health’s program ensures that patients are evaluated rapidly to expedite decisions about their course of treatment. The article is published in the October issue of Critical Care Nurse (CCN).

Essentia Health initiated the telestroke program in fall 2019, with coverage provided by a team of four interventional neurologists, three of whom work in the system’s Comprehensive Stroke Center in Fargo, North Dakota. In addition to this center, telestroke services are provided to five other acute stroke-ready hospitals throughout rural areas in the upper Midwest.

Through the telestroke program, neurology consultations are available to all of the sites 24 hours a day, every day of the year, and can be used for both inpatient and emergency department stroke activations at each of the facilities.

The team developed a tiered stroke alert algorithm and telestroke workflow chart to help healthcare professionals at rural sites determine eligibility for telestroke consultation to decide the treatment plan.

The algorithm categorized strokes as level I to III according to the symptoms and time when the patient was last known to be well. Telestroke consults were most often used for patients with level I stroke alerts since they were within the timeframe when they may be eligible for thrombolytic drug therapy or endovascular intervention.

Once staff members determine whether a telestroke consultation will be initiated, they refer to the step-by-step workflow chart, which specifies actions needed for each member of the multidisciplinary team.

Co-author Chelsey Kuznia, BSN, RN, SCRN, is the stroke program manager for Essentia Health’s Comprehensive Stroke Center in Fargo, one of only two such facilities in North Dakota.

“Regardless of the type of stroke, rapid diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke,” she said. “People living in rural areas not only have increased stroke risk factors, but they also face challenges to getting the advanced care they need in a timely way, which leads to higher rates of disability and death.”

In 2022, telestroke connections for 42 patients were completed, with a stroke diagnosis confirmed in 25 of them (61%). Fourteen of the patients with confirmed stroke received thrombolytic therapy while others were not eligible, either because of patient-related contraindications or because more than 4.5 hours had elapsed since their last-known well time.

Of the 25 patients with confirmed stroke, 18 (72%) were discharged home, while three were discharged to skilled nursing facilities, one to an inpatient rehabilitation unit, one to hospice and two died.

The year prior to implementation of the telestroke program, 11 of 15 eligible patients (73%) received thrombolytic therapy in less than 60 minutes, with a mean door-to-needle time of 61 minutes. During the year after implementation, the results improved: 11 of 12 eligible patients (92%) received thrombolytic therapy in less than 60 minutes, and the mean door-to-needle time decreased to 38 minutes.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

American Association of Critical-Care Nurses (AACN)

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October 1, 2023
Analysis Reveals Factors Associated With Patients With Sepsis Who Require Mechanical Ventilation

Newswise — An analysis of 10 years of health data showed that risk factors for needing mechanical ventilation changed for patients with newly diagnosed sepsis as more time passed after onset.

In the study, 13.5% of patients with a new diagnosis of sepsis required initiation of mechanical ventilation. More than half of these patients required mechanical ventilation within the first 24 hours after sepsis onset, while initiation of mechanical ventilation occurred after 24 hours in 47.4% of patients.

“Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study” examined 10 years of data from the University of Michigan Medical Center electronic health data warehouse. The analysis included adult patients with sepsis who were not receiving mechanical ventilation at sepsis onset. The study is published in American Journal of Critical Care (AJCC).

Co-author Robert Freundlich, MD, MS, MSCI, is an associate professor, department of anesthesiology, and chief of the anesthesiology informatics research division at Vanderbilt University Medical Center, Nashville, Tennessee. The research was conducted during his research fellowship in critical care at the University of Michigan, Ann Arbor.

“Requiring mechanical ventilation is often a pivotal point for patients with sepsis, and their risk of respiratory failure may vary with time,” he said. “Identifying patients at high risk and implementing targeted interventions in a timely manner has the potential to significantly improve outcomes.”

A total of 35,020 patients met sepsis criteria, and 28,747 patients were eligible for inclusion after exclusion criteria were applied. The dataset spanned July 10, 2009, to Sept. 7, 2019.

Of all eligible patients, 3,891 (13.5%) required mechanical ventilation within 30 days after sepsis onset. Of these, 2,046 (52.6%) required mechanical ventilation within 24 hours of diagnosis. Mechanical ventilation was subsequently initiated for 441 (11.3%) patients from one to two days after sepsis onset, and for 312 (8.0%) patients from two to three days following diagnosis. The remaining 1,092 (28.1%) experienced late respiratory failure or required mechanical ventilation three to 30 days after diagnosis.

Patients requiring mechanical ventilation had higher baseline illness severity and a higher prevalence of 27 of the 35 comorbidities on the Elixhauser Comorbidity Index, which measures overall severity of comorbidities.

They also had a higher in-hospital mortality rate (21%) than patients who did not require mechanical ventilation (7%). Further analysis revealed that of the patients who received mechanical ventilation before but not after sepsis onset, only 35 (4% of 822) died prior to hospital discharge.

Factors that were independently associated with an increased likelihood that mechanical ventilation would be needed included race, systemic inflammatory response syndrome (SIRS) score, Sequential Organ Failure Assessment (SOFA) score and congestive heart failure. Risks decreased with time for the SOFA score and congestive heart failure and varied with time for four comorbidities and three culture results.

The researchers recommend future proactive studies focus on the effects of fluid resuscitation and other processes of care on the need for mechanical ventilation in this patient population. The use of noninvasive ventilation and high-flow nasal cannula may also impact the need for intubation and mechanical ventilation and should be evaluated.

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of about 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

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September 1, 2023
Decision Guide Clarifies Indicators for Swallowing Consults

Newswise — A multidisciplinary group at ECU Health Medical Center in Greenville, North Carolina, developed a decision guide to provide healthcare teams with specific guidelines for swallowing care after extubation. The decision guide standardizes the process for clinicians to determine which recently extubated patients required further swallowing assessment by an appropriate professional.

As the only Level 1 trauma center east of Raleigh, North Carolina, ECU Health Medical Center serves a vast rural region home to more than 1.4 million people and is the largest resource for critically ill patients in eastern North Carolina. Critically ill patients are frequently intubated with an endotracheal tube to maintain an adequate airway for breathing. After the endotracheal tube is removed, patients often experience difficulty swallowing, also known as dysphagia, which is associated with a variety of poor outcomes.

“It is important that patients experiencing dysphagia be treated swiftly because dysphagia can cause difficulty eating, drinking or swallowing necessary medications,” said Waverlyn J. Royals, MS, CCC-SLP, speech-language pathology (SLP) clinical specialist and student education coordinator for rehabilitation services at ECU Health Medical Center. “Determining which patients need a swallowing assessment helps care teams intervene early and improve outcomes, as well as more efficiently use resources and reduce costs.”

Since ECU Health is an academic health system, its partnership with Brody School of Medicine at East Carolina University allows for team members such as Royals to conduct research to continue finding best practices for patients and care teams. The multidisciplinary group conducted a literature review as part of a process improvement project to help clarify decision-making for patients post-extubation. This review identified specific risk factors that healthcare teams should consider regarding dysphagia post-extubation.

These risk factors became points of decision in the guide. A “yes” answer to any of the decision points resulted in the patient’s continued non-oral status and triggered a consult to SLP professionals. If each question has a “no” response, it eliminates unnecessary requests to assess patients who already tolerate an oral diet. For patients with no positive indicators from the decision guide, including a water swallowing challenge, the nurse consulted with a healthcare provider about starting an oral diet.

“In addition to clarifying which patients need further evaluation, the guide provides nurses and providers with clear indicators to answer questions from patients and families about why individuals were deemed unready to safely resume eating and drinking,” Royals said.

“A Decision Guide for Assessing the Recently Extubated Patient’s Readiness for Safe Oral Intake” details the development of the guide, as well as the risk factors and clinical indicators it covers. The study is published in the February issue of Critical Care Nurse (CCN).

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 128,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

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February 1, 2023
UCHealth Initiative Reduces Off-Label Pulse Oximeter Placement

Newswise — The critical care team at UCHealth in Colorado reduced the off-label placement of pulse oximetry sensors from 15% to less than 1%, according to an article published in the December issue of Critical Care Nurse (CCN).

“Improving Patient Safety by Increasing Staff Knowledge of Evidence-Based Pulse Oximetry Practices” details how the short-term quality improvement initiative helped change the culture of pulse oximetry use, with long-term solutions, ongoing education and the addition of dedicated ear probes in each critical care patient room.

Pulse oximetry is a commonly used monitoring technology that provides an indirect and accurate method of measuring a patient’s oxygen saturation, an essential element in critical care units and many inpatient clinical areas. The results help inform decisions regarding oxygen therapy.

Many common clinical situations can result in using a pulse oximetry sensor in an off-label location, such as placing a finger sensor on an earlobe. With limited literature about the accuracy of such off-label use, it’s considered a best practice to follow the manufacturer’s guidelines and use sensors for only those locations for which they are designed.

Co-author Maureen Varty, PhD, RN, is a research nurse scientist at UCHealth University of Colorado Hospital and an assistant professor at University of Colorado College of Nursing, Aurora. She worked on the initiative with Danielle Hlavin, BSN, RN, CCRN-CMC, a charge nurse at UCHealth Memorial Hospital Central in Colorado Springs.

“When trying to get an oxygen reading, it can be easy to use the same sensor in various points, but pulse oximeters are not interchangeable,” Hlavin said. “By taking the time to understand the barriers to practice, we identified sustainable solutions and reinforced best practices for using the correct type of sensor and preventing pressure injuries that may develop.”

The initiative was a response to noticing that off-label placement was being used in critical care patient rooms, with inconsistent practices that could affect patient safety.

Audits were conducted by entering each occupied patient room and noting finger probes being used on off-label sites. In the preintervention audit, with 508 observations during August through October 2020, a finger probe was used off label in 77 patients (15.2%). In the postintervention audit in March and April 2021, with 365 observations, a finger probe was used instead of an ear probe in only three patients (0.8%).

The team used a simple preintervention survey to assess healthcare staff members’ knowledge of and confidence in pulse oximetry use and appropriate placement. Before the intervention, only 38.9% of bedside staff members said they knew not to use finger sensors on the ear. After the intervention, 85% of respondents knew not to do so.

They also evaluated the availability of pulse oximetry supplies, types of supplies and any barriers to obtaining this equipment. This assessment revealed anecdotal evidence that staff members had difficulty quickly locating ear probes for their patients, leading them to turn to off-label placement when finger sensors were not able to detect a good signal.

With the support of hospital management, 90 ear probes were purchased for critical care settings. These were labeled “ICU” and affixed to the pulse oximeter cable in each patient room for easy access.

A brief, formal educational presentation was first provided to 175 nurses in October 2020 during staff skill laboratories, and then to 37 respiratory therapists and 21 patient care technicians and advanced care providers during their staff meetings from October 2020 through January 2021.

Further education was provided in real time to mitigate the potential risks of pressure injuries developing from the use of ear probes and ensure that best practices continued to be followed.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 128,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

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December 1, 2022
Registration Opens for Premier Critical Care Nursing Conference
Newswise — The American Association of Critical-Care Nurses (AACN) invites nurses and other healthcare professionals who care for acutely and critically ill patients and their families to its 2023 National Teaching Institute & Critical Care Exposition (NTI) in Philadelphia, May 22-24.

The NTI experience will address nearly 50 clinical and professional development topics, allowing attendees to hone their clinical and professional practice skills while learning and networking with leading experts in critical care and colleagues from across the country.

NTI learning opportunities offer the following formats:
- Educational Sessions: More than 200 sessions are offered during the conference and available after the conference through Oct. 31, 2023. Sessions are 60, 75 or 150 minutes.
- SuperSessions: Large sessions for all participants feature motivational keynote speakers and AACN leaders, geared toward professional success, current and future trends, and/or national and global issues.
- Pharmacology Content: Online classroom sessions include a minimum portion of pharmacotherapeutic content on drug-specific information, safe prescribing practices, safe medication administration and prescribing methodologies.
- Posters: Self-viewing Beacon Journey for Excellence, Chapter Best Practices, CSI Academy Innovation, Evidence-Based Solutions and Research digital posters are offered during the conference and available after the conference through Oct. 31.
- Sunrise/Sunset Sessions: Sessions are funded by unrestricted grants from corporate supporters. Sessions are 60 minutes long with approximately 75% clinical and 25% product-specific content.
- ExpoEd Education: Product- and program-specific educational and in-service-style learning is provided by exhibitors. Sessions are 30 minutes.
NTI includes the Critical Care Exposition, the largest and most comprehensive trade show expressly for progressive and critical care nurses. Hundreds of exhibits spread over 200,000 square feet will encompass cutting-edge healthcare equipment, devices, supplies and career opportunities.

Following the in-person conference, AACN will offer NTI Virtual June 12-14, an online experience with the SuperSessions and educational sessions presented in Philadelphia, supplemented by live interaction with facilitators and attendees, and meaningful networking opportunities.

For NTI 2023, participants can earn 37.75 CE contact hours, which are calculated on a 60-minute hour and determined by the number of learning activities a registered NTI participant completes. Learners must view/read the entire learning activity and complete the associated evaluation, as well as the program evaluation, to be awarded CE contact hours or CERP credit. No partial hours or credit will be awarded.

More than 200 NTI sessions will be available on-demand with CE contact hours through Oct. 31.

About the National Teaching Institute & Critical Care Exposition: Established in 1974, AACN’s National Teaching Institute & Critical Care Exposition (NTI) represents the world’s largest educational conference and trade show for nurses who care for acutely and critically ill patients and their families. Bedside nurses, nurse educators, nurse managers, clinical nurse specialists and nurse practitioners attend NTI.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and over 200 chapters in the United States.
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November 10, 2022