Critical care nursing quarterly
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Central venous access devices are indispensable tools in caring for the gravely ill patients in today's critical care units. Unfortunately, they are also one of the major sources for nosocomial infections in the hospital setting. This article explores the pathophysiology and risk factors related to central venous access devices infections, and examine prevention strategies. The critical care nurse, using evidence-based practice guidelines in the care of these lines, can be instrumental in preventing catheter-related infections.
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In a fast-paced setting like the intensive care unit (ICU), nurses must have appropriate tools and resources in order to implement appropriate and timely interventions. Ventilator-associated pneumonia (VAP) is a costly and potentially fatal outcome for ICU patients that requires timely interventions. Even with established guidelines and care protocols, nurses do not always incorporate best practice interventions into their daily plan of care. ⋯ The first method is a personal process improvement model, and the second method is a team approach model. Both methods were utilized in order to implement interventions in a timely and complete manner to prevent VAP and its related problem, hospital-associated pneumonia, in the ICU setting. Success with these 2 methods has spurred an interest in other patient care initiatives.
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The implementation of a rapid response team or medical emergency team is 1 of the 6 initiatives of the Institute for Healthcare Improvement's 100,000 Lives Campaign with the goal to reduce the number of cardiopulmonary arrests outside the intensive care unit and inpatient mortality rates. The concept of RRT was pioneered in Australia and is now being implemented in many hospitals across the United States. ⋯ The first-quarter data after implementation are described. The unique role of the acute care nurse practitioner in this hospital's model is described.
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A significant reduction in morbidity and mortality can be achieved by using intensive insulin therapy to achieve normoglycemia in the critically ill patient. Nurses hourly titrate insulin infusion rates using protocols, most often in chart form, to guide practice. Despite the reported development of several intensive insulin protocols, information about the accuracy, practicality, ease of calculation, and preferences of critical care nurses have not been studied. ⋯ Overall, the accuracy of the calculations improved with each revision of the nomogram. The nurses did not have a preference of one tool over another but gave extensive feedback that helped refine the nomogram. The resultant nomogram was shown to be easy to use, helpful in improving the accuracy of insulin dosage calculation, and judged to be practical by the nurses who would use the tool at the bedside.