Pub Date : 2020-03-01DOI: 10.1097/01.CCN.0000654832.34404.99
M. Zimmermann, You “Jay” Chung, Cara Fleming, Jericho Garcia, Yekaterina Tayban, H. J. Alvarez, MaryAnn Connor
A s clinical practice continues to evolve and improve, technology has become increasingly integrated into everyday clinical workflow. From alarms and alerts to pointof-care electronic clinical communication tools, the future of healthcare depends on the ability to implement technology to improve quality and safety of patient care.1 Adoption of electronic health records (EHRs) has been found to improve clinicians’ performance by providing access to aggregated patient information such as lab results, nursing notes, and alerts.2 The use of decision support system technology, along with clinical reasoning, can help decrease errors and avoid delays in treatment.3 Real-time alerts and data to and from mobile platforms can lead to early diagnosis and detection, with the opportunity to improve quality of life and reduce healthcare costs.4 However, caution must be taken with these implementations to evaluate and address alert fatigue (often called alarm fatigue) and ensure alerts are clinically actionable and relevant.5 Development of alert algorithms through an EHR should help provide clinical decision support by supplying relevant information, at the time it is needed, to the correct clinician.6 An example of this includes the high-risk scenario of sepsis identification, with alerts triggered from the EHR. Research has shown that sepsis alerts can help improve patient outcomes by assisting with early detection.7,8 A study by Dziadzko and colleagues compared the emergence of smartphones for sepsis alerts to EHR-based notifications and pagers to determine the best method of notification delivery.6 Due to technologic failures and barriers, sepsis smartphone alerts were unsuccessful, and clinicians continued to use pagers and EHR-based alerts.6 Continued research and development were identified as needs to better evaluate the efficacy of smartphone alerts in a clinical setting.6 Since May 2013, the New York State Department of Health (NYSDOH) has regulated that hospitals maintain sepsis protocols that use explicit algorithms and/ or alert systems to assist in the early identification of patients with severe sepsis and septic shock.9,10 However, in January 2017, regulatory changes necessitated real-time, prospective identification of sepsis and standardized clinician documentation.11 This documentation was needed to record an initial assessment, and recognition of sepsis signs and symptoms as well as verifying reassessment of the patient’s sepsis signs and symptoms within 6 hours of management. At Memorial Sloan Kettering Cancer Center (MSKCC), the alert algorithm was initially set so that patients with three simultaneous abnormal vital signs, new (in a 24-hour period) altered mental status, or rigors in the presence of two abnormal vital signs triggered an alert. MSKCC has a unique population of oncology patients, and patient signs and symptoms or treatment adverse reactions could often be similar to sepsis indicators. Sepsis alerts were put in place to hel
{"title":"Implementing real-time sepsis alerts using middleware and smartphone technology","authors":"M. Zimmermann, You “Jay” Chung, Cara Fleming, Jericho Garcia, Yekaterina Tayban, H. J. Alvarez, MaryAnn Connor","doi":"10.1097/01.CCN.0000654832.34404.99","DOIUrl":"https://doi.org/10.1097/01.CCN.0000654832.34404.99","url":null,"abstract":"A s clinical practice continues to evolve and improve, technology has become increasingly integrated into everyday clinical workflow. From alarms and alerts to pointof-care electronic clinical communication tools, the future of healthcare depends on the ability to implement technology to improve quality and safety of patient care.1 Adoption of electronic health records (EHRs) has been found to improve clinicians’ performance by providing access to aggregated patient information such as lab results, nursing notes, and alerts.2 The use of decision support system technology, along with clinical reasoning, can help decrease errors and avoid delays in treatment.3 Real-time alerts and data to and from mobile platforms can lead to early diagnosis and detection, with the opportunity to improve quality of life and reduce healthcare costs.4 However, caution must be taken with these implementations to evaluate and address alert fatigue (often called alarm fatigue) and ensure alerts are clinically actionable and relevant.5 Development of alert algorithms through an EHR should help provide clinical decision support by supplying relevant information, at the time it is needed, to the correct clinician.6 An example of this includes the high-risk scenario of sepsis identification, with alerts triggered from the EHR. Research has shown that sepsis alerts can help improve patient outcomes by assisting with early detection.7,8 A study by Dziadzko and colleagues compared the emergence of smartphones for sepsis alerts to EHR-based notifications and pagers to determine the best method of notification delivery.6 Due to technologic failures and barriers, sepsis smartphone alerts were unsuccessful, and clinicians continued to use pagers and EHR-based alerts.6 Continued research and development were identified as needs to better evaluate the efficacy of smartphone alerts in a clinical setting.6 Since May 2013, the New York State Department of Health (NYSDOH) has regulated that hospitals maintain sepsis protocols that use explicit algorithms and/ or alert systems to assist in the early identification of patients with severe sepsis and septic shock.9,10 However, in January 2017, regulatory changes necessitated real-time, prospective identification of sepsis and standardized clinician documentation.11 This documentation was needed to record an initial assessment, and recognition of sepsis signs and symptoms as well as verifying reassessment of the patient’s sepsis signs and symptoms within 6 hours of management. At Memorial Sloan Kettering Cancer Center (MSKCC), the alert algorithm was initially set so that patients with three simultaneous abnormal vital signs, new (in a 24-hour period) altered mental status, or rigors in the presence of two abnormal vital signs triggered an alert. MSKCC has a unique population of oncology patients, and patient signs and symptoms or treatment adverse reactions could often be similar to sepsis indicators. Sepsis alerts were put in place to hel","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000654832.34404.99","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41766332","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}
Principle Using a supravital stain (e.g., new methylene blue), residual ribosomal RNA within the reticulocytes is precipitated. An equal volume of stain is added to EDTA-anticoagulated blood, the dilution mixture incubated, and a smear is prepared. The smear is examined to determine the number of reticulocytes present. An erythrocyte containing two or more particles of blue-stained material is a reticulocyte. The number of reticulocytes is expressed as a percentage of the total number of erythrocytes counted. 1
{"title":"Reticulocyte count","authors":"","doi":"10.32388/s5p8lj","DOIUrl":"https://doi.org/10.32388/s5p8lj","url":null,"abstract":"Principle Using a supravital stain (e.g., new methylene blue), residual ribosomal RNA within the reticulocytes is precipitated. An equal volume of stain is added to EDTA-anticoagulated blood, the dilution mixture incubated, and a smear is prepared. The smear is examined to determine the number of reticulocytes present. An erythrocyte containing two or more particles of blue-stained material is a reticulocyte. The number of reticulocytes is expressed as a percentage of the total number of erythrocytes counted. 1","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"510 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80080620","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}
Pub Date : 2020-02-01DOI: 10.1097/01.CCN.0000718340.28170.d1
M. J. Deem, J. Stephen
When an adult patient lacks the capacity to make her or his own healthcare decisions, the clinical team turns to a surrogate decision-maker (typically a family member) to assist in making decisions that protect and promote the interests of the patient. However, requests by a surrogate that may not be in the patient’s best interest may make the clinical team uncomfortable. In this article, a bioethicist, Michael
{"title":"Do a surrogate decision-maker's motives matter?","authors":"M. J. Deem, J. Stephen","doi":"10.1097/01.CCN.0000718340.28170.d1","DOIUrl":"https://doi.org/10.1097/01.CCN.0000718340.28170.d1","url":null,"abstract":"When an adult patient lacks the capacity to make her or his own healthcare decisions, the clinical team turns to a surrogate decision-maker (typically a family member) to assist in making decisions that protect and promote the interests of the patient. However, requests by a surrogate that may not be in the patient’s best interest may make the clinical team uncomfortable. In this article, a bioethicist, Michael","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49354631","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}
Pub Date : 2020-01-01DOI: 10.1097/01.CCN.0000612860.71342.d3
P. Conley
Achieving international dissemination of research findings involving critical care issues in nursing is essential to optimizing patient outcomes. Research evidence can impact the lives of individuals all over the world, but knowledge gaps exist due in part to lack of publication or presentation of research findings. Moher and colleagues reported that more than 50% of completed research findings are not published.1 This article discusses the need for global dissemination of research and outlines the steps researchers can take to publish their study results.
{"title":"International dissemination of evidence","authors":"P. Conley","doi":"10.1097/01.CCN.0000612860.71342.d3","DOIUrl":"https://doi.org/10.1097/01.CCN.0000612860.71342.d3","url":null,"abstract":"Achieving international dissemination of research findings involving critical care issues in nursing is essential to optimizing patient outcomes. Research evidence can impact the lives of individuals all over the world, but knowledge gaps exist due in part to lack of publication or presentation of research findings. Moher and colleagues reported that more than 50% of completed research findings are not published.1 This article discusses the need for global dissemination of research and outlines the steps researchers can take to publish their study results.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000612860.71342.d3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61632762","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}
Pub Date : 2020-01-01DOI: 10.1097/01.CCN.0000612832.74020.6e
Vincent M. Vacca
www.nursingcriticalcare.com Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, was first described in the 19th century by French neurologist Dr. Jean-Martin Charcot. In the 20th century, ALS also became known as Lou Gehrig disease, named after the famous New York Yankees baseball player who had the disease. Lou Gehrig died from ALS in 1941 at the age of 37.1 ALS is the most common form of motor neuron disease and is the third-most common neurodegenerative disorder behind Alzheimer and Parkinson diseases.2 There are an estimated 300,000 individuals currently living with ALS in the US.3 The median age of onset is 55 and the disease incidence peaks between 70 and 75 years of age.1,4 Males are affected more than females. About 90% of ALS cases are determined to be sporadic, or acquired, while the remainder are considered familial or hereditary. Known risk factors include age and family history, but there is now evidence that cigarette smoking is also a risk factor for ALS.1 This article provides critical care nurses with information about the etiology and pathophysiology, signs and symptoms, and diagnosis of ALS, as well as nursing considerations to help patients at end of life. Although treatment can slow disease progression, it is important for critical care nurses to understand that treatment is not curative. Abstract: About 7,000 new cases of amyotrophic lateral sclerosis (ALS) are diagnosed in the US every year. This neurodegenerative disease is rapidly progressive and always fatal. Although treatment can help slow disease progression, it is not curative. This article includes the etiology and pathophysiology of, signs and symptoms of, diagnosis of, and treatment for ALS, and special critical care nursing considerations to help patients at end of life.
{"title":"Amyotrophic lateral sclerosis","authors":"Vincent M. Vacca","doi":"10.1097/01.CCN.0000612832.74020.6e","DOIUrl":"https://doi.org/10.1097/01.CCN.0000612832.74020.6e","url":null,"abstract":"www.nursingcriticalcare.com Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, was first described in the 19th century by French neurologist Dr. Jean-Martin Charcot. In the 20th century, ALS also became known as Lou Gehrig disease, named after the famous New York Yankees baseball player who had the disease. Lou Gehrig died from ALS in 1941 at the age of 37.1 ALS is the most common form of motor neuron disease and is the third-most common neurodegenerative disorder behind Alzheimer and Parkinson diseases.2 There are an estimated 300,000 individuals currently living with ALS in the US.3 The median age of onset is 55 and the disease incidence peaks between 70 and 75 years of age.1,4 Males are affected more than females. About 90% of ALS cases are determined to be sporadic, or acquired, while the remainder are considered familial or hereditary. Known risk factors include age and family history, but there is now evidence that cigarette smoking is also a risk factor for ALS.1 This article provides critical care nurses with information about the etiology and pathophysiology, signs and symptoms, and diagnosis of ALS, as well as nursing considerations to help patients at end of life. Although treatment can slow disease progression, it is important for critical care nurses to understand that treatment is not curative. Abstract: About 7,000 new cases of amyotrophic lateral sclerosis (ALS) are diagnosed in the US every year. This neurodegenerative disease is rapidly progressive and always fatal. Although treatment can help slow disease progression, it is not curative. This article includes the etiology and pathophysiology of, signs and symptoms of, diagnosis of, and treatment for ALS, and special critical care nursing considerations to help patients at end of life.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000612832.74020.6e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41907683","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}
Pub Date : 2020-01-01DOI: 10.1097/01.CCN.0000612856.94212.9b
Amy Glasofer, Ann B. Townsend
ABSTRACT To support evidence-based nursing practice, the authors provide guidelines for nonresearch evidence, which includes clinical practice guidelines, consensus or position statements, literature review, expert opinion, organizational experience, case reports, community standards, clinician experience, and consumer preferences. This is the third in a three-part series.
{"title":"Determining the level of evidence: Nonresearch evidence.","authors":"Amy Glasofer, Ann B. Townsend","doi":"10.1097/01.CCN.0000612856.94212.9b","DOIUrl":"https://doi.org/10.1097/01.CCN.0000612856.94212.9b","url":null,"abstract":"ABSTRACT\u0000To support evidence-based nursing practice, the authors provide guidelines for nonresearch evidence, which includes clinical practice guidelines, consensus or position statements, literature review, expert opinion, organizational experience, case reports, community standards, clinician experience, and consumer preferences. This is the third in a three-part series.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000612856.94212.9b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48399420","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}
Pub Date : 2020-01-01DOI: 10.1097/01.CCN.0000612840.12139.f1
Gail Larkin, Tamara L. Bellomo, Lenel Caze
www.nursingcriticalcare.com Mrs. M, 54, was admitted to the ED after a syncopal episode that resulted in a head injury. Based on an ECG and echocardiography findings, she was diagnosed with hypertrophic cardiomyopathy (HCM). After her head injury was determined non-life-threatening, the treating physician discharged her with instructions to follow up with a cardiologist and consider having family members tested for this genetic disorder. HCM is a common genetically determined heart muscle disease. Worldwide, without discrimination for race, gender, or ethnicity, HCM has a prevalence of approximately 1 out of 200 to 1 out of 300 in the general population. Based on current data, the Hypertrophic Cardiomyopathy Association estimates that HCM affects 1 million or more people in the US and 36 million or more worldwide.1 HCM is differentiated from other types of cardiomyopathy by the absence of any known clinical cause. In some instances, its Abstract: Hypertrophic cardiomyopathy (HCM), a common congenital heart disease, is the leading cause of sudden cardiac death in adolescents, young adults, and athletes. Older adults with HCM are less likely to experience sudden cardiac death, but their quality of life can be impaired. This article discusses diagnostic criteria, treatments, and critical care nursing interventions, including patient teaching, for adults with HCM.
{"title":"Hypertrophic cardiomyopathy","authors":"Gail Larkin, Tamara L. Bellomo, Lenel Caze","doi":"10.1097/01.CCN.0000612840.12139.f1","DOIUrl":"https://doi.org/10.1097/01.CCN.0000612840.12139.f1","url":null,"abstract":"www.nursingcriticalcare.com Mrs. M, 54, was admitted to the ED after a syncopal episode that resulted in a head injury. Based on an ECG and echocardiography findings, she was diagnosed with hypertrophic cardiomyopathy (HCM). After her head injury was determined non-life-threatening, the treating physician discharged her with instructions to follow up with a cardiologist and consider having family members tested for this genetic disorder. HCM is a common genetically determined heart muscle disease. Worldwide, without discrimination for race, gender, or ethnicity, HCM has a prevalence of approximately 1 out of 200 to 1 out of 300 in the general population. Based on current data, the Hypertrophic Cardiomyopathy Association estimates that HCM affects 1 million or more people in the US and 36 million or more worldwide.1 HCM is differentiated from other types of cardiomyopathy by the absence of any known clinical cause. In some instances, its Abstract: Hypertrophic cardiomyopathy (HCM), a common congenital heart disease, is the leading cause of sudden cardiac death in adolescents, young adults, and athletes. Older adults with HCM are less likely to experience sudden cardiac death, but their quality of life can be impaired. This article discusses diagnostic criteria, treatments, and critical care nursing interventions, including patient teaching, for adults with HCM.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000612840.12139.f1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41953024","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}
Pub Date : 2020-01-01DOI: 10.1097/01.ccn.0000668576.18811.32
A. Palatnik
{"title":"Thank you for your resilience","authors":"A. Palatnik","doi":"10.1097/01.ccn.0000668576.18811.32","DOIUrl":"https://doi.org/10.1097/01.ccn.0000668576.18811.32","url":null,"abstract":"","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61632786","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}
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