1. careers
2. nursing

Navigating Change in the Healthcare Landscape
Joseph Kishel PharmD, MBA and Pam Hawn, BS, PharmD CONTENT DESCRIPTION
First, we will provide a high level overview of why health care changes were
brought to the forefront of social, economic, and political issues.
Then, we will discuss how health reform (specifically, the ACA
(ACA=Affordable Care Act)) attempts to address these forces, because a broad
understanding of the law first is helpful in order to have a deeper understanding
of any one aspect. Of course this is a 2000-page document (with many more
pages worth of interpretation), so we have identified key points to highlight.
Once we discuss a few of the key initiatives, we’ll go over a “current events
update” on topical issues in the news today (Medicaid expansion and health
insurance exchanges), as they relate to insurance and coverage reform.
Finally, we’ll take a closer look at the aspects that will most impact hospitals and
providers of care– payment and delivery reform. Some of you may be aware of
the value-driven payment initiatives are already underway, and we will take a
closer look at this and provide a few examples of how institutions are
responding.
OBJECTIVES
1. Provide overview of why healthcare changes were brought to the
forefront of social, economic, and political issues
2. Understand the rationale behind the ACA and the triple aim of the ACA
3. Discuss the reason for the move from fee for service delivery model to the
ideal of Global payment
CONTENT OUTLINE
I.
II.
III.
IV.
Forces driving health care change
a. State of US Healthcare
b. Unsustainable growth
c. High spending and poor performance
Affordable Care Act overview
a. The triple aim
b. Targets of ACA
c. Implementation
State implemented update
a. Medicaid expansion
b. Health insurance exchanges
Transforming payment and delivery models
Spotlight on Critical Care 2014
Navigating Change in the Healthcare Landscape
Joseph Kishel PharmD, MBA and Pam Hawn, BS, PharmD a. From fee for service to Global payment
V.
Summary & Questions
SELF-ASSESSMENT QUESTIONS
1. Can you describe the “triple aim” of the affordable care act?
2. What two options do the states have for expanding access to healthcare
under the affordable care act?
3. What are some of the impacts of value driven payment?
REFERENCES
Fineberg, HV. Shattuck Lecture. (2012). N Engl J Med, 366(11),1020-1027
Health at a Glance 2011: OECD Indicators. Why is health spending in the
U.S. So High? http://www.oecd.org/unitedstates/49084355.pdf
Squires, DA. (2011). The U.S. health system in perspective: a comparison of
twelve industrialized nations. Issue Brief (Commonw Fund),16, 1-14.
Berwick DM, et al. (2008).Health Aff (Millwood),27(3),759-769.
McCarthy D, et al. (2010). The Commonwealth Fund.
Spotlight On Critical Care 2014
Impact of an End of Life (EOL) Committee to Improve
Communication between Nurses and Patients about EOL Decisions
in the Intensive Care Unit (ICU)
Marlena Fisher RN, BSN, CCRN; Martha “Peachy” Beene RN, BSN, CCRN CONTENT DESCRIPTION
The presentation will focus on the role of an EOL committee in the ICU. We will
discuss what prompted us to begin an EOL committee in the MICU. Once the
committee was established our meetings focused on cultural awareness and how
that impacts communication with patients and families. Other interventions
included staff debriefings so that nurses had an outlet to discuss difficult patient
deaths and scenarios. Lastly, we will discuss how we plan to proceed and
expand the EOL committee at our institution.
OBJECTIVES
1. Participants will be able to describe the role of an End of Life Committee
in the ICU
2. Participants will be able to apply the tools to help improve nurse
communication at the end of life.
3. Participants will be able to explain the tools to help decrease nurses’ moral
distress in the ICU.
CONTENT OUTLINE
I.
II.
End of Life communication in the intensive care unit is flawed.
a. Nursing satisfaction scores in the Medical ICU identified a lack of
communication.
b. With further analysis it was identified that this lack of
communication was specific to end of life care.
c. A quality improvement project was drafted: The End of Life
Committee.
d. Pre-Survey was distributed to MICU staff nurses to gather baseline
data (n=32)
i. 77% of nurses experience moral distress
ii. 45% of nurses believed they provided futile care multiple
times a month
Aspects of the EOL Committee
a. Monthly meetings
i. Education including coping strategies for moral distress,
cultural awareness, and EOL Care.
ii. Debriefings on difficult patients
b. Goals of Care Guidelines were created
i. Initiate a family meeting and a palliative care consult if one
of the criteria are met
Spotlight on Critical Care 2014
Impact of an End of Life (EOL) Committee to Improve
Communication between Nurses and Patients about EOL Decisions
in the Intensive Care Unit (ICU)
Marlena Fisher RN, BSN, CCRN; Martha “Peachy” Beene RN, BSN, CCRN III.
IV.
V.
VI.
ii. Guidelines are reviewed every Tuesday (“Goal of Care
Tuesdays”)
Assessment of EOL Committee
a. Post-survey was distributed (n=26)
i. 90% of nurses reported monthly staff debriefing sessions
helped decrease moral distress
ii. 66% of nurses perceived an increase in Goal of Care
discussions
iii. 47% of nurses perceived an increase in palliative care
consults
The EOL Committee was able to help improve communication in the ICU,
increase resource utilization in the ICU, and decrease nurses’ moral
distress.
Future Goals of the EOL Committee
a. Continue the monthly meetings and staff debriefing sessions
b. Increase the membership to all ICUs (SICU and NSICU).
c. Educate new graduate nurses on End-of-Life Nursing Education
Consortium (ELNEC) information.
d. Provide more support for families and patients at the end of life
including comfort carts.
e. Education efforts will be focused on teaching nurses effective,
compassionate, and culturally sensitive end of life care.
Conclusion
a. As evidenced by our post-survey nurses’ perceived that the
interventions implemented by the EOL committee helped decrease
their moral distress and helped increase communication in the
MICU.
b. It is our goal to continue the EOL committee and expand our role
throughout the ICUs. As well as expanding our scope of
interventions to focus on education for new graduate nurses on
providing family members more support when their loved one is
dying.
SELF-ASSESSMENT QUESTIONS
1. True or False: Research indicates that communication is ineffective in the
ICU
2. True of False: One in five Americans die while in the ICU or soon
thereafter
Spotlight on Critical Care 2014
Impact of an End of Life (EOL) Committee to Improve
Communication between Nurses and Patients about EOL Decisions
in the Intensive Care Unit (ICU)
Marlena Fisher RN, BSN, CCRN; Martha “Peachy” Beene RN, BSN, CCRN 3. True of False: An End of Life Committee may be a useful tool for nurses to
learn better communication skills and how to care for patients at the end
of life.
REFERENCES
Boyle, D., Miller, P., Forbes-Thompson, S. (2005). Communication and End-oflife-care in the intensive care unit: Patient, family, and clinician outcomes. Critical
Care Nursing Quarterly 28, p.302-316.
White, D. B., Cua, S. M., Walk, R., Pollice, L., Weissfeld, L., Hong, S., Landefeld,
C. S., Arnold, R. M. (2012). Nurse-led intervention to improve surrogate decision
making for patients with advanced critical illness. American Journal of Critical
Care, 21(6), p. 396-409
Spotlight on Critical Care 2014
CARING FOR VENTRICULAR ASSIST DEVICE PATIENTS: NOT A
QUESTION OF IF, BUT OF WHEN
Tonya Elliott, RN, MSN, CCTC, CHFN CONTENT DESCRIPTION
This presentation will cover content about the incidence and prevalence of heart
failure (HF) as a platform for understanding how common this therapy is and
will likely be in the future. A review of the Pathophysiology of HF will give
participants a foundation to understand the rationale behind the therapies that
are now accepted in the 2013 Heart Failure Guidelines. Indications for pump
implant will give participants triggers for referring patients to advanced heart
failure therapy programs. Through images and demo models that will be passed
around the room, participants will be able to touch and see the components of
the systems. Handling and seeing the components will give participants a sense
of the commitment patients must make to this therapy.
The metamorphosis of this technology from a large volume displacement pump
to small continuous flow pumps changes the way patients are monitored and the
kinds of complications they experience. The impact of continuous flow
physiology will be reviewed by presenting the ways to monitor patients and
pump function and a discussion of the common complications of this therapy.
A description of the patient experience throughout the continuum of care will
provide participants with information about the surgery, recovery, transition to
home, and life in the community.
The growing number of patients with continuous flow physiology is having an
impact on the health care community. The model of care around this patient
population is changing creating the need for hub/spoke programs and shared
care practices. As VAD patients grow in number and length of support, they
require ongoing care from every discipline. It’s not a question of if, but when,
each of us will care of a VAD patient.
OBJECTIVES
1. Describe the indications for implantation of a ventricular assist device
2. Describe the basic components and operation of the system
3. State 5 “Do and Don’ts” while caring for VAD patients
CONTENT OUTLINE
I.
II.
Introduction:
a. Incidence and prevalence of HF
b. Impact of an aging population
VADs are a mainstay of treatment for advanced heart failure:
a. Indications for implant
Spotlight on Critical Care 2014
CARING FOR VENTRICULAR ASSIST DEVICE PATIENTS: NOT A
QUESTION OF IF, BUT OF WHEN
Tonya Elliott, RN, MSN, CCTC, CHFN III.
IV.
V.
VI.
VII.
VIII.
IX.
b. Definition of DT vs. BTT
Therapies for the treatment of HF
Referral to implant center
Evaluation process
Implant hospitalization
Transition of care
Community preparation
Managing an expanding patient population
SELF-ASSESSMENT QUESTIONS
1. Describe the progression of heart failure from stage A to stage D
2. State the basic components of Ventricular Assist Device Systems and their
function
3. Name 8 patient conditions that lead to poor pump performance
REFERENCES
Casida, J.M., Peters, R.M., & Magnan, M.A. (2009). Self-care demands of persons
living with an implantable LVAD. Res Theory Nurs Pract., 23(4), 279-93. doi:
10.1891/1541-6577.23.4.2791
Feldman, D., Pamboukian, S.V., Teuteberg, J.J., Birks, E., Lietz, K., Moore,
S.A.,…Rogers, J. (2013). The 2013 International Society for Heart and Lung
Transplatation guidelines for mechanical circulatory support. Journal Heart Lung
Transplant, 32(2), 157-187. Doi: http://dx.doi.org/10.1016/j.healun.2012.09.013
Khazanie, P., Hammill, B.G., Patel C.B., Eapen, Z.J., Peterson, E.D., Rogers,
J.G.,…Hernandez, A.F. (2014). Trends in the use and outcomes of VADs among
Medicare beneficiaries 2006-2011. JACC, 63(14), 1395-404. Doi:
10.1016/jacc.2013.12.020
Spotlight on Critical Care 2014
Management of Spontaneous Pneumothorax
Mary Duggan MS, RN, CCRN, ACNP‐BC; Christy Schatz RN, MSN, FNP‐BC, CRNFA CONTENT DESCRIPTION
This presentation will provide an overview of the pathophysiology of
spontaneous pneumothorax as a disease of the pleura with evidence of pleural
porosity and blebs. The presentation will provide a review of the importance of
intrapleural pressures to maintain an expanded lung. The presentation will
review clinical symptoms and diagnostic imaging. Presentation topics will cover
management of pneumothorax including observation vs chest tube, including
small bore vs large bore chest tubes, suction vs water seal, heimlick valve and
management of persistent air leak. This presentation will put emphasis on
prevention of recurrence of pneumothorax and provide an overview of surgical
procedures and post-op management including video of intraoperative VATS
procedures.
OBJECTIVES
1. Participants will be able to describe the risk factors, pathophysiology,
clinical presentation and differential diagnosis of spontaneous
pneumothorax
2. Participants will be able to differentiate clinical management options with
chest tube management
3. Participants will be able to identify the indications for and management of
patients undergoing surgery for pneumothorax
CONTENT OUTLINE
I.
II.
Pathophysiology and risk factors of pneumothorax
a. Disease of the pleura-primary vs secondary
b. Review intrapleural pressures
c. Risk factors-body type
d. Clinical symptoms of pneumothorax
e. Diagnostic imaging
Medical management of pneumothorax
a. Observation vs chest tube
b. Small bore vs large bore chest tubes
c. Suction vs water seal
d. Indications for ambulatory heimlick valve
e. Persistent air leak
f. Recurrence management
Spotlight on Critical Care 2014
Management of Spontaneous Pneumothorax
Mary Duggan MS, RN, CCRN, ACNP‐BC; Christy Schatz RN, MSN, FNP‐BC, CRNFA III.
Surgical procedures-curative treatment
a. Blebectomy, parietal pleurectomy, pleurodesis
b. VATS vs thoracotomy
c. Post-op management
SELF-ASSESSMENT QUESTIONS
1. What are the risk factors, pathophysiology, clinical presentation and
differential diagnosis of spontaneous Pneumothorax?
2. What are the different clinical management options after chest tube
placement?
3. What types of management strategies are used in persistent air leaks and
failure to re-expand?
REFERENCES
Baumann, MH et al. Management of spontaneous pneumothorax: (2001).
American College of Chest Physicians Delphi Consensus Statement. 119, p. 590-602.
Henry, M et al. BTS guidelines for the management of spontaneous
pneumothorax (2003). Thorax.58(2) p.39-52.
MacDuff, A et al. Management of spontaneous pneumothorax. (2010). British
Thoracic Society Pleural Disease Guidelines 65(2) p. 18-31
Miller, AC. (1993). Guidelines for the management of spontaneous
pneumothorax. BMJ 307 p. 114-116.
Spotlight on Critical Care 2014
High Risk Medications
Rose Dunkle, RN, BSN, MSN, CCRN CONTENT DESCRIPTION
Novice Nurses & nursing students in Critical Care can be easily overwhelmed
when faced with the large and diverse amounts of high risk medications
administered both IV push and via IV infusion. Common categories of high risk
medications will be reviewed. Best practices for administration of high-risk
medication will be reviewed. Review of complications of high-risk medications
will be discussed. The session will also include questions and answers.
OBJECTIVES
1. Discuss categories of High Risk Medications used in Critical Care
2. Discuss safety strategies & best practices when administering high risk
medications
3. Nursing considerations with IV push versus IV drip high risk medications
CONTENT OUTLINE
I.
II.
III.
Introduction-Overview of High Risk Medications
a. Electrolyte Replacements
b. Diuretics
c. Sedation & Analgesia
d. Vasoconstrictors & Vasodilators
e. Inotropes
Best Practices for Administration of High Risk Medications
a. Know your resources for safe medication administration
b. Review Generic as well as Brand Names
c. Review safe medication ranges
d. 2 RN double check & other best practices
e. Escalation
Complications of High Risk Medications
a. Dose related
b. Administration rate related
c. Drug interactions
SELF-ASSESSMENT QUESTIONS
1. Discuss 3 safety strategies/best practices when administering high risk
medications
2. List 3 IV medications that are categorized as positive inotropes
Spotlight on Critical Care 2014
High Risk Medications
Rose Dunkle, RN, BSN, MSN, CCRN 3. Discuss the complication of administering furosemide (Lasix) too quickly.
REFERENCES
(2013). Nursing pharmacology made incredibly easy, 3rd edition. Wolters
Kluwer/Lippincott, Williams & Wilkins.
(2013). Pathophysiology made incredible easy. Wolters Kluwer/Lippincott,
Williams & Wilkins.
(2014). Retrieved from http://epocrates.com/
Baird, M. S., & Bethel, S. (2011). Manual of critical care nursing interventions and
collaborative management, 6th edition. Elsevier.
White, K., (2013). Fast facts for critical care. Kathy White Learning System.
Spotlight on Critical Care 2014
10 OUT OF 10: CURRENT CHALLENGES AND STRATEGIES IN PAIN
MANAGEMENT
Brigit Hynes, RN, MSN & Robyn Smith, BSN, RN, CCRN CONTENT DESCRIPTION
Today in the acute care setting, nursing staff are faced with many challenges to
control their patient’s pain. With drug shortages, drug dependence, and patient
expectations, pain management is getting more difficult to treat with “just
opioids.” This can leave not only the patient dissatisfied with their pain relief,
but also the nurse frustrated and concerned for the safety of the patient. This
presentation will review several cutting edge modalities in pain management.
One of these regimes is ketamine. Long known as an anesthetic, ketamine can
now be used for analgesia without causing all the sedating and respiratory
depressing effects that opioids cause. In fact, ketamine may be used in the acute
care setting in and out of the ICU. Another cutting edge modality is with
Authorized Agent Controlled Analgesia, where pain management can be
administered to patients who are unable to medicate themselves. Different from
PCA by proxy, AACA is specifically designed for pain management by a
competent healthcare provider who is authorized to administer a pain regimen
to a patient without the long term sedative effects of a continuous infusion.
Great success has been made in pain management, even within the most
challenging situations. As healthcare professionals, we must continue to explore
other evidence based medications and administration routes, especially in our
vulnerable patient populations.
OBJECTIVES
1. Discuss the current evidence in support of using ketamine as an analgesic
2. Describe continuous ketamine infusions in the acute care setting for acute,
chronic and acute-on-chronic pain management
3. Determine two differences between AACA and PCA by proxy
CONTENT OUTLINE
I.
II.
Current challenges in pain management in the acute care setting:
a. Growing dependence on opioids in the outpatient population
b. Drug shortages and the impact on the acute care setting
c. Patient expectations in regards to pain control during hospital stay
Thinking beyond opioids:
a. Multimodal analgesia
b. Regional anesthesia
c. Continuous ketamine infusions
Spotlight on Critical Care 2014
10 OUT OF 10: CURRENT CHALLENGES AND STRATEGIES IN PAIN
MANAGEMENT
Brigit Hynes, RN, MSN & Robyn Smith, BSN, RN, CCRN III.
IV.
d. Authorized Agent Controlled Analgesia (AACA)
The role of ketamine in the intensive care unit patient:
a. To decrease total opioid requirements
b. To reduce adverse effects from opioids while receiving ketamine
infusion continuously
c. Management of side effects from ketamine
d. Indications for ketamine administration in the ICU patient
population
e. Current evidence based research of ketamine as an analgesic, not
just anesthetic
The role of AACA in the Intensive Care Unit:
a. AACA verses PCA by proxy
b. AACA in the adult population
c. Evidence in support of the AACA
d. Education of healthcare provider
SELF-ASSESSMENT QUESTIONS
1. True or False: Authorized Agent Controlled Analgesia (AACA) means
that the patients power of attorney or surrogate decision maker may push
the button to administer the patient a dose of pain medication.
2. True or False: When a patient is on a ketamine infusion for pain
management, they should NOT receive any other analgesics.
3. When should a benzodiazepine be administered to a patient receiving a
ketamine infusion?
4. What are two indications for using AACA?
REFERENCES
Cooney, M.F., Czarnecki, M., Dunwoody, C., Eksterowicz, N., Merkel, S., Oakes,
L.,& Wuhrman, E. (2013). American Society for Pain Management Nursing
position statement with clinical practice guidelines: authorized agent controlled
analgesia. Pain Management Nursing, 14(3), 176-181. Doi:
10.1016/j.pmn.2013.07.003.
Ely, E.W., Truman, B., Shintani, A., Thomason, J.W., Wheeler, A,P, Gordon,
S.,…Bernard, G.R. (2003). Monitoring sedation status over time in ICU patients:
reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Journal
of American Medical Association, 289(22), 2983-91. Doi:10.1001/jama.289.22.2983.
Spotlight on Critical Care 2014
10 OUT OF 10: CURRENT CHALLENGES AND STRATEGIES IN PAIN
MANAGEMENT
Brigit Hynes, RN, MSN & Robyn Smith, BSN, RN, CCRN Himmelseher, S., & Durieux, M.E. (2005). Ketamine for perioperative pain
management. Anesthesiology, 102(1), 211-220. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15618805
Infusion Nurses Society. (2011). Policies and procedures for infusing nursing, 4th ed.
Institute for Safe Medication Practice (ISMP). (2013). Fatal PCA adverse events
continue to happen…better patient monitoring is essential to prevent harm.
ISMP. Retrieved from
http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=50
The Joint Commission. (2012). Safe use of opioids in hospitals. The Joint
Commission Sentinel Event Alert (49). Retrieved from
http://www.jointcommission.org/assets/1/18/SEA_49_opioids_8_2_12_final.p
df
Pasero, C., McCaffery, M. (2011). Pain Assessment and Pharmacologic Management
(313-322). St. Louis, Missouri: Mosby Elsevier.
Pasero, C., McCaffery, M. (2005). Pain control: ketamine: low doses may provide
relief for some painful conditions. American Journal of Nursing, 105(4), 60-64.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15791081
White, P.F. (2005). The changing role of non-opioid analgesic techniques in the
management of postoperative pain. Anesthesia Analgesia, 101(5 Suppl), S5-22.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16334489
Spotlight on Critical Care 2014
Pulmonary Hypertension: The Nurse’s Role in Improving Outcomes
George Ruiz, M.D. CONTENT DESCRIPTION
Dr. Ruiz presents concepts using pictorial and descriptive devices that enable the
learner to comprehend challenging pathophysiology and treatment modalities.
The learner will be introduced to the presentation of and impact of pulmonary
hypertension. The interplay between the pulmonary vasculature and the right
heart will be explained conceptually with a focus on the pathological outcomes
of abnormalities. Dr. Ruiz will review the basic workup for pulmonary
hypertension, which will equip nurses to care for during this phase and educate
patients about what to expect. Additionally the treatment options and associated
patient education will be discussed.
OBJECTIVES
1. Develop a deeper understanding of pulmonary hypertension: How it
presents, why it matters and explore the interaction between pulmonary
vasculature and the right heart; how their interactions determine
outcomes.
2. Review the basic workup for a patient suspected of having pulmonary
hypertension
3. Explore treatment options available for pulmonary hypertension
CONTENT OUTLINE
I.
II.
III.
IV.
Introduction: (5 minutes)
a. New hope for patient with pulmonary hypertension
b. The role of the Pulmonary Hypertension Center of Excellence
Pathophysiology of Pulmonary Hypertension (15 minutes)
a. How it presents
b. Why it matters
c. The interaction between the pulmonary vasculature and the right
heart
d. How their interaction between the pulmonary vasculature and
right heart determine outcomes
Basic workup for a patient suspected of having pulmonary hypertension
(10 minutes)
a. History taking
b. Lab tests
c. Diagnostic studies
Treatment options available for pulmonary hypertension (15 minutes)
a. Oral Medications
Spotlight on Critical Care 2014
Pulmonary Hypertension: The Nurse’s Role in Improving Outcomes
George Ruiz, M.D. V.
i. Patient selection
ii. Patient education
b. Inhaled medications
i. Patient selection
ii. Patient education
c. Infused medications
i. Patient selection
ii. Patient education
Question and Answer (5 minutes)
SELF-ASSESSMENT QUESTIONS
1. Which symptoms are commonly present when pulmonary hypertension
patients initially present for medical care?
2. What is the interaction between the pulmonary vasculature and the right
heart? What symptoms does abnormal pulmonary vasculature cause?
3. What patient selection criteria should be considered for the various
medications used to treat pulmonary hypertension? What medications
education should patients receive?
REFERENCES
McLaughlin, V. V., Archer, S. L., Badesch, D. B., Barst, R. J., Farber, H. W., Lindner, J.
R.,...Varga, J. (2009). ACCF/AHA 2009 Expert consensus document on pulmonary
hypertension. Journal of the American Association of Cardiology, 53(17), 1573-1619.
Rogers, F. (2012). Helping patients understand the complex pulmonary hypertension
workup. Advances in Pulmonary Hypertension, 11(2), 65-66.
Stewart, T. (2010). Facilitating pulmonary arterial hypertension medication
adherence: Patient-centered management. Advances in Pulmonary Hypertension,
8(4), . Retrieved from
http://www.phaonlineuniv.org/Journal/Article.cfm?ItemNumber=786
Spotlight on Critical Care 2014
Introduction to Legal Issues in Hospital Setting
Mollie Slater RN, BSN, Esq (Ohio only) CONTENT DESCRIPTION
This presentation will not constitute legal advice. No attorney-client relationship
shall be established. No real names or real cases will be used.
The difference between criminal law and civil law is the intent of the outcome.
The criminal law is meant to punish, while the civil law is meant to make a
person whole. In the criminal law, individuals are found "guilty" and "not
guilty." In civil law, individuals are found "liable" or "not liable".
In the health care setting, negligence is the failure to meet the accepted standard
of care which is the actual and proximate cause of an injury. First, there is a trial
on liability only. Then, there is a separate trial or hearing on damages. Nurses
are included in suits under an agency theory of liability. Employers are
generally responsible for their employee's negligence as long as their employee
was acting within the course and scope of their employment. Statutes of
limitations are determined at the state level.
Many companies offer nurses and other licensed health care professionals their
own independent insurance policy, separate from anything that an employer
may provide. These offer extra protection in case of suit. However, plaintiffs'
attorneys seek out these policies as another means of recovering judgments.
Each health care professional should make the determination on his/her own as
to whether to purchase these supplemental policies.
OBJECTIVES
1. Define and describe criminal law, civil law, medical negligence & statute
of limitations
2. Describe the agency theory of liability & understand the pros and cons of
individual liability insurance
3. Describe the characteristics of good nursing documentation
CONTENT OUTLINE
I.
Introduction
a. Two Cases
i. Criminal vs. Civil;
ii. What’s the difference?
Spotlight on Critical Care 2014
Introduction to Legal Issues in Hospital Setting
Mollie Slater RN, BSN, Esq (Ohio only) II.
III.
Main Point
a. What is…
i. Negligence
ii. Standard of Care; how is it determined
iii. Proximate cause vs. Actual cause
iv. Burden of proof in civil and criminal law
b. Damages
i. Economic vs. Non-economic damages
ii. Punitive damages
iii. Proving damages – what evidence cane be used?
c. Liability – how are nurses “named” in suits?
i. Agency Theory of Liability
ii. Course and scope of employment
iii. What happens if you change hospitals; work as traveler or
agency nurse?
d. Purchasing supplemental insurance
i. Pros and cons
e. Statute of Limitations
f. Elements of good documentation
Conclusion
SELF-ASSESSMENT QUESTIONS
1. Do you know the required elements in a medical negligence suit?
2. Do you know the difference between criminal and civil law?
3. Do you know what to do if you receive a nursing-related legal document?
(i.e., subpoena, complaint, interrogatory)
REFERENCES
Bal, Sonny, B. (2009). An introduction to medical malpractice in the United
States. Clinical Orthopaedics and Related Research, 467(2), 339-347.
doi:10.1007/s11999-008-0636-2
Pegalis, Steven, E., & Bal, Sonny, B. (2012). Closed medical negligence claims can
drive patient safety and reduce litigation. Clinical Orthopaedics and Related
Research, 470(5), 1398-1404. doi: 10.1007/s11999-012-2308-5
Furrow, Barry, R., Greaney, Thomas, L., Johnson, Jost, Timothy, S., & Schwartz,
Robert, L. (2010). Health law: Cases, materials, and problems. Eagan, MN: West.
Spotlight on Critical Care 2014
Putting the Patient Picture Together: Using Critical Care Thinking
at the Bedside
Robin R. Jackson, MSN, RN‐BC, CCRN, CCNS & Rachel Smigelski‐Theiss, MSN, RN, ACCNS‐AG CONTENT DESCRIPTION
Putting the Patient Picture Together:
Critical thinking is an important tool in providing safe patient care. The concepts
of critical thinking are developed over time with increasing experience and by
asking questions related to the patient’s condition. Understanding how critical
thinking develops and using case studies help to cultivate critical thinking skills.
Part of critical thinking is knowing when and how to communicate patient
information. Situation, Background, Assessment, and Recommendation (SBAR)
provides a concise method of communication that provides key information to
the physician.
This talk will discuss concepts in critical thinking using case studies.
Communication with the Licensed Independent Practitioner (LIP) will be
covered using SBAR communication.
OBJECTIVES
1. Explain how critical thinking is developed.
2. Identify situations where critical thinking is needed in patient care.
3. Identify the components of SBAR communication.
CONTENT OUTLINE
I.
II.
III.
IV.
Introduction:
a. What is critical thinking?
b. What is critical thinking NOT?
Why is critical thinking so important to nurses?
a. To manage complex dilemmas
b. For empowerment: autonomous practice
c. To exchange views and information
d. Independent in mind or judgment; self-directed
Pitfalls/barriers to critical thinking:
a. Following an illogical process
b. Personal bias
c. Time factors
Factors that enhance critical thinking:
a. Being open minded
b. Being self-confident
Spotlight on Critical Care 2014
Putting the Patient Picture Together: Using Critical Care Thinking
at the Bedside
Robin R. Jackson, MSN, RN‐BC, CCRN, CCNS & Rachel Smigelski‐Theiss, MSN, RN, ACCNS‐AG V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
c. Support system
Key assumptions for critical thinking:
a. It is rational
b. It requires reflection
c. It is an expansion of problem solving and the nursing process
d. It involves both cognitive and affective skills
The skills can the taught, learned and measured:
a. The skills need to be practiced and reinforced
b. It involves creative thinking
c. It is both a process and an outcome
Are you a critical thinker?
Process of critical thinking:
a. How do experts and novices make decisions
Summary of critical thinking
Physician communication:
a. Follow the general guidelines to determine the need for calling the
physician
Nurse responsibility:
a. Collect, organize and analyze all patient data
b. Inform other nurses before making the call
c. Identify yourself, unit, patient, purpose of call, and
actual/potential problem
d. Convey information in a clear and concise manner
e. As appropriate, be prepared to answer questions and make
appropriate recommendations (SBAR)
Nurses are trained to be narrative and descriptive
Physicians are trained to be problem solvers, “What do you want me to
do?” or “Just give me the headlines” (SBAR).
SBAR communication:
a. Situation
b. Background
c. Assessment
d. Recommendation
Effective communication requires:
a. Structured communication –SBAR
b. Assertion/critical language- key words, the ability to speak up and
stop the show
c. Psychological safety- an environment of respect
Spotlight on Critical Care 2014
Putting the Patient Picture Together: Using Critical Care Thinking
at the Bedside
Robin R. Jackson, MSN, RN‐BC, CCRN, CCNS & Rachel Smigelski‐Theiss, MSN, RN, ACCNS‐AG XVI.
XVII.
XVIII.
d. Effective leadership- flat hierarchy, continuously inviting team
members into the conversation
SBAR in a nutshell:
a. Situation: the punch line, give it in 5-10 seconds
b. Background: a brief history that answers the question “how did we
get here?”
c. Assessment: data and findings
d. Recommendation: answer the question “what do we need to do?
And when?”
SBAR examples
Case studies
SELF-ASSESSMENT QUESTIONS
1. Define critical thinking as it relates to nursing
2. Identify components of critical thinking
3. Identify strategies to develop critical thinking
REFERENCES
Alfaro-LeFevre, R. (2003). Improving your ability to think critically. Healthcare
Traveler, 11(1), 72. Retrieved from
http://search.proquest.com/docview/216620691?accountid=35812
Hughes, R (ed.). (2008). Patient Safety and Quality: An Evidenced-based Handbook for
Nurses. Rockville, MD: Agency for Healthcare Research and Quality.
Jenkins, S.D. (2011). Cross-cultural perspectives on critical thinking. Journal of
Nursing Education, 50(5), 268-274. doi:http://dx.doi.org/10.3928/01484834-2011022802
Newton, S.E., & Moore, G. (2013). Critical thinking skills of basic baccalaureate and
accelerated second degree nursing students. Nursing Education Perspectives, 34(3), 154158. Retrieved from http://search.proquest.com/docview/1370894743?accountid=35812
Zori, S., Kohn, N., Gallo, K., & Friedman, M. (2013). Critical thinking of
registered nurses in a fellowship program. The Journal of Continuing Education in
Nursing, 44(8), 374-380. doi: http://dx.doi.org/10.3928/00220124-20130603-03
Spotlight on Critical Care 2014
What’s A Nurse To Do, When There Is Nothing Left to Do?
Palliative Care For Critically Ill Patients
Sarah Bayne, MSN, FNP‐BC, ACHPN CONTENT DESCRIPTION
Death is something that human beings cannot escape no matter how good
medicine or technology has become. Clinicians can and should help families
through this process to make it as good as it can be in the face of chronic and
debilitating illnesses that are often symptomatic. The trajectory of death has
changed over time and clinicians and educators have had to change how they
handle this process. Nurses have a unique role in caring for these patients across
all settings but specifically the inpatient setting. A basic understanding of the
differences between palliative care and hospice is integral. Early identification of
patients that may be appropriate for this type of care is necessary to facilitate
patient and family education and symptomatic improvement in the disease
process. The presence of palliative care in the intensive care unit setting has been
shown to decrease cost, unnecessary procedures, medications and interventions
while improving patient comfort and aligning the care with the patients’ goals.
Nurses have a pivotal role when caring for critically ill patients approaching end
of life.
OBJECTIVES
1. Discuss the role of palliative care in the hospital setting
2. Identify barriers to caring for chronically critically ill patients
3. Describe the nurses’ role is in providing primary palliative care for
critically ill patients in an inpatient setting (e.g., family education and
symptom management)
CONTENT OUTLINE
I.
II.
III.
Introduction of Palliative Care
a. Case Study
b. Describe the difference between inpatient palliative care and
hospice
c. Discuss the process of palliative consultation
Identification of critically ill patients appropriate for palliative care
a. Criteria for palliative care
b. Discuss disease specific palliative care interventions
Nursing Role
a. Symptom management
b. Patient and family education
Spotlight on Critical Care 2014
What’s A Nurse To Do, When There Is Nothing Left to Do?
Palliative Care For Critically Ill Patients
Sarah Bayne, MSN, FNP‐BC, ACHPN IV.
c. Family meeting and goals of care discussions
Conclusions and Questions
SELF-ASSESSMENT QUESTIONS
1. What is an example of an ICU patient appropriate for a palliative care
consult?
2. What are some barriers to caring for chronically critically ill patients?
3. What is the role of the nurse in providing palliative care?
REFERENCES
Norton, S. A., Hogan, L. A., Holloway, R. G., Temkin-Greener, H., Buckley, M. J.,
Quill, T. E. (2007). Proactive palliative care in the medical intensive care unit:
Effects on length of stay for selected high-risk patients. Critical Care Medicine, 35,
p. 1530-1535
The IPAL Project: Improving palliative care in the ICU. (2014). Retrieved from
http://www.capc.org/ipal/ipal-icu/.
Walker, K. A., Mayo, R. L., Camire, L., Kearney, C. D., (2013). Effectiveness of
integration of palliative medicine services into the intensive care unit. Journal of
Palliative Medicine 16(10), 1237-1241.
Spotlight on Critical Care 2014
Massive Transfusion in the Modern Age
Lois L. Collins, RN, MSN, CEN CONTENT DESCRIPTION
The role of massive transfusion protocols and rapid infusers are being ever more
widely used for trauma resuscitation in the emergency department, operating
room, and intensive care unit. This talk will review the initial management of
shock in trauma patients, and then focus on blood product resuscitation utilizing
the rapid infuser.
OBJECTIVES
1. Identify and discuss hemorrhagic shock
2. Describe the four classes of hemorrhagic shock
3. Describe the use of massive transfusion protocols and delivery of massive
transfusion utilizing a rapid transfusion system.
CONTENT OUTLINE
I.
II.
III.
IV.
V.
Introduction
a. Attention-getter video
b. Review of objectives
Overview of Shock
a. Recognition of Shock
b. Identification of causes/types of shock
Hemorrhagic Shock
a. Physical Exam
b. Classes of Shock
i. Confounding factors to classification
c. Evaluation of Fluid Resuscitation and Organ Perfusion
Massive Transfusion
a. Facility Protocols
b. Products Administered
c. Rapid Transfusers
Conclusion
Spotlight on Critical Care 2014
Massive Transfusion in the Modern Age
Lois L. Collins, RN, MSN, CEN SELF-ASSESSMENT QUESTIONS
1. What are the three components of the lethal triad of trauma?
2. How does the use of rapid transfusion technology impact patient
outcomes?
3. What are the components of an effective massive transfusion protocol?
REFERENCES
Holcomb, J.B., Jenkins D., Rhee, P., Johannigman, J., Mahoney, P., Mehta, S., et al.
(2007). Damage control resuscitation: Directly addressing the early coagulopathy
of trauma. Journal of Trauma, 62, p. 307-310
Gonzalez, E. A., Holcomb, J. B., Miller, C. C., Kozar, R. A., Todd, S. R., et al.
(2007). Fresh frozen plasma should be given earlier to patient's requiring massive
transfusion. Journal of Trauma, 67, p. 112
Malone, D., L., Dunne, J., Tracy, J. K., Putnam, A. T., Scalea, T. N., Napolitano, L.
M. (2003). Blood transfusion, Independent of shock severity, is associated with
worse outcome in trauma. Journal of Trauma. 54, p. 898.
Smith, M. J., Stiefel, M. F., Magge, S., Frangos, S., Bloom, S., Gracias, V. (2005).
Packed red blood cell transfusion increases local cerebral oxygenation. Critical
Care Medicine. 33, p. 1104.
Spotlight on Critical Care 2014
Super Bugs-Antibiotic Resistant Organisms and Fighting Back
Dorothy Belkoski RN, BSN, CCRN, CIC CONTENT DESCRIPTION
Antibiotics can save lives and are depended on to treat severe infections, such as
sepsis. But if not used properly-given to patients who do not need them, over
prescribe or prescribe at the wrong dosage, allow organisms to develop
resistance to the drugs that are used to treat serious infections. More organisms
are developing resistance to antibiotics using different mechanisms and some
organisms can transfer their resistance to other organisms. The supply and type
of antibiotics is limited for use as these organisms become resistant, plug drug
companies are not making as many new antibiotics. Some of the newer
antibiotics are expensive and not available in all facilities. So as more resistance
occurs, super bugs are taking over.
This presentation will explain how organisms develop resistance, the most
common, newest and most dangerous organisms, how to recognize resistance
using sensitivity reports from the laboratory, how to prevent transmission
through surveillance and isolation, and what can be done by employing
antibiotic stewardship programs to stop deadly drug resistant organisms from
developing and spreading.
OBJECTIVES
1. Identify multi-drug resistant organisms (MDROs) and why they are
resistant
2. Describe strategies to prevent transmission of MDROs
3. Describe strategies to prevent antibiotic resistance
CONTENT OUTLINE
I.
II.
III.
Multi-drug Resistant organisms-definition
a. MRSA
b. VRE
c. ESBL
d. CRE
Development of antibiotics and resistant organisms
a. 1940-2011
Modes of organisms resistance
a. Enzymatic inactivation
b. Inherent (natural) resistance
c. Acquired resistance
d. Vertical gene transfer
e. Horizontal gene transfer
Spotlight on Critical Care 2014
Super Bugs-Antibiotic Resistant Organisms and Fighting Back
Dorothy Belkoski RN, BSN, CCRN, CIC IV.
V.
Four Core Actions to Prevent Antibiotic Resistance
a. Prevent infections, prevent the spread of resistance
b. Tracking
c. Improving antibiotic prescribing/stewardship
d. Development of new drugs and diagnostic tests
Next steps and strategies
SELF-ASSESSMENT QUESTIONS
1. ESBL organisms make an enzyme that makes them resistant to which
antibiotic?
a. Tetracycline
b. Cephalosporins
c. Levaquin
d. Vancomycin
2. True or False: Antimicrobial Stewardship is one of four core actions that
prevent development of resistant organisms.
3. Which patients are the most prone of MDROs, especially CRE?
a. Pediatric patients
b. Patient's getting antibiotics for the first time
c. ICU patients with multiple co-morbidities, hospitalizations and
indwelling devices
REFERENCES
Antibiotic Resistance Threats in the United States. CDC. (2013). Retrieved from
www.cdc.gov/features/antibioticresistancethreats/.
Fact Sheet N*194. WHO Media Centere. (2014). Retrieved from
www.who.int/mediacentre/factsheets/fs194/en/.
Hanchett, Marilyn. A closer look-Antibiotic resistance and the microbiome.
(2013). Prevention Strategist. Winter-6(4) p. 60-63
Paddock, Catharine. New generation of antibiotics may lie with small peptides.
(2014). Retrieved from www.medicalnewstoday.com/articles/274561.php.
Spotlight on Critical Care 2014
CASE STUDIES IN HEART FAILURE: 101
Kristina Hidalgo, CCRN, CCNS, ACNP CONTENT DESCRIPTION
According to the CDC, there were one million heart failure admissions to the US
hospitals in 2010. Students and novice nurses would benefit from a review of the
evidence and guidelines for heart failure care with application via case studies.
The presentation is geared toward new graduate RN’s with an emphasis on the
physical examination, nursing interventions and pharmacological management
of heart failure patients. Case studies are utilized in the presentation to
emphasize application of the AHA/HFSA heart failure guidelines. The
presentation concludes with a brief look into the future of advanced heart failure
treatment so the new RN is aware of technological advances in the treatment of
heart failure.
OBJECTIVES
1. Describe the key points of the physical examination of the heart failure
patient, including (but not limited to): jugular venous distention, edema,
pulmonary and cardiac auscultation, and how they change in right, left
and biventricular failure.
2. Identify the mechanism of action, major contraindications, and side effects
of heart failure pharmacologic therapies including: diuretics, beta
blockers, ace-inhibitors, angiotensin receptor blockers, anti-arrhythmics
and anticoagulants.
3. Describe nursing interventions for the patient with heart failure,
including: diet and medication education, fluid restriction, daily weights,
and input/output documentation.
CONTENT OUTLINE
I.
II.
Introduction
a. Define heart failure
b. Etiology of heart failure
c. Cost of heart failure
d. Presentation objectives
Illustration of the Importance of the Physical Examination
a. Review of normal anatomy/physiology
i. Right ventricle to the lungs, low pressure chamber
ii. Left ventricle to the body, muscular high pressure chamber
b. Left heart failure case
i. Physical exam findings
Spotlight on Critical Care 2014
CASE STUDIES IN HEART FAILURE: 101
Kristina Hidalgo, CCRN, CCNS, ACNP III.
IV.
V.
ii. Warm/Cold Wet/Dry boxes
c. Right heart failure case
i. Physical exam findings
Guidelines regarding pharmacologic management and nursing
interventions
a. Case study presentation
b. Diuretics
i. Mechanism of action
ii. Contraindications
iii. Side effects
iv. Nursing interventions
c. Beta Blockers
i. Mechanism of action
ii. Contraindications
iii. Side effects
iv. Nursing interventions
d. Ace Inhibitors
i. Mechanism of action
ii. Contraindications
iii. Side effects
iv. Nursing interventions
e. Antiarrythmics
i. Mechanism of action
ii. Contraindications
iii. Side effects
iv. Nursing interventions
f. Anticoagulants
i. Mechanism of action
ii. Contraindications
iii. Side effects
iv. Nursing interventions
The Future of Heart Failure Treatments
a. Changes in ICD’s
b. LVADs, BiVADs, TAH
c. Transplantation
d. CardioMEMS
Questions
SELF-ASSESSMENT QUESTIONS
Spotlight on Critical Care 2014
CASE STUDIES IN HEART FAILURE: 101
Kristina Hidalgo, CCRN, CCNS, ACNP 1. What are signs of right heart failure vs. left heart failure?
2. What classes of drugs are recommended for heart failure patients and
what contraindications/side effects are there to these drugs?
3. What nursing interventions are relevant to caring for the heart failure
patient?
REFERENCES
Caccamo, M.A., & Eckman, P.M. (2011). Pharmacologic therapy for New York
Heart Association class IV heart failure. Congestive Heart Failure, 17(5), 213-219.
Doi: 10.1111/j.1751-7133.2011.00235.x
McMurray, J.J., Adamopoulos, S., Anker, S.D., Aurichhio, A., Bohm, M.,
Dickstein, K.,…Zeiher, A. (2012). ESC guidelines for the diagnosis and treatment
of acute and chronic heart failure 2012: the task force for the diagnosis and
treatment of acute and chronic heart failure 2012 of the European Society of
Cardiology. European Journal of Heart Failure, 14(8), 803-869. Doi:
10.1093/eurheartj/ehs104.
Nohria, A., Mielniczuk, L.M., & Stevenson, L.W. (2005). Evaluation and
monitoring of patients with acute heart failure syndromes. The American Journal
of Cardiology, 96(6A), 32G-40G. doi: 10.1016/j.amjcard.2005.07.019.
Yancy, C.W., Jessup, M., Bozkurt, B., Butler, J., Casey, D.E., Drazner,
M.H.,…Wilkoff, B.L. (2013). 2013 ACCF/AHA guideline for the management of
heart failure. A report of the American College of Cardiology
Foundation/American Heart Asscoiation task force on practice guidelines.
Circulation, 128(16), e240-e327. Doi: 10.1161/CIR.0b013e31829e8776.
Spotlight on Critical Care 2014
Stepping Forward by Stepping Back
with Fecal Microbial Transplant
Donna Stanczak, MS, RN, CCRN CONTENT DESCRIPTION
Clostridium difficile is the leading cause of hospital-acquired diarrhea among
adult patients. The identification of a new more virulent strain and the increased
incidence in low risk populations have seen the incidence almost double in the
last 10 years. It is well established that the infection begins with an alteration of
the normal gut flora usually attributable to the use of antibiotics and more
recently proton pump inhibitors. Surgical intervention has been associated with
mortality rates of almost 50%. Despite treatment approximately 20 – 30% of
patients experience at least 1 recurrence and the recurrence rates double with
each successive infection.
Fecal microbial transplant shows promise as a safe, cost-effective, permanent
cure for this proliferating disease. This approach was first described in humans
in 1958 and has long been used in animals with great success. Emerging
literature has demonstrated that fecal microbial transplant has been gaining
popularity and has documented cure rates of 90-94%. The information provided
here will prepare critical care nurses to understand and participate in this
emerging treatment modality.
OBJECTIVES
1. Identify the incidence and complications associated with Clostridium
difficile infection
2. Discuss the origins of fecal microbial transplant and mechanism of action
3. Discuss the use of fecal microbial transplant in the treatment of Clostridium
difficile infection
CONTENT OUTLINE
I.
Clostridium difficile
a. Epidemiology
b. Risk Factors
c. Complications
d. Prevention
e. Current Treatment
II.
Fecal Microbial Transplant
a. History
Spotlight on Critical Care 2014
Stepping Forward by Stepping Back
with Fecal Microbial Transplant
Donna Stanczak, MS, RN, CCRN b.
c.
d.
e.
III.
Pathophysiology
Screening
Procedure
FDA Regulations
Future Directions
SELF-ASSESSMENT QUESTIONS
1. True or False: Fecal transplant can be traced back to 4th century China.
2. True of False: C. difficile is the leading cause of antibiotic related diarrhea.
3. True or False: Proton pump inhibitors have been associated with an
increased risk of C. difficile infection.
REFERENCES
Floch, M. H. (2012). The power of poop: Probiotics and fecal microbial transplant.
Journal of Clinical Gastroenterology, 46(8), 625-626.
Johnson, D. A., & Oldfield, E.C. (2013). Reported side effects and complications
of long-term proton pump inhibitor use. Clinics of Gastroenterology and Hepatology,
11(5), 458-464.
Kelly, C. (2013). Fecal microbiota transplantation - an old therapy comes of age.
New England Journal of Medicine, 368(5), 474-475.
Khanna, S., & Pardi, D.S. (2012). Clostridium difficile infection: New insights into
management. Mayo Clinic Proceedings, 87(11), 1106-1117.
Rohlke, F., & Stollman, N. (2012). Feval microbiota transplantation in relapsing
Clostridium difficile infection. Therapeutic Advances in Gastroenterology, 5(6), 403420.
Van Nood, E., Speelman, P., Kuijper, E.J., & Keller, J.J. (2009). Struggling with
recurrent Clostridium difficile infections: Is donor faeces the solution?
Eurosurveillance, 14(34), 1-6.
Spotlight on Critical Care 2014
Multisystem Effects of Traumatic Brain Injury
Karen McQuillan RN, MS, CNS‐BC, CCRN, CNRC, FAAN CONTENT DESCRIPTION
When severe injury occurs to the brain it often impacts numerous body systems.
This session will review the pathologic effects that injury to the brain can have on
non-neurologic systems and explain how these potential complications can then
exacerbate secondary neurologic injury. Evidence based interventions to prevent
and manage various systemic complications associated with traumatic brain
injury will be described.
OBJECTIVES
1. State the non-neurologic complications that may be associated with severe
traumatic brain injury
2. Explain how non-neurologic complications can potentially exacerbate
secondary brain injury
3. Formulate an evidence based plan of care aimed at preventing and
treating potential non-neurologic complications associated with severe
traumatic brain injury
CONTENT OUTLINE
I.
II.
III.
IV.
V.
Introduction
a. Primary vs. Secondary brain injury
b. Incidence of non-neurologic organ dysfunction after severe brain
injury
c. Etiology of organ dysfunction after severe brain injury
Respiratory complications
a. Types and etiology
b. Consequences to the injured brain
c. Management of respiratory function in patient with severe brain
injury
Fluid and electrolyte imbalance
a. Etiology
b. Diabetes Insipidus
c. SIADH
d. Cerebral salt wasting
Coagulopathy
a. Etiology
b. Consequences
c. Management
Myocardial dysfunction
Spotlight on Critical Care 2014
Multisystem Effects of Traumatic Brain Injury
Karen McQuillan RN, MS, CNS‐BC, CCRN, CNRC, FAAN VI.
VII.
a. Rhythm abnormalities
b. Dysfunction etiologies
c. Consequences of hemodynamic instability
d. Management
Others
Conclusion
SELF-ASSESSMENT QUESTIONS
1. Which organ system has the highest incidence of dysfunction after a
severe traumatic brain injury?
a. Respiratory
b. Cardiac
c. Skin
d. Gastrointestinal
2. Hypoxia and hypercapnea can cause what type of brain injury?
a. Primary brain injury
b. Secondary brain injury
c. Both primary and secondary brain injury
3. SIADH can be treated with?
a. Fluid restriction
b. Salt
c. Vasopressin
REFERENCES
Hui X, Haider AH, Hashmi ZG, et al (2013). Increased risk for pneumonia among
ventilated patients with traumatic brain injury:every day counts! J Surg Research.
184, 438-443
Ledwith MB, Bloom S, Maloney-Wilensky E, et al. (2010). Effect of body position
on cerebral oxygenation and physiologic parameters in patients with acute
neurological conditions. J Neurosc Nurs, 42(5),280-287.
McQuillan KA, Thurman P. Traumatic Brain Injuries. In McQuillan KA, Flynn
Makic MB, Whalen E, et al. (Eds.). Trauma Nursing: From Resuscitation Through
Rehabilitation.(4th ed.). Philadelphia, PA: Elsevier, 2009.
Inaba K, Menaker J, Branco BC, et al. (2013). Aprospective multicenter
comparison of levetiracetam versus phenytoin for early posttraumtic seizure
prophylaxis. J Trauma Acute Care Surg, 74(3), 766-773.
Spotlight on Critical Care 2014
Multisystem Effects of Traumatic Brain Injury
Karen McQuillan RN, MS, CNS‐BC, CCRN, CNRC, FAAN Maegele M. (2013).Coagulopathy after traumtic brain injury: incidence,
pathogenesis nd treatment options. Transfusion, 53 (Supplement),28S-37S.
Oddo M, Levine JM, Kumar M, et al. (2012). Anemia and brain oxygen after
severe traumatic brain injury, J Intensive Care Med, 38, 1497-1504.
Shahlaie K, Keachie K, Hutchins IM, et al. (2012). Risk factors for posttraumatic
vasospasm. J Neurosurg, 115(3), 602-611.
Vespa PM. (2013). Hormonal dysfunction in neurocritical patients. Curr Opin Crit
Care, 19, 107-112.
Spotlight on Critical Care 2014
Partners in Facilitating the Gift of Donation
Matthew Niles, RN, MSN, MHA CONTENT DESCRIPTION
Caring for a donor in the ICU is complex. Through this presentation you will
learn why certain medication is given and certain tests are done during donor
management to optimize and assist with evaluation of organ function. We will
also detail the process of allocation of organs to transplant centers and their
recipients.
The nurse plays a pivotal role in the donation process: 1) timely referrals of
imminent deaths; 2) assisting us with understanding of family dynamics and
religion; 3) keeping us informed of family meetings; and 4) confirming to
families that donation is standard end of life care for all patients.
WRTC provides family care throughout the donation process. However, we also
provide ongoing support to our donor families for two years through timed
mailings of grief support brochures, in-house grief group sessions, recognition of
the gift on an annual basis, our area-wide Donor Family Gathering in April and
bringing together donor families and their recipients if desired.
OBJECTIVES
1. List three organ and three tissues that may be transplanted.
2. Describe four of the clinical management goals necessary to maintain
optimal organ function
3. Outline at least four components of the WRTC coordinator role
CONTENT OUTLINE
I.
II.
III.
IV.
It takes a team to facilitate organ and tissue transplants
a. Eighteen people die each day waiting for transplants
b. Medical and transplant team partner to improve outcomes
Role of the WRTC Coordinator
a. Education and consent
b. Coordination of donor care
Role of the Nurse
a. Care of donor and family
i. Discussion
ii. Education
b. Medical and Pharmacological support
i. Managing donor care to meet criteria
UNOs
Spotlight on Critical Care 2014
Partners in Facilitating the Gift of Donation
Matthew Niles, RN, MSN, MHA V.
a. Criteria for wait list
b. Donor registration
Conclusion
a. Organ and tissue donation saves lives
i. Coordination between WRTC and medical team
ii. Care of recipient and family
iii. You can make a difference!
SELF-ASSESSMENT QUESTIONS
1. What are the steps involved for the organ donation process?
2. Define brain death and how it relates to organ donation?
3. What vital roles do bedside ICU nurses play in successful organ donation?
REFERENCES
Gilligan, C., Sanson-Fisher, R., & Turon, H. (2012). The organ donation
conundrum. Progress in Transplantation, 22(3), 312-316.
Pickersgill, F., & Dean, E. (2011, June). Organ donation rate raised by dedicated
nurse-led service. Emergency Nurse, 19(3), 3.
The Organ Procurement and Transplant Network
(www.optn.transplant.hrsa.gov).
The quality standards subcommittee of the American Academy of Neurology.
Practice parameters for determining brain death in adults [summary statement].
(1995). Neurology, 45, 1012-1014.
The United Newtork for Organ Sharing (www.unos.org)
Wijdicks, E. F., Fabinstein, A. A., Manno, E. M., & Atkinson, J. D. (2008).
Pronouncing brain death: Contemporary practice and safety of the apnea test.
Neurology, 71, 1240-1244.
Wijdicks, E. F., Varelas, P. N., Gronseth, G. S., & Greer, D. M. (2010, June 8).
Evidence-based guidelines update: Determining brain death in adults: A report
of the quality standards of subcommittee of the American Academy of
Neurology. Neurology, 74, 1911-1918.
Spotlight on Critical Care 2014
Partners in Facilitating the Gift of Donation
Matthew Niles, RN, MSN, MHA Wilkinson, K., & Peet, D. (2013, November 22). Organ Donation. InnovAit 2014,
7(109), 109-116. http://dx.doi.org/10.1177/1755738013506565
Spotlight on Critical Care 2014
Leading from the Bedside: Understanding How to Influence Your
Colleagues and Overcome Communication Challenges
Karen Mack, MS, MBA, ACNP‐BC, CHFN and Kelly McNeil‐Jones, RN, BSN, MBA, RCIS CONTENT DESCRIPTION
From a needs assessment of GWAC’s student and first year nurses, concerns
regarding “Physician Intimidation” and “Lateral Violence/Bullying” were
identified. This session seeks to increase the learner’s knowledge base regarding
organization culture, personal leadership styles, interpersonal negotiation,
especially in collegial relationships with a “power-gradient”, and healthy work
environment.
Specific tools and case scenarios will provide learners with context the
opportunity to trial skills discussed in the session such as “Code Purple”, “The
Broken Record Technique”, “Validate and Verify”, “Speak up for Safety” and
mastering own beliefs and stories.
A Q&A period will allow learners to get feedback and information on
challenging scenarios they have experienced personally through the use of
question cards.
OBJECTIVES
1. Discuss the incidence and impact of ineffective communication (lateral
violence, intimidation, silence)
2. Understand the magnitude of importance that teamwork and clinical
leadership plays in the efficient processing of the patients from admission
through discharge
3. Discuss effective tools and techniques to facilitate communication and
clinical leadership
CONTENT OUTLINE
I.
II.
III.
Introduction
a. What is a healthy work environment?
b. Where is one found and how is one made?
c. Throughput and Quality- The ultimate team sports
Ineffective communication- The data about dysfunction
a. Lateral violence
b. Intimidation
c. Silence
The Clinical nurse’s toolbox for playing well in “The sandbox”
a. Personal leadership style- Nurture and Nature
Spotlight on Critical Care 2014
Leading from the Bedside: Understanding How to Influence Your
Colleagues and Overcome Communication Challenges
Karen Mack, MS, MBA, ACNP‐BC, CHFN and Kelly McNeil‐Jones, RN, BSN, MBA, RCIS b. Mastering your own stories
c. Being a great colleague: Banking good will for future
communication challenges
d. Speak up for safety
i. SBAR
ii. Validate and verify
iii. The broken record technique
e. Tools the de-escalate including the code purple
f. When to involve your leadership
IV.
V.
Case studies
Q&A via question cards
SELF-ASSESSMENT QUESTIONS
1. What is a healthy work environment?
2. What are the costs of interpersonal communication challenges in the
clinical setting?
3. What skills can I use when communication is challenging and the stakes
are high?
REFERENCES
American Association of Critical Care Nurses. (2005). AACN Standards For
Establishing And Sustaining Healthy Work Environments. Retrieved from
http://www.aacn.org/wd/hwe/docs/hwestandards.pdf.
Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial
Conversations: Tools for Talking When Stakes Are High. New York, NY: McGrawHill.
Rath, T. (2007). StrengthsFinder 2.0 (1st ed.). New York, NY: Gallup Press.
Spotlight on Critical Care 2014
Focus the Flame: Attention on Excellence
Karen McQuillan MS, RN, CNS‐BC, CCRN, CNRC, FAAN CONTENT DESCRIPTION
The tumultuous health care environment, the rapid pace of change, and the everincreasing cost constraints conspire to challenge nurses’ abilities to provide high
quality care and produce excellent outcomes. There is a connection between
attention and excellence; cognitive science tells us we need three kinds of focus:
inner, outer and other. We have an opportunity, some would say responsibility,
to “create a healthcare system driven by the needs of patients and families where
acute and critical care nurses make their optimal contributions”. In order to do
this it is imperative we develop capacity in four domains: fearlessness, inquiry,
resilience and engagement.
OBJECTIVES
1. Identify the importance of developing our “attention” muscle
2. Define different strategies to “build” F.I.R.E.
3. Imagine the possibilities for fulfilling the mission and vision
CONTENT OUTLINE
I.
II.
III.
IV.
V.
VI.
Introduction
a. President’s theme
b. AACN mission statement: the meaning and the majesty
The importance of the focus
a. Cognitive science of focus
b. Sources of focus: inner, outer, other
The meaning of words
a. F.I.R.E. and acronyms for the future
b. Strategies for building
Making sense of the chaos
a. Predicting the future
b. Leading, innovating, thriving
c. Engaging the vision
Conclusion:
a. Review of President’s theme
Questions
Spotlight on Critical Care 2014
Focus the Flame: Attention on Excellence
Karen McQuillan MS, RN, CNS‐BC, CCRN, CNRC, FAAN SELF-ASSESSMENT QUESTIONS
1. What is one way you will build your fearlessness, inquiry, resilience and
engagement?
2. How will you ensure you fulfill AACN’s mission?
3. What are the sources of focus you’ll need?
REFERENCES
Goleman, D. 2013. Focus: the hidden driver of excellence. HarperCollins Publishers
Inc.: New York.
Robinson, K. 2009. The Element: how finding your passion changes everything.
Penguin Group: New York.
Wheatley, M. 2010. Perservance. Berkana Institute:www.berkana.org
Spotlight On Critical Care 2014