Precedex for sedation

http://precedex.hospira.com/default.aspx

Please review in light of Diprivan shortage you will probablybe seeing more of this used in the ventilator patients.

Open Chart Reviews

Hey all-Chart reviews-you will find a book with the sheets in it to compete 2 per month along with a chart for you to check off once yours are complete for each RN. There is a reminder chart on the evolving new breakroom door. that resembles the one in the book.

Documentation resource

You are all aware of issues concerning documentation. As we progress toward a totally integrated computer document (the first step is getting the new bedside monitors installed so that they communicate to Powerchart) I feel it is time to reemphasize the content of the infomantion we enter into the chart. This is an excellent site that discusses documentation and legalities. Please take some time to review it-I think you will find it helpful in your everyday practice.






http://www.corexcel.com/html/documentation.title.ceus.htm

H1N1 for professionals

Nurses Air Flu FearsSome are skeptical about the new H1N1 vaccine, while infection control experts work to dispel 'myths'. By Joe Darrah
The debate concerning mandatory flu vaccinations for healthcare workers is likely to intensify as deadlines to receive them are enforced in New York and within various healthcare organizations across the country that are requiring vaccination.
Heated comments at the ADVANCE for Nurses Facebook page reveal a range of views on the topic among nurses, many strongly held. Some have no problem with the mandate and see it as the best way to increase the number of healthcare employees who are vaccinated. However, others express outrage at the idea they are being forced into vaccination, citing their concerns the vaccine can actually cause flu and their belief the mercury used in the shot can be linked to dementia and Alzheimer's. Additionally, many nurses have taken the opportunity to voice these same opinions through letters, phone calls, e-mails and comments at the ADVANCE for Nurses Web site.
"The myth that you can get sick from the flu vaccine is alive and well, and I don't know why," said Bill Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University and president-elect of the National Foundation for Infectious Diseases. "These are the same nurses who go through wonderful scientific training and use scientific principles in everything that they do. So, why would they have particular concern about this scientifically proven [vaccination] as opposed to other science-based treatments they tell their patients to take?"
But where do we draw the line separating myth and fact? How could certain segments of the nursing population believe their health is at risk by receiving the very vaccinations they offer and administer to their patients?
ADVANCE has attempted to get the answers to these questions.
H1N1 Fears
Particular concern recently expressed among nurses surrounds the soon-to-be-available vaccine for H1N1. Specific dates for the release of this vaccination have not been released by CDC officials, but a number of nurses have already contacted ADVANCE expressing fears of getting vaccinated specifically for H1N1 (the CDC has stated the H1N1 vaccine will be separate from the 2009 seasonal vaccination that's now available) because they believe it's being rushed. Many point to deaths reportedly associated with an H1N1 vaccine produced in 1976 - incidences that have been widely documented and refuted by some - as their evidence.
Among them is Melody Bowers Metz, RN, a critical-care nurse working in Ohio. A 2005 nursing graduate, Metz, 52, told ADVANCE she does receive the seasonal shot each year, but has real concerns regarding the H1N1 vaccine.
"In my honest opinion, the government and FDA rushed this through way too fast, and I am very leery about whether it is safe or not," she said. "It takes well over a year for a vaccine to be developed for the upcoming 'next' year and it is thoroughly tested. Those are the concerns that I personally have, and I will not be receiving the H1N1 vaccine."
Schaffner says she and anyone sharing the same sentiments are off base.
"They're just wrong," he said. "H1N1 is nothing new to us. To reach back to one unfortunate episode 33 years ago and say 'for that reason I'll never take flu vaccine' is like saying 'there was a plane crash in 1976; I'll never fly again.' We have 33 years of safety and lives saved, and we made this vaccine just the way we made other ones."
In fact, Schaffner said the regular trivalent seasonal influenza vaccine for 2009 contains killed H1N1 virus.
"I wonder if most know that?" he mused.
Metz told ADVANCE she didn't, but had already received her shot this year, so there's not much she can do.
"Knowing this in advance, no, I would not get the vaccine," she said.
Schaffner blames a lack of education for instances such as these.
"I think people have misunderstandings about flu," he said. "I think the major misunderstanding is this idea that you can know for sure you have it and you can segregate yourself until it's gone. All of our statistics show that doesn't work - that people have mild or asymptomatic illnesses, and that's probably when they're most at risk for spreading it. And that's the point we're trying to get across."
CDC Warnings
Though the CDC provides an abundance of information on the flu, it can come off as confusing, especially when addressing the issue of whether or not flu vaccine can cause illness. Officials clearly indicate the vaccine can cause side effects (beyond allergic reactions) that vary in degree depending on whether one receives the injected or nasal spray form.
While the injection form is made with inactivated virus, the nasal spray does include a live, albeit weakened, form, according to the CDC. Potential side effects to both vaccine varieties include low-grade fever.
So, who's not to say this getting a fever isn't a definition of being "sick?"
Janet Keen, MS, RN, CIC, director of infection prevention and control at Piedmont Hospital, Atlanta, offers clarification.
"A low fever is the body's normal response to making the antibodies that will protect it against flu," she said. "Typically, with influenza, you have a pronounced fever that lasts more than a day. There's a difference between being sick and not feeling well. The risk of acquiring the flu far outweighs the risks of experiencing serious side effects from the vaccination."
This is said to be true even of the nasal form.
Preference vs. Responsibility
"I encourage any nurse who feels uncomfortable with the vaccine to research it, to look at the CDC and other professional literature," Keen said.
At Piedmont Hospital, nursing staff is not currently required to receive either seasonal or H1N1 vaccination, but they're encouraged to, Keen said. She and hospital administrators have also established a mandatory educational program for all employees regarding flu.
"It dispels some of the myths and helps promote compliance with vaccination; and it's really helped," she said.
Concerning the use of mercury in the vaccine, Keen said she "hasn't read compelling literature that supports that."
Schaffner said nurses should weigh their preferences against their responsibilities.
"[Not getting the flu vaccine] is an example where the healthcare worker's interests are being put ahead of the interests of patients, and that's not the tradition of healthcare," he said. "The nurses I've worked with didn't run out of the hospital when we had patients with HIV or SARS or were exposed to anthrax - that's the kind of spirit I want to call forth from nurses and doctors now."
Joe Darrah is senior associate editor at ADVANCE.

Troponin

Troponin-Based Risk Stratification of Patients With Acute Nonmassive Pulmonary Embolism
Systematic Review and Metaanalysis
David Jiménez, MD,
Fernando Uresandi, MD,
Remedios Otero, MD,
José Luis Lobo, MD,
Manuel Monreal, MD,
David Martí, MD,
Javier Zamora, MD,
Alfonso Muriel, MD,
Drahomir Aujesky, MD and
Roger D. Yusen, MD, FCCP
+ Author Affiliations

From the Respiratory Department (Dr. Jiménez), the Cardiology Department (Dr. Martí), and the Biostatistics Unit (Drs. Zamora and Muriel), Ramón y Cajal Hospital, Madrid, Spain; the Respiratory Department (Dr. Uresandi), Cruces Hospital, Bilbao, Spain; the Respiratory Department (Dr. Otero), Virgen del Rocío Hospital, Sevilla, Spain; the Respiratory Department (Dr. Lobo), Txagorritxu Hospital, Vitoria, Spain; the Medicine Department (Dr. Monreal), Germans Trias i Pujol Hospital, Barcelona, Spain; the Division of General Internal Medicine (Dr. Aujesky), University of Lausanne, Lausanne, Switzerland; and the Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences (Dr. Yusen), Washington University School of Medicine, St. Louis, MO.
David Jiménez, MD, Respiratory Department, Ramón y Cajal Hospital, Colmenar Rd, Kilometer 9.100, 28034 Madrid, Spain; e-mail: djc_69_98@yahoo.com
Abstract
Background: Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated systematic review and a metaanalysis of troponin-based risk stratification of normotensive patients with acute symptomatic PE. The sources of our data were publications listed in Medline and Embase from 1980 through April 2008 and a review of cited references in those publications.
Methods: We included all studies that estimated the relation between troponin levels and the incidence of all-cause mortality in normotensive patients with acute symptomatic PE. Two reviewers independently abstracted data and assessed study quality. From the literature search, 596 publications were screened. Nine studies that consisted of 1,366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality (95% CI, 2.13 to 8.50; heterogeneity χ2 = 12.64; degrees of freedom = 8; p = 0.125). Summary receiver operating characteristic curve analysis showed a relationship between the sensitivity and specificity of troponin levels to predict overall mortality (Spearman rank correlation coefficient = 0.68; p = 0.046). Pooled likelihood ratios (LRs) were not extreme (negative LR, 0.59 [95% CI, 0.39 to 0.88]; positive LR, 2.26 [95% CI, 1.66 to 3.07]). The Begg rank correlation method did not detect evidence of publication bias.
Conclusions: The results of this metaanalysis indicate that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE who are at high risk for death from those who are at low risk for death.
Footnotes
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

New Heparin Reference Standard

Heparin: Change in Reference Standard
Audience: Pharmacists, physicians, hospital risk managers and consumers
[Posted - 10/01/2009] FDA notified healthcare professionals and patients of a change to heparin, effective October 1, 2009, which will include a new reference standard and test method used to determine the potency of the drug and able to detect impurities that may be present in heparin. The change, which will also harmonize the USP unit dose with the WHO International Standard unit dose, will result in approximately a 10% reduction in the potency of the heparin marketed in the United States.
This may have clinical significance in some situations, such as when heparin is administered as a bolus intravenous dose and an immediate anticoagulant effect is clinically important. Healthcare providers should be aware of the decrease in heparin potency as they monitor the anticoagulant effect of the drug; more heparin may be required to achieve and maintain the desired level of anticoagulation in some patients.
There will be simultaneous availability of heparin manufactured to meet the “old” and “new” USP monograph, with potential differences in potency. Products using the new “USP unit” potency definition are anticipated to be available on or after October 8. FDA is working with the manufacturers of heparin to ensure that an appropriate identifier is placed on heparin made under the new USP monograph. Most manufacturers will place an “N” next to the lot number. FDA is also working with the heparin manufacturers to study the impact of this variation in potency and will make the results available when the studies have concluded.
[10/01/2009 - Public Health Alert - FDA]
[10/01/2009 - Information for Consumers - FDA]

Chest Tubes