New Abstract and Commentary

Effectiveness of an Aspiration Risk-Reduction Protocol (Authors’ Abstract)

BACKGROUND: Aspiration of gastric contents is a serious problem in critically ill, mechanically ventilated patients receiving tube feedings.
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a three-pronged intervention to reduce aspiration risk in a group of critically ill, mechanically ventilated patients receiving tube feedings.
METHODS: A two-group quasi-experimental design was used to compare outcomes of a usual care group (December 2002-September 2004) with those of an Aspiration Risk-Reduction Protocol (ARRP) group (January 2007-April 2008). The incidence of aspiration and pneumonia was compared between the usual care group (n = 329) and the ARRP group (n = 145). The ARRP had three components: maintaining head-of-bed elevation at 30 degrees or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes.
RESULTS: Two of the three ARRP components were implemented successfully. Almost 90% of the ARRP group had mean head-of-bed elevations of 30 degrees or higher as compared to 38% in the usual care group. Almost three fourths of the ARRP group had feeding tubes placed in the small bowel as compared with less than 50% in the usual care group. Only three patients met the criteria for the high gastric residual volume algorithm. Aspiration was much lower in the ARRP group than that in the usual care group (39% vs. 88%, respectively). Similarly, pneumonia was much lower in the ARRP group than that in the usual care group (19% vs. 48%, respectively).
DISCUSSION: Findings from this study suggest that a combination of a head-of-bed position elevated to at least 30 degrees and use of a small-bowel feeding site can reduce the incidence of aspiration and aspiration-related pneumonia dramatically in critically ill, tube-fed patients.
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59, 18-25.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This fascinating study exemplifies excellent translational research. Translational research involves moving research findings into practice with a rigorous and systematic evaluation of adherence to the new practice and patient outcomes.
Description of elements in the care bundle being “tested” follow along with the rationale for the use of each practice.
1. Keeping patients who receive tube feedings in an elevated head-of-bed position (at least 30°); this practice has been found to decrease pneumonias caused by aspiration of tube feedings. The likelihood that patients are kept in the elevated positions has been found to increase when physician orders include this practice.
2. Feeding patients in the distal small bowel; this practice reduces the likelihood of gastroesophageal reflux, and the risk of microaspiration. Small bore feedings tubes can be placed in the distal small bowel by trained nurses.
3. Using an algorithmic approach to dealing with high gastric residual volumens (> 500 ml); this practice involves feeding disruptions, and can involve prokinetic drugs.
As can be seen from the results of the study, adherence to the bundle was good for elevated positioning and tube placement. Only 3 patients qualified for use of the algorithm for high residual volume; none received care based upon the algorithm. Thus, the findings show significantly improved patient outcomes given use of 2 of the 3 bundle elements. Nurses caring for critically ill, mechanically ventilated patients who receive tube feedings may want to consider use of the 2-factor bundle (HOB ↑ 30°; feeding tube placement in distal small bowel).

Find it Fast!! Video Tutorial series from Yale University on EBM

Find it Fast! is a series of 10 video tutorials which highlights a variety of resources used in Evidence Based Medicine including The Cochrane Library, Clinical Evidence, Clinical Queries in Medline and more. In addititon, these video tutorials also cover  issues such as "how to ask a clinical question" using the PICO framework. This video series is easy to understand and lends a valuable perspective on the basics of EBM. While specifically oriented to Medicine, much of the information applies equally well to Evidence Based Nursing. Thank you Harvey Cushing/John Hay Whitney Medical Library at Yale!!

Julie's picks for January from the nursing lit

Here's one New Years resolution you can easily keep!! Catch our monthly picks from the EBN nursing literature! Staff at St. Joseph Hospital , Orange or Children's Hospital of Orange County may be able to access many of these articles through Burlew Medical Library's website or ask library staff to obtain the full text for them.

1. Thrombolysis administration by nurses: an evolving UK evidence

base?(includes abstract); Sloman M; Williamson GR; International Emergency Nursing, 2009 Oct; 17 (4): 193-202 (journal article - research, systematic review, tables/charts) ISSN: 1755-599X PMID: 19782332 CINAHL AN: 2010453128

2. Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting.(includes abstract); Estrada N; Worldviews on
Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 200-9 (journal article) ISSN: 1545-102X CINAHL AN: 2010504911

3. The latest evidence on the effectiveness of behavioral counseling interventions with adults.Melnyk BM; Worldviews on Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 250-4 (journal article)
ISSN: 1545-102X CINAHL AN: 2010504917

4. Factor V Leiden: impact on infusion nursing practice.(includes abstract); Weinstein SM; Journal of Infusion Nursing, 2009 Jul-Aug; 32 (4): 219-23 (journal article) ISSN: 1533-1458 PMID: 19606001 CINAHL AN: 2010352064

5. Sleep in adolescence: a review of issues for nursing practice.(includes abstract); Vallido T; Peters K; Brien L; Jackson D; Journal of Clinical Nursing, 2009 Jul; 18 (13): 1819-26 (journal article - research, systematic review) ISSN: 0962-1067 PMID: 19638045 CINAHL AN: 2010314625

6. Nursing resources and patient outcomes in intensive care: a systematic review of the literature.(includes abstract); West E; Mays N; Rafferty AM; Rowan K; Sanderson C; International Journal of Nursing
Studies, 2009 Jul; 46 (7): 993-1011 (journal article - research, systematic review, tables/charts) ISSN: 020-7489 PMID: 17964577 CINAHL AN: 2010351654

7. Evaluating central venous catheter care in a pediatric intensive care unit.(includes abstract); Hatler C; Buckwald L; Salas-Allison Z; Murphy-Taylor C; American Journal of Critical Care, 2009 Nov; 18 (6):
514-20 (journal article - research, tables/charts) ISSN: 1062-3264 PMID: 19880953 CINAHL AN: 2010464302

8. Hourly rounds: what does the evidence indicate? Halm MA; American Journal of Critical Care, 2009 Nov; 18 (6): 581-4 (journal article - research, systematic review, tables/charts) ISSN: 1062-3264 PMID:
19880960 CINAHL AN: 2010464309

9. Acute confusion/delirium.Sendelbach S; Guthrie PF; Schoenfelder DP; Journal of Gerontological Nursing, 2009 Nov; 35 (11): 11-8 (journal article - pictorial, review, tables/charts) ISSN: 0098-9134 PMID:
19904851 CINAHL AN: 2010471514

10. Lessons learned while conducting a clinical trial to facilitate evidence-based practice: the neophyte researcher experience.(includes abstract); Brim CB; Schoonover HD; Journal of Continuing Education in
Nursing, 2009 Aug; 40 (8): 380-4 (journal article) ISSN: 0022-0124 PMID: 19681576 CINAHL AN: 2010368156

11. Glycemic control in the hospital: how tight should it be?(includes abstract); Kessler C; Nursing, 2009 Nov; 39 (11): 38-44 (journal article - CEU, exam questions, pictorial, tables/charts) ISSN:
0360-4039 PMID: 19859000 CINAHL AN: 2010464169

12. Metasynthesis: a goldmine for evidence-based practice.(includes abstract); Beck CT; AORN Journal, 2009 Nov; 90 (5): 701-2, 705-10 (journal article - tables/charts) ISSN: 0001-2092 PMID: 19895928 CINAHL AN: 2010470525

13. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia.Hooper VD; Chard R; Clifford T; Fetzer S; Fossum S; Godden B; Martinez EA; Noble KA; O'Brien D; Odom-Forren J; et al.; Journal of PeriAnesthesia Nursing, 2009 Oct; 24 (5): 271-87
(journal article - algorithm, tables/charts) ISSN: 1089-9472 PMID: 19853810 CINAHL AN: 2010471997

14. Review summaries: evidence for nursing practice. Brief interventions for heavy alcohol users admitted to general hospital wards.Jayasekara R; Journal of Advanced Nursing, 2009 Dec; 65 (12): 2511-2 (journal
article - abstract) ISSN: 0309-2402 CINAHL AN: 2010502042

15. A review of cohort study design for cardiovascular nursing research.(includes abstract); Hood MN; Journal of Cardiovascular Nursing, 2009 Nov-Dec; 24 (6): E1-9 (journal article - abstract) ISSN:
0889-4655 PMID: 19858946 CINAHL AN: 2010464140

The best medical iphone apps for nurses and doctors

Check out this great compilation of the best iPhone and iPod apps for nurses from  go student nurse  .

Also, see this  categorized list of 55 apps for doctors and medical students brought to you by http://www.softwareadvice.com/medical/

Kresge Library at Scripps Clinic and Green Hospital has a wonderful, ongoing compilation of medical app links for Apple, Android, Palm, and Blackberry Devices. Also, just come across a post from Kevin Pho, MD who runs the popular medical blog KevinMD.com. This post opines "Why doctors should choose Google Android over the iPhone for medical apps"

How to help Haiti

Normally I wouldn't post requests for donations, but under the circumstances this seems appropriate.  "International Medical Corps is a global, humanitarian, nonprofit organization, founded by volunteer doctors and nurses and dedicated to saving lives and relieving suffering through relief and development programs. There are still thousands of patients seeking treatment of which approximately 80% are in need of surgery and are running out of time - especially with the tremendous aftershocks still devastating this country. The team is treating crush injuries, trauma, substantial wound care, shock and other critical cases with the few available supplies - And they're in it for the long haul. I would love your help spreading the word by blogging or tweeting about IMC's rescue efforts. We've put up a blogger friendly widget here on our site:
http://www.imcworldwide.org/haiti
With the widget it's really easy to let your readers know that donating $10 to help the people of Haiti is as simple as sending a text message of the word "haiti" to 85944. "

I also want to mention Doctors without Borders .
This article in the NY Daily News gives a comprehensive list of vetted donation organizations that have received high ratings from the American Institute of Philanthropy .

FYI-- I also came across this link from the American Psychological Association on "Managing your distress about the earthquake from afar"

Check out our new blog: Flat Maggie's Magnet Blog

We have started a new blog at St. Joseph Hospital in Orange. Flat Maggie's St. Joseph Hospital (Orange) Blog details her adventures and learnings as she tours around our hospital and learns about our efforts toward Magnet re-designation. The concept of “Flat Maggie” is based on the concept of “Flat Stanley” which has been widely used in the education arena. Flat Stanley is meant to facilitate letter-writing by schoolchildren to each other as they document their adventures with Flat Stanley.

Julie's picks for Dec from the nursing lit

Check out these recent nursing articles dealing with nursing research or EBN. Staff at St. Joseph Hospital in Orange/CHOC can access some of these articles through the library's website

1. Review summaries: evidence for nursing practice. The impact of
hospital visiting hours policies on paediatric and adult patients and
their visitors.Moola S; Xue Y; McArthur A; Journal of Advanced
Nursing, 2009 Nov; 65 (11): 2293-4 (journal article - abstract,
tables/charts) ISSN: 0309-2402 PMID: 19832749 CINAHL AN: 2010445839

2. Review of the evidence for treatment of children with Autism with
selective serotonin reuptake inhibitors [corrected] [published erratum
appears in J SPEC PEDIATR NURS 2009 Oct;14(4):301].(includes abstract);
West L; Brunssen SH; Waldrop J; Journal for Specialists in Pediatric
Nursing, 2009 Jul; 14 (3): 183-91 (journal article - research,
systematic review, tables/charts) ISSN: 1539-0136 PMID: 19614827 CINAHL
AN: 2010343341

3. One hospital's "peanutty" path to MAGNET designation.(includes
abstract); Bennett S; Raupers D; Hicks M; Schoener L; American Nurse
Today, 2009 Sep-Oct; 4 (8): 59-60 (journal article - tables/charts)
ISSN: 1930-5583 CINAHL AN: 2010447020

4. Teaching levels of evidence: the Santa project.Burton M;
Dilts-Skaggs MK; Journal of Nursing Administration, 2009 Oct; 39 (10):
412-4 (journal article - tables/charts) ISSN: 0002-0443 PMID: 19820522
CINAHL AN: 2010450326

5. Structured review: evaluating the effectiveness of nurse case
managers in improving health outcomes in three major chronic
diseases.(includes abstract); Sutherland D; Hayter M; Journal of
Clinical Nursing, 2009 Nov; 18 (21): 2978-92 (journal article -
research, systematic review, tables/charts) ISSN: 0962-1067 PMID:
19747197 CINAHL AN: 2010442812

6. Evidence-based guideline for suctioning the intubated neonate and
infant.(includes abstract); Gardner DL; Shirland L; Neonatal Network,
2009 Sep-Oct; 28 (5): 281-302 (journal article - practice guidelines,
research, systematic review, tables/charts) ISSN: 0730-0832 PMID:
19720593 CINAHL AN: 2010389820

7. Clinical practice guidelines: What are they? Where are they? How
good are they?Smith JR; Donze A; Neonatal Network, 2009 Sep-Oct; 28
(5): 343-50 (journal article - tables/charts) ISSN: 0730-0832 PMID:
19720600 CINAHL AN: 2010389825

8. Implementing a journal club in a palliative care setting: a link in
the chain of evidence-based practice.(includes abstract); O'Connor L;
Bennett P; Gardner A; Hawkins MT; Wellman D; Collegian, 2009; 16 (3):
147-52 (journal article - research, tables/charts) ISSN: 1322-7696
PMID: 19831148 CINAHL AN: 2010424123

9. Evidence-based practice. Accessing and deaccessing ports: where is
the evidence?Camp-Sorrell D; Steele-Moses SK; Clinical Journal of
Oncology Nursing, 2009 Oct; 13 (5): 587-90 (journal article -
pictorial, research, tables/charts) ISSN: 1092-1095 PMID: 19793716
CINAHL AN: 2010441057

10. A case study in evaluating infrastructure for EBP and selecting a
model.(includes abstract); Newhouse RP; Johnson K; Journal of Nursing
Administration, 2009 Oct; 39 (10): 409-11 (journal article - case
study, tables/charts) ISSN: 0002-0443 PMID: 19820521 CINAHL AN:
2010450325

11. Research education for clinical nurses: a pilot study to determine
research self-efficacy in critical care nurses.(includes abstract);
Swenson-Britt E; Reineck C; Journal of Continuing Education in
Nursing, 2009 Oct; 40 (10): 454-61 (journal article - research,
tables/charts) ISSN: 0022-0124 PMID: 19831327 CINAHL AN: 2010443034

Another article published out of St. Joseph Hospital, Orange with a nurse as lead author

Congratulations to the following St. Joseph Hospital, Orange authors for their recent article entitled "One kidney transplant center's experience: linking process improvements and Medicare/Medcaid conditions of participation" in 

 Progress in Transplantation 19(4):326-332 2009 Dec.

Wendy Escobedo, RN, BSN, CCTN

Peter Hosseinpour, PharmD

Marlene Abe, RN, BS CPTC

J. Michael Cecka, PhD

Ervin P Ruzics, MD

Staff at St. Joseph Hospital, Orange/CHOC may access the full text of this article through the CINAHL database via the library's website.