American Journal of Critical Care. 2007;16: 432
Copyright © 2007 by the American Association of Critical-Care Nurses.
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
Birck Cox, Illustrator
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Noninvasive Temperature Measurement
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Are your temperature measurements as accurate as they can be? Tympanic temperature measurement uses a noncontact infrared measurement to detect the energy emitted from the ear and should be obtained after inspecting the lens and using a proper seal. Lawson and colleagues compare a variety of noninva-sive temperature measurements.
- Temporal artery temperature measurement is used to provide a measure of core temperature; radiant heat loss through the skin is accounted for by simultaneous measurement of ambient temperature.
- Diaphoresis can affect measurement accuracy and is controlled for by using measurement behind the ear, an area less affected by diaphoresis.
- A combined method of forehead plus behind the ear measurement is recommended for all patients.
See Article, pp 485–496
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Disease Management and the Chronically Critically Ill
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Disease management programs (DMPs) have long been promoted as a major medical cost-saving mechanism, although research on the topic shows conflicting results. A successful example of a DMP for the chronically critically ill is described in the article by Douglas and colleagues. Their DMP had a positive effect on hospital readmission and potential economic advantages.
- DMPs have been shown to improve outcomes and lower costs associated with such chronic conditions as asthma, diabetes, and heart failure.
- Frequently a key component of the program is individual case management by an advanced practice nurse (APN). The APN focuses on communication among patients, family, and healthcare providers as well as consistency of care across settings.
- Discussions of realistic discharge planning including mortality and morbidity risks are essential.
See Article, pp 447–457
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Levels of Evidence and Case Reports
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A solid evidence base should be the foundation for all aspects of patient care. However, there are many levels of evidence, ranging from large randomized clinical trials to anecdotal case reports. Although case reports are the weakest form of formal evidence, they may be the only type of evidence available, especially in conditions that are significant but uncommon. Patel and colleagues review several case studies and small case series to evaluate the use of a new therapy for calcium channel blocker overdose and, based on this evidence, recommend consideration of its use.
- As these authors describe, because cases are generally not uniform, direct application of the evidence may be difficult.
- All types of evidence therefore should be evaluated carefully for clinical usefulness.
See Articles, pp 498–503; 520, 518–519
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Effective Nurse-Physician Collaboration
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The link between healthy work environments and patient safety, nurse retention, and recruitment—and thus the bottom line—is irrefutable. In their article, Stein-Parbury and Liaschenko describe an understanding of physician and nurse collaboration based on situations in which collaboration breaks down (eg, when caregivers are dealing with a confused patient).
- Two of the 6 ingredients for success are skilled communication and true collaboration.
- In this patient context, use of case knowledge rather than patient knowledge contributed to the breakdown.
- Read more about Healthy Work Environments on the AACN Web site: http://www.aacn.org/AACN/hwe.nsf/vwdoc/HWEHomePage.
See Article, pp 470–478
Clinical Pearls is designed to help implement evidence-based care at the bedside by summarizing some of the most clinically useful material from select articles in each issue. Readers are encouraged to photocopy this ready-to-post page and share it with colleagues. Please be advised, however, that any substantive change in patient care protocols should be carefully reviewed and approved by the policy-setting authorities at your institution.
Related articles in AJCC:
- Chronically Critically Ill Patients: Health-Related Quality of Life and Resource Use After a Disease Management Intervention
- Sara L. Douglas, Barbara J. Daly, Carol Genet Kelley, Elizabeth O’Toole, and Hugo Montenegro
AJCC 2007 16: 447-457.
[Abstract]
[Full Text]
- Understanding Collaboration Between Nurses and Physicians as Knowledge at Work
- Jane Stein-Parbury and Joan Liaschenko
AJCC 2007 16: 470-477.
[Abstract]
[Full Text]
- Accuracy and Precision of Noninvasive Temperature Measurement in Adult Intensive Care Patients
- Lari Lawson, Elizabeth J. Bridges, Isabelle Ballou, Ruthe Eraker, Sheryl Greco, Janie Shively, and Vanessa Sochulak
AJCC 2007 16: 485-496.
[Abstract]
[Full Text]
- Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: A Review
- Nirav P. Patel, Meredith E. Pugh, Steven Goldberg, and Glenn Eiger
AJCC 2007 16: 498-503.
[Abstract]
[Full Text]
- Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: Case Report
- Nirav P. Patel, Meredith E. Pugh, Steven Goldberg, and Glenn Eiger
AJCC 2007 16: 520-518.
[Abstract]
[Full Text]
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