Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants

Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.

source: Advances in Neonatal Care

Summary

A Quality Improvement Project.

[Posted 5/Jun/2024]

AUDIENCE: Nursing

KEY FINDINGS: Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.

BACKGROUND: Late preterm births account for a large portion of preterm births, yet the optimal method of nutrition and enteral feeding in this population remains unclear and often involves intravenous (IV) fluids. Aim of this study is to develop and implement a late preterm feeding protocol in order to decrease the necessity of IV access, decrease the use of starter parenteral nutrition (PN), and reduce the pain endured by an infant in the neonatal intensive care unit.

DETAILS: The Plan-Do-Study-Act quality improvement model was utilized as a framework for the implementation of this quality improvement project. A literature review was conducted and subsequently, a feeding protocol was developed and included the more judicious use of starter PN. This protocol was implemented, evaluated, and adopted. A second Plan-Do-Study-Act cycle was completed with the addition of an auto-text reminder incorporated into admission notes in the electronic medical record. The implementation of the protocol significantly reduced placement of IV access and the use of starter (PN) in late preterm infants without considerable differences in balancing measures. The percentage of infants who received peripheral IV access declined considerably from 70% to 42% (P = .0017) subsequently, less pain endured by the infants. There was a decrease in the initiation of starter PN from 55% to 7% (P < .00001).

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Source: Hanford, J., McQuay, C., Vachharajani, A., et al. (2024). Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants: A Quality Improvement Project. Advances in Neonatal Care. 2024; 24(3): 219-226. Published: June, 2024. DOI: 10.1097/ANC.0000000000001125.



Improving the Ability of Nursing Students in Neonatal Resuscitation by Using the Helping Babies Breathe Program

Resuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation

source: J. Neonatal Nurs.

Summary

A Quasi-Experimental Study.

[Posted 10/Jul/2024]

AUDIENCE: Nursing, Family Medicine

KEY FINDINGS: Resuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation

BACKGROUND: Nursing graduates must have sufficient skills to perform adequately in newborn resuscitations. New nurses should be provided with appropriate situations in order to practice the necessary skills required during a newborn resuscitation. This study aimed to improve the performance of nursing students during neonatal resuscitations through the use of a Helping Babies Breathe Program.

DETAILS: This quasi-experimental study with a control group (simulator with low similarity) and an interventional group (Helping Babies Breathe Program) was conducted on 84 eighth-semester nursing students studying at Isfahan University of Medical Sciences, Iran. A resuscitation workshop was held for a single day for 5 h with students performing standard practices for each step of the resuscitation. Knowledge and skills of students were assessed using two scenarios and a standardized checklist. The mean score of knowledge and basic neonatal resuscitation skills were significantly different between the two groups before and immediately after training, as well as Post-Internship (p < 0.05). The highest score of knowledge (17.38) belonged to the intervention group. Appropriate skills are critically important when performing bag-valve-mask ventilation. Before the intervention occurred, students in the interventional group obtained the lowest scores in resuscitation skills; however, after the intervention, all interventional group students obtained a full score and demonstrated the necessary skills required for effective newborn resuscitations.

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Copyright © Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.

Source: Nazari, A., Namnabati, M., and Ajoodanian, N. (2024). Improving the Ability of Nursing Students in Neonatal Resuscitation by Using the Helping Babies Breathe Program: A Quasi-Experimental Study. Journal of Neonatal Nursing. 2024; 29(3): 453-458. Published: June, 2024. DOI: 10.1016/j.jnn.2022.06.005.



Bleeding Reversal With Antifibrinolytics or Cryoprecipitate Following Thrombolysis for Acute Ischemic Stroke

While limited by its small sample size, this case series demonstrates significant variability in reversal strategies for thrombolysis-associated bleeding. It also provides additional evidence for the role of antifibrinolytics in this setting.

source: AENJ

Summary

A Case Series

[Posted 2/Jul/2024]

AUDIENCE: Nursing

KEY FINDINGS: While limited by its small sample size, this case series demonstrates significant variability in reversal strategies for thrombolysis-associated bleeding. It also provides additional evidence for the role of antifibrinolytics in this setting.

BACKGROUND: Patients who develop an intracerebral hemorrhage (ICH) following thrombolysis in acute ischemic stroke (AIS) have a mortality rate as high as 50%.

DETAILS: Treatment options include blood products, such as cryoprecipitate, or antifibrinolytics, such as tranexamic acid (TXA) or ε-aminocaproic acid (EACA). Current guidelines recommend cryoprecipitate first-line despite limited data to support one agent over another. In addition, compared to antifibrinolytics, cryoprecipitate is higher in cost and requires thawing before use. This case series seeks to characterize the management of thrombolytic reversal at a single institution as well as provide additional evidence for antifibrinolytics in this setting. Patients were included for a retrospective review if they met the following criteria: presented between January 2011-January 2017, were >18 years of age, were admitted for AIS, received a thrombolytic, and received TXA EACA, or cryoprecipitate. Twelve patients met the inclusion criteria. Ten (83.3%) developed an ICH, one (8.3%) experienced gastrointestinal bleeding, and one (8.3%) had bleeding at the site of knee arthroscopy. Eleven patients received cryoprecipitate (median dose: 10 units), three received TXA (median dose: 1,000 mg), and one patient received EACA (13 g). TXA was administered faster than the first blood product at a mean time of 19 min and 137 min, respectively. Hemorrhagic expansion (N = 8, 66.67%) and inhospital mortality (N = 7, 58.3%) were high.

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Source: Bailey, A. M., Baum, R., Nestor, M .,et al. (2024). Bleeding Reversal With Antifibrinolytics or Cryoprecipitate Following Thrombolysis for Acute Ischemic Stroke: A Case Series. Advanced Emergency Nursing Journal. 2024; 46(2): 101-107. Published: April/June, 2024. DOI: 10.1097/TME.0000000000000512.



Risk Predictors of Glycaemic Control in Children and Adolescents With Type 1 Diabetes

For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control

source: J Clin Nurs

Summary

A Systematic Review and Meta-Analysis

[Posted 25/Jun/2024]

AUDIENCE: Nursing, Pediatric

KEY FINDINGS: For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control, and the relationship between diagnosis age and blood glucose control needs to be further explored.

BACKGROUND: Aim of the study is to conduct systematic evaluation of the risk predictors of glycaemic control in children and adolescents with type 1 diabetes mellitus.

DETAILS: Cohort studies on risk predictors of glycaemic control in children and adolescents with type 1 diabetes were retrieved from CNKI, PubMed, Web of Science, Embase databases, etc. from the construction of the repository to 3 February 2023. Literature screening was conducted according to inclusion and exclusion criteria, then data extraction of region, sample size, age, follow-up time, risk predictors, outcome indicators, etc., and quality evaluation of The Newcastle-Ottawa Scale were conducted by two researchers while the third researcher makes decisions if there are disagreements. Finally, Revman5.4 and StataMP17 were used for meta-analysis. A total of 29 studies were included, and the results showed that insulin pump [Weighed mean difference (WMD) = -.48, 95% CI (-.73, -.24), p < .01], high-frequency sensor monitoring, early use of insulin pumps, prospective follow-up male, white race, large body mass index-standardised scoring, conscientiousness, agreeableness of mothers, eicosapentaenoic acid, leucine and protein (p < .05) were beneficial for reducing HbA1c levels in children and adolescents with diabetes. Ketoacidosis [WMD = .39, 95% CI (.28, .50), p < .01], selective admission, higher HbA1c level at one time (p < .01), higher glutamate decarboxylase antibody at 1 month after diagnosis, lower socio-economic status, non-living with biological parents, non-two-parent family, family disorder, family history of diabetes and high carbohydrate intake (p < .05) increased HbA1c levels in children and adolescents with diabetes.

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Source: Gangqiang, G., Hua, C., and Hongyu, S., (2024). Risk Predictors of Glycaemic Control in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis. J Clin Nurs. 2024; 33(7): 2412-2426. Published: July, 2024. DOI: 10.1111/jocn.17110.



The Effectiveness Of Preoperative Delirium Prevention In Intermediate To High-Risk Older Surgical Patients

Despite the promising results for fascia iliaca compartment block and methylprednisolone, there is limited knowledge regarding evidence-based delirium prevention interventions.

source: J Clin Nurs

Summary

A Systematic Review

[Posted 20/May/2024]

AUDIENCE: Nursing

KEY FINDINGS: Despite the promising results for fascia iliaca compartment block and methylprednisolone, there is limited knowledge regarding evidence-based delirium prevention interventions. Most studies had small sample sizes indicating that the current evidence is exploratory. There is an urgent need for the funding and conduct of trials to test preventative interventions for older surgical patients at intermediate to high risk of developing delirium.

BACKGROUND: Few reviews have addressed delirium prevention among intermediate to high-risk older surgical patients. Purpose of this study is to map preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of developing delirium, assess outcomes and identify gaps in knowledge.

DETAILS: A systematic search was conducted of the literature published from 1990 to October 2022 in Medline, CINAHL and Ageline and of the grey literature in Google Scholar. Randomised controlled trials were retrieved that assessed the effectiveness of preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of delirium. Data were extracted using a data extraction tool, and results were tabulated. Studies were assessed for bias using the Cochrane Collaboration Risk of Bias tool. Twenty-one studies met the selection criteria including N = 5096 participants. Two studies tested cognitive training, two studies tested fascia iliaca compartment block and one study assessed femoral nerve block. Ten studies tested prophylactic medications including methylprednisolone. Five studies investigated geriatric assessment and management. One study assessed transcutaneous electrical acupoint stimulation. In the two studies testing fascia iliaca compartment block, there was a reduction in postoperative delirium for orthopaedic patients. Methylprednisolone reduced postoperative delirium in orthopaedic patients and in those undergoing gastrointestinal surgery. Results of all other interventions on the occurrence of postoperative delirium and additional outcomes including the severity and duration of delirium were inconclusive.

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Source: Lay, N., Foley, P., and Allen, J. (2024). The Effectiveness Of Preoperative Delirium Prevention In Intermediate To High-Risk Older Surgical Patients: A Systematic Review. J Clin Nurs. 2024; 33(5): 1666-1683. Published: May, 2024. DOI: 10.1111/jocn.17020.



Probable Non-Ventilator-Associated Hospital-Acquired Pneumonia

Consistent oral care, early and frequent physical activity, and measures aimed to reduce aspiration risk are key interventions for all hospitalized patients to prevent non-ventilator-associated hospital-acquired pneumonia.Consistent oral care, early and frequent physical activity, and measures aimed to reduce aspiration risk are key interventions for all hospitalized patients to prevent non-ventilator-associated hospital-acquired pneumonia.

source: Crit Care Nurse

Summary

A Case Report.

[Posted 7/May/2024]

AUDIENCE: Nursing

KEY FINDINGS: Consistent oral care, early and frequent physical activity, and measures aimed to reduce aspiration risk are key interventions for all hospitalized patients to prevent non-ventilator-associated hospital-acquired pneumonia. Further research is warranted to assess shifts in oral bacteria and general oral health during hospitalization, which could provide clinically meaningful data on risk for non-ventilator-associated hospital-acquired pneumonia.

BACKGROUND: Non-ventilator-associated hospital-acquired pneumonia is a preventable health care-associated infection accounting for 1 in 14 hospital deaths. Clinical factors influencing this condition include oral health and bacteria and oral care. This case report addresses diagnostics and clinical variables related to non-ventilator-associated hospital-acquired pneumonia and emphasizes the importance of prevention.

DETAILS: A 90-year-old woman was admitted to the hospital with shortness of breath and generalized weakness from new-onset atrial fibrillation and suspected heart failure exacerbation. During the hospitalization, her oral health status declined and oral bacterial colonization shifted, with Neisseria becoming the most common oral bacterial genus around the time of development of probable non-ventilator-associated hospital-acquired pneumonia. Diagnosis: The patient had new respiratory symptoms and a chest radiograph positive for pneumonia on day 4 and was subsequently diagnosed with probable non-ventilator-associated hospital-acquired pneumonia. Interventions: Intravenous antibiotic treatment was initiated. Oral care was completed on only 2 of 7 days. The patient received limited ambulation assistance and encouragement from staff and family members. No dysphagia screening was documented. On day 6, the patient was discharged with oral antibiotics to her independent living facility with home health care.

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Copyright © American Association of Critical-Care Nurses. All rights reserved.

Source: Rathbun, K. P., Bourgault, A. M., and Sole, M. L. (2024). Probable Non-Ventilator-Associated Hospital-Acquired Pneumonia: A Case Report. Crit Care Nurse. 2024; 44(2): 49-58. Published: April 1, 2024. DOI: 10.4037/ccn2024693.



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