Clinical Pearls

Abstract

With an increased demand and an overall shortage of available organs to transplant, donation after cardiac death (DCD) has become a viable option during the last decade. Donation after brain death (DBD) has well-established protocols in adults and children; however DCD protocols still meet some resistance due to concerns about a negative end-of-life experience for a patient’s family and staff. Cowl and colleagues surveyed a multidisciplinary pediatric intensive care unit’s (PICU) staff regarding their acceptance of a protocol for DCD in comparison to DBD. They found the following:The authors concluded that DCD had been fully integrated into their PICU with no reported differences in their acceptance of DCD from DBD.—Rochele Armola,rn, msn, ccrnSee Article, pp 322–327Frequently, patients placed in a step-down unit require close monitoring and surveillance. What tools are available that may help predict clinically unstable conditions before they happen? Yousef and colleagues studied 326 patients admitted to a 24-bed adult surgical-trauma step-down unit during an 8-week period. Overall, 112 patients (34%) met criteria for cardiopulmonary instability. They found the following:Additional statistical analysis showed that the tool had high specificity (97%) but low sensitivity (6%). A CCI of 0, or no comorbid conditions in this study was a good predictor of which patient would not become clinically unstable.—Maureen Seckel,rn, msn, apn, aprn-bc, ccrn, ccnsSee Article, pp 344–351We may ask if our patients have an advance directive (AD) and check the appropriate box, but do we really evaluate our patients’ understanding of ADs? Johnson and colleagues assessed this in their study by asking the following questions:They found that older age, white race, and presence of family members were significant predictors of having and understanding an AD. Patients with comorbid conditions were more likely to complete ADs while hospitalized. Simply asking the questions and offering the opportunity to complete an AD is not enough. Confusion about ADs and an inability to communicate end-of-life wishes needs to be addressed in a more complete manner.—Alethea Sment,rn, bsn, ccrn-cscSee Article, pp 311–320A landmark study done in 2009 demonstrated how many microbes can be found in the wash basins of our patients. The study in this issue done by Powers and colleagues showed a 95% reduction in bacterial growth in the basins when chlorhexidine gluconate is used for bathing.This reduction in bacterial growth drastically reduces the risk for hospital-acquired infections among critically ill patients.Florence Nightingale noted that the amount of relief and comfort experienced by patients after the skin has been carefully washed and dried was one of the most common observations she made at the sick bed. So, never forget the basics at the bedside.—Helen Miley,rn, phd, ccrn, ancp, gnpSee Article, pp 338–343