Healthstream : miscellaneous (CAUTI/CLABSI, Palliative Care, Comfort Measures, Mental Health, Alcohol Abuse, Substance Abuse) with Complete Solutions!!

Catheter-associated urinary tract infection (CAUTI) - ANSWER-Identified in 2007 by TJC as requiring special attention and included as a National Patient Safety Goal under "Health care-associated Infections" Approved as a separate NPSG by TJC for 2012 (ongoing for 2015) Identified in 2008 by CMS as a preventable hospital-acquired condition CAUTI care is not reimbursed by CMS Length of indwelling time is the most significant risk factor Data is insufficient to prove antibiotic or silver-coated catheters are more effective at preventing CAUTI CAUTI: What to Do - ANSWER-Obtain urine sample from sampling port (if new catheter will not be reinserted) Remove old catheter Obtain an order for a new one or replace if pt still requires one according to facility or TJC/CDC criteria Obtain urine specimen for culture from new catheter sampling port Implement prevention practices according to TJC and CDC guidelines Central-line associated bloodstream infection (CLABSI) or Catheter-related bloodstream infection (CRBSI) - ANSWER-Most common cause of healthcare-associated bloodstream infection Identified in 2007 by TJC as requiring special attention and included as a National Patient Safety Goal under "Health care-associated Infections" Approved as a separate NPSG by TJC for 2012 (ongoing for 2015) Identified in 2008 by CMS as a preventable hospital-acquired condition Proven by several facilities as capable of being reduced to ZERO incidence ICU patients are at highest risk due to insertion condition, access frequency, and extended indwelling time CLABSI: What to Do - ANSWER-Notify practitioner and obtain blood cultures via venipuncture If catheter still necessary, insert new in alternate site before removing old catheter Send tip of old catheter for culture (send entire implanted port for culture) Administer ABx as ordered Implement prevention practices according to TJC and CDC guidelines Palliative care - ANSWER-Care designed not to heal or cure, but to relieve suffering, usually in the end stages of a disease process Focus is relief for progressive or poorly-controlled symptoms that decrease quality of life; usually a major part of hospice care Should not be delayed for patients in distress who are still pursuing disease-directed treatment Discussion of palliative care should begin early, and include discussion of advance directives and patient goals New S/S that do not relate to current dx or expected progression should be investigated Palliative care diagnoses - ANSWER-advanced cancer, AIDS, CFH, COPD, ESRD, liver failure, stroke, dementia Palliative care signs and symptoms - ANSWER-Pain (most common) Dyspnea GI S/S (e.g., N/V, anorexia) Psych (e.g., depression, anxiety) Comfort measures - ANSWER-actions or items that increase comfort (mental, emotional, spiritual) as well as relieve physical pain Some practitioners interchange the term "comfort measures" with "nonpharmacologic pain control" Do not confuse with the term "comfort measures only (CMO)," which usually applies to DNR or terminal patients Examples of comfort measures - ANSWER-Religious symbols: crosses, pictures of spiritual leaders or icons Fan: may provide relief for patients who feel short of breath or claustrophobic Family presence: depends on the relationship! Pain control: nonpharmacologic pain relief measures may incorporate physical modes of relief such as massage and heat/cold, as well as cognitive modes such as imagery Delirium - ANSWER-acute restlessness and confusion with incoherency and decreased awareness of true surroundings; occurs with fever, sepsis, medication withdrawal, after general anesthesia, and during other acute illnesses