Adopting Braden Q in the NICU to Identify Neonates at Risk of Developing Pressure Injuries.

There are numerous factors placing neonates at increased risk of developing pressure injuries while hospitalized. Prevention of hospital-acquired pressure injuries in this vulnerable patient population requires early risk identification. Unfortunately, identifying neonates who are at risk of developing pressure injuries is complicated because of the lack of pressure injury risk assessment tools validated for use in neonates. The Braden Q risk assessment scale was adopted by two NICUs within a health care system to aid in identifying neonates at risk of developing a pressure injury. Additionally, the electronic health record was adapted to assist nurses in implementation of appropriate interventions to prevent pressure injuries based on Braden Q subscores.

Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM.

Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the front line for antibiotic stewardship, a workshop was convened to specifically address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The working definition of antibiotic stewardship is "the right drug at the right time and the right dose for the right bug for the right duration." A major emphasis was that antibiotic stewardship should be a core competency of critical care clinicians. Fear of pathogens that are not covered by empirical antibiotics is a major driver of excessively broad-spectrum therapy in critically ill patients. Better diagnostics and outcome data can address this fear and expand efforts to narrow or shorten therapy. Greater awareness of the substantial adverse effects of antibiotics should be emphasized and is an important counterargument to broad-spectrum therapy in individual low-risk patients. Optimal antibiotic stewardship should not focus solely on reducing antibiotic use or ensuring compliance with guidelines. Instead, it should enhance care both for individual patients (by improving and individualizing their choice of antibiotic) and for the ICU population as a whole. Opportunities for antibiotic stewardship in common ICU infections, including community- and hospital-acquired pneumonia and sepsis, are discussed. Intensivists can partner with antibiotic stewardship programs to address barriers and improve patient care.

Progressive Care of Obese Patients.

Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63).

Progressive mobility as a team effort in transitional care.

With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. The benefits of early progressive mobility are examined with a focus on the interdisciplinary collaboration for care in a transitional care program of a skilled nursing facility. The program's goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families.

Meeting the nutritional needs of the bariatric patient in acute care.

Meeting the nutritional needs of the bariatric (severely obese) patient in acute and critical care can be a challenge. Assessment of metabolic needs and energy expenditure is imperative to calculate nutritional needs. Achieving adequate nutrition is a result of multidisciplinary team collaboration, with the nurse providing important data for the dietitian to calculate needs. This article reviews aspects of nutritional support of the bariatric patient including assessment, planning, implementation, and evaluation.

Caring for the bariatric patient with obstructive sleep apnea.

Caring for the bariatric patient in the acute care environment poses many challenges to the team delivering care. The management of obstructive sleep apnea with noninvasive ventilation is one priority. Treatment options, including bi-level ventilation and continuous positive airway pressure, and delivery strategies are reviewed in conjunction with other aspects of care that ensure a holistic, comprehensive plan of care. The most effective plan of care for the bariatric patient is one that uses a multidisciplinary coordinated team effort.

Progressive care series. Part 1. Keep with step-down care.

Progressive care units provide care to stable, critically ill patients of varying acuities. Managers of these diverse units must consider care delivery systems, staffing, technology, acuity measurement, and regulatory issues.

Journey of a survivor of near drowning, polymicrobial pneumonia, and acute respiratory distress syndrome.

This article discusses a woman who collapsed and landed in a puddle of water in a park near a horse trail. Her rescue and resuscitation started an extraordinary effort by her body to heal from multiple insults. This case study highlights the diagnosis and support of polymicrobial pneumonia secondary to near drowning and the multisystem complications throughout the 3-month hospitalization. It highlights the evidence for treatment of the polymicrobial nature of submersion injury, acute lung injury, and benefits of progressive mobility. Social media as a tool for the family's communication and coping are also discussed.