Accuracy of glycemic measurements in the critically ill.

BACKGROUND: Recent evidence emphasizes the importance of maintaining normoglycemia in critically ill patients to reduce morbidity and mortality. Different analytical methods of varying accuracy exist for obtaining and measuring blood glucose in critically ill patients. The purpose of this study was to determine if there were differences in blood glucose values measured by whole blood capillary and arterial samples using three different bedside blood glucose meters and a blood gas analyzer as compared to a reference blood glucose analyzer. METHODS: Sixty subjects were recruited from a university hospital medical/surgical intensive care unit. Matching capillary and arterial samples were analyzed by a clinical blood glucose reference analyzer (YSI, Yellow Springs Instrument, Yellow Springs, OH) and three blood glucose meters (Lifescan [Milpitas, CA] SureStepFlexx, Roche [Indianapolis, IN] Accu-Chek Inform, and Abbott [Alameda, CA] FreeStyle). Additionally, the arterial samples were analyzed by a point-of-care blood gas analyzer (Chiron 865, Bayer, Tarrytown, NY). RESULTS: Data analysis included repeated-measures analysis of variance, Consensus Error Grid analysis, Bland-Altman plots, and numerical estimates of inaccuracy. With capillary samples there were high numbers of errors as compared to the reference instrument. Measurement of blood glucose with arterial samples demonstrates a higher degree of accuracy. With arterial samples, the Abbott FreeStyle blood glucose meter and the blood gas analyzer glucose exhibited the lowest median and mean relative absolute deviation. CONCLUSION: In critically ill adult patients, measurement of blood glucose using arterial samples is recommended. Using arterial blood, the Abbott FreeStyle blood glucose meter and the point-of-care blood gas analyzer (Bayer Chiron 865) were shown to be highly accurate instruments to measure arterial blood glucose.

Knowledge and skill acquisition for critical care nursing practice.

In many critical care units, extended orientation or education programs have been offered to prepare the registered nurse to work in this specialty area. Current shortages of nurses and less experienced nurses applying for critical care positions have augmented the need for educational programs. In the Edmonton region, a partnership between two public institutions led to the development and implementation of an innovative educational program. In this article, we describe challenges and strategies to prepare critical care nurses to integrate knowledge, and meet the standards and expectations of both partners. In particular, methods are described to achieve theoretical and clinical outcomes. This article contributes to the discussion and implementation to offer knowledge and skill acquisition for a novice critical care nurse.

A survey of nurses' beliefs about the medical emergency team system in a canadian tertiary hospital.

BACKGROUND: Nurses are the primary activators of the medical emergency team (MET). Although the MET system can empower nurses to seek help in managing acutely ill patients, few data on nurses' beliefs about the system are available. OBJECTIVE: To evaluate nurses' beliefs and behaviors about the MET system. METHODS: Nurses from a large academic hospital in Canada were surveyed (2 demography-related questions and 17 Likert-scale questions). RESULTS: Of 614 nurses employed on units participating in the MET system, 293 (47.7%) were approached and 275 completed the survey (response rate, 93.9%). Most respondents (84.2%) believed that the MET could prevent cardiopulmonary arrest in acutely ill patients, and 94% believed that the MET allowed them to seek help for patients they were worried about. Most nurses (75.9%) would call the responsible physician before activating the MET. Fifteen percent indicated reluctance to activate the MET because of fear of criticism, but only 2.2% considered the MET overused. Most (81.3%) believed that the MET did not increase their workload, and 91.3% did not believe that the MET reduced their skills. Forty-eight percent of nurses indicated that they would activate the MET for a patient they were worried about, even if the patient had normal vital signs. CONCLUSION: Nurses value the MET system. Nurses believe that the MET can help them care for acutely ill patients and improve outcomes. However, barriers to MET activation exist, including a fear of criticism and an adherence to a more traditional model of first contacting the responsible physician before activating the MET.