1. Section Editor(s): Leininger-Hogan, Susan MSN, RN

Article Content

Few things can be accomplished for patients in the critical care unit without collaboration with other hospital departments and services. It is vital that nurses appreciate and utilize the expertise of ancillary personnel as they manage various aspects of care. Careful coordination, teamwork, and precise communication are essential elements in successful operations.


Chan-Tompkins shares her expertise in managing multiple-drug-resistant gram-negative pathogens in patients who have become resistant to carbapenems. Her article, "Multidrug-Resistant Gram-Negative Infections: Bringing Back the Old," stresses both the value and dangers in using polymyxin B and colistimethate, which have been resurrected to treat patients infected with multiple-drug-resistant pathogens and outlines the vital role of clinicians in preventing the potential neurotoxicity and nephrotoxicity that may accompany the use of these agents.


Estes tackles the complex issues associated with implementing best practices in managing community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections, which present to hospitals, especially in the emergency department. In her work, "MRSA Skin and Soft Tissue Infections," she uses a review of literature to trace the history of a "superbug" and discusses the consequences of undertreating or mistreating these serious infections. She outlines current treatment guidelines, including antimicrobial choices and wound care regimens.


"Pneumonia Management in the Intensive Care Setting," by Leininger-Hogan, describes the quality processes for improving compliance with the core measures associated with pneumonia. She describes the screening associated with admitted or transferred patients with a diagnosis of pneumonia or a high risk for its development during the hospitalization course. The role of nurses in daily assessments of patients, monitoring of chest radiographs, and sputum cultures is presented along with how one hospital was able to identify and resolve key issues with core measure compliance.


Cvitkovic explains the role of a laboratory compliance manager in point-of-care testing procedures. In the article, "Point-of-Care Testing: Conception, Regulations and Usage," the author briefly explains how the Connectivity Industry Consortium set the stage for ensuring technological controls that are essential for the success of today's point-of-care testing programs in hospitals. Using a glucose meter as an illustration of a common testing device, the reader will be able to appreciate the various components of preanalytical, analytical, and postanalytical phases of quality management.


Benitez and Pattillo champion the role of an advanced practice nurse in an important initiative aimed at rapid intervention for coronary patients who could benefit from percutaneous coronary interventions. Their article, "Achieving Door-to-Balloon Times in Less than 90 Minutes," discusses the barriers that impeded one hospital's capability to meet the established guidelines. With the leadership of an advanced practice nurse, an interdisciplinary team was introduced as a viable way to overcome obstacles and affect a seamless flow of activities from initial patient presentation to intervention in the cardiac catheterization laboratory.


In "The Underutilization of Venous Thromboembolism Prophylaxis in Medical Patients," by Kaczorowski and Pattillo, the authors identify reasons that recommended preventative measures are not consistently followed by clinicians. They suggest that the clinical nurse specialist is in an ideal position to ensure that guidelines of the American College of Chest Physicians are assimilated by staff and regularly followed in practice.


Robbins' article, "Hospital Checklists: Transforming Evidence-Based Care and Patient Safety Protocols into Routine Practice" illustrates the value of checklists as a component of patient safety protocols. His accounts of successful applications of such tools in the operating room should encourage critical care nurses to consider how these tools may be used in the Intensive Care Unit (ICU) to increase compliance with accepted standards of practice. On the basis of the recommendations of the World Health Organization's Safe Surgery Saves Lives Program, industry has responded with user-friendly technology to support evidence-based checklists.


Although not a pleasant topic to present, Leininger-Hogan addresses the problems associated with bedbugs appearing as unwelcome visitors in the health care facility. In her article, "Bedbugs in the Intensive Care Unit: A Risk You Cannot Afford," she shares information about an approach for this confounding problem using environmental services and ICU staff as "partners in practice." This article reveals, in an uncanny way, the nuances of an age-old crawling pest that possesses the power to invade the hospital and derail the fundamental operations of today's high-tech ICU.


Bonuel and colleagues at DeBakey VA Medical Center in Houston describe their new fall prevention strategy, "CATCH." Practice improvements within the facility illustrate that measurable and positive outcomes have been achieved.


Finally, Laird shares case studies on two vital topics, Ischemic Colitis and Acute Respiratory Distress Syndrome. His works demonstrate the value of professional collaboration among ICU staff in the management of complex cases. Through successful partnerships in practice, improved outcomes can be realized.


Susan Leininger-Hogan, MSN, RN Issue Editor