Drug Shortage Alert: Electrolyte Medication

The Society of Critical Care Medicine’s Drug Shortages Task Force has produced a comprehensive guide for assessing and responding to shortages of sodium acetate injection, concentrated sodium chloride, potassium acetate and chloride injection, phosphate injection, calcium chloride and gluconate injection, and magnesium sulfate injection. Manufacturers report a number of reasons for these shortages, including increased demand, manufacturing delays, suspended production, and discontinuation by the manufacturer.

The alert Electrolyte Medication Shortages includes information on the shortage’s impact in intensive care units, including suggested management strategies, pharmacotherapeutic considerations, and safety concerns. The recommendations are based on a combination of current evidence, clinical experience from multiple clinicians, and the need for conservation during these shortages.

Visit www.sccm.org/currentissues to access all Drug Shortage Alerts, including those addressing:

  • Intravenous Sodium Bicarbonate
  • Web Resources
  • Intravenous Loop Diuretics
  • General Considerations

John Lewin, MBA, PharmD, and other members of the Drug Shortage Task Force discuss safe and consistent management of drug shortages as well as on additional resources and strategies.

CDC Urges Better Antibiotic Stewardship

A new Vital Signs report from the Centers for Disease Control and Prevention (CDC) shows that clinicians in some hospitals prescribe three times as many antibiotics than clinicians in other hospitals, even though patients were receiving care in similar areas of each hospital. In addition, about one-third of the time, prescribing practices to treat urinary tract infections and prescriptions for the critical and common drug vancomycin included a potential error – given without proper testing or evaluation, or given for too long. The report also found that, in hospitals, a 30% reduction in use of the antibiotics that most often cause deadly diarrheal infections with Clostridium difficile can reduce these infections by more than 25%. The same antibiotics also prime patients for future super-resistant infections.

To help hospitals develop antibiotic stewardship programs, CDC released practical tools that include seven key elements, a self-assessment checklist, and an in-depth implementation document.

The Vital Signs report follows several calls to action from CDC on antibiotic resistance including the Antibiotic Resistance Threats to the United States, 2013 report, the Get Smart about Antibiotics Week, and the upcoming coming Transatlantic Taskforce on Antimicrobial Resistance 2013 report.

ACGME, AOA and AACOM Agree to Single Accreditation for Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) have agreed to a single accreditation system for graduate medical education (GME) programs in the United States. After months of discussion, the allopathic and osteopathic medical communities have committed to work together to prepare future physicians with the highest quality GME, ultimately helping to ensure the quality and safety of health care delivery.

The single accreditation system will allow graduates of allopathic and osteopathic medical schools to complete residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common Milestones and competencies. Currently, the ACGME and AOA maintain separate accreditation systems for allopathic and osteopathic educational programs.

“A single system standardizes the approach to GME accreditation, and ensures that all physicians have access to the primary and sub-specialty training necessary to serve patients,” said AOA President Norman E. Vinn, DO. Under the single accreditation system:

  • AOA and AACOM will become ACGME member organizations and will nominate members to the ACGME Board of Directors.
  • Two new osteopathic Review Committees will be created to evaluate and set standards for the osteopathic aspects of GME programs seeking osteopathic recognition.
  • An extended transition period — July 1, 2015 to June 30, 2020 is set for AOA-accredited programs to apply for and receive ACGME recognition and accreditation.
  • Opportunity is created for MD and DO graduates who have met the prerequisite competencies to access any GME program or transfer from one accredited program to another without being required to repeat education.
  • Efficiencies are realized because institutions need not sponsor “dually accredited” or “parallel accredited” allopathic and osteopathic medical residency programs.

The New Yorker Puts Spotlight on Post-Intensive Care Syndrome

The New Yorker profiled intensive care unit (ICU) patient Charlie Atkinson and his struggle with the long-term outcomes of his care. “After a month in the I.C.U., Atkinson was well enough to leave the hospital. He had ‘made it.’ But he remained dependent on a ventilator and confused—able to recognize his own name and little else. He didn’t know it, but he had crossed an invisible threshold into a territory of protracted sickness and uncertain hope for improvement,” according to the article “The Limbo Between A Life Worth Living and Death.” The article details the challenges patients face after critical illness and signifies a rising awareness about post-intensive care syndrome.

The Society of Critical Care Medicine offers numerous resources to help educate patients about post-intensive care syndrome at www.MyICUCare.org, including several interviews with former ICU patients.

In addition, the Society’s ICU Liberation initiative offers clinicians tools to improve long-term outcomes. A recently added presentation from Alison Clay, MD, recounts her own ICU survivor story.

New Edition of Critical Care Ethics: A Practice Guide

The intensive care unit can be the site of many ethical controversies. Critical Care Ethics: A Practice Guide, Third Edition, explores thought-provoking ethical questions that critical care professionals must face in real life situations.

Topics include:

  • euthanasia
  • artificial nutrition
  • management of drug shortages
  • palliative care
  • religious views of end-of-life care
  • unique considerations in pediatric and neonatal care

The references and suggested readings that accompany each chapter provide resources for further exploration of complicated issues.

Critical Care Ethics: A Practice Guide, Third Edition is available for purchase in the SCCM Store in print and electronic formats.

Practice and Prepare with the Adult and Pediatric Board Review Courses

The Society of Critical Care Medicine’s (SCCM) 2014 Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC) set the standard in board preparation. Whether you need to certify, recertify or simply review, MCCBRC provides an excellent update and thorough overview of the field.

Comprehensive Learning Experience
Receive 4.5 days of extensive coverage of core concepts in critical care, including cardiology, endocrinology, gastrointestinal disorders, infectious diseases, monitoring, neurology, nutrition, respiratory care, sepsis, and more. Each comprehensive session is presented by world-class faculty.

Accurate Skills Assessment
Daily interactive board preparation sessions will consist of practice board questions, answers and rationales. Monitor your progress through audience response system technology and receive accurate feedback regarding areas that may need further refinement.

Valuable Study Resources
As a registered participant, you will receive the course syllabus, online access to practice questions, post-course online access to MCCBRC On Demand videos and downloadable MP3 files of all the lectures, and networking opportunities with colleagues and world-renowned experts in critical care.

The 2014 Adult and Pediatric MCCBRC will be held August 12 to 16, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online for the Adult or Pediatric MCCBRC using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

Help Change the Face of Patient Care

Liberate your patients from the harmful effects of pain, agitation and delirium in the ICU and improve their long-term outcomes. Among the resources available at www.ICULiberation.org is a newly added presentation from the 43rd Critical Care Congress from Alison S. Clay, MD, who shares her experience and recovery as an intensive care unit patient.

In addition, the site offers the Pain, Agitation and Delirium Guidelines and numerous tools related to the assessment, treatment and prevention of these conditions.

Self-Directed Ultrasound Now Available

The Society of Critical Care Medicine’s (SCCM) new Self-Directed Critical Care Ultrasound training courses allow you to learn at your own pace from the comfort and convenience of your home or office. Choose from the following:

Self-Directed Critical Care Ultrasound

Self-Directed Critical Care Ultrasound provides a relaxed learning experience with access to the same didactic sessions from the live version of the Critical Care Ultrasound course. This course includes 4 modules with synchronized speaker audio and pre- and post-tests are utilized to assess your knowledge. 8.5 hours of CE is available for nurses and physicians.

Self-Directed Critical Care Ultrasound with Simulation

Benefit from all of the features provided with the Self-Directed Critical Care Ultrasound course, plus enhance your learning experience with a hand-held simulation sensor that transforms your personal computer into your own ultrasound training solution and includes links to specific case-based simulations that allow you to practice the techniques presented in the didactic lectures. The cases cover a broad spectrum of normal and pathologic cases.

For more product details or to make a purchase, visit the SCCM Online Store.

Pre-Congress Educational Sessions Now Available On Demand

Now you can experience the stimulating pre-Congress educational sessions from the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress as if you were there.

The following On Demand courses are available for purchase:

The On Demand versions of the pre-Congress educational sessions give you access to videos containing both slides and lectures in a searchable format, making it the next best thing to attending the live event. Once you’ve purchased an On Demand course, you can access the material as often as you like by logging into MySCCM.org.

If you were a registrant for a pre-Congress educational session, your Congress On Demand subscription now includes complimentary access to that session. Your subscription to this service can be accessed by logging into MySCCM.org with your Customer ID and password.

Is Tight Glucose Control Beneficial for Critically Ill Children?

The detrimental effects of hyperglycemia in critically ill patients has been well described in the literature. However, the benfefits of maintaining normoglycemia using insulin infusions has been controversial. In 2009, The New England Journal of Medicine published a study by the NICE-SUGAR Study Investigators that appeared to answer the question about risks and benefits of intensive insulin therapy. Studying more than 6,000 subjects, the authors showed an increase in mortality in critically ill adults who underwent intensive glucose control, compared to those who underwent conventional control of their blood sugars. Interestingly, in the same year, a pediatric study was published in Lancet by Vlasselaers et al that demonstrated a decrease in mortality and length of pediatric intensive care unit (PICU) stay in those patients who had intensive glucose control, compared to the conventional therapy. Though it should be noted that while this study randomized 700 children, it was a single-center trial whose subjects were primarily children who had undergone cardiac surgery (around 75%).

In this study by Macrae et al, the authors randomized more than 1,300 critically ill children from 13 centers to undergo either tight glucose control (maintaining blood glucose levels between 72-126 mg/dl) or conventional therapy (infusing insulin only in patients whose blood glucose levels were over 216 mg/dl until they dropped to 180 mg/dl). The authors recruited children between the ages of 36 weeks of corrected gestational age and 16 years of age. Like the the Vlasselaers study, a predominance of subjects underwent cardiac surgery compared to other reasons for PICU admission (around 60% and 40%, respectivley). The aims of this study were to assess whether tight glycemic control could reduce morbidity and mortality rates and associated costs for critically ill children compared to conventional therapy.

Read more…

Registration is Now Open for the 2014 Board Review Courses

The Society of Critical Care Medicine’s (SCCM) 2014 Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC) are the preferred resource for critical care professionals seeking a comprehensive review of content focused on the diagnosis, monitoring and management of critically ill patients.

These four-and-a-half-day intensive courses include interactive board preparation sessions using audience response technology and feature practice board questions, answers and rationales. World-class faculty will focus on preparing fellows and attendings for their critical care certification and recertification.

Participants benefit by fulfilling continuing education  requirements and gaining accurate assessments of their knowledge in critical care. The course also provides an excellent update for any critical care professional seeking the most current review of the field.

The 2014 Adult and Pediatric MCCBRC will be held August 12 to 16, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Visit the Adult and Pediatric MCCBRC webpages for more information and to register.

Join the Creative Community

Joining the Society of Critical Care Medicine’s Creative Community is one of the most important contributions a member can make in helping the Society achieve its mission and vision. If you are interested in joining the Creative Community, the online committee application must be completed by logging into MySCCM.org. Applications are due May 1, 2014. Appointments are made each September for the following year.

Please note that reappointment to a committee is not automatic. If you are already a committee or task force member and your term is about to expire, you will need to reapply.

Members of the Creative Community not only play an active role in Society activities and initiatives, they also gain leadership skills and networking opportunities.

Visit the Creative Community Resource Center for more information.

AHA Survey Seeks Critical Care Input

The American Heart Association (AHA) is preparing to revise its 2010 guidelines for cardiopulmonary resuscitation  and emergency cardiovascular care. The AHA’s Emergency Cardiovascular Care Committee has identified members of the critical care community as key stakeholders in this process. Please participate in this brief survey to provide feedback that may be used to craft the 2015 guidelines.

SCCM Offers Influenza Resources

Intensive care units (ICUs) have already seen an influx of patients with the influenza virus this year, including influenza A (H1N1) pdm09 (pH1N1). That activity is expected to increase substantially in the coming weeks and months. Prevention with influenza vaccination is strongly recommended; all persons aged 6 months and older, including healthcare personnel, should be vaccinated now.

The Society of Critical Care Medicine has gathered influenza resources to keep ICU professionals informed.

Staying up to date on the latest developments this influenza season is vital as ICU professionals strive to provide the Right Care, Right Now.™

43rd Critical Care Congress On Demand is Now Available

sq-CongressNow you can experience the stimulating educational content from the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress as if you were there.

Congress On Demand gives you access to videos containing both slides and lectures from every session in a searchable format, making it the next best thing to attending the live event. Once you’ve purchased Congress On Demand, you can access the materials as often as you like by logging into www.MySCCM.org.

Bring the Congress educational experience to your home or office. Congress On Demand is available for purchase in the SCCM online store. The registration rate for SCCM members is just $295 ($385 for nonmembers).

If you attended this year’s Congress, your subscription to this service was included in your registration fee. The materials can be accessed by logging into www.MySCCM.org with your Customer ID and password.

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