Is there evidence-based research to support using ice packs for postoperative pain management?

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Adie S, Kwan A, Naylor JM, Harris IA, Mittal R.  Cyrotherapy following total knee rcplacement.  Cochrane Database Syst Rev. 2012 Sep 12;9:CD007911
Bottom Line:  In regard to postoperative pain following total knee replacement,this Cochrane Systematic Review  had 11 randomized controlled trials  and one controlled trial with  a  total of 809 participants which met its inclusive criteria.  The author found that potential benefits of cryotherapy  on blood loss, postoperative pain and range of motion was too small to justify its use and the quality of evidence was low or very low for all main outcomes. Additionally another Cochrane Systemic Review,  Bala, MM, Riemsma, RP, Woff, R,  Kleijnen  J.  Cryotherapy for liver metastases. Cochrane Database for Syst. Rev. 2013 June 5;6 , stated there is  insufficient evidence that cyotherapy benefited patients with liver metastases from various primary sites in terms of survival or recurrence compared with conventional surgery.

The databases searched were PubMed, CINAHL and Joanna Briggs.   My search stratedy was the following: (ice packs OR cyrotherapy)  AND postoperative pain limited from 2000-present and human and English language.

Eight randomized controlled trials  results saw benefits from cold therapy relieving postoperative pain from different parts of the body.    Lastly another randomized controlled trial, Modabber A, Rana M, Ghassemi A,  Gerressen M,  Gellrich NC, Holzle  F, Rana M.  Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods:  a randomized observer-blind prospective study.  Trials. 2013 Jul 29;14:238,  found that hilotherapy was a more efficient cooling method than conventional cooling in relieving postoperative pain and swelling.



Reviewed by John Nemeth 4/14

							

		
		
	


				
					
	

		

						
For patients on ventilator receiving neuromuscular blockade, how frequently should patient’s response to dose be monitored with peripheral nerve stimulation?

			
						

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Bottom line: No published evidence compares monitoring frequency (eg, q4, q8, etc.) to determine what is safest and most effective for monitoring dosage of neuromuscular blocking agents.  Professional recommendations advocate every 2-12 hours.


Summary:  ASA.  Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration.  Anesthesiology.  2009; 110(2): 218-230.

Page 221 begins review of recommendations and evidence for effectiveness of methods for detecting respiratory depression, and on p. 222, recommendation by expert consensus for monitoring after single injection and continuous infusion depend on class of drugs (neuraxial lipophilic opioids v. neuraxial hydrophilic opioids), clinical condition of patient and concurrent medications.


AACN Procedure Manual for Critical Care, 6th ed. [In print at EUH]



Recommends train of four (TOF) testing every 4-8 hours during infusion after patient is stable and after optimal dose for neuromuscular blockade is achieved (p. 310.)  References guidelines (see below.)


Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient.  Crit Care Med.  2002;30:142-156.

In the monitoring section, the guidelines recommend monitoring but do not provide specifics.  They do however, cite a study (Kleinpell) that surveys ICUs about their practices, as well as one prospective study (Strange) that compares TOF to clinical assessment and one retrospective study (Frankel) about implementing standards for monitoring in a surgical unit.


(“Monitoring, Physiologic”[MAJR]) AND “Neuromuscular Blockade”[MAJR] AND (train-of-four OR electric stimulation) AND (prospective study OR observational study OR cohort study OR comparison study)

Here is a PubMed search for comparison and cohort studies evaluating train-of-four.  Some are evaluating specific devices or stimulation methods.  Baumann (2004) and Strange (1997) address the use of the TOF itself.


There is also an RCT by Rudis (1997) that compares clinical assessment to TOF for reduction in dose of neuromuscular nondepolarizing agent to maintain paralysis .


Reviewed by John Nemeth 4/14

					

		
		
	


				
					
	

		

						
Is there evidence on fall prevention audit tools and how to get nurses engaged in preventing falls?

			
						

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Articles are arranged by topic.


Engagement of nurses in fall prevention efforts; these articles cover a variety of techniques


Colon Emeric, Cathleen S, et al. “CONNECT for Better Fall Prevention in Nursing Homes: Results from a Pilot Intervention Study.” Journal of the American Geriatrics Society 61.12 (2013):2150-2159.


Lea, Emma, et al. “Beyond the ‘tick and flick’: facilitating best practice falls prevention through an action research approach.” Journal of clinical nursing 21.13-14 (2012):1896-1905.


Barker, Anna, et al. “The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.” Injury prevention 17.4 (2011):e5-e5.


Bonuel, Nena, et al. “Best practice fall prevention strategies. CATCH!” Critical care nursing quarterly 34.2 (2011):154-158.


Healey, Frances. “A guide on how to prevent falls injury in hospitals.” Nursing older people 22.9 (2010):16-22.


Koh, S L, et al. “Impact of a fall prevention programme in acute hospital settings in Singapore.” Singapore medical journal 50.4 (2009):425-432.


Koh, Serena S L, et al. “Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.” BMC health services research 8(2008):105-105.


Ireland, Sandra, et al. “The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study.” Worldviews on evidence-based nursing 10.2 (2013):95-103.


Saint, Sanjay, et al. “Introducing the patient safety professional: why, what, who, how, and where?” Journal of patient safety 7.4 (2011):175-180.


Tzeng, Huey-Ming. “Nurses’ caring attitude: fall prevention program implementation as an example of its importance.” Nursing forum 46.3 (2011):137-145.


Unruh, Lynn, ManishaAgrawal, and SusanHassmiller. “The business case for transforming care at the bedside among the “TCAB 10” and lessons learned.” Nursing administration quarterly 35.2 (2011):97-109.


Stetler, C B, et al. “Integration of evidence into practice and the change process: fall prevention program as a model.” Outcomes management for nursing practice 3.3 (1999):102-111.


Dean, Erin. “Reducing falls among older people in hospital.” Nursing older people 24.5 (2012):16-16, 19.


Rask, Kimberly, et al. “Implementation and evaluation of a nursing home fall management program.” Journal of the American Geriatrics Society 55.3 (2007):342-349.


Audit


Audit criteria


Chapman, Joanne, Deborah Bach, and Kristiina HyrkÃs. “Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting.” Journal of nursing management 19.1 (2011):133-142.


Poe, Stephanie S, et al. “The Johns Hopkins Fall Risk Assessment Tool: postimplementation evaluation.” Journal of nursing care quality 22.4 (2007):293-298.


Perell, K L, et al. “Fall risk assessment measures: an analytic review.” The journals of gerontology. Series A, Biological sciences and medical sciences 56.12 (2001):M761-M766.


Oliver, D, et al. “Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.” BMJ. British medical journal 315.7115 (1997):1049-1053.


Taylor, Jo A, et al. “A model quality improvement program for the management of falls in nursing homes.” Journal of the American Medical Directors Association 8.3 Suppl (2007):S26-S36.


Milisen, Koen, AnneliesGeeraerts, and EddyDejaeger. “Use of a fall prevention practice guideline for community-dwelling older persons at risk for falling: a feasibility study.” Gerontology 55.2 (2009):169-178.


Wong Shee, Annkarin, BevPhillips, and KeithHill. “Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care.” Archives of gerontology and geriatrics 55.3 (2012):653-659.


Koh, Serena Siew Lin, et al. “Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit.” Journal of evaluation in clinical practice 13.5 (2007):722-727.


Reviewed by John Nemeth 4/14

					

		
		
	


				
					
	

		

						
What are some ways to increase compliance of VTE Prophylaxis as well as barriers?

			
						

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Biffl WL et al. ““Leaning” the process of venous thromboembolism prophylaxis.” The joint commission journal on quality and patient safety 37.3 (2011):99.


Tiryaki, Funda ; Nutescu, Edith A. ; Hennenfent, Joel A. ; Karageanes, Annette M. ; Koesterer, Larry J. ; Lambert, Bruce L. ; Schumock, Glen T.Anticoagulation therapy for hospitalized patients: Patterns of use, compliance with national guidelines, and performance on quality measures. American Journal of Health-System Pharmacy, 2011 Jul 1; 68 (13): 1239-44.


Wang Z et al.”Compliance with surgical care improvement project measures and hospital-associated infections following hip arthroplasty.” Journal of Bone and Joint Surgery; American volume 94.15 (2012):1359.


Brown, Alexandra Preventing venous thromboembolism in hospitalized patients with cancer: Improving compliance with clinical practice guidelines.

American Journal of Health-System Pharmacy, 2012 Mar 15; 69 (6): 469-81.


Li F ; Walker K ; McInnes E ; Duff J Testing the effect of a targeted intervention on nurses’ compliance with “best practice” mechanical venous thromboembolism prevention. Journal of Vascular Nursing, 2010 Sep; 28 (3): 92-6.


Gaston, Sherryl ; White, Sarah louise Venous thromboembolism ( VTE) risk assessment: Rural nurses’ knowledge and use in a rural acute care hospital. International Journal of Nursing Practice, 2013 Feb; 19 (1): 60-4.


Gaston, Sherryl, White, Sarahlouise, Misan, Gary. Venous Thromboembolism (VTE) Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the Acute Care Setting. The JBI Library of Systematic Reviews. 10(57):3812-3893, 2012.


Databases: CINAHL and Joanna Briggs. Keywords: VTE, Venous Thromboembolism, compliance, barriers


Reviewed by John Nemeth 4/14

					

		
		
	


				
					
	

		

						
Guidelines for Continuous Pulse Oximetry

			
						

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Jeffrey J. Pretto, Teanau Roebuck, Lutz Beckert and Garun Hamilton. Clinical use of pulse oximetry: Official guidelines from the Thoracic Society of Australia and New Zealand. Respirology. 2014 Jan;19(1):38-46. doi: 10.1111/resp.12204. Epub 2013 Nov 20.


Pulse Oximetry. [Recommended Practices], 2016.


Dao Le, Long Khanh,. Pulse Oximetry: Clinician Information. {Evidence Summaries]. 2016.


Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration: An updated report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2016 Mar;124(3):535-52. doi: 10.1097/ALN.0000000000000975.


Pedersen T1, Nicholson A, Hovhannisyan K, Møller AM, Smith AF, Lewis SR. Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev. 2014 Mar 17;(3):CD002013. doi: 10.1002/14651858.CD002013.pub3. PubMed PMID: 24638894 .


I searched PubMed, CINAHL AND Joanna Briggs.   Keywords:  Continuous Pulse Oximetry Guidelines.


Updated Joanna Briggs and Cochrane links, 10/16/2017 ldt

							

		
		
	


				
					
	

		

						
Use of betadine on postoperative surgical sites

			
						

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“Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Philadelphia, Pa. 1976) 30.15 (2005):1689.


Lid scrub may reduce endophthalmitis rate when used with topical Betadine… including commentary by Trattler WB. Ocular Surgery News 2009 vol:27 iss:19 pg:16


Swenson BR ; Hedrick TL ; Metzger R ; Bonatti H ; Pruett TL ; Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infection Control & Hospital Epidemiology, 2009 Oct; 30 (10): 964-71.


Giordano, Salvatore, et al. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthetic surgery journal 33.5 (2013):675-680.


Haas, David Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database of Systematic Reviews. 2014 Dec 21;(12):CD007892. doi: 10.1002/14651858.CD007892.pub5.


Spinal Surgery: Prevention and Management of Infection. [Recommended Practices] 2013


Searched CINAHL, PubMed & Joanna Briggs. Keywords: Betadine or Povidone-iodine, postoperative


Reviewed by John Nemeth 4/14


Updated links for last two items, 10/16/2017 ldt

					

		
		
	


				
					
	

		

						
What is the effectiveness of sitters for preventing patient falls?

			
						

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Adams, Jewel, and RobertaKaplow. “A sitter-reduction program in an acute health care system.” Nursing economic$ 31.2 (2013):83-89.


Spiva, LeeAnna, et al. “An evaluation of a sitter reduction program intervention.” Journal of nursing care quality 27.4 (2012):341-345.


Tzeng, Huey-Ming, Chang-YiYin, and JulieGrunawalt. “Effective assessment of use of sitters by nurses in inpatient care settings.” Journal of advanced nursing 64.2 (2008):176-183.


Harding, Andrew D. “Observation assistants: sitter effectiveness and industry measures.” Nursing economic$ 28.5 (2010):330-336.


“Falls/ambulation: Reducing sitter use: Decision outcomes.” Nursing Management 42.12 (2011):37.


Searched CINAHL and PubMed. Keywords: sitter and (fall or falls)


Reviewed by John Nemeth 4/14