Inventory management.

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices.

Caring for the chronically critically ill patient: establishing a wound- healing program in a respiratory care unit.

Chronically critically ill patients may recover from their acute catastrophic illness but still require intensive nursing care. In the Respiratory Care Unit (RCU) at Mount Sinai Hospital, nurse practitioners, working with nurses and physicians, act as coordinators of care for these patients. This interdisciplinary collaboration is the basis of the RCU wound healing program and has brought about desirable patient outcomes.

Healing of elderly patients with diabetic foot ulcers, venous stasis ulcers, and pressure ulcers.

Although elderly patients have physiologic impairments in wound healing, their wounds should be expected to heal with the same frequency of closure as those in younger populations, albeit at a slower rate. However, compared to the general population, the elderly population has a higher incidence of chronic wounds: diabetic foot ulcers, pressure ulcers, and venous stasis ulcers. Experimental and clinical data indicate physiologically impaired healing is characterized by decreased angiogenesis and synthesis of critical growth factors.

Nursing the chronically critically ill patient.

The provision of care to the CCI patient is complex, challenging, and unique. The advanced practice nursing model at Mount Sinai Hospital is one successful care delivery model that fills the needs of both CCI patients and the nurses who work with them. The following transferable aspects of the RCU add to the unit's successful outcomes: (1) an interdisciplinary approach assures that all aspects of care are included in the clinical plan; (2) clinical care pathways, algorithms, and standard protocols based on physician, NP, and clinical nurse collaboration are successful management strategies; (3) formal discharge planning meetings with participation of patients, families, NPs, and social workers provide a forum for discharge planning and an avenue to address ethical issues such as advance directives, resuscitation status, and patient self-determination decisions; (4) full participation by nurses in all aspects of the unit's activities is a cost-effective strategy for maximizing positive outcomes for patients and their families.