CRRT @ Cardon Children’s PICU – Low Volume/High Risk Skill – Previous experience – Patients...
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Transcript of CRRT @ Cardon Children’s PICU – Low Volume/High Risk Skill – Previous experience – Patients...
Instilling Confidence and Competence: CRRT Training and Troubleshooting in the
Simulation Lab
Vickie Hawkins
Background
• CRRT @ Cardon Children’s PICU– Low Volume/High Risk Skill– Previous experience– Patients transferred to other facilities– No continuity of patient care– Decreased RN confidence– Decreased MD confidence
• The education “fix” at the time– Training from company educators– Tech support from company– Practice– Support from adult ICU
0
5
10
15
20
25
NE RMH RM BT AT
Prisma
Prisma Flex
NxStage
Baxter
Legend:NE: no experienceRMH: run machine with helpRM: run machine without helpET: Basic trainingAT: Advanced training
The Road from Then to Now
• Goals– Core group of PICU staff– Set-up and Troubleshoot
• 30 minute set up time• Access• Clotted Filter• Initiation and Disconnect• Improve confidence levels
– Assist with future education & training
• Resources– Evidence-based education lacking for CRRT– Simulation shown to assist learners transition skills into practice
Simulation
• Logistics– Cost
• Schedules• Equipment
– Develop curriculum• Weighted Checklists• Eight hour didactic session• Three 4-hour based simulations• Mandatory monthly 4-hour simulation session
– Simulation• Use of saline in simulation not satisfactory to replicate
troubleshooting• Develop tubing to accommodate blood• Create scenarios
Outcomes
• Remediation decreased as the skill level of the nurse increased
Goal: less than 30 minutes
Time to Set Up
Confidence Levels Increased
Nursing self-confidence increased significantly
Physician confidence increased significantly
Process replicated 6 months later
2010 20110%
20%
40%
60%
80%
100%
16%
53%41%
98%97% 100%
Initiation & Discontinu-ation
Initial Attempt Comple-tion Score
FirstSecondThird
2010 20110%
20%
40%
60%
80%
100%
27%
70%
48%
78%
AccessInitial Attempt Completion
Score
FirstSecond
2010 20110%
20%
40%
60%
80%
100%
13%
62%63%78%
Clotted FilterInitial Attempt Completion Score
FirstSecond