ABSTRACTS from 16th International COnference on ... - CRRT Online

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<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT, SAN DIEGO, FEB 14-17, 2012 NURSING ISSUES 80. CRRT Super Users To The Rescue Linda Ford, Tanya Bazelais, Terri Delese Memorial Sloan Kettering Cancer Center, New York Purpose: To increase the comfort level of nurses caring for patients receiving CRRT in the Intensive Care Unit. Nurses working at a national comprehensive cancer center were noticeably stressed and anxious when assigned to care for patients receiving CRRT. Nurses who did not have an opportunity to work on a regular basis with patients receiving CRRT were faced with a daunting task. They felt too much nursing time was devoted to caring for "the machine" which added the burden of managing multiple liters of fluid volumes each hour monitoring an extracorporeal circuit in addition to caring for a critically ill patient. They were frustrated that "the machine" was always alarming and were uncomfortable trying to troubleshoot. Methods: Volunteers were chosen to serve as leaders (Superusers) for the project 3 nurses were chosen <strong>from</strong> the day shift and 3 nurses <strong>from</strong> the night shift. There was a balance of both novice and experienced ICU nurses. The identified Superusers worked on the project with the CRRT machine for 2 months. With the dialysis nurse as part of the workgroup effort, they revised policies and created teaching materials that included a CRRT power point and reference flowchart. The group posted colorful visual aids in the unit including troubleshooting tips for CRRT and obtained other educational assistance <strong>from</strong> the CRRT provider. A CRRT binder was developed which hosted Evidence Based practice articles related to CRRT for reference as needed. Competency forms were developed for new nurses in addition to an ongoing competency assessment form. Results/Conclusion: The Superusers became proficient and knowledgeable with CRRT and shared their expertise with other ICU nurses. The training sessions were well received by all nurses in the Intensive Care Unit. The dialysis nurse and CRRT Superusers are readily available to assist with the set-up and troubleshooting of "the machine" as needed. There is a noticeable difference with the reduction in anxiety and discomfort of the ICU nurses assigned to patients receiving CRRT. Nurses are not as reluctant to care for these patients. Some nurses have frequently requested an assignment with a patient receiving CRRT as they become more comfortable and proficient. Since the start of Superusers there is a decrease with the complaint of problems with "the machine" and as a result it has a more welcome presence in the ICU for nurses caring for patients with acute renal failure who are receiving CRRT. 81. Electronic CRRT Flowsheet: Decreasing Errors and Increasing Nurse Recruitment Troy Gideon, Mary Wickman, Marysol Cacciata St. Jude Medical Center Purpose: The Critical Care nurse manages all aspects of renal therapy and nursing care in providing Continuous Renal Replacement Therapy (CRRT) in the Critical Care Unit (CCU). A flowsheet is the tool used to document and guide the management of these complex patients and can be in paper or 185
<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT, SAN DIEGO, FEB 14-17, 2012 electronic format. Flowsheets are typically designed to keep a historical depiction of care but can also be structured to keep track of fluid volume calculations. The purpose of this project was to design and test an electronic flowsheet to improve patient care by making calculations more accurate while ensuring patient safety through consistent documentation. Methods: CRRT patient volumes have to be calculated multiple times to achieve the ordered fluid removal. The number of calculations can vary <strong>from</strong> 1 to 16 over a 24 hour time period. These calculations in and of themselves are fairly basic, but when you combine the multitude of calculations needed, the occurrence of utilizing negative numbers, and the high acuity level of care needed for these patients, the risk for error increases significantly. Chart reviews showed that 92% of audited records had at least one calculation error and 17% of these errors resulted in a patient volume variation error greater than 5 mL’s in a 12 hour period. Surveys also showed that for non CRRT certified CCU nurses; the worry of making a calculation error was a primary reason for not wanting to get certified. In response to these issues, we created an electronic flowsheet that performed the calculations. At a later date when our computerized documentation system could accommodate the calculations, we incorporated the program into the system to prevent multiple forms of documentation. Summary of Results- By creating this tool, the calculation error rate decreased to 3%, and errors resulting in a patient volume variation of greater than 5 mL’s in a 12 hour period decreased to less than 1%. Our number of certified CRRT nurses increased by 15% since tool implementation and when surveyed, 7% of the nurses stated that the new tool positively affected their decision to become certified. Conclusion: CRRT flowsheets are more complex than normal patient care flowsheets because of their need to function as a worksheet, this complexity results in increased work for the nurse and high incidence for error. Significantly, this tool not only increased calculation accuracy but also was a positive recruitment tool for CRRT nurses. 82. How is it Possible to Mobilize Patients Treated with CRRT Anna Kraegpoeth, Elisabeth Kastbjerg, Gitte Aalling, Jens Madsen, Susanne Joergensen Dept. of Anaesthesiology and Intensive Care Odense University Hospital Denmark Introduction: It is a multidisciplinary unit with 22 beds. 8 beds for CRRT. Standard treatment is CVVH pre– and post-dilution: 35 ml/kg. Intensive care nurses provide all tasks in connection to CRRT. In 21 95 patients were treated with CRRT. The unit has a no sedation strategy and a nurse patient ratio 1:1. Purpose: Creating awareness of the possibility that critical ill patients can be mobilized <strong>from</strong> bed to chair. CRRT 186
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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SPECIAL LECTURE Engineering Critica
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Nishimura R, Ornato JP, Page RL, Ri
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Do Vasoactive Drugs and Fluids Impr
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Blood Transfusions are Important fo
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Thinking Outside of the Box: A Nove
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Nursing Forum 2 Luncheon Benchmarki
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4. Mori K, Lee HT, Rapoport D, Drex
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Differential Diagnosis of AKI: Can
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Myocardial Stunning and Brain Edema
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4. Udy A, Roberts JA, Lipman J. Wha
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CRRT and ECMO: Techniques and Outco
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Management of Severe Heart Failure:
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Avoiding Anticoagulation for CRRT:
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Improving Outcomes from</st
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The Changing Face of AKI: Snapshots
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Alkaline Phosphatase Peter Pickkers
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creatinine (Cr) was measured using
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Surveillance and Early Recognition
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therapy admitted to general intensi
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A01 Assessing the Microcirculation
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A01 Assessing the Microcirculation
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C03 Critical Care Pharmacology: Vas
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D04 Biomarkers 1: Principles and Ap
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6. Ferguson JW, Dover AR, Chia S, C
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G07 Fluids and Solutions in the Cri
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A09 Vascular Access /Membrane and C
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A09 Vascular Access /Membrane and C
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C11 Critical Care Management: Nutri
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D12 Biomarkers 2: Application in AK
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Educational Objectives: E13 Liver a
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G15 Fluids and Solutions in the Cri
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Educational Objectives: 1) Discuss
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B18 Fluid Management Ravindra L. Me
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C19 Acid Base and Electrolyte Probl
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D20 Extracorporeal Techniques for S
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the mediatordelivery hypothesis. In
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F22 Ensuring Patient Safety and Qua
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H24 Patient Centered Care in the IC
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B26 Starting and Stopping RRT for A
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C27 Acid Base and Electrolyte Probl
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D28 Extracorporeal Techniques for S
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E29 Heart Failure and Cardio-Renal
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F30 Ensuring Patient Safety and Qua
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H32 Withdrawing & Withholding Suppo
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Patel SS, Holley JL. Withholding an
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