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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
25
Prism a
Prism a Flex
20
NxStage
15
Baxter
10
5
0
NE
RMH
RM
BT
AT
Legend:
NE: no experience
RMH: run machine with help
RM: run machine without help
ET: Basic training
AT: 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
Time to Set Up
Goal: less than 30 minutes
Confidence Levels Increased
Nursing self-confidence
increased significantly
Physician confidence
increased significantly
Process replicated 6 months later
Initiation & Discontinuation
Initial Attempt Completion
Score
97%
100%
98%
Access
Initial Attempt Completion Score
100%
100%
80%
60%
40%
20%
78%
80%
53%
41%
16%
First
60%
Second
40%
Third
20%
0%
70%
48%
First
27%
Second
0%
2010
2011
2010
2011
Clotted Filter
Initial Attempt Completion Score
100%
80%
60%
40%
20%
0%
63%
62%
78%
First
13%
2010
Second
2011
Thank you
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