Instilling Confidence and Competence CRRT Training and Troubleshooting

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 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% 80% 60% 40% 20% 78% 70% 80% 53% 41% 16% First 60% Second 40% Third 20% 0% 48% First 27% Second 0% 2010 2011 Clotted Filter Initial Attempt Completion Score 100% 80% 60% 40% 20% 0% 63% 78% 62% First 13% 2010 Second 2011

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