NURSING CHALLENGES IN CRRT Sue Taylor Nursing CRRT
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NURSING CHALLENGES IN CRRT Sue Taylor Nursing CRRT Lead
Background CRRT history Ø Total PICU admissions at KCH was 1273 over last 2 years. Ø Children’s Critical Care performed CVVH in 71 patients in the last 2 years ( 476 episodes) Ø Total CVVH bed days = 1643 Ø Of these, 173 episodes were for Acute Liver Failure
Nursing expectations Ø Following the decision to perform CRRT bedside nurses are responsible for the setting up and priming of the CVVH machines Ø Ensuring the prescriptions are available and correct Ø Preparing and commencing of treatment Ø Performing bedside ACT and initiating intervention if required Ø Calculation of patients daily fluid requirements and adjustments. Ø Discontinuing treatment when indicated by physician
Training at King’s “How training on CRRT has evolved over the last few years at King’s” Ø 2012 -2013 - Didactic and interactive teaching sessions ½ day for all grades of staff Ø 2013 -2014 - Didactic and ½ Simulation training day for all grades of staff Ø 2014 -2015 – Simulation lead training day including extensive trouble shooting using previous Adverse incidents reported ØDocumentation of individuals skills in CRRT using competency framework records
Nursing ratios for CRRT PICS standards state; Ø Ventilated patients receiving CVVH = 1. 5/1 Ø Non ventilated patients receiving CVVH = 1/1(cubicle) 0. 5/1 In reality; Ø Increased bed usage and staff shortages due to sickness/ maternity and vacancy are less flexible and therefore patients receiving CVVH do not always get the correct nursing ratio they deserve.
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