Crrt program -department final dr.osma elshahat
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This document outlines the steps for creating a continuous renal replacement therapy (CRRT) program in an intensive care unit (ICU). It discusses identifying the need for the program and assessing available resources. Key steps include identifying stakeholders, developing standardized protocols and orders, training dialysis and ICU nurses, and implementing the program starting with a stable patient. Ongoing support and education are emphasized to ensure successful adoption of CRRT in the ICU.
Crrt program -department final dr.osma elshahat
- 1. How to create CRRT program Dr. Osama El-Shahat Consultant Nephrologist Head of Nephrology Department New Mansoura General Hospital (international) ISN Educational Ambassador
- 2. DO we need protocol to cerate CRRT program in ICU? • Identifying a need for this program
- 3. Factors affecting potential utilization of a CRRT program Hospital factors Size and type of hospital Nature of Services provided (e.g. Trauma, Transplantation, Cardiac Surgery) # ICU Beds Availability of resources Commitment of hospital administration ICU staffing support Dialysis services Dedicated budget to purchase equipment ICU Staff training support Patient Factors # Patients with AKI in ICU # Patients dialyzed in ICU Type of patients e.g. liver transplant
- 4. Before you think of Initiating a CRRT in ICU program, think of,
- 5. Step 1 Unfreezing the need for change is identified, planned for, and individuals are made aware of impending change. Step 3 Refreezing new changes are stabilized and integrated into the existing operating system Step 2 Moving the planned change is implemented Steps of process To Change
- 6. Possible driving and restraining forces in implementing a CRRT program Driving Forces Staff member’s past positive experiences/patient outcomes with CRRT Key staff member with CRRT experience who can be resources and “champion” the procedure Physician/Administrative support of the program Potential improvement in patient outcomes Knowledgeable critical care nephrology nurses to assist with implementation Restraining forces Staff member’s past negative experiences/patient outcomes with CRRT Control issues between critical care and nephrology personnel ICU nurses resistance to taking responsibility for an additional machine at the bedside in a busy, stressful environment Staffing availability
- 8. Identify key players Decide on technique to be used Develop protocols for CRRT technique Standardize orders and flow sheets Train core group of dialysis nurses Develop nursing manuals and list of responsibilities Involve key personnel from major ICU’s in discussions Purchase equipment and disposables Implementing a CRRT program: Preparation
- 9. HD Nurse ICU Nurse Procedure Set up + - Initiation + + + In service ICU + - Hourly Monitoring - + Access Care + + + Trouble Shooting + + + Filter Change + - Emergency Filter Discontinuation + + + Preparation for Transfer to OR + + + + Monitoring in OR + + + Clearance + + - Blood Drawn + + + Anticoagulation Monitoring + + + Delineation of nursing responsibilities for CRRT
- 10. Nursing responsibilities in CRRT Nephrology Nurse 1. Review the physician’s order 2. Prime the hemofilter and circuit 3. Initiate and monitor the first hour of therapy 4. Daily assessment of the system and the patient’s response to therapy 5. Changing the circuit 6. Available 24 hours a day for consultation, troubleshooting and system initiation 7. Provide education regarding CRRT to the patient, family and health care poviders
- 11. Nursing responsibilities in CRRT Critical Care Nurse 1. Verify the Consent for Treatment is signed 2. Obtain baseline laboratory specimens, patient weight and hemodynamic parameters 3. Obtain and set up additional infusion pumps and equipment 4. Assist with vascular access placement 5. Continuous assessment of the patient’s hemodynamic status 6. Routine maintenance of the vascular access and CRRT system 7. Achieve the patient’s hourly net fluid balance Perform hourly intake/output calculations Adjust UF pump rate Administer replacement fluid 8. Obtain laboratory specimens and report abnormal results 9. Monitoring and titration of anticoagulation 10. Report technical or clinical problems to the nephrology nurse, nephrologist or clinical nurse specialist (CNS) 11. Discontinue the CRRT system 12. Provide education and support regarding CRRT to the patient and family
- 12. Nursing responsibilities in CRRT Nurse Educator 1. Participate in the CRRT Implementation Process Assist in writing or obtaining policies, procedures, resource and education material Assist in formal and informal education 2. Act as staff resource for CRRT 3. Maintain resource manuals and education materials 4. Assist in providing ongoing education 5. Participate in the CRRT Quality Improvement process
- 14. Implementing a CRRT program: Information dissemination Initial introduction Plan in service education of key ICU nurses Utilize support of ICU physicians and nursing supervisors Educate physician care givers Provide information on dialysis and ICU responsibilities Emphasize full support of dialysis personnel for set up training and troubleshooting Develop a plan for initiation Formal instruction Lectures Hands on training Skills assessment Patient care experience
- 16. Carefully select a relatively stable patient for first CRRT Dialysis nurse should set up and stay as long as necessary to ensure understanding and comfort for ICU staff and safety of patient Demonstrate support from nephrology consultants/other staffs Provide back up for troubleshooting and monitoring Involve ICU staff in feedback and refine protocols as needed Implementing a CRRT program: Initiation
- 18. Build on initial experience to continue CRRT Maintain support level and continue periodic in services Train more dialysis nurses/ICU nurses on procedure Continue to involve ICU personnel in protocol modifications Provide positive reinforcement to ICU and dialysis staff Implementing a CRRT program: Follow up
- 20. Common problems resulting in a negative experience with CRRT Technical Poor access Inadequate anticoagulation Improper monitoring Lack of standardized technique Administrative Lack of knowledge Inadequate preparation and training of ICU and dialysis staff Lack of support from ICU physicians Goals not well defined
- 22. Motivation and involvement of Nephrologist Educated dialysis staff Standardized protocols and orders Support from and for ICU personnel Periodic in servicing for dialysis and ICU personnel Requirements for a successful CRRT program
- 23. CRRT Workshop ( Hands on )