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

0

5

10

15

20

25

NE RMH RM BT AT

PrismaPrisma FlexNxStageBaxter

Legend:NE: no experienceRMH: run machine with helpRM: run machine without helpET: Basic trainingAT: 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

Goal: less than 30 minutes

Time to Set Up

Confidence Levels Increased

Nursing self-confidence increased significantly

Physician confidence increased significantly

Process replicated 6 months later

2010 20110%

20%40%60%80%

100%

16%

53%41%

98%97% 100%

Initiation & Discontinu-ation

Initial Attempt Comple-tion Score

FirstSecondThird

2010 20110%

20%40%60%80%

100%

27%

70%48%

78%

AccessInitial Attempt Completion

Score

FirstSecond

2010 20110%20%40%60%80%

100%

13%

62%63% 78%

Clotted FilterInitial Attempt Completion Score

FirstSecond

Thank you