Pediatric CRRT Programs: A tool-kit for evaluation

Helen Currier BSN, RN, CNNAssistant Director, Renal/PheresisTexas Children’s HospitalHouston, Texas

Patient care improves through a thorough product evaluation.

Formulate criteria and use these to comment critically:– The product’s impact– The extent to which it meets a need– Its purpose– Resource limits

Patient care improves through technology and design…….

Size matters………………

So why do users place a different value on different products?

The Pediatric Ideal: CRRT Circuit

Minimum priming volume with low resistance

Exchangeable components

Biocompatible membrane

The Pediatric Ideal: CRRT Equipment

Separate and accurate pumps and scales for each component of CRRT

Range of blood flows with a minimum of 20ml/min

Thermoregulation MAXIMUM safety features

The Pediatric Ideal: CRRT Equipment

Comes with a expert nurse!

What are the competencies?

How CRRT works (fluid and solute balance, changes in nutrition and medications)

Reason for treatment When and how to terminate treatment How to troubleshoot alarms (AP, VP, blood leak,

error codes, air detector) When and how to recirculate the system How to care for catheter and catheter exit site When and how to contact nephrologist or nephrology

nurse How to operate extracorporeal circuit warmer

More competencies

Demonstrate– How to calculate fluid balance– How to assess clotting in the system– How to adjust AP and VP limits, BFR, UFR– How to verify dialysis and replacement fluid solution and

rates– Document continuing care in nursing notes and flow sheet

Patient care improves through thorough product evaluation. How is the product designed so that it is suitable for is suitable

for a low-volume or high-volume pediatric program?

What are the costs of the DME, disposables and associated labor (biomedical, nursing)?

Are the supplies, tools and equipment specialized or general purpose?

Who determines the quality of the finished product?

How is the level of quality maintained?

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Institute of Medicine 12

Definition of Healthcare Quality

“Quality of care is the degree to which health services for individual and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.”

Quality of care is the degree to which CRRT services SCUF slow continuous ultrafiltration CAVHCAVH continuous arteriovenous continuous arteriovenous

hemofiltrationhemofiltration CAVHDCAVHD continuous arteriovenous continuous arteriovenous

hemodialysishemodialysis CVVH continuous venovenous

hemofiltration CVVHD continuous venovenous

hemodialysis CVVHDF continuous venovenous

hemodiafiltration

For individual (pediatric patient) and populations increases the likelihood of desired outcomes Optimal clearance and ultrafiltration Safe extracorporeal volume Hemodynamic stablity Infection free Functional access Error free therapy

And the care/outcomes are consistent with current professional knowledge

Professional guidelines (ADQI®,

Nephrology Nursing Standards and Guidelines)

Science (ppCRRT)

Recommendations

Evidence Based Practice: What is it? Activities that result in the best possible

patient outcomes Practice based on research evidence is

more likely to achieve quality patient outcomes

Evidence based practice:How do we know our care is best practice?

Accreditation - Establishes standards National Organizations (AACN, ANNA) -

Promotes specialty Practice Acts - Protect the public Internal Policies - Guide practice Research - Provides evidence

Standards Applications

Quality Improvement systems Data bases Policies, procedures, protocols Position descriptions and performance appraisals Educational programs Staff training Patient education Regulatory systems Critical care and nephrology nursing research