CRRT Nursing CRRT Nursing Education Education Program:Program:

Impact on Filter Life and Impact on Filter Life and CostCost

Theresa Mottes, RNUniversity of MichiganC. S. Mott Children’s HospitalApril 8, 2010

Program RedesignProgram Redesign

►Comprehensive Program Assessment Comprehensive Program Assessment Patient ActivityPatient Activity

►Patient/Year; CRRT Days; TrendsPatient/Year; CRRT Days; Trends

Cost MetricsCost Metrics►Supplies; Staff TimeSupplies; Staff Time

Nursing EducationNursing Education Nursing Roles and Responsibilities Nursing Roles and Responsibilities Nursing Time StudiesNursing Time Studies

Current StateCurrent State

►25-35 Patient/year25-35 Patient/year

►300 – 350 Days/year300 – 350 Days/year

►$96,064 (US)/year$96,064 (US)/year SuppliesSupplies Direct staff timeDirect staff time

Current StateCurrent State

►Filter LifeFilter Life Mean Filter Life 42.2 hours ( <1 to Mean Filter Life 42.2 hours ( <1 to

98)98) Mean filters/treatment 4.75 (1-21)Mean filters/treatment 4.75 (1-21)

► Incident Rate for Adverse EventsIncident Rate for Adverse Events Adverse Event defined as hypotension, Adverse Event defined as hypotension,

bradycardia, de-saturation requiring bradycardia, de-saturation requiring medical interventionmedical intervention

Mean 0.85/treatment (0.28-1.84) Mean 0.85/treatment (0.28-1.84) ►0.18/initation (0.06-0.39) 0.18/initation (0.06-0.39)

Current StateCurrent State

►Education ProgramEducation Program Established new user class Established new user class No infrastructure for ongoing/advanced No infrastructure for ongoing/advanced

education education Challenges with low volume/high Challenges with low volume/high

technologytechnology►NursingNursing

Overall Comfort and Specific KnowledgeOverall Comfort and Specific Knowledge►Comfort Score – 3.7 (1-5)Comfort Score – 3.7 (1-5)►CRRT Principles - 60%CRRT Principles - 60%►Circuit Pressures – 76%Circuit Pressures – 76%

Filter Life Filter Life

►CRRT Filter Life – 168 Filters CRRT Filter Life – 168 Filters (Previous (Previous Year) Year) Filter Life > 72 hour – Only 34 (20%)Filter Life > 72 hour – Only 34 (20%)

►Root Cause Analysis of Filter Life < 72 Root Cause Analysis of Filter Life < 72 hourhour 31 unpreventable 31 unpreventable 113 potentially preventable (67%)113 potentially preventable (67%) 68 correlated to alarms and interventions 68 correlated to alarms and interventions

(40%) (40%)

Extending Filter Life BenefitsExtending Filter Life BenefitsAdverse Events Associated Filter Initiations

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

42.7 50 55 60 65 70 72

Filter Life

Inci

dent

Rat

e

Combined

Blood Prime

Standard

15 % Improvement 12% Reduction

68 % Improvement 41% Reduction

Extending Filter Life BenefitsExtending Filter Life Benefits

Potential Cost Reduction

50,000

55,000

60,000

65,000

70,000

75,000

80,000

85,000

90,000

95,000

100,000

42.5 50 55 60 65 70 72

Filter Life

Supplies &Staff

15% - $14,000 Saving

Overall - $45,000 Saving

Nursing EducationNursing Education

►Define nursing roles and responsibilities Define nursing roles and responsibilities Initiator RoleInitiator Role Preceptor RolePreceptor Role Bedside RoleBedside Role

►Define behaviors and associated skillsDefine behaviors and associated skills Competent; Proficient; ExpertCompetent; Proficient; Expert

►Develop ongoing education for nurse to Develop ongoing education for nurse to advance clinical skills and confidenceadvance clinical skills and confidence Annual – Bedside Annual – Bedside Semiannual - InitiatorSemiannual - Initiator

► Track nurses progression to advanced skill Track nurses progression to advanced skill levellevel

Nursing EducationNursing Education

►Education processEducation process Simulation Technology Simulation Technology

►Allows for integration of knowledge into Allows for integration of knowledge into practicepractice

Scenarios based on identified targeted Scenarios based on identified targeted roles, knowledge gaps, patient safety roles, knowledge gaps, patient safety reports and nurses suggestionsreports and nurses suggestions►Scenarios re-evaluated annuallyScenarios re-evaluated annually

4 scenarios – 10 minutes4 scenarios – 10 minutes Debriefing – Review scenarios, responses Debriefing – Review scenarios, responses

and potential future topicsand potential future topics

Nursing Survey ResultsNursing Survey Results

0%10%20%30%40%50%60%70%80%90%

100%

Indications Principles Alarms/ Pressures

April 2008 - Combined

Feb 2010 - Combined

April 2008 - Initiators

Feb 2010 - Initiators

Relative reduction of 46%

Average increase of>13h (32%)

ConclusionConclusion

► 31% (13 hr) improvement in Filter Life 31% (13 hr) improvement in Filter Life Improvement in Nursing Scores in all areasImprovement in Nursing Scores in all areas 46% Reduction in Filter Loss for Unknown 46% Reduction in Filter Loss for Unknown

► 28% Reduction in Cost28% Reduction in Cost All training done budget neutral All training done budget neutral

► 22% reduction in potential adverse events22% reduction in potential adverse events

Nursing education using innovative simulation techniques improves the delivery of CRRT while reducing cost.

AcknowledgementsAcknowledgements

►Tom Shanley and David KershawTom Shanley and David Kershaw►Matthew Niedner Matthew Niedner ►Tonie Owens, Alyssa Akers-Nowicki Tonie Owens, Alyssa Akers-Nowicki

and Julie Junoand Julie Juno►Mike HeungMike Heung