Makayla Cordoza1, Kristen Rachinski, Kristin Nathan, Elisa B Crain, Diane Braxmeyer, Sarah Gore, Stephanie D Dubuc, Joel Wright. 1. Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dr Cordoza); Arena Kaiser Permanente Sunnyside Medical Center, Clackamas, Oregon (Ms Rachinski); Legacy Health, Portland, Oregon (Dr Braxmeyer, Mss Nathan, Crain, and Gore and Mr Wright); and Gonzaga University, Spokane, Washington (Ms Dubuc).
Abstract
BACKGROUND: Continuous renal replacement therapy (CRRT) is a lifesaving intervention for critically ill patients. Delays in initiation, or an inability to resume CRRT following a temporary suspension in therapy (CRRT restart), can result in suboptimal CRRT delivery. LOCAL PROBLEM: Intensive care units across the health care system were experiencing significant delays in CRRT initiation and restarts. APPROACH: A multimodal quality improvement initiative was implemented across 7 adult intensive care units, which allowed unit-based staff nurses to initiate and restart CRRT, a task that had previously been delegated to non-unit-based dialysis nurses. OUTCOMES: A 75% reduction in CRRT initiation delays and a 90% reduction in CRRT restart delays were observed in the 12 months following the initiative. There were no adverse events or increased disposable CRRT circuit usage following the initiative. CONCLUSIONS: Implementation of CRRT initiation and restarts by unit-based nurses were achievable and resulted in substantial improvements in timeliness of CRRT delivery.
BACKGROUND: Continuous renal replacement therapy (CRRT) is a lifesaving intervention for critically ill patients. Delays in initiation, or an inability to resume CRRT following a temporary suspension in therapy (CRRT restart), can result in suboptimal CRRT delivery. LOCAL PROBLEM: Intensive care units across the health care system were experiencing significant delays in CRRT initiation and restarts. APPROACH: A multimodal quality improvement initiative was implemented across 7 adult intensive care units, which allowed unit-based staff nurses to initiate and restart CRRT, a task that had previously been delegated to non-unit-based dialysis nurses. OUTCOMES: A 75% reduction in CRRT initiation delays and a 90% reduction in CRRT restart delays were observed in the 12 months following the initiative. There were no adverse events or increased disposable CRRT circuit usage following the initiative. CONCLUSIONS: Implementation of CRRT initiation and restarts by unit-based nurses were achievable and resulted in substantial improvements in timeliness of CRRT delivery.
Authors: Claudio Ronco; Zaccaria Ricci; Daniel De Backer; John A Kellum; Fabio S Taccone; Michael Joannidis; Peter Pickkers; Vincenzo Cantaluppi; Franco Turani; Patrick Saudan; Rinaldo Bellomo; Olivier Joannes-Boyau; Massimo Antonelli; Didier Payen; John R Prowle; Jean-Louis Vincent Journal: Crit Care Date: 2015-04-06 Impact factor: 9.097