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Improving Delivery of Continuous Renal Replacement Therapy: Impact of a Simulation-Based Educational Intervention

Mottes, Theresa RN1; Owens, Tonie RN, MSN2; Niedner, Matthew MD2; Juno, Julie RN, MSN2; Shanley, Thomas P. MD2; Heung, Michael MD3

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p 747–754
doi: 10.1097/PCC.0b013e318297626e
Feature Articles

Purpose: To describe our experience with transitions in both nursing model and educational training program for delivery of continuous renal replacement therapy. There have been very few comparisons between different care and educational models, and the optimal approach remains uncertain. In particular, we evaluated our experience with introducing a simulation-based educational model.

Design: Prospective quality control observational study.

Setting: The ICU of a tertiary care pediatric referral center.

Patients: All patients undergoing CRRT between July 2007 through July 2010 were included.

Measurements and Main Results: We monitored CRRT filter life during a transition from a collaborative to critical care nursing model, and subsequently during a transition from a didactic education program to simulation-based training. During the study period, 80 patients underwent continuous renal replacement therapy with use of 343 filters. Process control charts demonstrated a significant increase in filter life and a decrease in unplanned filter changes. Both of these signals emerged at the same time and corresponded with the introduction of the simulation-based education program. Further statistical analysis showed that filter life improved from 42.5 hours (18.2–66.4 hr) during the didactic education program to 59.4 hours (22.2–76.4 hr) during the simulation-based education program (p = 0.008). This relationship persisted when excluding nonpreventable premature filter discontinuations and in a multivariate model that accounted for other potential influences on filter life.

Conclusions: We report on the impact of transitioning between different educational programs for continuous renal replacement therapy, specifically with the introduction of a simulation-based approach. We observed a significant and sustained improvement in the delivery of continuous renal replacement therapy as demonstrated by a marked increase in filter lifespan.

1Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

2Division of Critical Care, Department of Pediatrics & Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

3Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

Ms. Owens is employed by the University of Michigan Health Centers. Dr. Shanley receives royalties from Springer, travel/accommodations/meeting expenses from Ext advisory boards, provides expert testimony for legal firms, received grant support from the National Institutes of Health, and received royalties from Springer. Dr. Heung consulted for Novartis, provided expert testimony for legal firms (expert medical review in legal cases), received grant support from the Renal Research Institute, and lectured for the Henry Ford Health System (Detroit, MI) and St. John Hospital (Detroit, MI).

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies