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Lemarie P, Husser Vidal S, Gergaud S, Verger X, Rineau E, Berton J, Parot-Schinkel E, Hamel JF, Lasocki S. High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial. Anesth Analg 2020; 129:121-128. [PMID: 29933269 DOI: 10.1213/ane.0000000000003581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015). CONCLUSIONS High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.
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Affiliation(s)
- Pierre Lemarie
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Solenne Husser Vidal
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Soizic Gergaud
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Xavier Verger
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Emmanuel Rineau
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Jerome Berton
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Elsa Parot-Schinkel
- L'UBL, Université d'Angers, Maison de la Recherche, CHU d'Angers, Angers, France
| | - Jean-François Hamel
- L'UBL, Université d'Angers, Maison de la Recherche, CHU d'Angers, Angers, France
| | - Sigismond Lasocki
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
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Abstract
PURPOSE OF REVIEW The consideration of acute kidney injury, its incidence and its impact on the outcome of patients has grown continuously in recent years, leading to an increase in the use of renal replacement therapy (RRT) techniques. However, the successful conduct of RRT depends on the effectiveness of the entire team, doctors and nurses. It is therefore important to know the essential elements to be implemented in the ICU to ensure optimal RRT. RECENT FINDINGS Recent studies show that the successful conduct of a RRT session requires a good knowledge of the principles of the technique, regular basic training, identification of experts, drafting clear and well followed protocols and good communication between the various stakeholders. In addition, the use of the latest advances, such as regional citrate anticoagulation, allows further optimization of therapy, only if, again, both physicians and nurses are properly trained and highly involved. SUMMARY We now have a better understanding of the measures to be deployed to optimize RRT. Organization, training, evaluation and protocols are the key points of the team's efficiency for a safe and effective implementation of RRT.
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Abstract
PURPOSE OF REVIEW Quality and safety are important priorities in the care of critically ill patients. For patients with acute kidney injury (AKI) or for those receiving continuous renal replacement therapy (CRRT), measures and outcomes associated with quality of care have been suboptimally developed and evaluated. The review is timely as it summarizes current quality practices in AKI and CRRT, and presents ongoing and future developments. RECENT FINDINGS The review begins with the history of quality and safety in healthcare. We then discuss the current quality of care offered in AKI and CRRT. Quality measure development methodology, such as plan-do-study-act and the focus-analyze-describe-execute models and lean thinking are then presented and discussed. Finally, recent evidence for quality in AKI and CRRT care, including proposed quality measures, are discussed. SUMMARY Few studies have examined the quality of care provided to patients with AKI and CRRT. Evidence suggests opportunities to improve the quality of care received by patients at risk of or who have developed AKI. Priorities for improving quality of care exist across several important themes including risk identification, diagnosis, monitoring, investigation, and strategies for management. Similarly, evidence-informed quality measures of CRRT care have not been rigorously evaluated. These are important knowledge-to-care gaps that require further investigation.
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