1. CRRT Nursing Education Program: Impact on Filter Life and Cost Theresa Mottes, RN University of Michigan C. S. Mott Children’s Hospital April 8, 2010

2. Program Redesign • Comprehensive Program Assessment • Patient Activity • Patient/Year; CRRT Days; Trends • Cost Metrics • Supplies; Staff Time • Nursing Education • Nursing Roles and Responsibilities • Nursing Time Studies

3. Current State • 25-35 Patient/year • 300 – 350 Days/year • $96,064 (US)/year • Supplies • Direct staff time

4. Current State • Filter Life • Mean Filter Life 42.2 hours ( <1 to 98) • Mean filters/treatment 4.75 (1-21) • Incident Rate for Adverse Events • Adverse Event defined as hypotension, bradycardia, de-saturation requiring medical intervention • Mean 0.85/treatment (0.28-1.84) • 0.18/initation (0.06-0.39)

5. Current State • Education Program • Established new user class • No infrastructure for ongoing/advanced education • Challenges with low volume/high technology • Nursing • Overall Comfort and Specific Knowledge • Comfort Score – 3.7 (1-5) • CRRT Principles - 60% • Circuit Pressures – 76%

6. Filter Life • CRRT Filter Life – 168 Filters (Previous Year) • Filter Life > 72 hour – Only 34 (20%) • Root Cause Analysis of Filter Life < 72 hour • 31 unpreventable • 113 potentially preventable (67%) • 68 correlated to alarms and interventions (40%)

7. Extending Filter Life Benefits 68 % Improvement 41% Reduction 15 % Improvement 12% Reduction

8. Extending Filter Life Benefits 15% - $14,000 Saving Overall - $45,000 Saving

9. Nursing Education • Define nursing roles and responsibilities • Initiator Role • Preceptor Role • Bedside Role • Define behaviors and associated skills • Competent; Proficient; Expert • Develop ongoing education for nurse to advance clinical skills and confidence • Annual – Bedside • Semiannual - Initiator • Track nurses progression to advanced skill level

10. Nursing Education • Education process • Simulation Technology • Allows for integration of knowledge into practice • Scenarios based on identified targeted roles, knowledge gaps, patient safety reports and nurses suggestions • Scenarios re-evaluated annually • 4 scenarios – 10 minutes • Debriefing – Review scenarios, responses and potential future topics

11. Nursing Survey Results

12. Relative reduction of 46%

13. Average increase of>13h (32%)

15. Conclusion • 31% (13 hr) improvement in Filter Life • Improvement in Nursing Scores in all areas • 46% Reduction in Filter Loss for Unknown • 28% Reduction in Cost • All training done budget neutral • 22% reduction in potential adverse events Nursing education using innovative simulation techniques improves the delivery of CRRT while reducing cost.

16. Acknowledgements • Tom Shanley and David Kershaw • Matthew Niedner • Tonie Owens, Alyssa Akers-Nowicki and Julie Juno • Mike Heung