CRRT

Presenter:
Ms. Sudha Anbalagan,
MSN, RN, RM, PGDHM, Ph.D (N), CPHQ
Nursing Educator,
Wadi Aldawaser General Hospital, KSA.
Fresenius Multifiltrate CRRT Machine Prismaflex Gambro CRRT Machine
 INTRODUCTION
CRRT is progressively more applied in the intensive care settings. It’s
significant for critical care nurses to be skillful and knowledgeable in
initiating and managing the patients receiving CRRT by ensuring safety
and quality of care. It’s been observed that in the course of COVID
outbreak since the year 2020 there’s additional necessity for CRRT care
services due to ARF/AKI secondary to COVID-19.
Henceforth, found that in WDGH lack of trained and practiced
nursing staffs for CRRT on hemodynamically unstable patients in the
critical areas of ICU and COVID-ICU. And moreover there was role
confusion and conflict between AKU & critical areas in this regard.
Henceforward to prevent the problem in the future this topic has been
initiated for the project.
 QUALITY OF HEALTH CARE MODEL-BEFORE CRRT-PIP
Includes all of the is the sum of all actions contains all the effects on
factors that affect the required in CRRT-PIP. patients or staffs including
CRRT. Actions required as changes to health status,
follows: behaviour, or knowledge
as well as patient
**CRRT performed in **Identify the problem satisfaction and etc.
AKU & AKU Nurses **Organize a team
STRUCTURE

OUTCOME
**Lack of utilization

PROCESS
**Clarify the current **No pathway for CRRT
CRRT Machines- process
Fresenius & Gambro required patient
**Understand the management
**Lack of Staff training current problem
on CRRT. **Lack of international ICU
**Select desired standard care
**Less number of expected outcome
trained nurses on CRRT **↑Time of care
in Critical Care Units. & **↑ Patient risk
**No PPG, Pathway & **Plan for actions **Affecting quality,
Competency checklists **Implement the action efficiency & continuity of
for CRRT plans service
**COVID-19 **Check for all the end
Environment. results of PIP
METHODOLOGY
FOCUS PDCA
 F-Find an opportunity to improve
To increase CRRT trained nursing staffs from 38% to 100% in critical
care units of ICU & COVID-ICU within 3 months.
Less volume of trained nursing staffs for CRRT on hemodynamically
unstable patients in the intensive care settings of ICU & COVID-ICU. As a result
of increasing number of CRRT trained staffs in the critical areas through accurate
educational programs with practice sessions can be improved CRRT care of renal
failure patients in critical care settings.
 O-Organize a team
CRRT Members with Roles Responsibilities
Professional Status
Ms. Sudha Anbalagan Team Leader / Project ➔ Create rationale of project & selects members.
(Nurse Educator) Manager ➔ In-depth team leadership throughout the process to keep project on
track.
➔ Educate, support team members.
➔ Time management, decision making, planning.
➔ Prepares timeline of project
➔ Provide expertise for data analysis.
➔ Assists project manager in transition phase.
➔ Report to sponsor & Documents at end of process.
Ms. Sonia T.S Project Assistant ➔ Prepare meeting agenda & attendance sheet.
(ICU-Head Nurse) ➔ Reminding team members for meeting schedule.
➔ Time keeper of each meeting.
➔ Evaluate performance of each member.
➔ Coordinating with project coordinators for training sessions.
➔ Reminding and arranging the critical care nursing staffs for attending
training sessions.
➔ Evaluate the CRRT competencies of critical care nursing staffs.

Ms. Nilda Project ➔ Ensure the CRRT machines for proper functioning.
(AKU-Head Nurse) Co-ordinator ➔ Prepare the necessary equipment for CRRT training.
➔ Provide complete CRRT training for critical care nursing staffs.
Ms. Simi George Member
(AKU-Charge Nurse)
Ms. Mariamma T. Project Coordinator ➔ Write meeting minutes of each meeting.
(Covid ICU-Staff Nurse) ➔ Evaluate the CRRT competencies of critical care nursing staffs.
 O-Organize a team Contd…
CRRT Members with Roles Responsibilities
Professional Status

Dr. Sayed Tayee Subject Expert ➔ Formulating CRRT Guidelines.

(HOD, Nephrologist, AKU) ➔ Creating CRRT Policy & Procedure.
➔ Provide ideas and creative input to solutions and process
improvements.
Dr. Ahmed Ewis Subject Expert ➔ Providing lectures and training with nursing trainers.
(Nephrologist) ➔ Support team members in team actions, preparation and delivery of
presentation to quality.
➔ Help to identify appropriate process metrics and collect, chart and
Dr. Gamal Ali Member analyze process data.
(ICU-Specialist)
Mr. Yasser Al Suwais Member ➔ Arranging and coordinating with external CRRT trainers.
(Education & Training ➔ Certificating the nursing staffs for after CRRT training.
Coordinator)
Ms. Jessamine Facilitator ➔ Analyze and understand CRRT related issues and conflicts.
(TQMPS-Staff) ➔ Recommend right techniques/tools for team improvement.
➔ Participate in team meetings.
➔ Ensure time keeping throughout the project.
➔ Make sure team members understand their duties and are
comfortable with the direction of the project.
➔ Ensure effective communications.
C-Clarify the current process
 U-Understand the
Problems/Variations in the Process
 FISH BONE ANALYSIS FOR CRRT
Methods Manpower
❖ No CRRT policy & ❖ Deficiency of CRRT trainers
procedure guidelines ❖ Nursing staffs shortage
❖ No frequent CRRT internal ❖ Less number of patients

Procedure
& external trainings requiring CRRT

CRRT
Environment Less volume of Trained Critical Care Nursing Staffs for

❖ Covid-19 pandemic ❖ No CRRT nursing

circumstances competencies
❖ Inadequate CRRT equipment
& supplies for training
Measurements Materials
 S-Select the desired Outcome(s)
 To train 100% of critical care unit nursing staffs for
performing CRRT procedure.
 To minimize transferring hemodynamically unstable and
critical patients from critical care areas to AKU for CRRT.
 To create nursing competencies to assess and evaluate
the critical care nurses’ skills on CRRT procedure.
 To make pathway, policy & procedure guidelines for CRRT
in critical care settings.
P-Plan the Project, Assign Tasks
P-Plan the Project, Assign Tasks Contd…
Activity Responsible Target Date Resources Outcome

List critical care nurses Ms. Sudha Anbalagan One week Nursing Department Critical care nurses list
Nurse Educator Database made
Ensure sources for CRRT Ms. Nilda, AKU-HN, Two weeks AKU & Bio Medical The sources to be ensured.
training Ms. Simi George, AKU-CN. Department
Arrange internal & Ms. Sudha Anbalagan Three Fresenius & Gambro ♦ Internal trainers
external trainers Nurse Educator. months Company, Riydh. arranged.
Mr. Yasser Alsuwais, ♦ External trainers to be
Hospital Education & Training arranged.
Coordinator.
Train all critical care Nurse Educator, Two AKU Department ICU & Covid ICU nurses
nurses AKU Trainers, months to be trained.
Nephrologists.
Schedule CRRT training Ms. Sudha Anbalagan One week Monthly Duty Schedule The educational plan &
Nurse Educator training schedule need to
be prepared.
Prepare CRRT pathway, Dr. Sayed Tayee, AKU-HOD, One week ♦ MOH hemodialysis The pathway, PPG and
policy and procedure Dr. Ahmed Ewis, Nephrologist, manual Nursing competencies to
guidelines, competency Dr. Gamal Ali, ICU-HOD, ♦ PPG-KSMC, be formulated &
checklists, Ms. Sudha Anbalagan Riyadh. approved.
Nurse Educator ♦ PPG-KFH, Makkah.
Implement newly Dr. Sayed Tayee, AKU-HOD, One month Formulated & approved To be achieved.
formulated and approved Dr. Gamal Ali, ICU-HOD. PPG, Pathway will be
CRRT-PPG & pathway. available.
D-Do the Work that’s Needed
C- Check the Results, and Measure Changes
 A- Act to Maintain the Changes
 Adhere to the CRRT policy, procedure and pathway.
 Constant CRRT competency assessment is required.
 Continuous education and training is required for critical
care nurses on CRRT at best of every six months in a year.
 External CRRT training need to be arranged particularly
for trouble shooting the alarms.
 CRRT training should be made as a pre-requisite for
critical care nurses before appointing them into the unit.
 QUALITY OF HEALTH CARE MODEL -AFTER CRRT PIP
Includes all of the
factors that affect the
CRRT.
**CRRT performed in
Critical Care Units for
hemodynamically stable
STRUCTURE
is the sum of all actions
carried out in CRRT-PIP.
Based on FOCUS-PDCA
Methodology
**Identified the problem
contains all the effects on
patients or staffs including
changes to health status,
behaviour, or knowledge
as well as patient
satisfaction and etc.

**Organized a team

OUTCOME
& unstable patients by **Clear pathway for

PROCESS
Critical Care Nurses
**CRRT Machines-
Fresenius & Gambro
utilized.
**Internal & External
Trainings on CRRT
arranged.
**100% Critical Care
Nurses Trained on CRRT.
**CRRT PPG, Pathway &
Nursing Skill
Competency checklists
developed & available.
**Clarified the current patient management
process **Met with ICU
**Understood the current standardized care
problem **Decreased Time of care
**Selected desired **Decreased Patient risk
expected outcome
&
**Planned for actions
**Implemented the action
plans
**Checked for all the end
results of PIP