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.
Anesth Analg. 2019 Jul;129(1):121-128. doi: 10.1213/ANE.0000000000003581.
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.
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.
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).
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.
尽管连续肾脏替代疗法（CRRT）很常见，但计划外中断（UI）经常限制其用途。在许多单位，护士负责 CRRT 管理。我们假设，基于高保真模拟的护士培训计划将降低中断治疗的发生率。
我们进行了一项 2 阶段（培训和评估）、随机、单中心、开放研究：在培训阶段，重症监护病房护士接受了 6 小时的培训计划，并随机接受（干预）或不接受（对照）额外的高保真模拟培训（6 小时）。在评估阶段，CRRT 治疗的管理被随机分配给干预或对照护士。如果治疗被中断，并且中断在 3 小时前没有书面规定，则该治疗被定义为 UI。
研究护士在接受培训前有血液透析经验，但没有 CRRT 经验。干预组护士的知识测试得分高于对照组护士（等级，中位数[Q1-Q3]，14[10.5-15]比 11[10-12]/20；P=0.044）。在 13 个月的时间里，在 50 名患者（平均年龄 70±13 岁，简化急性生理学评分 II 平均 69[54-96]）中随机分配了 106 次治疗（每组 n=53）。未分析 21 次治疗（4 次未进行，17 次治疗期间患者死亡）。在分析的 42 次干预和 43 次对照治疗中，25 次（59%）和 38 次（88%）被标记为 UI（相对风险[95%CI]，0.67[0.51-0.88]；P=0.002）。干预护士的帮助需求明显较少（0[0-1]比 3[1-4]次/治疗；P<0.0001）。多水平混合效应逻辑回归分析中与 UI 相关的 2 个因素是序贯器官衰竭评估评分（比值比[95%CI]，0.81[0.65-99]；P=0.047）和干预组（比值比，0.19[0.05-0.73]；P=0.015）。
高保真模拟护士培训降低了 CRRT 治疗中断的发生率和护士寻求帮助的需求。这种干预措施在护理人员频繁更替的情况下可能特别有用。
