Safe Staffing for ICU Nurses who Perform CRRT at the bedside
Continuous Renal Replacement Therapy (CRRT) was introduced over decades ago as a therapeutic option intended to aid patients who require renal support (Schell-Chaple, 2017). Patients that require this type of therapy are usually at a very high risk of dying from their complications. However, the procedure is reported to have several adverse effects, which may eventually result in the death of the patient. Reports indicate that the mortality rate for patients suffering from kidney has remained steady at approximately 50%, even after the introduction of CRRT. The inadequate response of the patients to this therapy can be attributed to the fact that different people respond differently to the treatment. Therefore, they need to be under constant supervision by a healthcare provider, most likely, a registered nurse.
In the past decades, the use of CRRT has significantly increased in managing critically ill patients with renal failure. For better results to be obtained, the quality of the procedure has to be improved. This process requires increasing personnel. The procedure is very involving for a single patient, and hence one nurse would not be enough to handle more than one patient. If circumstances were to force a nurse to be in charge of more than one patient, the degree of monitoring would not be enough to achieve the desired outcome. Don't use plagiarised sources.Get your custom essay just from $11/page
When handling such cases, the patients require undivided attention to help them in the recovery process. CRRT takes over the role of the kidney in removing waste products from the body. The procedure is run over twenty-four hours to get rid of substances such as excess fluid, solutes, and metabolic waste. Accumulation of these substances to dangerous levels result in toxicity within the body, and eventually death. It is for this reason that the entire procedure should be closely monitored to ensure that it runs smoothly. Any defects in the process may result in an untimely death.
The primary role of a nurse, in this case, is to acknowledge the CRRT order (Maxwell, 2019). Part of this job includes assembling all the required equipment for the dialysis to happen. Assuming that one nurse was in charge of three or four patients, the effort needed to gather all the equipment would be overwhelming. Also, the nurse may be in a hurry while setting up the system. This may result in forgetting some critical equipment or steps. It would be, therefore, ideal to assign one nurse to a single patient to ensure that the procedure is set up well.
Setting up the dialysis circuit is also the nurse’s responsibility. Once the setup is up and running, the nurse is supposed to monitor the levels of electrolytes and fluids in the body. If the dialysis results in electrolyte imbalance, the nurse is required to discontinue dialysis immediately. If a patient suffers from electrolyte imbalance and nobody is watching the vitals, the individual may succumb to the complication. This scenario further emphasizes the necessity of having a patient-nurse ratio of 1:1. Having a nurse present at all times will ensure that the patient’s health and safety are guaranteed throughout the dialysis process.
A patient undergoing URRT usually has some procedures recommended for them by a healthcare provider. The professional prescribes the rates of ultrafiltration and blood flow to be titrated as per the needs of the patient. These values differ significantly from patient to patient since their levels of kidney failure and their different levels of metabolism. If such information from three different patients is given to the same nurse, it is possible or the nurse to have the values mixed up. Once this happens, the patients may receive wrong rates of blood flow and ultrafiltration. Such errors can be avoided by having a single nurse dedicated to handling an individual patient. Remembering the values for a single patient is much more comfortable, thus promoting efficiency and accuracy of the procedure.
The devices used in URRT need to be checked on an hourly basis to ensure that they are functioning correctly. Levels of electrolytes and fluids in the body also need to be tested in the same period to ensure patient safety. Having a single nurse continually moving from one station to another monitoring these aspects is tiresome. Besides, there may be complications in one of the patient’s stations that require immediate attention. As the nurse is dealing with the patient at hand, the other patients would be left unattended. In this case, any problems that may arise in the different setups may not be identified on time. This poses an immediate threat to the lives of the patients undergoing dialysis. It would be more efficient to have a single nurse monitor the progress of an individual patient.
Having a patient-nurse ratio of 1:1 also offers the benefit of allowing the nurse to concentrate fully on a single patient. By doing so, the nurse can immediately notice any arising complications and raise the alarm as appropriate. Also, the nurse will be able to plan their schedule well to suit both parties. For example, since the checks are meant to be at least hourly, the nurse can break for lunch immediately after performing a check and ensuring that everything was fine. The nurse would then have enough time to complete her lunch break and return to her patient.
In contrast, having one nurse assigned to three patients would put a strain on her. Assuming that each check lasts for fifteen minutes, by the time the third check is complete, it would be time to return to the first patient. This would be a vicious cycle that would completely drain the nurse’s energy. In addition, she would be deprived of any time for breaks.
The process of dialysis requires the use of catheters. Catheters are usually inserted into the urethra of an individual (Maxwell, 2019). These parts are generally private, and most people, if not all of them, are not comfortable exposing these parts to other individuals. Given that catheters must be inserted as part of the procedure, patients have to come to terms with the fact that their privacy would have to be “invaded” at some point. With this in mind, a patient I likely to be more comfortable exposing their privacy to a single person rather than different people on different occasions. Therefore, it would be advisable to have a single nurse assigned to take care of ensuring that the patient assigned to them gets comfortable enough around them to allow them to insert the catheter without a fuss. The pain associated with the insertion of the catheter will also reduce when the patient becomes more comfortable.
Lastly, the relationship between a patient and the nurse has to be good. Once this is achieved, the patient is more likely to open up to the nurse in case they feel that something is not right. As the patient and the nurse continue to interact, the trust between them grows steadily. At some point, the nurse becomes well aware of the patient’s behavior to a point whereby it is possible to tell when something is wrong with the patient without asking questions. It has also been determined that patients respond well to treatment in cases where they trust the hospital personnel and the treatment procedure.
References
Maxwell, T. (2019). Building a continuous renal replacement therapy program in a community hospital. Nursing2020 Critical Care, 14(6), 6-12
Schell-Chaple, H. (2017). Continuous renal replacement therapies: Raising the bar for quality care. AACN advanced critical care, 28(1), 28-40.
Rauen, C. A., Knippa, S., Brewer, H., Carothers, B., Franklin, H., Harvey, J., … & Herrmann, C. (2017). Continuous renal replacement therapies: raising the bar for quality care. Critical Care Nurse, 37(6), 81-85.