39 Nurses Can Resuscitate

Abstract

Abstract Introduction Fluid resuscitation in the first 48 hours post burn is crucial in the management of burn shock. Hourly titration of fluids is needed to avoid complications of over or under resuscitation which can increase morbidity and mortality. Historically these titrations have been driven by the burn physician; we hypothesized that given protocols with specific resuscitation parameters the burn nurse can accurately resuscitate the burn patient without complications. Methods This quality improvement project at our ABA verified adult Burn Center tracked performance of a nurse-driven protocol for all inpatients with burns who underwent formal fluid resuscitation. Education regarding the nursing-driven protocol was provided to 90 surgical intensive care nurses. Badge buddies with both the Parkland formula and the Modified Albumin formula were made for the staff. Burn order sets were updated to reflect burn resuscitation guidelines with fluid adjustment parameters. A 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses and all resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow up and education reinforcement was done in real time by the clinical nurse specialist following each burn resuscitation. Results Over a one-year period, 23 patients’ resuscitations were tracked and reviewed by the burn quality team. One patient was excluded because of early transition to comfort care. After the initial three tracked resuscitations, the data collection tool was evaluated and modifications made to more effectively capture relevant findings. Mean age of patients was 45.1 (18–82) with a mean TBSA burn injury of 32.5 (15–42.5) In the first 24 hours patients (n=22) received a mean volume of 3.47 ml/kg/%TBSA (0.66 – 8.39) with a mean urine output of 0.95 mL/kg/hr (0.30 – 2.16 ml/kg/hr). For patients who remained on resuscitation during the second 24 hours (n = 16), they received a mean volume of 2.68ml/kg/%TBSA (0.56- 8.44) and had a mean urine output of 1.31 mL/kg/hr (0 .30–2.16). There were no complications related to fluid administration. Appropriate hourly fluid adjustments were made in 21 of the 22 patients. The one patient who did not have fluids titrated appropriately was attributed to resident physician education because the resident failed to provide the burn order set that includes the fluid resuscitation protocol. Conclusions Using a multidisciplinary approach and preparatory and real time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow up in real time can improve the process. Applicability of Research to Practice The use of nurse-driven protocols can improve outcomes for burn patients.