787 Burn Resuscitation Critical Reflective Practice

Abstract

Abstract Introduction The Burn Resuscitation Critical Reflective Practice (CRP) was started as collaborative meetings to review 1st 48 hours of admission for burn resuscitations (resus) October 2018- July 2019. All multi- disciplinary teams were invited. The problem identified was on average burn resus patients (>20% TBSA) were being over resuscitated in 1st 24 hours of admission. The goals of the CRP were: 1) Decrease resus fluid in the 1st 24 hours; 2) Increase knowledge of the current fluid resus pathway; 3) Increase communication with interdisciplinary teams during the resus. Methods CRP initiated in October 2018. 6 CRPs were held October 2018- July 2019.The average ml/ KG/ TBSA prior to CRP from January 2017- September 2018 was 5.17ml/kg/TBSA (goal: < 4ml). Chart reviews were done to gather data from each resus (i.e. urine output, fluids, labs, events). Discussions held with staff involved in the 1st 24 hours of resus regarding any communication/process issues.Patient data was presented & staff members present would discuss questions/ issues that came up during the resus. Multi-disciplinary teams surveyed prior to CRP to assess comfort/competence with current resus pathway and communication. 46 surveys received prior to initiating CRP. After initiating CRP October 2018- July 2019, staff members that had attended >1 CRP were post-surveyed. Results January 2017- October 2018 average ml/ KG/ TBSA was 5.17ml/kg/TBSA. October 2018- July 2019 POST CRP implementation, the avg ml/ KG/ TBSA was 3.86 ml LR/ kg/ TBSA in 1st 24 hours of resus. 3 new practices were implemented 1) Decrease fluids by 200ml/hr (instead of 100) when UOP is >100/hr at least 2 hours into resus; 2) Double sign by 2 RNs required when calculating Parkland Formula; 3) Guideline created to guide communication between Burn RNs & trauma bay when burn resus arrives. Post- survey data showed increase in comfort communicating with physicians regarding resus & increase in comfort/confidence in calculating Parkland Formula. 2 additional subjective questions were added onto the post- CRP survey. Conclusions Fluids given in the 1st 24 hours decreased from 5.17 to 3.86 average ml/ kg/ TBSA post- CRP. 3 new practices were implemented as discussed in results. Staff felt more comfortable communicating with team & calculating Parkland formula. Staff had positive responses on the post- survey. Applicability of Research to Practice The monthly CRPs are to be continued to discuss all burn resus patients received during the prior month. Allows team members to continue to modify practice as needed by what’s learned through each CRP to help better our patient outcomes and decrease overall resus fluids.