Nurses’ expertise is critical to cancer patients’ recovery after treatment, and nurses in the medical center’s Intensive Care Unit (ICU) care for some of the most ill, including those going through kidney failure.
|Nurses Jeff Flinner, left, and Harding Aguirre monitor a patient’s dialysis. (Photo by Darrin S. Joy)|
To provide the best care possible, ICU nurses recently took charge of continuous renal replacement therapy, or CRRT, an alternative to traditional kidney dialysis.
“The ICU nurses saw added value if they could learn CRRT, so they wanted to take ownership of the program,” said Regina Buchanan, R.N., M.S.N./E.D., C.C.R.N., clinical director of critical care, pediatric and diagnostic cardiology. “They stepped up to the plate and have done a spectacular job running this program.”
Buchanan noted that the procedure, and the nurses’ handling of it, makes a crucial difference in patient care.
Some patients recovering from complicated surgery, bone marrow transplant or serious cancer-related illnesses may experience organ failure, including problems with their kidneys. But traditional dialysis can be risky for these patients.
CRRT is more similar to regular kidney function. It works more slowly than dialysis and can take over the kidneys’ job for seven to 10 days. According to Buchanan, CRRT has been key to the survival of some acutely ill patients. It also lowers the odds that patients will suffer chronic kidney failure, which requires a lifetime of regular dialysis treatment.
Buchanan initiated CRRT at City of Hope in 2006 through a contracted service. That improved care for very ill patients, but the arrangement sometimes resulted in treatment delays. Nurses also expressed concern over the continuity of care.
“I think that’s just the nature of our ICU nurses,” said Kate Butcher, R.N., one of the area’s nurses. “We want to be involved with everything that affects our patients. If there’s a machine in the patient’s room, we want to know all about it — even how to fix it.”
They asked to take over CRRT, and 33 ICU nurses were trained in 2009. They began delivering the treatment in 2010 using three new CRRT machines. A fourth was recently added.
ICU staff and physicians are pleased with the results.
“Outcomes of our patients on CRRT are significantly better compared to hemodialysis,” said nephrologist Bashir Ahmad, M.D., who helped bring the therapy in-house. “Having our nursing staff handle this procedure makes it not only efficient and timely, but also cost-efficient.”
The change eliminated treatment delays, and nurses found that patients’ family members felt more comfortable with familiar City of Hope nurses delivering the care.
“This way, you’re not depending on somebody else to make your family member better,” said Jesee Castro, R.N., B.S.N., ICU clinical nurse manager. “Your parent, your husband, your wife is being taken care of by one nurse who is looking at the whole picture.”
The nurses’ efforts to take on a new therapy have earned them accolades.
“This could serve as a model for other areas,” said David Horak, M.D., ICU medical director and chief of the Division of Pulmonary and Critical Care Medicine. “It shows our staff is dedicated, innovative and confident enough to break new ground.”
Stories abound of patients who once faced tough odds but ultimately walked out of the ICU and returned to life as normal, thanks in part to the nurses’ delivering CRRT.
“When nurses get to see patients leave the ICU, that’s what keeps them going,” said Buchanan. “That’s what it’s all about — getting this person back to better health.”