Surviving Shock: Nurse Driven Protocol for Application of Hemodynamic Monitoring Device

Abstract

Problem/Purpose: Shock is a problem seen in Intensive Care Units (ICU) and in its early stages are reversible, but a delay in diagnosis and/or timely initiation of treatment can lead to organ failure and death. A Surgical ICU (SICU) within a large urban academic medical center was identified as the project site. The purpose of this quality improvement (QI) project was to implement an algorithm that will allow nurses to apply advanced hemodynamic monitoring to patients exhibiting shock states given the array of shock states frequently seen on the unit and lack of utilization of monitoring. Advanced hemodynamic monitoring platforms have been shown to be effective in providing goal-directed fluid therapy (GDFT). Methods: A nurse driven protocol was created to assist nurses in recognizing patients who would qualify. Implementation occurred over 14 weeks in Fall of 2022. Education occurred during week one and included basic education on hemodynamics, device set-up, appropriate patient selection and the protocol. Weekly audits evaluated the number of patients who met criteria and the number of patients who were applied. Results: Prior to the implementation of the protocol a survey of patients on the unit revealed that no patients who met criteria were applied to advance hemodynamic monitoring. A total of 268 patients were audited over 14 weeks. Since initiation of the protocol there has been an 60% (n=15/25) increase in recognition of patients who exhibit shock states. Conclusion: In conclusion, the nurse driven protocol for advance hemodynamic monitoring is a safe and effective way for nurses to identify patients who are exhibiting shock states and that qualify for monitoring. Future studies could evaluate whether patients with advanced hemodynamic monitoring had a reduction in post-operative complications and ICU LOS which could be potentially cost effective for hospitals.