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Crit Care Nurse. 2013 Feb;33(1):25-35. doi: 10.4037/ccn2013385.

Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project.

Author information

  • 1University of Colorado Hospital, Mail Stop F796, 12605 East 16th Avenue, Aurora, CO 80045, USA. kyra.fahlstrom@uch.edu

Abstract

BACKGROUND:

Burn resuscitation, including titration of fluids and administration of colloids, is often driven by physicians' orders. Inconsistencies in burn resuscitation cause overresuscitation, which has adverse consequences.

METHODS:

Retrospective chart reviews were completed to evaluate fluid resuscitation and complications for 12 months before and after development and implementation of a nurse-driven burn resuscitation protocol.

RESULTS:

Before implementation of the protocol, results at 24 hours after injury indicated that 58% of patients were overresuscitated, had a serum level of lactate of at least 2 mmol/L (100%), and had complications (pulmonary edema 20%, abdominal compartment syndrome 7%, acute lung injury/acute respiratory distress syndrome 30%) within the first 5 days. Two outcomes differed from before to after implementation of the protocol: serum level of lactate at 24 hours (t(37.8) =2.38, P =.007) and central venous pressure at 48 hours (t(31) =2.27, P =.03). After implementation of the protocol, no patients had abdominal compartment syndrome develop.

CONCLUSIONS:

Implementation of the nurse-driven burn resuscitation protocol improved nurses' awareness and assessment of fluid status during resuscitation and improved patients' outcomes.

PMID:
23377155
[PubMed - indexed for MEDLINE]
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