Nxstage CRRT Documentation

[Aloe_sky]

I have a question for those that run NXStage CRRT regarding documentation. I’ve ran CRRT with nxstage for about 8 Years, at this new facility how I was taught to document makes absolutely zero sense to me. I reached out to the educator and asked how I should be documenting. It is totally different from how the nurses are documenting on the floor.

The nurses on the floor still use paper, do hand calculations and don’t even update the totals into the EMR. I am not use to paper so I get my totals from the EMR and document my pressures Into the EMR. 

The main problem is the CRRT totals for the hours (Pressures and total removed from the machine) the floor nurses document on a totally different hour from the machine.

So eg. I start the machine at 2131, the totals for 2131-2200 (which is actually 2131 to 2159 since results pop up at the start of 2200hrs) I document under 2100 hours those results. The nurses document everything 0 from the pressures to the total removed and document those actual totals the next hour, so for that example under 2200. I can’t wrap my head around why when it is not 0, the machine clearly has the results on the screen. 

Nobody, NOT ONE person can give me an answer. It’s simply the way it is. 

My manager simply said he’s not use to charting in the EMR because it’s too confusing, the staff said it is also. I get it because most nurses at this facility are in their late 60s but cerner is not the difficult! It clearly tells you where to put your results! 

Does anyone else chart it on a different hour? If so can you explain why. 

[chare]

3 hours ago, Aloe_sky said:

[...]

So eg. I start the machine at 2131, the totals for 2131-2200 (which is actually 2131to 2159 since results pop up at the start of 2200hrs) I document under 2100hours those results. The nurses document everything 0 from the pressures to the total removed and document those actual totals the next hour, so for that example under 2200. I can’t wrap my head around why when it is not 0, the machine clearly has the results on the screen. 

[...]

If I understand correctly you would document your 2200 results at 2100 (or in this case 2131 when you started CRRT), 2300 results at 2200, 2400 results at 2300, etc.  What is your rationale for this?  You wouldn't do this with any other vital signs or intake/output would you?

3 hours ago, Aloe_sky said:

[...]

my manager simply said he’s not use to charting in the EMR because it’s too confusing, the staff said it is also. I get it because most nurses at this facility are in their late 60s but cerner is not the difficult [emphasis added]! It clearly tells you where to put your results!

[...]

Do you really think this is appropriate?

[Okami_CCRN, BSN, RN]

I use Epic for CRRT documentation, our critical care wide policy is to document on the hour (2200, 2300, 0000, etc), what was pulled the previous hour, as well as machine pressures, warming devices, etc. 

So if fluid removal was 148ml for 2100-2159, then at 2200 you would document 148ml of fluid removal. Same thing if you your filter goes down at 0810, and you get it up and running by 0850 you would still document what the fluid removal was at 0900 for 0800-0859. 

Hope that helps!

[Aloe_sky]

On 11/18/2022 at 7:39 AM, chare said:

If I understand correctly you would document your 2200 results at 2100 (or in this case 2131 when you started CRRT), 2300 results at 2200, 2400 results at 2300, etc.  What is your rationale for this?  You wouldn't do this with any other vital signs or intake/output would you?

Do you really think this is appropriate?

that is exactly my point. To simplify it, if a dialysis nurse is running dialysis for 1 hour and starts at 2100hrs and she completes it at 2159 and the total removed for 2100hrs pops up at 2200hrs. That is not the same as taking vitals at 2200.

that is my point, this is why I want feedback from nurses that run CRRT with nxstage. If not, I guess to understand is if dialysis is running from 2100 to 2159 and the nurse has been removing fluid for that hour, when the total output for that hour pops up at 2200 that is not the same as vital signs. When you do your I and Os do you do it at the start of the hour or at the end of the hour?

it is very appropriate when the nurses themselves verbalized they are too old to learn the EMR and it is comfortable to them to do it on paper, a paper from an old company the hospital is no longer under and hasn’t been under for 3 years. They refuse to learn the computer system which they were introduced to almost 2 years ago. 

[Aloe_sky]

9 hours ago, Okami_CCRN said:

I use Epic for CRRT documentation, our critical care wide policy is to document on the hour (2200, 2300, 0000, etc), what was pulled the previous hour, as well as machine pressures, warming devices, etc. 

So if fluid removal was 148ml for 2100-2159, then at 2200 you would document 148ml of fluid removal. Same thing if you your filter goes down at 0810, and you get it up and running by 0850 you would still document what the fluid removal was at 0900 for 0800-0859. 

Hope that helps!

OK thank you! I’m just trying to wrap my head around why it’s not documented on the actual hour the fluid removal and pressures were measured. Did they ever explain? 

[Aloe_sky]

9 hours ago, Okami_CCRN said:

I use Epic for CRRT documentation, our critical care wide policy is to document on the hour (2200, 2300, 0000, etc), what was pulled the previous hour, as well as machine pressures, warming devices, etc. 

So if fluid removal was 148ml for 2100-2159, then at 2200 you would document 148ml of fluid removal. Same thing if you your filter goes down at 0810, and you get it up and running by 0850 you would still document what the fluid removal was at 0900 for 0800-0859. 

Hope that helps!

For our charting it says at the beginning of the hour document the I&Os from the previous hour (then the computer calculates what to program the CRRT machine to). 
 

Then in the next column it says at the end of the hour document the actual fluid removed (then it calculates how much was unremoved/removed) and then that gets carried over to the next hour in the calculation of what to program the machine to. 

[Okami_CCRN, BSN, RN]

I also let Epic calculate my IVF/Drip totals, and verify them for accuracy. We keep everything in the EMR because nephrology can view the CRRT progress remotely and call/secure message the primary RN with questions or concerns.

Doing away with paper has really enhanced and improved our process of managing these patients. 

[beachynurse, ASN, BSN]

my manager simply said he’s not use to charting in the EMR because it’s too confusing, the staff said it is also. I get it because most nurses at this facility are in their late 60s but cerner is not the difficult [emphasis added]! It clearly tells you where to put your results!

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Personally, I find this comment offensive. I am 60 years old with 37 years of Nursing behind me and I can use the computer just fine. It's definitely not a good idea to generalize, because it's usually an untrue statement. 

[chare]

5 hours ago, beachynurse said:

my manager simply said he’s not use to charting in the EMR because it’s too confusing, the staff said it is also. I get it because most nurses at this facility are in their late 60s but cerner is not the difficult [emphasis added]! It clearly tells you where to put your results!

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Personally, I find this comment offensive [emphasis added]. I am 60 years old with 37 years of Nursing behind me and I can use the computer just fine. It's definitely not a good idea to generalize, because it's usually an untrue statement. 

As do I, at 65 years of age with 25 years nursing.

This isn't an age issue.  It's a matter of nurses being to lazy to either learn it or do it, couple with a manager that lacks the intetistinal fortitude to make the staff use the EMR.

What I'm gobsmacked with js the fact that the neurologists are willing to put up with this.