Inappropriate fluid administration can lead to negative effects on patients’ health, and much attention should be paid to using effective fluid therapy oriented to preventing fluid overload. Still, the prediction of patients’ fluid responsiveness is a challenging task, and the problem of determining the amount of fluid to administer is unresolved in many cases. The purpose of this paper is to describe the solution to the identified problem, define the organization’s culture, discuss outcomes, describe the method to achieve them, and analyze the impact of outcomes on care.
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To solve the problem of predicting fluid responsiveness and avoiding the blood pressure elevation in patients, it is necessary to propose the following intervention: passive leg raise (PLR) should be used in healthcare facilities to increase venous return and predict fluid responsiveness without causing fluid overload. PLR techniques are proved to be accurate diagnostic measures that are used to determine fluid responsiveness in hypotensive adults and patients diagnosed with circulatory failure (Pinsky & Payen, 2005; Rex et al., 2004; Teboul, Monnet, & Richard, 2005). Pinsky (2015) and Cherpanath et al. (2016) also found that PLR can be used to stabilize blood pressure without provoking adverse effects and stimulating an increase in blood pressure. In current studies, Monnet and Teboul (2015), Monnet et al. (2016), and Monnet, Marik, and Teboul (2016) noted that PLR can be actively used to predict preload responsiveness because of the absence of any adverse effects on patients. Thus, recent studies support the conclusions made by researchers in the 2000s regarding the effectiveness of using PLR to improve blood pressure outcomes in hypotensive patients.
The proposed solution can be effectively implemented in the selected organization. The reason is that the hospital administration is interested in providing all the required resources to realize the project and increase the accuracy of testing fluid responsiveness with the help of PLR. Nurses and physicians working in this hospital are trained to use PLR in their practice, and the only barrier to applying this technique is the absence of guidelines to use PLR in all cases while working with hypotensive patients.
The implementation of the proposed intervention will lead to such expected results as the stabilization of blood pressure in hypotensive patients. After three months of using PLR, it will be possible to observe significant improvements in blood pressure outcomes associated with the effective use of the fluid therapy in those patients who were tested with the help of PLR in contrast to a control group of patients. As a result, fluid responsiveness will be determined accurately, and fluid overload will be prevented.
Method to Achieve Outcomes
The following plan should be addressed to achieve the determined outcomes:
- To develop guidelines for applying PLR and monitoring fluid responsiveness.
- To assign nurse practitioners to participate in the project.
- To design procedures for applying PLR.
- To assign patients to intervention and control groups.
- To implement PLR.
- To assess outcomes in two groups of patients and evaluate achievements.
Specific barriers to be addressed in this project are nurses’ lack of knowledge regarding the integration of PLR and assessment of volume responsiveness to make conclusions on the use of fluids. To address this barrier, nurses should complete additional training on using PLR before participating in the project.
The achieved outcomes will influence the quality of provided care, patient-centered care, efficiency of processes, and professional expertise. Thus, the quality of care for hypotensive patients will improve because of predicting fluid overload and adverse effects. The patient-centered care will also improve because of the possibilities to determine fluid responsiveness individually and with the help of the evidence-based technique. As a result, the processes of testing fluid responsiveness will become more efficient. Finally, nurses will improve their skills in fluid administration and treatment of hypotensive patients.
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The paper has described the solution with reference to the organization’s culture. The possible expected outcomes are analyzed along with methods to achieve them. The impact of outcomes is also described to accentuate the project’s significance.
Cherpanath, T. G., Hirsch, A., Geerts, B. F., Lagrand, W. K., Leeflang, M. M., Schultz, M. J., & Groeneveld, A. J. (2016). Predicting fluid responsiveness by passive leg raising: A systematic review and meta-analysis of 23 clinical trials. Critical Care Medicine, 44(5), 981-991.
Monnet, X., Cipriani, F., Camous, L., Sentenac, P., Dres, M., Krastinova, E.,… Teboul, J. L. (2016). The passive leg raising test to guide fluid removal in critically ill patients. Annals of Intensive Care, 6(1), 46-58.
Monnet, X., Marik, P., & Teboul, J. L. (2016). Passive leg raising for predicting fluid responsiveness: A systematic review and meta-analysis. Intensive Care Medicine, 42(12), 1935-1947.
Monnet, X., & Teboul, J. L. (2015). Passive leg raising: Five rules, not a drop of fluid! Critical Care, 19(1), 18-22.
Pinsky, M. R. (2015). Functional hemodynamic monitoring. Critical Care Clinics, 31(1), 89-111.
Pinsky, M. R., & Payen, D. (2005). Functional hemodynamic monitoring. Critical Care, 9(6), 566-578.
Rex, S., Brose, S., Metzelder, S., Hüneke, R., Schälte, G., Autschbach, R.,… Buhre, W. (2004). Prediction of fluid responsiveness in patients during cardiac surgery. British Journal of Anaesthesia, 93(6), 782-788.
Teboul, J. L., Monnet, X., & Richard, C. (2005). Arterial pulse pressure variation during positive pressure ventilation and passive leg raising. Functional Hemodynamic Monitoring, 3(2), 331-343.