Inland Northwest Chapter of AACN

Acute and Critical-Care Symposium

Spokane Convention Center
334 West Spokane Falls Boulevard
Spokane, WA 99201

Monday, March 11, 2019 at 7:00am PT - Tuesday, March 12, 2019 at 4:30pm PT
This event has ended.

334 West Spokane Falls Boulevard, Spokane, WA 99201

Info

Speaker(s)

Megan Brunson, Patty Hahn, Nicole Kupchik, Elizabeth Mattox, Jerry Zimmerman and many more!

Credits Offered

This event offers 12.25 contact hours to attendees.
Accreditation Info: This continuing nursing education activity was approved by the American Association of Critical-Care Nurses, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. ANCC Accredited Approver number A0012..


Additional Information

Hello Acute & Critical-Care Nurses of the Inland Northwest and beyond,

     Please join us for our annual two-day Acute & Critical-Care Symposium on March 11th and 12th, 2019 in Spokane, WA.  This year the Spokane Convention Center is playing host to our event; it is conveniently located in downtown Spokane along the shores of the Spokane River and only 1.4mi from I-90.  Parking is available directly on site in a covered lot for $8.00/day (Parking Lot 1 - see attached PDF file under the Handouts Section).

     We are planning two full days of lectures on a myriad of topics including cardiology, nephrology, sepsis, ethics, and more.  See the agenda for each day of the event to see specific speakers and their topics; as we receive information from our presenters we will update the agendas.  We are happy to announce our keynote address will be by the AACN's President-Elect, Megan Brunson.  Other nationally recognized speakers include Nicole Kupchik and Elizabeth Mattox.  We will do our best to keep the agendas updated, but please understand that speakers, topics, and time slots may be subject to change.  During registration, you will be asked to select break out sessions.  These are not required selections, but are designed to give us a head count for each presentation.  Our break out sessions should have adequate space to accomodate all who wish to attend.  On the second day, 3/12/19 one talk is sponored by NovaBiomedical and we have been approved for 1 CERP hour (vs. CE hr) for this talk.  This continuing nursing education activity was approved by the American Association of Critical-Care Nurses, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. ANCC Accredited Approver number A0012.

     When you register, you will have the option to purchase a Two Day ticket or a Single Day ticket for Monday or Tuesday.  As always, AACN members will receive preferred pricing.  Early Bird discounts will be in effect until February 5th, 2019. 

     Please email us prior to registration through the website or at INWC2018@gmail.com to receive information about nursing student and retired nurse pricing options.  This year you have the option to securely pay on-line with a credit card.  Checks will also be accepted. Please make checks out to INWC AACN and maid to P.O. Box 2190 Spokane, WA 99210.  Note that your registration will not be confirmed until the check is received and manually processed into the system.  Thank you for registering for this event, if you have any questions please contact us by e-mail. 

Refund Policy: For some folks we know that schedules are not finalized yet, which is party why we extended Early Bird Registration.  But if something comes up, we can offer a full refund for the cost of the symposium and parking if we are notified in writing or by email to INWC2018@gmail.com by February 18th.  We can offer a 50% refund of symposium registration and parking fees until March 1st.  After March 1st all registrations are non-refundable.  We cannot refund the service fee for registering, only the cost of the ticket and parking if you selected that option.  Thank you.

Event Agenda

Acute and Critical-Care Symposium

Event Agenda

Monday, March 11, 2019 at 7:00am PT - Tuesday, March 12, 2019 at 4:30pm PT

All times listed in Pacific Time (US & Canada).
Download event agenda (PDF)

Monday, March 11, 2019

  • 8:00am - 9:15am

    Our Voice, Our Strength: Powerful Beyond Measure

    Megan Brunson MSN, RN, CNL, CCRN-CSC (AACN President-elect)
    1.25 CE Credits

    The world of healthcare is ever changing and evolving. Outside forces often drive the acute and critical care nursing practice. How can we, as nurses, take charge of our practice within the healthcare world of change? It might be surprising what is within a nurse’s locus of control. This presentation explores the characteristics of positive deviance and how being a positive deviant can influence how we practice. The presentation will explore the work of the IHI Break the Rules initiative and Amy Cuddy’s work on Presence. Attendees will contemplate the ways in which they can ACT their way into a new way thinking and a new way of being.

    Objectives:
    Identify characteristics of positive deviance.
    Explore a posture of influence and power.
    Describe how an individual can use their voice and their strength to act their way into a new way of being
    CERP Category C

  • 9:30am - 10:30am

    Case Studies in Medical Ethics

    Dr. Andi Chatburn, DO, MA (Hospice/Palliative Care Specialist and Ethicist at Providence Sacred Heart Medical Center)
    1.0 CE Credit

    Learning Objectives:
    ·         Introduce Clinical Ethics as a way of being with one another in community

    ·         Explore trends in Critical Care Ethics and case examples that inform those trends

    ·         Apply principles of ethics to cases through a 4-box analysis

    CERP Category B

  • 9:30am - 10:30am

    Promoting Value in the ICU by Practicing Less is More

    Dr Jerry Zimmerman, MD, PhD, FCCM (President Society of Critical-Care Medicine)
    1.0 CE Credit

    • The house that value built
    Quality, cost, delivery, safety, informed and engaged staff, patients and families first
    • Overuse and waste as a patient safety issue
    • Promoting Value In Critical Care By Practicing, “Less Is More”
    1. Begin with one or more elements of, Choosing Wisely.
    2. Incorporate the ICU Liberation A through F bundle as "usual care" for every ICU patient.
      3. Promote a learning health care environment in the ICU
    • Choosing Wisely
    1. Don’t order diagnostic tests at regular intervals.
    2. Don’t transfuse red blood cells in hemodynamically stable, non-bleeding patients with a reasonable hematocrit.
    3. Don’t prescribe parenteral nutrition in adequately nourished patients during their first week.
    4. Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten that sedation.
    5. Don’t continue life support for patients at high risk for death or severely impaired functional recovery without also offering comfort care only.
    • Other wise choices
    Less fluid
    Less oxygen
    Less radiographs
    Less antimicrobials
    Less immobilization
    • ICU Liberation, as clinical standard work for “usual care” in the ICU, promotes less is more
    A = Always prioritize treatment of pain.
    B = Undertake scheduled daily spontaneous breathing trials and spontaneous awaking trials.
    C = Be cognizant of the choice of drug classes utilized for sedation.
    D = Monitor for and minimize delirium.
    E = Facilitate early mobilization.
    F = Empower and engage families in the care plan.
    • Complete ABCDEF bundle performance was associated with lower likelihood of seven outcomes:
    Hospital death within 7 days (AHR 0.32 [0.17—0.62])
    Next-day mechanical ventilation (AOR] 0.28 [0.22—0.36])
    Coma (AOR, 0.35 [0.22–0.56])
    Delirium (AOR 0.60 [0.49–0.72])
    Physical restraint use (AOR 0.37 [0.30–0.46])
    ICU readmission (AOR 0.54 [0.37– 0.79])
    Discharge to facility, not home (AOR 0.64 [0.51–0.80)
    • Waiting, Waste and ICU Liberation
    1. The biggest waste in medicine is waiting.
    2. The unwritten engine of ICU Liberation is weaning
    3. Proactive, scheduled weaning will reduce waiting.
    4. Reducing waiting in the ICU will increase value:
    By improving quality
    By decreasing waste (unnecessary costs)
    • Learning Health Care Environment
    1. Attributes
    a. Multidisciplinary care
    b. Shared educational model
    c. Translational/clinical/quality improvement research
    2. Benefits
    a. Facilitates delivery of high value patient and family care
    b. Promotes wellness for the community ICU practitioners
    3. Components
    a. Practice evidence-based medicine whenever possible.
    b. Design clinical standard work modules to reduce practice variation; conduct iterative c. Plan/Do/Study/Act cycles; display outcomes of continuous process improvement activities.
    d. Participate in interdisciplinary teaching/education.
    e. Demand a culture of safety.
    f. Support clinical and translational research.
    g. Promote wellness and resiliency for ICU providers and patients and families alike.
    • Value in everyday ICU practice
    1. We should treat our patients and not laboratory test results.
    2. We should develop and utilize clinical standard work.
    3. We should "wean" when appropriate to reduce waiting,
    but resist the temptation to always “just do something” when watchful waiting may improve clarity.
    CERP Category C

  • 10:45am - 11:45am

    Getting the Fluids Right: It’s Time to Stop Guessing!

    Nicole Kupchik MN, RN, CCNS, CCRN, PCCN-CMC, Critical-Care CNS
    1.0 CE Credit

    Objectives:
    Discuss the latest Sepsis Guidelines & CMS Core Measure recommendations regarding fluid resuscitation
    Discuss the timing, type & amount of fluid to use in resuscitation
    Describe the concept of fluid responsiveness & stroke volume optimization
    CERP Category A

  • 10:45am - 11:45am

    Night Shift: How Nurses and Patients Can Adapt to the Dark

    Megan Brunson MSN, RN, CNL, CCRN-CSC (AACN President-elect)
    1.0 CE Credit

    Abstract
    On the surface, day and night-shift can appear the same, however, an experienced nightshift nurse will tell you the differences are enormous when it comes to patient care and a nurse’s work-life balance. Typically, novice nurses or nurses new to facilities are hired to work nightshift even though there are limited resources and support. Nurses need to have an understanding of the physical and physiological impact the shift has on their care delivery, their own health, and the resources available to them. Looking first at the impact to patients, The Journal of Intensive Care Medicine reported patients frequently experience poor sleep, characterized by sleep disruptions, loss of circadian rhythms, and lack of restorative rest in the hospital environment. Sleep architecture is rarely considered as it relates to coordinating patient care. The Journal of American Medical Association recognized frequent waking of patients has been linked to patient dissatisfaction, increased readmissions, and increased safety risks. It is also important to consider the impact to nightshift workers. According to studies, nightshift confronts more health and safety risks than other shift and requires greater effort to balance one’s personal needs and restorative sleep. The National Institute of Occupational Health and Safety believes in educating nurses on the individual differences that influences nurses’ ability to adjust to being on the opposite side of the clock. In spite of these challenges, nightshift nurses exhibit greater clinical autonomy along with creativity and strategies to combat fatigue and sleeplessness. By exploring the differences between day and night-shift, healthcare leaders can advocate for patients’ and nurses’ needs in a 24-hour care environment to improve outcomes, decrease length of stay, and provide tactics for nurses to be resilient who work at night.

    Objectives:
    Explore the physical and physiological impact of nightshift on nurses and patients
    Provide resources to manage working nightshift as a nurse by identifying steps to improve work-life balance
    Discuss various approaches to support healthier environment for nightshift nurses and minimize risk to patients in the hospital environment
    Understand how patient care is impacted on nightshift
    CERP Category A

  • 12:00pm - 12:45pm

    Differentiating Thrombotic Microangiopathies/Atypical Hemolytic Uremic Syndrome

    Dr Samer Banihani, MD

    Alexion is sponsoring lunch and this presentation, no CE will be offered.

  • 1:00pm - 2:00pm

    Critical Care Studies You Should Know About

    Nicole Kupchik MN, RN, CCNS, CCRN, PCCN-CMC, Critical-Care CNS
    1.0 CE Credit

    Identify current controversial clinical topics and discuss the types of research questions that may arise
    Describe critical care studies which advance critical care nursing by increasing understanding of concept related to AACN priorities
    Discuss translation strategies, research implications and areas for further study based on AACN’s priorities and presented studies
    CERP Category A

  • 2:15pm - 3:15pm

    APP's in Critical-Care: Where They've Been and Where They're Going

    Alison Houchin, ARNP and Kathryn Al-Hafian, ARNP (APP's with The Intensivist Group at Providence Sacred Heart Medical Center)
    1.0 CE Credit

    PAST
    Where have we been and where are we going? The forces at play moving advanced practice forward
    Anticipated growth by 130% (2008-2025)

    PRESENT
    Impact of the APP on
    Quality
    Outcomes
    Pt satisfaction
    Cost
    Affordable care act
    Education, present
    Scope of practice
    Reimbursement policies
    Shortage of faculty

    FUTURE
    Educational competences
    Implementation of non-hierarchal team based care
    Inter-professional education/team based collaboration
    Opportunities vs challenges
    New frontiers for Advanced Practice Nursing (beyond primary care)
    Expansion of the rose (drivers of expansion)
    CERP Category B

  • 2:15pm - 3:15pm

    Cardio-Renal Syndrome

    Dr. Chia Hsu, MD (Providence Kidney Care)
    1.0 CE Credit

    Objectives:
    Define Cardiorenal Syndrome
    Review prevalence
    How to classify various forms of CRS
    Review Case Studies
    Overview of lab work needed to help diagnose CRS
    Management strategies for CRS
    Review of diuretics
    CERP Category A

  • 3:30pm - 4:30pm

    Sepsis: Why the big deal?

    Katie Schatz, ARNP
    1.0 CE Credit

    Objectives:
    Discuss why rapid recognition and treatment of Sepsis is critical
    Review criteria for sepsis, severe sepsis and septic shock
    Identify the key concepts in the pathobiology of sepsis.
    Identify differences between Sofa, qSofa, SIRS criteria
    Apply the latest CMS guidelines and the Surviving Sepsis guidelines published in 2018 to clinical scenarios.
    CERP Category A

  • 3:30pm - 4:30pm

    Comparison of Trauma Patients Between Cameroon, West Africa and Spokane, WA

    Dr. Timothy Bax, MD (General Surgeon Providence Sacred Heart Medical Center)
    1.0 CE Credit

    Objectives:
    Define facilities, resources and patient populations in both locations
    Compare statistics of mechanism of injury
    Compare statistics of resulting types of injuries
    Compare statistics on state of trauma patient on initial presentation
    Review statistics of disposition of patients from ER
    Review limits of this data set
    Offer recommendations based on data
    CERP Category A

Tuesday, March 12, 2019

  • 8:00am - 9:00am

    Your Voice: Transforming Clinical and Fiscal Outcomes

    Debbie Brinker, RN, MSN, BSN (Professor of Nursing at Washington State University)
    1.0 CE Credit

    Objectives
    Describe an innovative program that assists staff nurses to create improvements that achieve positive patient/family, clinical, and fiscal outcomes.
    Discuss how to develop, implement, and sustain an innovative change project that targets a clinical outcome on the unit.
    Explain and share tools, methods and activities that support a successful foundation for change.
    CERP Category C

  • 8:00am - 9:00am

    Assessing Heart Tones, A Lost Art?

    Patty Hahn, RN, MN, ARNP (faculty University of Washington MEDEX)
    1.0 CE Credit

    1. Identify the underlying pathophysiology associated with the following heart sounds:
    Pericardial friction rub
    Cardiac murmurs
    S3 ventricular gallop
    S4 atrial gallop

    2. Discuss underlying disease processes associated with the following abnormal heart sounds:
    Pericardial friction rub
    Cardiac murmurs
    S3 ventricular gallop
    S4 atrial gallop

    3. Discuss the importance of heart sound assessment in making an accurate medical diagnosis.
    CERP Category A

  • 9:15am - 10:15am

    EP update: VT ablation and Leadless Pacemakers

    Dr. Patrick Henley, DO (Cardiologist - Heart Clinics Northwest)
    1.0 CE Credit

    Catheter Ablation of Ventricular Tachycardia

    Ventricular Tachycardia
    Causes
    Sudden Cardiac Death
    Treatment
    Catheter Ablation Therapy
    Patient selection, risks/benefits
    CT, Echocardiography, MRI imaging involved
    Catheters and therapies they deliver, access to patient’s heart
    Procedure in EP lab – sedation requirments – anticoagulation
    Inta cardiac vs epicardial ablation
    Post op care of patients with VT ablations
    Groin, neck site care,bedrest
    Follow up care

    Leadless Pacemakers

    Overview of traditional pacemakers
    Leadless pacemakers – how they differ from traditional pacemakers
    Selection of patients who will benefit from leadless pacemaker systems.
    Follow up care of leadless pacemaker patients.
    CERP Category A

  • 9:15am - 10:15am

    Clinical and Regulatory Update for Hospital Bedside Glucose Testing - Recent FDA Clearance & Consequences

    Evan Ntrivalas MD, PhD
    1.0 CE Credit

    The importance of point-of-care (POC) glucose testing in the management of dysglycemia of hospitalized patients will be discussed. Using peer-reviewed publications and clinical case studies, the potential negative effects of inaccurate POC glucose results, due to interferences related to patients’ pathophysiologic factors and exogenous substances, will be presented. Additionally, data will be presented highlighting the importance of accurate POC glucose meter results for improved clinical outcomes and patient safety.
    Additional objectives - At the end of the session, attendee will be able to
    Review FDA activity for Glucose Meter Manufacturers
    Describe StatStrip critical care clearances and labelling
    Summarize arterial & venous claim study design + results
    Report on the FDA Advisory Panel presentations
    Summarize capillary claim study design + results
    Discuss implications for use of glucose meters
    *This presentation is sponsored, approval is pending with AACN, but should be eligible for 1h CERP category A credit. CERP hours count toward certification renewal, but NOT toward license renewal like CE.

  • 10:30am - 11:30am

    Sepsis Rollercoaster Ride: Sepsis from a Patient and Family Perspectives

    Sharon Hansen, RN, MN, CCRN (2018 Sepsis Hero, Lecturer at UW Tacoma Nursing & Leadership Program
    1.0 CE Credit

    Objectives:
    Using a case study, verbalize the effect of sepsis on the individual and family
    Discuss post-sepsis syndrome, challenges, and resources
    CERP Category B

  • 10:30am - 11:30am

    Opiates and Opioids: Washington Poison Center’s Experience

    Jared O'Connor, MPH (Educator - Washington Poison Center)
    1.0 CE Credit

    Abstract:
    Prescription drugs, including opioids, were the leading cause of unintentional death in Washington last year far outpacing motor vehicle accidents. This presentation will give an overview of the various drugs that are involved in the epidemic including Fentanyl, Carfentanil, Krokodil, Kratom, Naloxone and others. Further, this presentation will discuss factors that contributed to creation of the epidemic, where trends are taking us, and the Washington Poison Center’s experience.
    Following this presentation, the audience will be able to:
    · Identify the leading opioids that are abused in Washington
    · Discuss the limitations of naloxone as a lifesaving drug
    · List factors that contributed to the Opioid Epidemic
    CERP Category A

  • 12:45pm - 1:45pm

    Peripheral Vascular Complications

    Elizabeth Mattox, MS, MSN, RN, ARNP, CPPS
    1.0 CE Credit

    By the conclusion of the session, learners will be able to:

    Describe complications related to peripheral vascular access devices (PVADs)
    Utilize the the prevention, detection and recovery framework to patient harm related to complications
    Evaluate personal practice related to management of PVADs

    Session Outline

    Introduction
    Type of PVADs
    Prevalence of use
    Perception of risk
    Legal implications

    Prevention – Detection – Recovery framework

    Phlebitis
    Definition
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies

    Infiltration & extravasation
    Definitions
    Infiltration
    Extravasation
    Vesicant
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies

    Air embolism
    Definition
    Clinical scenarios resulting in air embolism
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies

    Tubing and catheter misconnections
    Definitions
    Examples
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies

    Device fragment embolization (in brief)
    Definitions
    Mechanism of fragmentation and embolization
    Signs & symptoms
    Prevention – Detection – Recovery strategies

    Retained peripheral vascular access device (in brief)
    Definition and risk
    Prevention – Detection – Recovery strategies

    Radial nerve injury (in brief)
    Mechanism of injury
    Prognosis
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies

    Tourniquet retention (in brief)
    Definition
    Signs & symptoms
    Risk factors
    Prevention – Detection – Recovery strategies
    CERP Category A

  • 2:00pm - 3:00pm

    From Osler to Perloff: Why There Are Now More Adults than Children Living with Congenital Heart Disease and Why You Should Care

    Dr. Jeremy Nicolarsen, MD, FACC (Director of Providence Adult and Teen Congenital Heart Program)
    1.0 CE Credit

    ❖ Understand how the success of our predecessors has changed the face of congenital heart disease medicine
    for us…forever.
    ❖ Learn key concepts in the care of adults with congenital heart disease.
    ❖ Learn about the Providence Adult and Teen Congenital Heart Program (PATCH)
    CERP Category A

  • 2:00pm - 3:00pm

    Care of the Patient with ARDS

    Dr. Djamshed "Jama" Samiev, MD (Critical Care Physician with The Intensivist Group at Providence Sacred Heart Medical Center)
    1.0 CE Credit

    Acute Respiratory Distress Syndrome- History
    What is it? Why is it important? Etiology.
    Clinical Picture
    Diagnostic Criteria- Incorporating the Berlin Criteria
    Differential Diagnoses- Cardiogenic Pulmonary edema, Diffuse alveolar hemorrhage, Acute PE, Acute interstitial PNA, etc.
    Imaging- CT, CXR
    Misdiagnosis
    Pathophysiology- 3 phases
    Exudative Phase- First 7 days
    Proliferative Phase- 7-21 days
    Fibrotic Phase- 21+ days
    Treatment of ARDS
    Strategies that improve outcome and mortality
    Lung Protective Ventilation
    ARDS Network, what does the research tell us?
    Principals of treatment, Evidence of Benefit, Optimal Goals
    Volutrauma, Biotrauma, Atalectrauma
    Neuromuscular Blockade
    Proning
    Strategies that feel good, but don’t improve outcome and mortality
    Nitric Oxide/Epoprostenol
    APRV-Can increase mortality
    Recruitment maneuvers-Can increase mortality
    General Principals
    Recognize and treat underlying medical disorder
    Minimize procedures and complications
    Recognize and treat nosocomial infections promptly
    Provide adequate nutrition
    Prophylaxis treatment
    CERP Category A

  • 3:15pm - 4:15pm

    Science of Gratitude

    Philip Watkins, PhD (Professor of Psychology Eastern Washington University)
    1.0 CE Credit

    Participants will be able to:
    Define gratitude as an emotion and as a disposition
    Understand how gratitude is important to emotional well-being
    Understand how gratitude encourages meaning in life
    Learn gratitude techniques that help one to reorient to a more positive perspective
    Understand who benefits most from gratitude.
    CERP Category B

Handouts

Directions and Parking Info (2.4 MB)

Directions to Spokane Convention Center from 1-90 as well as locations of multiple parking lots nearby, we highly recommend the lot labeled "1" as it is directly connected to the venue and is covered.

AACN Explanation of CCRN/PCCN Renewal CERP requirements (690 KB)

This file explains how to calculate CERP or Continuing Education Recognition Points.  

Day One - Getting the Fluids Right in Sepsis (Kupchik) (8.7 MB)

Day One - Getting the Fluids Right in Sepsis (Kupchik)

Day One - Clinical Studies You Should Know About (Kupchik) (18 MB)

Day One - Clinical Studies You Should Know About (Kupchik)

Day Two - VT & Wireless Pacemakers (Henley) (64 MB)

This file is formated for Keynote (the apple version of powerpoint), sorry for the inconvenience.