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.
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 CreditsThe 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 CreditLearning 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 CreditObjectives:
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 CreditAbstract
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 CreditIdentify 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 CreditPAST
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 facultyFUTURE
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 CreditObjectives:
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 CreditObjectives:
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 CreditObjectives:
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 CreditObjectives
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 Credit1. Identify the underlying pathophysiology associated with the following heart sounds:
Pericardial friction rub
Cardiac murmurs
S3 ventricular gallop
S4 atrial gallop2. Discuss underlying disease processes associated with the following abnormal heart sounds:
Pericardial friction rub
Cardiac murmurs
S3 ventricular gallop
S4 atrial gallop3. 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 CreditCatheter 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 careLeadless 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 CreditThe 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 CreditObjectives:
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 CreditAbstract:
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 CreditBy 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 PVADsSession Outline
Introduction
Type of PVADs
Prevalence of use
Perception of risk
Legal implicationsPrevention – Detection – Recovery framework
Phlebitis
Definition
Signs & symptoms
Risk factors
Prevention – Detection – Recovery strategiesInfiltration & extravasation
Definitions
Infiltration
Extravasation
Vesicant
Signs & symptoms
Risk factors
Prevention – Detection – Recovery strategiesAir embolism
Definition
Clinical scenarios resulting in air embolism
Signs & symptoms
Risk factors
Prevention – Detection – Recovery strategiesTubing and catheter misconnections
Definitions
Examples
Signs & symptoms
Risk factors
Prevention – Detection – Recovery strategiesDevice fragment embolization (in brief)
Definitions
Mechanism of fragmentation and embolization
Signs & symptoms
Prevention – Detection – Recovery strategiesRetained peripheral vascular access device (in brief)
Definition and risk
Prevention – Detection – Recovery strategiesRadial nerve injury (in brief)
Mechanism of injury
Prognosis
Signs & symptoms
Risk factors
Prevention – Detection – Recovery strategiesTourniquet 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 CreditAcute 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 CreditParticipants 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 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.
This file explains how to calculate CERP or Continuing Education Recognition Points.
Day One - Getting the Fluids Right in Sepsis (Kupchik)
Day One - Clinical Studies You Should Know About (Kupchik)
This file is formated for Keynote (the apple version of powerpoint), sorry for the inconvenience.