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Fluid Resuscitation of the Pediatric Burn Patient: A Process Improvement Project
Stephanie Morgenstern, BSN, RN, CCRN, Dylan Stewart, MD, FACS, Jim Fackler, MD, Erik Su, MD, Traci Antes, MSN, RN, CPNP-AC, CPN, Leann McNamara, Pharm D, Kim Conner, Pharm D, Susan Ziegfeld, MSN, CPNP-AC, CPN, Lisa Puett, BSN, RN. Johns Hopkin's Children's Center, Baltimore, MD, USA.

Fluid resuscitation of the pediatric population requires a fine balance of preserving vital organ perfusion but avoiding complications of fluid overload. Specifically in the burn patient there is further complexity related to capillary leaking, massive insensible losses, systemic inflammation and the hypermetabolic response. After observing variations in practice and complications of fluid resuscitation this academic, level-one pediatric trauma and burn center identified the opportunity for process improvement in fluid resuscitation of their pediatric burn patients. An extensive literature review was conducted, including existing nurse-managed algorithms from other burn centers, the American Burn Association's published guidelines, and existing research on burn pathophysiology and resuscitation outcomes. A hypothesis that a defined policy for fluid resuscitation practice would improve outcomes and limit complications of fluid overload was formed. The policy was drafted with algorithms for urine output based nurse-managed fluid resuscitation, physician-managed vasopressor and colloid introduction, and nurse-managed post-resuscitation interventions. Implementation included extensive nursing education including case-study reviews and in-service education with burn resource nurses. Prescribers were given access to the case-study review, attended lecture-style education on the new policy content, and were encouraged to review independently. In conclusion, this institution implemented a process improvement project to increase the precision of the fluid resuscitation of their pediatric burn patients.


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