Kansas City Project Seeks to Ensure Accurate Analysis of Hemodynamic Waveform
Tom Ahrens joined members of the Kansas City WAVE
Project training group at the 14th annual critical care nursing
symposium in Kansas City, Mo.
By Caryl Goodyear-Bruch, RN, MSN, CCRN
President, Greater Kansas City Chapter
A project designed to ensure accuracy of hemodynamic waveform analysis for optimal treatment interventions in critically ill patients has been instituted by the Greater Kansas City Chapter of AACN.
Known as the Kansas City Heymodynamic Waveform Analysis, Validation, and Education (WAVE) Project, the program responds to a call for better education of physicians and nurses in the area.
Using the research- and theory-based Hemodynamic Protocols for Practice and the expertise of Tom Ahrens, RN, DNS, CCRN, CS, a past AACN national board member, the chapter brought together a panel of educators from 18 Kansas City Area hospitals to assist in developing a change in practice in accordance with the most current literature.
Ensuring accuracy of waveform analysis will contribute greatly to treatment of the critically ill patient. Consistent education and validation of current concepts in hemodynamic monitoring was the essence of the project, with all hospitals adopting the same practices and providing the resources to help change practice.
The following practices were adopted as the minimum expectation to accurately analyze hemodynamic waveforms:
• Appropriate referencing related to patient body position will be used to obtain accurate pulmonary artery and arterial pressure measurements.
• Instead of digital values, graphic printing for measurement of hemodynamic values will be used.
• The optimal dynamic response for troubleshooting hemodynamic values will be used. (Square wave test)
• ECG will be correlated to hemodynamic waveforms for improved accuracy of measurements.
• Mean arterial pressure will be calculated using systolic value plus diastolic value divided by two with elevated heart rates.
• Mean “a” wave pressure will be calculated from graphic printing for accurate RA and PCWP values.
• Accurate RA and PCWP values will be obtained in light of elevated “v” waves.
• Analysis of the RA and PCWP waveforms will be accurately measured at end-expiration, both with spontaneous and mechanically ventilated assisted respirations.
Project leaders Lisa Riggs, RN, MSN, CCRN, CS, past president of the chapter, and Carol Cleek, RN, MSN, CS, president-elect, conducted the first meeting of the expert training group in November 2000. They fully introduced the project and the objectives to meet, and outlined the timetable for implementation over the next year. Because having representation from all of the hospitals in the Kansas City area was important, letters and follow-up phone calls were made to seek support for this project.
The project initially focused on a group of expert hospital educators to learn appropriate waveform analysis. These educators were to then contemplate an educational plan that would fit their institutions and analyze their barriers to implementation of these standard practices. Opportunities existed to network with colleagues about institutional barriers. The WAVE project group developed policy and procedures, as well as an educational plan.
The decision to do a pre- and post-test was approved by the group. Self-learning packets were decided for the main educational endeavor, with follow-up support from the educators at each of the institutions. The content change was divided into three self-learning packets. The first would address leveling to the phlebostatic axis and square wave testing. The second would cover waveform analysis with correlation of PAP, CVP, and PAOP waveforms with ECG on graphic printout, reading the “a” wave for CVP and PAOP values. The third would speak to obtaining CVP and PAOP values with abnormal conditions, such as elevated “v” waves, atrial fibrillation, or ventricular paced rhythms, and identification of end-expiration to analyze PA catheter waveforms.
The self-learning packets were established by meeting the standards as set forth in the Program Approval Guide of AACN Certification Corporation. Continuing education units are planned through the chapter’s approval number under the umbrella of the national office. The WAVE Project group set completion dates for the pre-test and the packets. Currently, we are implementing the pre-test and the first packet will be available as soon as the pre-test is done.
It was important for us to ensure that we were correct in our content change and to have an expert to consult throughout the project. We were fortunate that Ahrens could consult on this project. The chapter board approved money to cover the consulting costs. However, we also secured some funding through vendors.
Ahrens has been invaluable to us in the development of the project and spoke at our spring symposium in March 2001, when the WAVE Project was introduced.
By participating in this collaborative research-based practice change, we have impacted quality of care through implementation of research-based and theory-based practice protocols. The WAVE Project can be used as a model for change in an efficient, cost-effective manner, while ensuring that positive patient outcomes are enhanced.
Circle of Excellence: President’s Award Goes to Connecticut Chapter
The Western Connecticut Chapter of AACN, Danbury, Conn., received the Chapter President’s Award for 2001 for best exemplifying the “Make Waves: The Courage to Influence Practice” theme of 2000-01 AACN President Denise Thornby, RN, MS.
This award, which is part of the AACN Circle of Excellence recognition program, was presented to the Western Connecticut Chapter at AACN’s National Teaching Institute™ and Critical Care Exposition in May 2001 in Anaheim, Calif.
Receiving honorable mention for the award was the Heart of the Piedmont Chapter, Kernersville, N.C.
Following are excerpts from the exemplars submitted in connection with this award.
Western Connecticut Chapter
The Western Connecticut Chapter is not a chapter in name only. The number of educational opportunities provided to the membership, as well as community service projects performed make this chapter of 38 members a major contributor and has indeed demonstrated the theme envisioned by President Denise Thornby, “Make Waves: The Courage to Influence Practice.”
The Chapter’s board members have established a strong educational program that brings a variety of topics each month to the chapter and healthcare community. Nine educational programs are offered throughout the year. The most personal topic, “Experiencing Breast Cancer: Through Our Colleagues Eyes,” was presented during Breast Cancer Awareness Month. In this program, a panel of breast cancer survivors who are all members of our healthcare team discussed their experiences. They were joined by an RN who spoke on the treatments and disease process. They also participated in the planning of our local Fall Regional Meeting.
In addition, we participated in Career Days at New Fairfield High School. We interacted with approximately 55 sophomores, talking with them about the challenges and rewards of critical care nursing, including: discussions about assessment, vital signs and drug calculations, as well as salaries,work hours and nursing opportunities. We have also broadened our membership to include nursing students from our local university. We now have an instructor from the program as a member and she encourages her students to attend our monthly meetings.
Other community service projects we embarked upon included renovating a room in a local shelter for abused and battered women with children and putting an advertisement on the local cable channel: “Tired of warnings to buckle up? That may be your last warning. It’s better than the alternative.” We were proud as an organization to include AACN as the sponsor.
This commitment to education and interest in the community makes our chapter a vibrant and vital component in the healthcare field. The opportunities designed by our leadership and provided to our chapter create a learning environment that extends well beyond our small chapter.
Heart of the Piedmont Chapter
Although our chapter was struggling, we now are “making waves”! Through commitment, courage and support by the AACN National Office and resources, we have increased our membership eight-fold. Our nurses are participating in the chapter committees, educational activities and community events.
The theme of “Make Waves: The Courage to Influence Practice,” was not on our minds initially. In fact, our membership recruitment team went over the rainbow of ideas on recruitment. A kick-off membership drive drew lots of interest as the nurses played games, such as “Dorothy Gets Her CCRN.”
The first meeting, which included NTI attendees presenting their thoughts on the annual conference, was a success. Community service projects were high on the list as many members participated in the juvenile diabetes walk and registered participants for the Heartstrides 5K and Fun Run to raise money for cardiac rehab patients.
We “drew blood,” or at least learned about blood, when an area physician updated us on the finer aspects of bloodbanking.
Then, we joined forces with the North Carolina Nurse Association, District #9, to learn how nurses can make waves in the political scene.
We also supported the efforts of the High Point AIDS Coalition by attending the vigil and march. In the hospital lobby we presented red ribbons to visitors and staff in recognition of World AIDS Day.
New challenges were faced when the needs assessment results were tabulated and educational programs planned. New technologies were discussed as we learned about a new procedure being performed in High Point, TMR. More excitement built as we displayed AACN information at the NCNA Student President’s Day. We were calmed by a medical legal presentation and fears were alleviated as we confirmed our positive practice habits.
The goals of our chapter this year were to create a solid foundation of commitment from the nurses in our area and increase membership participation in AACN-sponsored events. Although we haven’t finished our work, it is a great beginning as we make waves in High Point.
On the Leadership Trail, the Journey Is Most Important
Close to 200 chapter leaders from throughout the country gathered in Anaheim, Calif., in May 2001 for the second annual Chapter Leadership Development Workshop.
Nominated by their chapters to attend the daylong workshop, conducted during AACN’s National Teaching Institute™ and Critical Care Exposition, the participants were guided on a “Journey into New Discoveries.”
In addition to fun activities designed to renew the participants’ spirit and focus in the nursing profession, the participants heard from representatives of the national AACN leadership team, who shared some of the leadership lessons they have learned.
Denise Thornby, RN, MS, 2000-01 AACN president, set the tone for the day’s activities. She stressed that chapter leaders play an important role in making it possible for AACN to fulfill its mission.
The organization is not about the board of directors, the staff or the NTI, she said, but about the daily activities and “trying to make a difference with our mission.”
“How we do that is through [the chapters].”
Chapter activities should be significant and meaningful, Thornby continued. However, everyone involved should leave with a sense of time well spent and a sense of community and fun.
“There will be times when it’s rocky, when people don’t come to your activities, or it doesn’t turn out exactly how you planned,” she said. “You just have to laugh and remember it’s part of the journey.”
She reminded the chapter leaders that the AACN national board and staff are available to help with the journey.
Michael L. Williams, RN, MSN, CCRN, 2001-02 AACN president, spoke about his own career.
“I don’t always know where I’m headed in my career,” he said. “People ask me and I can say this is where I’m headed at the moment and I’m loving it. It’s the journey and the people on the journey that are important.”
Williams said he is impressed with chapters that, instead of being satisfied with a particular destination, continue to strive for something better, to improve their mission. He encouraged chapters to develop measures of success, which he added can be simple goals.
Williams also asked the chapter participants to remember the leader within.
“An important part of being a leader within AACN and within your chapter is nurturing the leader within you,” he said.
Doing so requires knowing when to ask for feedback and when to step back and delegate responsibility.
AACN CEO Wanda Johanson, RN, MN, told the chapter leaders that strong leaders must surround themselves with people who see the vision and who have the right talents to the right job.
She warned against micromanaging and encouraged the workshop participants to think creatively to accomplish their goals.
“What is the outcome you want?” she asked. “Find the best people who can find the best ideas and the best ways to accomplish that goal and let them do it.”
This can include using expert consultants or finding people within the chapter to lend their particular expertise to a project, she added.
Capping off the workshop was a closing address by past AACN President Mary G. McKinley, RN, MSN, CCRN, who explained the “Six Steps for Smooth Sailing” survival kit that was presented to each participant. These steps are:
1. Prepare for changes in the weather.
2. Chart a steady course.
3. Know your crew. Listen to them.
4. Be aware of your “equipment,” or the resources that are available within AACN.
5. Care for yourself.
6. Celebrate success!
What Participants Said
Following are a few of the comments by chapter members who participated in the Chapter Leadership Development Workshop in Anaheim, Calif.
Excellent program, information very valuable to my new role as president. Thanks for a great motivator.
—Deborah Fox, RN, BSN, CCRN
This was very helpful, especially as a new leader.
—Elizabeth Williamson, RN, BSN
Thank you for re-energizing the nursing spirit.
—Claudia Irmiere, RN, MSN, CCRN, NP
This was a very informative and energizing session to take back to chapter members to be more effective.
—Joy Powell, RN, BSN, MS, CCRN
I really enjoyed this day ( much to my surprise) and I know that it will be supremely beneficial to me in my new role as president of my chapter.
—Mary Stephens, RN, MSN, BA CS
The 2002 Chapter Leadership Development Workshop is scheduled for May 5, in conjunction with NTI 2002 in Atlanta, Ga. Chapters will receive nomination forms in December 2001.
Chapters Lauded at Presidents Luncheon
Describing chapters as “the translators of our vision and the glue that bonds our association,” 2000-01 AACN President Denise Thornby, RN, MS, applauded the important work of chapters during the annual Chapter Presidents Luncheon at AACN’s National Teaching Institute™ and Critical Care Exposition in May 2001 in Anaheim, Calif.
“Your leadership makes AACN strong and your commitment to our initiatives is strengthening AACN’s position as the undisputed and indispensable leader of acute and critical care nursing in the United States,” Thornby said.
As a longtime chapter member, Thornby said she has learned that chapters are a critical link between AACN’s national leadership team and each individual member.
“It’s where I learned that only through the strength and commitment of our 250 chapters will AACN’s vision become reality in every community across the United States.”
Also during the luncheon, which was sponsored by Nellcor, Thornby accepted major contributions from the Northwest Chicago Area Chapter and the New York City Chapter to the Sharon J. Connor Memorial Fund, which was established to honor a longtime national office staff member who died of breast cancer in 1997. The fund support leadership development and recognition initiatives, including the Sharon J. Connor Award for Excellence in Chapter Leadership Development.
“At AACN, we believe that leadership means being able to influence ourselves and others so that, together, we can accomplish our outcomes and bring about necessary change,” Thornby said. “Our association is committed to providing resources that will help nurses develop themselves as leaders in every dimension of their life.”
Special speaker for the luncheon was Golden Globe-winning actress Ann Jillian, a 16-year survivor of breast cancer, who expressed her gratitude to the audience as representatives of the critical care nurses who had helped her in several situations: during her recovery from breast cancer, during her parents’ final days in home care and while she was in the hospital after giving birth to her son.
“You [critical care nurses] have a common touch that comes from a compassionate, wonderful place,” Jillian told the audience. “You stand shoulder to shoulder with the researchers and the doctors when you are administering the profession you have chosen. You have been commissioned by God. This is a calling.”
What's on Tap
The Hawaiian Islands Chapter will present “Critical Care Systems Review/CCRN Examination Review” on Sept. 22, 2001, in Hawaii. For more information, contact Sharon Chun, RN, BSN, BS, CCRN, at (808) 833-7697; e-mail,
The Northwest Chicago Area Chapter will present “Gene Therapy” on Sept. 19, 2001, in Park Ridge, Ill. For more information, contact Jodi Gunther, RN, MS, CCRN, at (847) 526-5865; e-mail,
The Northeast Indiana Chapter will present its fourth annual Critical Care Potpourri on Sept. 13, 2001, in Fort Wayne, Ind. For more information, call (219) 460-4747; e-mail
The Lehigh Valley of Pennsylvania Chapter will present “NurseFest” on Aug. 23 and 24, 2001 in Bethlehem, Pa. For more information, e-mail
The Lehigh Valley of Pennsylvania Chapter will host the Region 3 meeting on Aug. 25, 2001, in Bethlehem, Pa. For more information, e-mail,
Does your chapter have a program or special event coming up? Send the information to AACN News, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail,