Learn about the top trends from NTI 2015 Day 1 including three presentations that highlight the great work that can be achieved by empowering nursing staff to utilize various technologies through nurse-driven protocols and interventions; from the leader in healthcare supply chain management solutions, MD Buyline. For the full article, visit http://www.mdbuyline.com/research-library/articles/top-trends-nti-2015-day-1/.

1. Top Trends from NTI 2015
Day 1
by: Brandi Crow, BSN, RN
Katie Regan, MA
This article was originally published with ADVANCE for Nurses.
With over 8,000 registered attendees, NTI is the largest nursing
conference for critical care nurses. This show is an excellent opportunity
for education and networking, and also
features the Critical Care Exposition
that provides attendees hands-on
experience with the latest technology.
The first day of NTI was filled with a
variety of sessions and different focus
areas. While it would be impossible to
cover all the great discussions, three
well-liked presentations highlighted the
great work that can be achieved by
empowering nursing staff to utilize
various technologies through nurse-driven protocols and interventions.
Managing Drug Diversion
At one time or another in their career most clinical leaders have had the
unfortunate experience of dealing with drug diversion and its
devastating consequences. Nearly 15% of healthcare professionals
struggle with drug dependence at some point in their career with

2. approximately 9,000 nurses per year reentering the workforce after
being treated for dependence. Diversion is not a new phenomenon.
However, it’s important to understand that it’s a CRIME, and it is
preventable with active multidisciplinary surveillance and coordinated
intervention and communication. In a thought-provoking session, Dale
Pfrimmer, RN, MS from Mayo Clinic discussed his work in developing a
multidisciplinary drug diversion response team (DDIRT). As Mr. Pfrimmer
delved into the behavioral, physical and patient-related signs of likely
drug diversion, I flashed back to several occurrences and investigations
I’ve been a part of over the years and this presentation was spot-on.
He offered three key pearls of wisdom: Understanding that ACCESS=RISK
and that transparency is key to identifying and stopping diversion.
Knowing WHAT was diverted and HOW it was diverted should drive the
conversation.
In his information-packed session he also provided some great DOs and
DON’Ts to help curb this growing issue.
Don’t
 Share passwords
 Participate in “Virtual Wasting”
 Ignore red flags
 Leave controlled medications unattended
 Underestimate the value of becoming involved
Do
 Establish a zero-tolerance policy
 Assemble a multidisciplinary response team
 Properly document medication administered and pain scores
 Review audit data regularly
 Resolve discrepancies immediately

3. Non-Invasive Monitoring
This was the focus of several sessions, and we expect to see a heavy
vendor presence in this space at the Critical Care Exposition as well.
In a presentation by the rapid response nursing team from the
University of Kansas Hospital, non-invasive assessment of functional
hemodynamics and standard use of capnography was highlighted. The
team discussed lessons learned and evidence-based practices they have
implemented to not only decrease out of ICU codes, but to proactively
prevent the occurrence of complications. Functional hemodynamics,
which measures the patient’s response to an intervention using either
passive leg raise or 300-500 ml fluid challenge assessed over 5-10
minutes, is extremely well validated in the literature. However, this
requires some measure of continuous CO of SV, or dynamic indices in
most cases.
Since only half of patients typically respond to fluid, it’s important to
quickly recognize if a patient needs volume or pressors. Volume
overload in the critically ill is linked to increased LOS and mortality, while
early fluid resuscitation is associated with improved outcomes. This
quote from the presenters summed up the rationale – “clinical
indicators of hypovolemia are often inaccurate, confounding or late
signs.”
Another positive impact the team is making is with the use of
capnography monitoring in high-risk patients receiving opioids. Since
2013, the number of rapid response calls, at the University of Kansas
Hospital associated with respiratory depression, has been reduced
significantly and the incidence of Narcan administration has seen a 49
percent decrease with this evidence-based intervention. The team also

4. discussed their focus on OSA patients as well as patients receiving
procedural sedation.
They also highlighted other uses of capnography including in patients
who have issues with increased dead space. By assessing the PaCO2-
PEtCO2 gradient using capnography, several PEs have been diagnosed
and even ruled out post implementation of the intervention. This has
also helped to avoid risky transport of unstable patients for STAT
imaging tests
Other related technologies/devices the team discussed for non-invasive
monitoring included:
 Respiratory Acoustic Monitoring (RAM) to monitor for the
presence of OSA
 Capnography monitoring with positive airway pressure
 Non-invasive hemoglobin monitoring
 Pleth Variability Index
 Volume Clamp Stroke Volume Monitor finger BP cuff
 Tissue oxygenation sensors (StO2 monitors)
In another informative session, Barbara Leeper, CNS at Baylor University
Medical Center provided an in-depth look at hemodynamic monitoring
modalities within the progressive care and telemetry areas. The
presence of overflowing critical care units and the increasing acuity of
patients needing care highlighted the importance of evaluating and
monitoring various hemodynamic parameters using non-invasive
technology.
To prevent ICU bounce backs and improve patient outcomes, Ms.
Leeper stressed the importance of identifying high-risk patients earlier
through multi-modality monitoring. Pros and cons of invasive and non-
invasive hemodynamic monitoring technologies (MAP, CVP, ScvO2,

5. SpO2, respiratory rate and end-tidal CO2) relevant to progressive care
and telemetry were covered.
Improving Resuscitation
A fun and interactive presentation by Nicole Kupchik provided a unique
overview of evidence supporting the current 2010 AHA, BLS and ACLS
guidelines and the new evidence and lessons learned shaping upcoming
changes to 2015’s AHA guidelines.
The 2010 guidelines brought some key changes and shifted the
emphasis and approach to improving the quality of resuscitation from
previous years. Major areas of change included capnography, early
defibrillation and a much larger focus on rate and depth of
compressions. Going forward, Ms. Kupchik says it will be important to
drive quality improvements through the lens of the entire team from
pre-hospital to in-hospital interventions.
Key takeaways that are guiding current technology advances, practice
and change are the importance of:
 CPR quality
 Early and effective defibrillation
 Post arrest temperature control
 Performance feedback to teams
 Measuring practice and improvements
To demonstrate perceived versus actual CPR quality, several volunteers
participated in a two-person CPR challenge. The audience was able to
quickly see how depth, rate and position can vary between the provider
and how being able to harness real-time defibrillator data can drive
rapid performance improvement.

6. Other findings discussed in the session included possible future changes
in drug selection and dosing. Several studies that support these changes
were reviewed in the session with a focus on epinephrine and
amiodarone. Draft guidance for the 2015 ACLS/BLS Guidelines can be
found at www.ilcor.org.
Be sure to read about the Top Trends from Day 2 of NTI.