Application of Renal Replacement Therapy —
Training activity: 6

Details

Respond to and assist in the management of technical alarms and safety features

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Calibrations
• Pressures
• Air detection
• Balance alarms
• Service history
• Risk management

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to effectively responding to and assisting with technical alarms and safety features on Continuous Renal Replacement Therapy (CRRT) equipment.
• Consider how the learning outcomes apply, specifically in relation to setting up and programming the machine, evaluating and resolving technical issues, and ensuring safe practice through effective risk management during alarm management.
• Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for identifying the root cause of common CRRT alarms and local protocols for managing critical safety features.

What is your prior experience of this activity?

• Think about what you already know about CRRT equipment alarms and safety features, perhaps from observations, training sessions (e.g., attending induction/training for CRRT), or general knowledge of critical care equipment.
• Consider possible challenges you might face during the activity, such as identifying the cause of a specific alarm (e.g., filter clotting, air detection), understanding the required response, or needing to troubleshoot under pressure.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the alarm suggests a critical circuit issue that cannot be resolved via routine troubleshooting (e.g., persistent high pressures or air detection), necessitating senior intervention or evaluation.
• Acknowledge how you feel about embarking on this training activity, particularly concerning your confidence in identifying and assisting with the resolution of technical alarms.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently identifying, interpreting, and responding appropriately to different technical alarms and safety features on CRRT machines, drawing upon previous experiences or observations of similar monitoring equipment.
• Identify the specific insights you hope to gain into the relationship between CRRT settings and alarms, the clinical implications of specific technical issues (e.g., the risk associated with extra corporeal circuits), or effective communication during alarm management.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of CRRT equipment management or reflections related to general technical troubleshooting.
• Identify important information you need to consider before embarking on the activity, such as familiarising yourself with the specific CRRT machine model being used, reviewing quick guides for common alarms and troubleshooting during CRRT, or understanding the escalation pathway for unresolved technical issues.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst responding to and assisting in the management of technical alarms and safety features?
• Are you encountering situations such as:
  • An unusual combination of alarms triggers simultaneously, complicating the identification of the root cause or required sequence of troubleshooting?
  • A standard troubleshooting step fails to resolve the alarm, requiring immediate deviation from routine protocol to address the technical issue?
  • The patient exhibits an unexpected physiological change (e.g., hypotension or excessive bleeding) immediately following the alarm, complicating the required safety response?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to troubleshooting protocols or seeking senior assistance based on the alarm complexity? Did the unexpected event affect your ability to calmly assist in managing the issue?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing the CRRT machine and implementing the standard safety protocol (e.g., clamping lines) while simultaneously consulting the equipment manual
  • Quickly consulting the clinical team due to the severity of the alarm or an associated unexpected patient reaction (e.g., patient hypotension associated with the blood leak alarm)
• How are you feeling in that moment? For instance, are you finding it difficult to remain calm and systematic during the alarm management? Is it affecting your confidence in quickly identifying the issue’s cause?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the technical alarm by implementing routine troubleshooting steps, ensuring the system is safe? Or are you needing support because the specific issue (e.g., persistent high filter pressures or an unresolvable air detection alarm) requires senior medical/technical intervention to safely resolve?
• What are you learning as a result of the unexpected development? For example, are you mastering a more efficient checklist for differentiating between pressure alarms? Or gaining insight into the specific technical limits and safety features of the CRRT equipment?

On action

What happened?

• Begin by summarising the key steps you took when responding to and assisting in the management of the technical alarm(s) on the Continuous Renal Replacement Therapy (CRRT) machine, including the type of alarm and the steps taken to address it.
• Consider specific events, actions, or interactions which felt important, such as successfully resolving a difficult pressure alarm caused by filter clotting or safely managing an air detection alarm that required implementing safety clamps.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting the equipment manual when a complex, unusual alarm code appeared or quickly implementing safety clamps when a blood leak was detected.
• How did you feel during this experience, e.g., did you feel confident in your technical troubleshooting ability or stressed by the clinical urgency of the finding?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding technical alarms and safety features. What strengths did you demonstrate, e.g., meticulous adherence to the safety protocol during an urgent alarm?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the complexity of interpreting high effluent pressure alarms?
• Compare this experience against previous engagement with similar activities (e.g., technical alarms on other monitoring equipment) – were any previously identified actions for development achieved? Has your practice improved in rapidly differentiating between technical and clinical causes for CRRT alarms?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the required intervention for resolving a persistent, complex pressure alarm, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your understanding of alarm mechanisms and troubleshooting protocols for CRRT.
• What will you do differently next time you approach managing CRRT technical alarms, for instance, by proactively reviewing the manufacturer’s guide for less common safety features before starting a new therapy?
• Do you need to practise any aspect of the activity further, such as efficiently troubleshooting air detection alarms or key learning outcomes related to evaluating and resolving technical issues?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of troubleshooting complex technical issues (e.g., persistent high pressures or filter clotting) on CRRT or other critical care equipment since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, having to troubleshoot a persistent error during maintenance for different monitoring equipment forced you to re-evaluate the speed of your initial assessment or diagnosis of alarm cause during your first attempt at this training activity.
• Considering what you understand about CRRT alarm mechanisms, safety feature function, and governance protocols now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your protocol adherence or systematic troubleshooting checklist for CRRT alarms based on further learning and experiences? For example, how you proactively integrated a double-check of the fluid circuit and pressure lines to rule out procedural error before consulting technical support based on further learning and experiences.
• Has discussing challenging alarm scenarios or unexpected equipment failures or the impact of delayed alarm response on patient safety or circuit integrity with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a blood leak alarm that was missed due to high ambient noise refined your understanding of the critical nature of vigilant and timely alarm recognition and response.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent experiences of assisting with CRRT technical alarms, contributed to your overall confidence and ability in the prompt recognition, initial assessment, and systematic troubleshooting of technical CRRT issues, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in prompt recognition of alarm type, understanding safety feature function, and initial assessment of potential cause now enables you to confidently and systematically troubleshoot an issue with CRRT at the bedside during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to CRRT alarm response and associated risk management? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Senior Clinician immediately when a persistent high pressure or air detection alarm [based on conversation history] suggests a critical circuit issue that cannot be resolved via routine troubleshooting, necessitating senior intervention or evaluation.
• Looking holistically at your training journey, how has this initial technical alarm management experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to evaluating and resolving technical issues and evaluating and managing risk to practice safely? For example, how this foundational experience has supported your development in applying rapid problem-solving skills and critical thinking necessary for ensuring the safe and effective application and management of CRRT.

Relevant learning outcomes

#	Outcome
# 1	Outcome Set up and programme a renal replacement therapy machine.
# 2	Outcome Evaluate and resolve clinical and technical issues relating to therapy.
# 4	Outcome Evaluate and manage risk to practice safely in all elements of patient care.