The Blended Dialysis/PICU Program

1. The Blended Dialysis/PICU Program Jerry Schwartz, RN, BSN, MHHA Clinical Director, PICU Cincinnati Children’s Hospital Medical Center

2. The “Old” Model for CRRT • Treatment management led almost exclusively by the PICU • Dialysis provided the PrismaFlex • Nephrology would initiate treatments • PICU medical team would manage most elements in the prescription • Algorithm for citrate/calcium management used to guide therapy • No contact between dialysis nurses and PICU nurses

3. Center for Acute Care Nephrology (CACN) • The CACN will function to coordinate the clinical, education and research initiatives to improve quality and outcomes for the child • with, or at risk for, AKI/ARF • requiring renal supportive therapy (PD, CRRT, etc.) • requiring therapeutic apheresis • Brought Dialysis/Nephrology and PICU together to manage patients requiring CRRT • CACN nurses initiate treatments and provide support via rounds or telephonic during off hours • PICU RN’s manage the care of patients

4. The “New” Model for CRRT • Standardized treatment initiation protocol • Nephrology more engaged in patient management • Citrate/calcium is managed differently • Order set in place to clarify prescription and management parameters • Orders are discontinued and re-written with each circuit change to maximize clarity/safety • Collaborative working relationship between the CACN and PICU Nurses

5. PICU Super User Team • PICU nurses having expressed an interest in learning more about and being more involved with CRRT patients • Participated in a class dedicated to recognition/troubleshooting of CRRT issues • Assigned to either care for CRRT patients or in resource RN role to support staff caring for these patients • Provide support to other units where CRRT is not done as frequently (i.e. CICU, NICU)

6. Opportunities for Future • Communication • Increasing comfort of staff caring for patients • Retaining competence in caring for CRRT patients