Pediatric CRRT Nursing Model

1. Pediatric CRRT Nursing Model The Transition to an ICU based Model Theresa Mottes RN, J Vamos, RN, W Wieneke RN University of Michigan, C. S. Mott Children’s Hospital

2. Pediatric CRRT Trend: Patient/Fiscal Year

3. Pediatric CRRT Trend:CRRT Days/Year Represents a 4-Fold increase

4. The Trends and The Challenges The Trends • CRRT activity increase from 2004 to 2007 by 25% • Number of patient • Number of day/hours • Critical Care beds increasing by 50% • New available therapies, TPE.

5. The Trends and The Challenges The Challenges • Reviewing our Pediatric Dialysis Program • Chronic Program • Patient volume with minimal variation • Acute Program • Inpatient/Acute HD treatments increasing • CRRT increasing • Nursing Staff • 6-8 nurses • Demanding On-Call schedule (40% call in rate) • Variability in acute activity, makes for increase in staff difficult to justify.

6. Current Nursing Model - Shared • ICU Nurse Responsibilities • Calculate set the Patient Fluid Removal Rate. • Hourly assessment of CRRT circuit pressures. • Troubleshooting alarms as necessary. • Titrating Calcium and Citrate infusions. • Drawing labs as ordered. • Catheter dressing changes per hospital policy. • Dialysis Nurse Responsibilities • All initiations and circuit changing procedures. • Daily circuit checks. • Troubleshooting with the bedside nurse as necessary • Remaining as a resource for therapy questions/issues.

7. Planning for the Future Overall Goal • Fiscally responsible • Decreases the overall burden on the staff • Compliments the existing nursing care • Maintain the collaboration between nephrology and critical care medicine • Improve response time from order to initiation • Adaptable

8. New CRRT Nurse Model: ICU based ICU based Model has 3 basic components • Program Coordinator • Coordinate between Nephrology and Critical Care • Training ICU staff • CQI • Clearly Defined Roles/Responsibilities • Core CRRT Nurse • Initiator CRRT Nurse • Training • Machine • Patient Initiation (Assisted) • Ongoing Practice Demo

9. New CRRT Nurse Model: ICU based Potential Impact and Implications • Nursing Time • CRRT Knowledge/Understanding • Patient Care Issues • Cost • Decrease in Overtime cost • Decrease in supply cost

10. Measuring the Impact • Nursing Impact – Survey • Nursing History • Perceived comfort providing care for CRRT • Perceived versus Measured knowledge of basic CRRT Principles • Fiscal Impact • Training Hours • Time Studies for CRRT associated activity • Patient Care Impact • Time from order to initiation • Delays in patient care

11. Pre-Transition Results Nursing Experience

12. Pre-Transition Results Overall Perceived Comfort

13. Pre-Transition Results Basic Knowledge/Understanding of CRRT

14. Summary • Our transition to date has been successful • Important to frequently evaluate the process/progress • Reassess every 4 months • The pre-transition data has allowed us to identify areas of educational needs and adapt our education program • Focus on areas with an overall score less than 85% • Adapting the education to meet specific groups

15. Thank You • Joetta Vamos • Wendy Wieneke • Julie Juno • Pediatric Nephrology and Pediatric Critical Care