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

2. The Center for Acute Care Nephrology 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. The Center for Acute Care Nephrology 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 Center for Acute Care Nephrology 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. The Center for Acute Care Nephrology 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. The Center for Acute Care Nephrology Opportunities for Future Communication Increasing comfort of staff caring for patients Retaining competence in caring for CRRT patients