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 CCRRT activity increase from 2004 to 2007 by 25% −N−N umber of patient −N−N umber of day/hours CCritical Care beds increasing by 50% NNew available therapies, TPE.

5. The Challenges RReviewing our Pediatric Dialysis Program −C−C hronic Program PPatient volume with minimal variation −A−A cute Program IInpatient/Acute HD treatments increasing CCRRT increasing −N−N ursing Staff 66-8 nurses DDemanding On-Call schedule (40% call in rate) V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