Delivering Safe Pediatric CRRT: Development of a Multidisciplinary Program Cheri McEssy RN, BSN, CCRN CMH CRRT Program Coordinator Children’s Memorial Hospital Chicago, IL

Historical Perspective “The Way It Was” Management Team Members – independent decision making; practical disconnect Expert Support at the Bedside – resources not available; under utilized or inconsistent information Errors – unable to ensure patient safety; inability to identify cause of error; calculation and pump management mistakes Staff Dissatisfaction

Evolution of the CRRT Program Identified the need for process change; improvement began with one person Development of the program was possible through the active support of all disciplines (physicians, nurses, administrators, dialysis services, pharmacy, central supply, vendors, support staff, Biomedical Engineering, etc.)

Evolution of the CRRT Program Development of CRRT specific Nursing Procedures Compilation of information regarding the theory and management of CRRT into a Resource Binder for use at the bedside CRRT supplies accessible from in-hospital settings

3 Main Areas Identified for Process Improvement Development of Effective Communication and Role Definition Creation of Expert In-Hospital Support Implementation of Education Programs

Communication and Role Definition Identify the members of the team Who oversees the medical care of the patient and writes the orders How are those orders communicated How does Pharmacy stay updated on the patient’s needs Who do you call, and for what Are there too many people involved, or not enough?!

Communication and Role Definition Dialysis Services – DaVita Integral part of the CRRT delivery process Integral part of the CRRT delivery process Specific responsibilities to CRRT in addition to the many other Dialysis treatment responsibilities in the hospital Specific responsibilities to CRRT in addition to the many other Dialysis treatment responsibilities in the hospital On Call system On Call system Coordination of nursing roles Coordination of nursing roles

Expert In-Hospital Support Who administers and manages CRRT Critical Care Units only Formation of PICU based team of CRRT Specialists

Expert In-Hospital Support CRRT Specialists Who are they? Who are they? What do they do? What do they do? Chain of communication at the bedside Chain of communication at the bedside Data collection Data collection Advanced education Advanced education

Education Nurses Initial Initial Ongoing Ongoing Competencies CompetenciesPhysicians PICU Fellows and Attendings PICU Fellows and Attendings Support Services and/or other Patient Care Departments NICU, OR, ECMO NICU, OR, ECMO Pharmacy Pharmacy

Outcomes of Process Improvement Have we developed an effective multidisciplinary team approach to CRRT? Are we able to ensure patient safety when administering CRRT? Have we been entirely successful, or do we have further work to do?

Future Ongoing Data Collection Quality Assessment Research New Technology Sharing of experiences with other programs