Transcript Delivering Safe Pediatric CRRT: Development of a Multidisciplinary

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
Specific responsibilities to CRRT in addition to
the many other Dialysis treatment
responsibilities in the hospital
On Call system
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?
What do they do?
Chain of communication at the bedside
Data collection
Advanced education
Education
Nurses



Initial
Ongoing
Competencies
Physicians

PICU Fellows and Attendings
Support Services and/or other Patient Care
Departments


NICU, OR, ECMO
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
[email protected]