How do I manage orders for admitted patients on dialysis?

Question: How do I manage orders in Connect Care for admitted patients on hemodialysis (HD) or peritoneal dialysis (PD)?

Context: If an admitted patient requires HD/PD, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. (Note: There is a separate blog post for managing orders for Long-Term Care/Supportive Living patients on dialysis.)

Patients receiving dialysis have their dialysis treatment and associated intradialytic medications ordered via the Hemodialysis Therapy Plan or Peritoneal Dialysis Therapy Plan. When a patient with a Hemodialysis/Peritoneal Dialysis Therapy Plan is admitted to the hospital, the Therapy Plan is automatically placed on hold so that the Nephrology team can adjust the prescription and intradialytic medication orders. Once the prescription and orders have been adjusted, the Therapy Plan is available for the duration of the admission.

Answer: For HD and PD, to ensure information flows correctly and medication and blood product orders function properly in Connect Care, a non-nephrologist admitting prescriber should first place a consult order to Nephrology. Then there are specific workflows for medication and blood product ordering, including (but not limited to) the below: 

  • For HD: The dialysis treatment prescription, anemia and intradialytic medications are already included in the Hemodialysis Therapy Plan, and changes are to be made by the Nephrologist. It is important to ensure there are not duplicative orders for medications, as duplicative orders may lead to patient safety concerns. 
  • For PD: All PD treatments and medication orders are ordered via the Peritoneal Dialysis Adult Order set and inpatient orders by the Nephrologist. 
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