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Continuous Renal Replacement Therapy (CRRT)-Based Dose Adjustment - Adult - Inpatient [5]

Continuous Renal Replacement Therapy (CRRT)-Based Dose Adjustment - Adult - Inpatient [5] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 5
Delegation Protocol Title:
Continuous Renal Replacement Therapy (CRRT)-Based Dose Adjustments - Adult - Inpatient
Delegation Protocol Applies To:
UWHC Inpatients: adults in intensive care units in whom CRRT is ordered
Target Patient Population:
All adult inpatients started or discontinued on CRRT on medications that need adjustment with concomitant
CRRT therapy.
Delegation Protocol Champions:
Alexander Yevzlin, MD - Department of Medicine – Nephrology
R. Allan Jhagroo, MD - Department of Medicine-Nephrology
Delegation Protocol Reviewers:
Jeffrey Fish, PharmD, BCPS – Pharmacy Department
Ryan Draheim, PharmD – Pharmacy Department
Responsible Department:
Department of Pharmacy
Purpose Statement:
The purpose of this protocol is to delegate authority from the ordering or provider to pharmacists to adjust of
medication doses for inpatients either started or discontinued on CRRT as specified in the Guideline for
Continuous Renal Replacement Therapy Based Dose Adjustments or the Renal Function Based Dose Adjustment
Guideline in Adults.
Who May Carry Out This Delegation Protocol:
Clinical pharmacists in the inpatient setting that have completed all relevant training and demonstrated
competency in dosage adjustment for patients on CRRT.
Guidelines for Implementation:
1. The trigger for the protocol is an order written by a provider to start or discontinue CRRT [i.e. SCUF (slow
continuous ultrafiltration), CVVH (continuous venovenous hemofiltration, or CVVHD (continuous
venovenous hemodialysis)].
2. When an order for CRRT is received, the clinical pharmacist will review the patient’s medication profile and
assess the need for dosing adjustments of medications listed in the Guideline for Continuous Renal
Replacement Therapy Based Dose Adjustments, and will adjust doses based on those guidelines.
3. When an order for discontinuation of CRRT is received, the clinical pharmacist will review the patient’s
medication profile and assess the need for dosing adjustments listed in the Renal Function-Based Dose
Adjustments in Adults Guideline, and will adjust doses based on those guidelines.
4. The pharmacist will document any dose adjustment related to CRRT into the patient’s medical record.
5. If the ordering provider does not want a clinical pharmacist to initiate dosage adjustments based on CRRT,
then the order must include “do not adjust dose for CRRT” in the administration instructions.
Order Mode: Protocol/Policy, Without Cosign
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


References:
1. John S, Eckardt KU. Renal replacement strategies in the ICU. Chest. 2007;132:1379-1388.
2. Bouman CS, van Kan HJ, Koopmans RP, Korevaar JC, Schultz MJ, Vroom MB. Discrepancies between
observed and predicted continuous venovenous hemofiltration removal of antimicrobial agents in critically
ill patients and the effects on dosing. Intensive Care Med. 2006;32:2013-2019.
3. Schetz M, Ferdinande P, Van den Berghe G, Verwaest C, Lauwers P. Pharmacokinetics of continuous renal
replacement therapy. Intensive Care Med. 1995;21:612-620.
4. Micromedex® Healthcare Series, (electronic version). Thomson Micromedex, Greenwood Village, Colorado,
USA. Available at: http://www.thomsonhc.com (cited: December 2008).
5. Facts & Comparisons® 4.0, (online). Wolters Kluwer Health, Inc. Accessed December 2008.


Collateral Documents/Tools:
1. UWHC Guidelines for Continuous Renal Replacement Therapy Based Dose Adjustments.
2. CRRT Dose Adjustment Table.

Approved By:
UWHC Antimicrobial Use Subcommittee – May 2013, August 2016 (expedited review)
UWHC Pharmacy & Therapeutics Committee – May 2013, August 2016 (expedited review)
UWHC Medical Board – June 2013, August 2016

Effective Date: August 2016

Scheduled For Review: August 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org