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The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multi-center quality transformation effort whose primary aim is to minimize exit-site infection and peritonitis rates among pediatric chronic peritoneal dialysis patients. The project, developed by the quality improvement faculty and staff at the Children's Hospital Association's Quality Transformation Network (QTN) and content experts in pediatric nephrology and pediatric infectious diseases, is modeled after the QTN's highly successful Pediatric Intensive Care Unit and Hematology-Oncology central line-associated blood-stream infection (CLABSI) Collaboratives. Like the Association's other QTN efforts, the SCOPE Collaborative is part of a broader effort to assist pediatric nephrology teams in learning about and using quality improvement methods to develop and implement evidence-based practices. In addition, the design of this project allows for targeted research that builds on high-quality, ongoing data collection. Finally, the project, while focused on reducing peritoneal dialysis catheter-associated infections, will also serve as a model for future pediatric nephrology projects that could further improve the quality of care provided to children with end stage renal disease. Keywords Pediatric . Dialysis . Peritonitis . Infection . Improvement, Introduction Chronic peritoneal dialysis (CPD) is the most common dialysis modality utilized for children with end stage renal disease (ESRD) worldwide [1, 2]. Peritoneal dialysis (PD) catheter-related infections, including exit-site [...]

Catheter infections are a significant problem in pediatric hemodialysis. To reduce infection rates, the use of closed luer-lock access connectors, which create a mechanically and microbiogically closed system while allowing unobstructed blood flow, was implemented. Infection rates fell from 7.8 infections per 1000 patient days to 3.65 infections per 1000 patient days after the switch to the closed connector (p = 0.04). The adoption of a closed connector system appeared to produce a significant reduction in bloodstream infections. [ABSTRACT FROM AUTHOR]

Background: A 15-year-old male with psychiatric diagnoses on hemodialysis. This is complicated by his history of behavioral issues. He has attention deficit disorder and oppositional defiant disorder. On hemodialysis he has frequent anger outbursts. These outbursts usually require security involvement. Purpose and hypothesis: Behavior management while on hemodialysis. How can we safely dialyze this child to improve his overall well being, while needing in center dialysis? Materials and methods: An inpatient psychiatric admission allowed for close mentoring for patient and dialysis staff. A primary dialysis nurse was assigned and attended weekly team meetings, which included mom, outpatient psychiatrist, inpatient psychiatry nurse and doctor, nephrology attending physician and primary nurse, and teacher. A plan of care was made with the input and approval of the patient and staff. Art therapy, Childlife, volunteer services, teacher rounding during HD sessions were organized to alleviate the perceived boredom of the dialysis routine. Results: After much involvement with psychiatry, patient, patient's mother and dialysis primary nurse, the plan for dialysis was initiated. One month following discharge, the patient is more cooperative, appears happier, more adherent, uses call light instead of calling out, and initiates conversations with other patients in a friendly manner. Patient/staff communication has greatly improved, requiring less frequent interventions. Discussion: Patients on hemodialysis are at risk for psychosocial issues such as depression. These issues impact their quality of life. Children are vulnerable too and need skills to cope with their disease for the rest of their lives. Early involvement of psychiatry, Childlife, volunteers, and art/music therapy can greatly reduce stressors and improve quality of life for those requiring in-center hemodialysis. [ABSTRACT FROM AUTHOR]