“These kids don’t survive without us”

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Amid the coronavirus outbreak, lifesaving dialysis continues at Riley for pediatric patients whose kidneys are failing.


By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

Dialysis nurses have a stressful job. When you add a life-threatening virus to the mix, that stress could rightly go off the charts. But at Riley Hospital for Children, the nurses are warriors.

Not just in the dialysis unit, of course, but for purposes of this story, it’s that unit and those nurses and their patients we want to spotlight.

Shannon “Shay” Anderson has been a nurse in Riley’s outpatient dialysis clinic for eight years. Wearing personal protective equipment is nothing new for her or the multiple other specialized nurses who provide the lifesaving care to children experiencing kidney failure.

They’ve always been vigilant when it comes to protecting their kiddos from germs or blood-borne pathogens.

Now, she says, “We’ve upped our game a little.”

Maybe a lot.

The novel coronavirus outbreak required a significant change in procedures for the unit, including altering shifts for dialysis, prohibiting parents from sitting with their children during the three- to four-hour treatment and making use of more isolation rooms to treat kids who might be symptomatic.

Riley is Indiana’s largest provider of diagnostic and treatment services for children with kidney conditions and the state’s biggest pediatric dialysis unit.

ADAPTING QUICKLY

Currently, there are 14 hemodialysis patients who come to the clinic three times a week at different times of the day. Additionally, Riley has another 20-plus peritoneal dialysis patients who take their treatment at home but come to the hospital monthly for labs and checkups.

“When COVID was breaking out, dialysis units all over the country were saying, ‘What are we going to do?’ We spent a lot of time over several weeks figuring out the best way to take care of our patients and staff,” said Dr. David Hains, division chief for pediatric nephrology at Riley.

Gone are the days of multiple team members buzzing in and out of the unit. Traffic is kept at an absolute minimum, which includes just one nephrologist, Dr. Amy Wilson, checking in with most of the kids each day.

“It’s not every day that I really need to be down there,” she said, but for now, I’m showing my face there every day as a way to say that it’s OK, we’re OK. We all need to keep our focus and remember that ultimately it’s our duty to serve these kids the best we can. They don’t survive without us.”

Dr. Hains and manager of clinical operations Shannon Stewart established first-line and second-line teams of nurses to better protect those team members who fall into high-risk categories. Everyone who enters the unit – from patients to physicians to social workers to nurses to EVS workers – has his or her temperature checked before entering.

Staff pre-screen patients over the phone before they arrive and meet them at the entrance to the hospital to bring them to the unit.

The hypervigilance is the best way to ensure the safety of everyone, Dr. Hains said.

“If we get sick and we’re out, we can’t care for all the other kids, so we have to be really smart about this,” he said. “We can’t just snap our fingers and rustle up some more people. As the hospital gets full, we need to be ready to help everybody.”

Dr. Hains, a born-and-bred Hoosier who attended Butler University for undergrad and IU for medical school, came to Riley as division chief in 2017. Since he arrived, he has expanded the pediatric nephrology program to further enhance Riley’s standing in the state and the nation.

Though he had not been involved in the day-to-day running of the dialysis unit, he stepped into that role when his medical director of dialysis, Dr. Neha Pottanat, went on maternity leave at the end of February.

“I told her I’ll man the ship while she’s out,” he said, figuring it was already a well-oiled machine and he could just keep it humming along. “But COVID hit and we really needed to quickly revamp how we handle things.”

“WE STRIVE TO DO THINGS BETTER”

One of his messages to team members early on was to accept that every change would lead to a better way of doing things.

“You’re never going to get it right the first time, no matter how much you plan. But we don’t have to plow forward with blinders on.”

Agility is crucial.

“That’s one of the reasons I came back to Riley in the first place,” he said. “There’s a real culture here that is difficult to describe, but it’s tangible and it’s palpable when you come here and talk to people. We strive to do things better, but we know we can improve.”

It’s been stressful at every level, he understands, adding that everyone has made some personal sacrifice to make it work.

“But I’m very proud of how the unit has handled it. Our patients are troopers. Our nurses have hearts of gold. We have a positive culture that everybody is rallying around. It just speaks volumes about all the people we have and how much they are dedicated to making sure these kids get cared for to the best of our ability.”

Nurse Anderson agrees.

“It’s a little more stressful, but our team is very strong and I feel like it’s pulled us together.”

She’s thankful for the physicians and others who are checking in to make sure she and her colleagues are doing OK.

“We appreciate that, and I hope other areas of the hospital are doing that too because it does make a difference. It lets you know you’re part of this big team that’s doing everything we can for the kids.”

Dr. Wilson doesn’t have a crystal ball, but she expects the lockdown in dialysis to continue for a minimum of several more weeks, at least through May, and perhaps longer.

“We will be extra cautious for a while. Nobody knows if there will be a second wave of this as places try to reverse course from social distancing and stay-at-home orders,” she said. “We will probably stay locked down until we’re comfortable that the community transmission has slowed considerably.

“We’re going to be here taking care of these patients no matter what,” she added. “But we just can’t speak loudly enough about the importance of everybody who can stay home – stay home.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org

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