UHN Division of Nephrology House Staff/NP Guidebook DIVISION OF NEPHROLOGY July 2019 Welcome to nephrology at the University Health Network. The Division of Nephrology is one of the largest nephrology programs in Canada, encompassing treatment of chronic kidney disease (CKD) with dialysis and transplantation, general nephrology, subspecialty clinics, teaching and research. Dr. Christopher Chan, Medical Director, Division of Nephrology and Home Hemodialysis (HD) Dr. Joanne Bargman, Medical Director, Peritoneal Dialysis (PD) Dr. Vanita Jassal, Medical Director, Toronto Rehab (TR) Hemodialysis, O’Neill Centre PD Dr. Charmaine Lok, Medical Director, Multi-Care Kidney Clinic (MCKC), HD, and Vascular Access Program Dr. Joseph Kim, Co-Director, Kidney Transplant Program During your general nephrology rotation it is hoped that this guidebook will assist you with the management of nephrology patients utilizing accepted protocols and useful suggestions. Inpatient services include: A 5 inpatient bed on a combined GIM/Nephrology unit (Peter Munk 6A) 2 nephrology consult team’s that cover inpatients at TGH, TWH, PMH, WCH & MSH. Outpatient clinical services include: Outpatient General Nephrology, AKI Clinic, Oncology-Nephrology Clinic, Glomerulonephritis Clinic, Hereditary Kidney Disease Clinic, MCKC, Home PD Unit, Outpatient HD, Home HD, and Self-Care HD. TR HD unit at University Avenue which provides HD for patients in rehab, TR Bickle Centre HD unit at Dunn Avenue for patients in rehab and complex continuing care, and O’Neill Centre Nursing Home for PD. UHN Nephrology Philosophy of Care The philosophy of care at UHN is guided by care that empowers patients living with kidney disease to live well at home and encourages chronic disease self-management, and home/self-care modalities of dialysis (PD, HD, and nocturnal HD). During this rotation, you will have exposure to, and learn how to manage many of the following conditions: acute kidney injury (AKI), CKD, end-stage kidney disease (ESKD), an understanding of dialysis (HD and PD), hypertensive disorders, renal disorders in pregnancy, tubulointerstitial renal diseases, cystic diseases and other hereditary disorders, glomerular and vascular diseases (including the glomerulonephritides, diabetic nephropathy, and atheroembolic disease), disorders of mineral metabolism (including nephrolithiasis and renal osteodystrophy), disorders of fluid, electrolyte, and acid-base regulation, and disorders of drug metabolism and renal drug toxicity. We hope that this guidebook will assist you in the management of your patients and in your learning experience. In an effort to continually improve the Nephrology Program at UHN we welcome feedback on this document. Guidebook Editor Anna Gozdzik, Nurse Navigator Nephrology Contributors: UHN Division of Nephrology, Renal Pharmacists, Nephrology Allied Health, and Nephrology Nurse Practitioners Note: This document is available on http://ukidney.com/uhn and on http://www.nephroed.com with a log in. 2 Table of Contents Division of Nephrology ..............................................................................................................13 Specialty Clinics .....................................................................................................................13 Acute Kidney Injury Follow-Up Clinic (AKI Clinic) ...............................................................13 AKI Referral Form ..............................................................................................................15 Cardiac and Renal Endocrine Clinic (C.a.R.E. Clinic) ........................................................16 Elder Kidney Care Service .................................................................................................16 Elder Kidney Care Service ........................................................................................................19 Inpatient Referral ......................................................................................................................19 Referring Service ...............................................................................................................19 Patient Information .............................................................................................................19 Referral Details ..................................................................................................................19 Contact Information ............................................................................................................19 Glomerulonephritis Clinic (GN Clinic) .................................................................................20 Oncology – Nephrology Clinic ............................................................................................21 Hereditary Kidney Disease (HKD) Clinic ............................................................................22 Nephrology Team and Affiliated Areas ...................................................................................23 Multi-Care Kidney Clinic (MCKC) .......................................................................................23 Nursing Support Team .......................................................................................................25 Nurse Navigator .................................................................................................................25 Geriatric Rehab ..................................................................................................................25 Vascular Access Coordinator .............................................................................................25 PD Access Coordinator ......................................................................................................25 Informatics Team ...............................................................................................................26 Physiotherapy/Occupational Therapy .................................................................................26 Renal Pharmacists .............................................................................................................29 Hemodialysis Unit ..............................................................................................................30 Physician Coverage for Hemodialysis Units .......................................................................31 Toronto Rehab Transitional Unit (Hemodialysis Extension Unit) ........................................32 Dialysis Start Unit (DSU) ....................................................................................................32 Home Hemodialysis Unit ....................................................................................................33 3 Peritoneal Dialysis Unit ......................................................................................................33 Toronto Rehab (TR) ...........................................................................................................34 Sheppard Centre & Sussex Centre Assisted Self Care Dialysis Units ................................34 Renal Dietitians (RD) .........................................................................................................36 Renal Social Worker ..........................................................................................................39 Alerts Dashboard ...............................................................................................................39 Peritoneal Dialysis Off-Unit Nurses ...........................................................................................42 Inpatients ..................................................................................................................................43 Inpatients Nephrology Beds on Nephrology/Multi-Organ Transplant Unit ...............................43 Medical Coverage ..................................................................................................................43 Red and Blue Teams (“Acute Care Teams”): .........................................................................43 Yellow Team (“Inpatient/Ward Team”) and TWH Nephrology: ...............................................43 Yellow Team: Team Culture and Purpose ..........................................................................44 Yellow Team Fellow (TG) Responsibilities .........................................................................45 Consult (TW) Fellow Responsibilities .................................................................................48 TWH Microscope Room .....................................................................................................48 Discharges .........................................................................................................................49 Microscope Rooms ............................................................................................................52 Bloodwork ..........................................................................................................................52 Allergies .............................................................................................................................52 Admissions ...............................................................................................................................52 Admissions Policy for Yellow Team .......................................................................................52