Continuous kidney replacement therapy (CKRT) may be compromised by delayed initiation, access dysfunction, interruptions, circuit clotting, blood loss and unmet fluid goals. We describe a consultant-led, nursing-enabled CKRT quality programme across a multi-ICU service.

From 2023, the programme combined structured training with Excel-based data collection. Variables included CKRT episodes, prescription dose and effluent volume at initiation, filter life, blood return, termination cause, anticoagulation and access signals. The prescription dose target was 25-30 mL/kg/h at initiation, allowing for downtime while aiming for KDIGO delivered effluent 20-25 mL/kg/h. Anticoagulation was mainly none, with selective regional citrate anticoagulation (RCA) and rare heparin use. Nurse leads planned regular CKRT training, supported four-monthly nurse CME, coordinated machine troubleshooting, and reinforced access awareness, rising transmembrane pressure recognition and failure-cause documentation. Fellows received prescription and RCA teaching. Over three years, 123 staff attended a 3-hour CKRT and ICU dialysis session. Nurses sustained Excel entry, validation and dashboard preparation.

CKRT activity remained high, with 217 episodes in 2023, 216 in 2024 and 202 filter episodes captured in 2025. Median filter life improved from 14 hours in 2023 to 18 hours in 2024 and 22 hours in 2025. Filters lasting at least 24 hours increased from 22.7% in 2023 to 35.6% in 2024 and 46.9% in 2025. In 2025, 86.5% of episodes had blood returned, while clotting-related termination remained high at 69.3%. Prescription dose at initiation in 2025 ranged from 17.1-48.0 mL/kg/h, median 30.0 mL/kg/h; 53 of 85 episodes (62.4%) were within 25-30 mL/kg/h and 75 (88.2%) were at least 25 mL/kg/h. Early 2026 monitoring showed prescribed dose range 11.0-45.0 mL/kg/h, median 28.0 mL/kg/h, with persistent clotting signals.

The programme improved CKRT visibility and circuit performance while clarifying prescription practice at initiation. Nursing involvement in training planning, bedside education, data collection and validation was central to sustainability. Staff turnover requires repeated training. Future work will expand RCA training to improve filter life, alongside access optimisation, dynamic dosing, fluid balance assessment and automation to reduce workload.