Transcript Document
Journal Clubs Provide the Perfect Duet: A Crescendo of Staff Development and A Prelude to Improved Patient Care Karen T. Bell, RN, MSN, CNN and Sheri Sauthoff, RN, BSN, CNN Dialysis Access: Infection Prevention, Cannulation Technique Modification Journal Clubs [email protected] % of Infections in Dialysis Access Excluding those Present on Admission 60 2 AVG 40 AVF (rotating sites) 30 AVF Buttonhole 20 CVC % of Encounters 50 1.5 1 0.5 Insertion site 10 0 0 Q1 2010 Q2 Q3 2010 2010 Q4 Q1 Q2 2010 2011 2011 Q3 2011 Graph 1 IP CVC 3 OP CVC 2 IP AVG/AVF 1 OP AVG/AVF 0 Q1&2 2010 2011 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Graph 3 Graph 2 IV Iron and Anemia Management Implications Article: "Improving IV Iron and Anemia Management In Hemodialysis Settings: A Collaborative CQI Approach”7 Results: • Revision of Anemia Management Protocol in the chronic unit in Nov, 2009 • Regular replenishment of IV iron increased from 21%(11/09) to 41%(12/09) • Increased overall stability of patients’ hemoglobin levels • Decreased usage of (expensive) erythropoiesis-stimulating agent (ESA) UCH Chronic Dialysis IV Iron Use c D e v N o O ct ep t S ug A Ju ne Ju ly ay Q4 M Q3 pr 0 A 10 2011 ar 20 2011 2010 M 2010 eb 2009 30 F 40 80 70 60 50 40 30 20 10 0 Ja n 50 Q2 Journal Clubs are an ideal venue to: • Empower nurses to find, present and use evidence to improve patient care • Provide a forum for collegial collaboration that ‘ends on a high note’ for everyone UCH Chronic Dialysis Average ESA Use 60 Q1 Case Study: “Mysterious Parathyroid Hormone (PTH) Values after Parathyroidectomy in a Patient on Maintenance Dialysis”8 directly related to two patients with similar PTH inconsistencies Results: • Assess / document arm in which reserved parathyroid tissue is placed post parathyroidectomy • Drawing blood for PTH level from opposite arm provided more consistent results 4 Bacteremia 2010 Average ESA Use (units/pt) Articles: “Pictures and Perspectives: A Unique Perspective on Intradialytic Weight Gain”1 and “Dialysis Staff Encouragement and Fluid Control Adherence in Patients on Hemodialysis (HD)”2 Results: Revision and increased use of a patient education tool for managing fluid intake specific to the HD patient Infe ctions Re late d to Dialys is Acce s s in Hom e He m odialys is Dialysis Access by % of Population % of Population Receiving IV Iron Fluid Management Articles: “Buttonhole Technique: Strategies to Reduce Infections”3 and “Buttonhole Cannulation in Patients on Hemodialysis”4 Results: • Application of constant site cannulation technique in chronic unit (Graph 1) • Revision of the procedure for Buttonhole cannulation • Creation of a comprehensive Buttonhole Assessment Tool to decrease infection rates (Graph 2) Articles: "Preventing Infection in HD Fistula & Graft Vascular Accesses"5 and "Effectiveness of Guidelines to Prevent Intravascular Catheter-Related Infections in Patients on HD”6 Results: Modification of access procedures yielding very low infection rates in the acute unit (Graph 3) % of population Past: Used for teaching and increasing knowledge Present: Find evidence-based research. Apply research findings to patient care. Improve outcomes Purpose: Use the peer-reviewed Nephrology Nursing Journal’s ANCCCNE articles which apply directly to our renal patients Methods: Search for evidence from the last three years to modify our practice and improve patient outcomes Outcomes: With CNS/Educator as mentor, 15 Journal Clubs were presented by staff nurses who were primarily responsible for initiating practice changes, peer education and data collection PTH Test Accuracy We acknowledge our Journal Club presenters: Neil Bagamasbad, BSN; Sigrid Bressler, BSN; Reynold Dilag, BSN; Mary Ann Isales, BSN; Melissa Nasser, BSN; Beth Overbey, BSN; Maggie Quinn, BSN; Josh Tiongson, BSN; Cecil Villanueva, BSN, Vickylyn Yambao, BSN Citations: 1. Sinclair & Parker (2009) Nephrology Nursing Journal, 36(6), 589-597. 2. Yokoyama,et al (2009) Nephrology Nursing Journal, 36(3), 2289-297. 3. Ball (2010) Nephrology Nursing Journal, 37(5), 473-478. 4. Birchenough,et al (2010) Nephrology Nursing Journal 37(5), 491-499. 5. Deaver,K (2010) Nephrology Nursing Journal 37(5), 503-506. 6. Bakke (2011) Nephrology Nursing Journal 37(6), 601-616. 7. Johnson,et al(2007) Nephrology Nursing Journal 34(2), 206-213. 8. Thompson & Schiller (2009) Hemodialysis International 13, 543-546. [email protected]