Use of a RN-Initiated Protocol for Recognition, Management, and Documentation of Intradialytic Hypotension in End-Stage Renal Disease Patients on In-Center Hemodialysis: A Quality Improvement Project
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Authors
Wills, Christie
Issue Date
2022-05-14
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Abstract
Background: Nearly 519,000 patients in the U.S. receive renal dialysis. Intradialytic hypotension (IDH) is the most frequent complication of dialysis and has significant health, psychosocial, and financial consequences for patients and dialysis clinics. IDH definitions and mitigating strategies have been proposed by various nephrology organizations. However, there is currently no standardized definition of IDH or uniform practice recommendations for responding to it. This issue creates a barrier to prompt recognition and treatment of IDH in outpatient dialysis.|Purpose: Development and implementation of an evidence-based nursing protocol for recognizing, treating, and documenting IDH episodes in an outpatient dialysis clinic.|Population/Setting: Adult patients receiving hemodialysis at a 30-chair urban outpatient dialysis clinic in St. Paul, MN.|Methods: Protocol and documentation form was developed based on available evidence. Clinic RNs received education and assessment regarding IDH definitions and protocol use. Protocol was utilized for each dialysis treatment over a period of 8 weeks. Documentation forms were analyzed using descriptive statistics.|Results: Protocol use doubled from Week 1 to Week 8. IDH was recognized and protocol utilized in 7.02% of dialysis treatments during the pilot period. Most IDH episodes were resolved after one (36%) or two (49.33%) 10-minute UF pauses with interventions and two-thirds of IDH episodes required less than 200mL IV NS bolus. Mean target weight variance was low at 0.86 kg. In 90.67% of cases, IDH episodes resolved without indication to contact the nephrology provider.|Conclusion: A nursing protocol for recognition, management, and documentation of IDH standardized and expedited care while demonstrating positive patient outcomes in this dialysis clinic.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University