Use of an RN-Initiated Protocol for Recognition, Management, and Documentation of Intradialytic Hypotension in Patients with End Stage Kidney Disease on In-Center Hemodialysis: A Quality Improvement Project

Although intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD), there is currently no standardized definition or uniform practice recommendations for response. A quality improvement project included nine registered nurses (RNs) and 96 adult patients receiving HD at a...

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Published inNephrology nursing journal : journal of the American Nephrology Nurses' Association Vol. 46; no. 6; pp. 495 - 504
Main Authors Wills, Christie A, Carrico, Cathy
Format Journal Article
LanguageEnglish
Published United States Jannetti Publications, Inc 01.11.2022
Anthony J. Jannetti, Inc
Subjects
Adult
Blood pressure
Care and treatment
Comorbidity
Complications and side effects
Development and progression
Diabetes
Documentation
Evaluation
Hemodialysis
Humans
Hypotension
Hypotension - etiology
Hypotension - therapy
Kidney diseases
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Medical protocols
Medicare
Mortality
Nephrology
Nursing
Nursing care
Pathophysiology
Patients
Peritoneal dialysis
Quality Improvement
Quality of care
Renal Dialysis - adverse effects
Renal Dialysis - methods
Vital signs
United States
United States > US
hemodialysis
intradialytic hypotension
nursing protocol
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Summary:Although intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD), there is currently no standardized definition or uniform practice recommendations for response. A quality improvement project included nine registered nurses (RNs) and 96 adult patients receiving HD at a 30-station Midwest urban dialysis clinic. The project focused on development of an evidence-based RN-initiated protocol, RN education, and implementation of the RN-initiated protocol to recognize, treat, and document IDH. IDH was recognized in 7.02% of dialysis treatments, with protocol use doubling from Week 1 to Week 8. Most IDH episodes were resolved after one (36%) or two (49.33%) 10-minute ultrafiltration (UF) pauses with interventions. The use of an RN-initiated IDH protocol standardized care and led to positive patient outcomes in this dialysis clinic.
Bibliography:ObjectType-Article-1
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ISSN:1526-744X
2163-5390
DOI:10.37526/1526-744X.2022.49.6.495