Journal Clubs Provide the Perfect Duet:
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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. PTH Test Accuracy.

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Past used for teaching and increasing knowledge

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

PTH Test Accuracy

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 ANCC-CNE 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

  • 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

  • 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 acomprehensive 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)

Graph 3

Graph 1

Graph 2

IV Iron and Anemia Management

Implications

Fluid Management

  • 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)

  • 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

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

Citations:

1. Sinclair & Parker (2009) Nephrology Nursing Journal, 36(6), 589-597.

2. Yokoyama,et al (2009) Nephrology NursingJournal, 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.

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

[email protected]

[email protected]


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