Ronice Wagner 1 Igor Semhaev 1

1. Ward control alignment for Patient's Anemia: Planning, constructing, staff-training, implementation and follow-up. Ronice Wagner1 Igor Semhaev1 Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Israel 1

2. Background Erythropoietin is a glycoprotein hormone that controls and regulates red blood cell production. It is produced and secreted in the kidney. Chronic renal failure is associated with various degrees of anemia due to erythropoietin deficiency resulting from multiple factors

3. Among those factors we find - • Decreased erythropoietin production as a result of kidney damage. • Decreased RBC lifespan secondary to uremia. • Reduced bone marrow response to circulating erythropoietin. • Ongoing blood losses from dialyzer and tubing, blood sampling, gastrointestinal blood loss, and blood losses at the time of dialysis needle placement and removal. • Depletion of iron stores precedes impaired production of iron-containing proteins, the most prominent of which is hemoglobin

4. The mainstay Anemia treatment includes Administration of I.V Erythropoietin and Iron. . • Till the end of 2009 our patients received monthly prescriptions for medications and were required to purchase them personally. The reasons that this procedure was never smooth and effective were : • Physician’s decisions were based on narrow scope of data. • Delays in delivering reports to the physicians. • Patients were unreliable in purchasing and delivering medications on-time.

5. Objective In order to reduce the burden and relieve the patients from this tedious procedure we decided to make the ward responsible for the monthly drug supply.

6. Method - On December 2009 a new role was established : Anemia Coordinator

7. Anemia Coordinator’s duties included –1 - Creating a ward monthly tabledisplaying blood tests and present prescribed treatment

8. 2 - Creating a monthly personal physicians’ tabledisplaying his/hers patient blood tests results and present medical treatment leaving empty space forchanges.

9. 3 - Building a summing-up order formfor ward medication supply.

10. ) Create a registration formwhich checks indicates and updates the expiring dates of drug supply confirmation, given by the Central Pharmacy: Ronice 2011

11. Anemia coordinator monthly duties are - 1. Fill in the new Laboratory Results in the Monthly table , Personal physicians’ table and Ward Medication Supply List . 2. Give every physician his personal patients list. Get new medical orders and add them to the patient's files. 3.Send the corrected Ward Medication Monthly Supply Listto the Central Pharmacy 4.Upon medical supply arrivel, storeit according to the hospital and medical regulations. 5. Give proper instructions and guidanceto the ward team.

12. Mean Hb levels during activity period of Anemia Coordinator (n=100 - 110) Since appointing an Anemia Coordinator we have observed – 1.Improved stability in ward Hemoglobin.

13. 2.Improved stability in Iron saturation values

14. - 3.Significant reduction in number of blood transfusions

15. Conclusions and Recommendations Observing the positive results of the new method we recommend other units to implement this management concept in order to improve Anemia Alignment.

16. לכל המעוניינ/ת בטבלאות המצורפות מוזמנ/ת לפנות במייל: ronisv@clalit.org.il ronisvagner@gmail.com