Past: Used for teaching and increasing knowledge

1. 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 karen.bell@uch.edu sheri.sauthoff@uch.edu