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Evidence-Based PD Change Improves QOL
- 1. Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change Lourdesee Luty Acute Gerontology Nurse Practitioner Program, Walden University Nurse 6052C-6, Essentials of Evidence Based Practice Dr. Christine Frazer February 11, 2022
- 2. From wakehealth.edu Mission To improve health, elevate hope and advance healing----for all Vision To be the first and best choice for care Culture Commitments We create a space where all Belong We Work as One to make great things happen We earn Trust in all we do We Innovate to better the now and create the future We drive for Excellence----always School of Medicine Innovations Improving health through collaborative innovation between industry and the faculty and staff of Wake Forest Baptist Medical Center.
- 3. Opportunity Change in the way information is presented to new dialysis patients! Description Peritoneal dialysis is not presented fairly as a strong choice for dialysis. Scope • Nephrologist must establish patient eligibility for PD and emphasize decreased mortality based on EBP. • Nephrology nurses must reinforce education and answer patient questions • Adjusted mortality decreased by nearly 15% in patients receiving hemodialysis and by nearly 20% in patients receiving peritoneal dialysis between 2009 and 2018 (USDHHS, 2021). Stakeholders • Patient, physician, nurses, educators, organization Risks • Patient not a candidate ex. Contraindications, AKI • Patient overwhelmed, information overload • Time constraints • Resistance to change
- 4. MD identifies PD eligible patient in acute setting MD talks to patient about benefits and risk Patient starts HD in acute setting, dialysis nurse present Dialysis nurse educates patient about HD and PD, use Ottawa personal decision guide with patient, answers questions, refer concerns to MD Patient make informed decision. Improved QOL IDEA (Ottowa Research Institute, 2019)
- 5. PLAN Assess the situation Form a group of experts, collect EBP literature, collaborate with MD, nurse leaders, the medical director (knowledge creation) Present to organization EBP findings (organizational adoption) Podium lectures (dissemination) Workshops (dissemination) Determine resources (organizational adoption) Write procedures and policy to incorporate education in dialysis initiation. (Implementation) Have technical support encode education process as a choice in HER (implementation)
- 6. Dissemination -Peer review journals gather studies and determine validity Rapid critical appraisal (RCA), they will review each study to determine * its level of evidence. * how well it was conducted. * how useful it is to practice. (Fineout-Overholt et al., 2010) -Clinical workshops This topic is specific to the nephrology group Setting specific target Group shares common interest
- 7. Measurable Outcomes • Improved quality of life • Decreased mortality rate in ESRD patients • Decreased hospitalizations Bing.com
- 8. Lessons Learned Not all evidence is good evidence The process of synthesis: seeing similarities and differences across the body of evidence (Fineout-Overholt et al., 2010). Aids in the search and filtering process RCA is conducted along with an RCA checklist that's specific to the research design of the study being evaluated-and before any data are entered into an evaluation table (Fineout-Overholt et al., 2010). Used as a guide Time is relevant to information, something practiced 10 years ago may outdated and found obsolete with EBP. Reading the charts and graphs are important and knowing what to look for
- 9. • The peer-reviewed articles met the requirements necessary to provide support of my theory that PD therapy has better QoL than HD. • While most of the articles had a large enough sample size to gather data from, the one that was limited was very regionally specific. The This Photo by Unknown author is licensed under CC BY-SA.
- 10. • The Critical Appraisal Tool Worksheet was very thorough and precise to the information needed. • The Appraisal tool took a large amount of information and broke things down to an understandable level. This Photo by Unknown author is licensed under CC BY-SA.
- 11. Resources Budhram , B., Sinclair, A., Komenda, P., Severn, M., & Sood, M. M. (2020, October 19). A comparison of patient- reported outcome measures of quality of life by dialysis modality in the treatment of kidney failure: A systematic review. Canadian journal of kidney health and disease. Retrieved December 19, 2021, from https://pubmed.ncbi.nlm.nih.gov/33149924/ Chuasuwan, A., Pooripussarakul, S., Thakkinstian, A., Ingsathit, A., & Pattanaprateep, O. (2020). Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: A systematic review and meta- analysis. Health and Quality of Life Outcomes, 18(1). https://doi.org/10.1186/s12955-020-01449-2 Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN, et al. Evidence-Based Practice Step by Step: Critical Appraisal of the Evidence: Part I. Am. J. Nurs.. 2010;110(7):47-52. doi:10.1097/01.NAJ.0000383935.22721.9c. Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN, et al. Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part II: Digging deeper-examining the "keeper" studies. Am. J. Nurs.. 2010;110(9):41-48. doi:10.1097/01.NAJ.0000388264.49427.f9. Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN, et al. Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III. Am. J. Nurs.. 2010;110(11):43-51. doi:10.1097/01.NAJ.0000390523.99066.b5. Hiramatsu , T., Okumura, S., Asano, Y., Mabuchi, M., Iguchi, D., & Furuta, S. (2019, December 12). Quality of life and emotional distress in peritoneal dialysis and hemodialysis patients. Therapeutic apheresis and dialysis : official peer- reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. Retrieved December 19, 2021, from https://pubmed.ncbi.nlm.nih.gov/31671240/
- 12. Resources Cont. The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/ U.S. Department of Health and Human Services. (2021). Kidney Disease Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 11, 2022, from https://www.niddk.nih.gov/health- information/health-statistics/kidney-disease Wang, J., Zeng, J., Liu, B., Cai, B., Li, Y., & Dong, L. (2020). Outcomes after transfer from hemodialysis to peritoneal dialysis vs Peritoneal Dialysis as initial therapy: A systematic review and meta‐analysis. Seminars in Dialysis, 33(4), 299– 308. https://doi.org/10.1111/sdi.12896
Editor's Notes
- Hello Dr. F and Collegues. My name Lourdesee Luty. This is Evidence-based project 4, my recommending an evidence-based practice change. While I am in this AGNP Program at Walden University, I am a Certified Nephrology Nurse working in dialysis at the acute setting.
- I work at Atrium Health Hospital. This organization has a mission and vision statement and cultural commitments that line with my beliefs. It is a learning hospital with a school of medicine and has a great innovations program. The innovations statement, "Improving health through collaborative innovation between industry and the faculty and staff of Wake Forest Baptist Medical Center says it all.
- As a dialysis nurse, I have initiated many very first treatments for patients. I feel there is not enough education and discussion physicians have with the patient when it is determined the patient needs dialysis. Yes, education is given, but only for the hemodialysis treatment and the process of what is currently happening. There is limited information given on the other options a patient has like PD and home hemodialysis or even transplant. It is in the scope of the nephrology team to ensure the patient truly understands why it is important to dialyze at home than in the centers. All the stakeholders listed should be made aware. There are risks just the same as with all new things. Resistance and time are the most frequent. What nurse wants extra work?
- Most people have a history of kidney disease and failure in the family so they have a Nephrologist following them to monitor kidney function. As a proactive measure, the physician has a fistula place in the arm of the patient in preparation for imminent dialysis initiation. Instead of that, anticipate the start with tenckhoff catheters used for PD instead of a fistula. And in the acute setting, introduce and inform patients earlier of availability to do PD. Then during emergent dialysis starts with the dialysis nurse, the nurse can begin answering questions and reinforcing education to the patient. During the course of a treatment, the nurse can initiate a personal decision guide with the patient to help fill in the gaps.
- The idea can be introduced and implemented by gathering a group of people in the organization and presenting the findings in a for of podium lectures and workshops. This can attract the correct specialty of people that work in this field. Presenting this to one's organization and seeking interest to incorporate the practice can lead to new policies and procedures.
- Sharing peer reviewed journals for this information and clinical workshops is the best choice. The workshops can include the professional opinion and expertise of those that attend in a form of a discussion.
- Measurable outcomes include less hospitalizations, decreased mortality rate and improved QoL. The less I see the patient in the acute setting dues to complications of ESRD the better.
- The main lesson learned is that not all evidence is good evidence, I am certain I read it somewhere but cannot remember exactly where. I have learned how to filter a large body of information and compress the findings to what I need with the help of filter parameters.
- The peer reviewed articles were very dense just going in and reading everything. At first glance, the journals all sounded exactly what I wanted. The limitation to the search made some of the findings small because there was enough current dats relevant to the time frame.
- As I stated in the previous slide, the article were very dense and full of information. I found the critical appraisal tool helpful in compartmentalizing the journals into smaller and more manageable parts. When I sought out the information for each category it was easier to understand.
- Resources are on last 2 slide