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S 26 Short Orals
Programme of the Session
Title: Short Orals
O 59
Assessment of pain and adequacy of analgesia in hemodialysis patients
Patricia Martínez Alvarez (Spain)
O 60
Monthly blood / patient reviews: A focused team based approach
David McIntyre (Australia)
O 61
Nursing coordinators in the dialysis unit
Regina Hais (Israel)
Samar Abed Abo Foul (Israel)
O 62
Anxiety, depression and quality of life in patients undergoing chronic haemodialysis; observational cross section study
Afra Masià Plana (Spain)
O 63
Ischemic hand in dialysis patients: a survey about prevalence, clinical signs and symptoms
Ilaria Irma Sinisi (Italy)
O 64
Awareness of renal nurses in identification and education of patients with inherited renal diseases
Faduma Sharif (United Arab Emirates)
O 65
Strict monitoring of isoagglutinins levels is required for ABOincompatible living-donor kidney transplantation
Chloé Couat (France)
O 66
Interconnected care in haemodialysis: patient, nurse and informal caregiver
Virginia Henriques (Portugal)
O 67
Haemodialysis — Rethinking our environmental responsibilities
Adrian Bastar (Romania)
Abstracts
O 59 / P 019
Assessment of pain and adequacy of analgesia in haemodialysis patients
R. Pelayo Alonso1, P. Martínez Alvarez1, J.L. Cobo Sanchez1, M. Gándara Revuelta1, E. Ibarguren Rodriguez1,
1Nefrology Department. Haemodialysis Unit, "Marqués de Valdecilla" University Hospital, Santander, Cantabria, Spain
Background
Pain is the most common symptom in renal patients due to comorbidity, the dialysis technique and more time on haemodialysis.
Objectives
To determine the prevalence of intradialytic and chronic pain as well as the adequacy of analgesic therapy in patients on haemodialysis.
Methods
Descriptive study in 33 patients on haemodialysis in which different rating scales were used: Brief Pain Inventory (to determine the chronic pain), Visual Analogue Scale (to assess the intradialytic pain) and Pain Management Index (for checking the conformity of analgesia).
Results
Chronic pain occurs in 57.57% of patients and intradialytic pain in 78.8%. In both cases, pain was musculoskeletal, mild (3.14 points and 3.13 points respectively); and related to more time on haemodialysis. Chronic pain interfered with the mood, the usual work and relationship with others. The adequacy of the treatment was successful for chronic pain but not for intradialytic pain.
Conclusion/Application to practice
Pain is a frequent symptom in our sample. The intradialytic pain presents a worst pharmacological management than the chronic pain.
O 60 / P 076
Monthly blood / patient reviews: A focused team-based approach
D. McIntyre1, N. Lorenzen2, K. Jakeman1, M. Rice3
1Renal, The Royal Brisbane and Womens Hospital, Brisbane, Australia; 2Dietetics, The Royal Brisbane and Womens Hospital, Brisbane, Australia; 3Phamacy, The Royal Brisbane and Womens Hospital, Brisbane, Australia
Background
The previous only medical model often led to poor communication and fragmented follow up. With the introduction of a Nurse Practitioner and a focused nurse manager, a tailored interdisciplinary approach was trialled. The reviews maximised the finite resources of the MDT and better targeted the nephrologists time. The MDT consisted of a Renal Nurse Practitioner, Pharmacist, Dietitian and Nurse Unit Manager. Patient’s haemodialysis information, monthly biochemical and haematological results, medications, nutritional status and psychosocial concerns were reviewed. The MDT reviews featured real time documentation with the patient clinical record and feedback provided to the patient within 48 hours.
Objectives
To report on the implementation and outcomes of monthly MDT reviews within a satellite dialysis unit.
Methods
A documented framework for the MDT to follow and regular review of the initiative identified ways to improve efficiency and target areas for the unit to focus on. The MDT reviews are fully supported by nephrologists and have facilitated an increase in their clinic availability.
Results
A fully collaborative approach to monthly patient reviews has resulted in:
• Maintenance of biochemical and haematological performance key indicators comparable with the previous medical only model
• Increased patient involvement
• More timely referrals and follow up
• Transparent review process with real time documentation
• Optimisation of limited allied health resourses
• Ongoing professional development for the MDT
Conclusion/Application to practice
Monthly MDT reviews are now embedded into our practice. The process improves efficiency and is highly valued by patients, nursing staff, the MDT and Nephrologists.
O 61 / P 028
Nursing coordinators in the dialysis unit
R. Hais1, S. Abed Abo Foul1
1Dialysis, Assuta Hospital, Haifa, Israel
Background
There is a diversity of care required for dialysis patients, which includes pain management, infection prevention, vascular access care, diabetic care, phosphate control, transplant care and education about renal failure.
The increased number of dialysis patients raises the need for nurses with specified responsibilities in various specialties, including patient education, improvement of work procedures, implementation of new protocols and ensuring a continuum of care between the specialties.
Objectives
Nurses were appointed as coordinators responsible for an area of specialized care, including pain treatment, infections, vascular access, diabetic care, phosphate control, transplant care and patient education. A survey was conducted to assess their impact on the quality of care and patient knowledge.
Methods
A questionnaire relating to patient satisfaction and understanding of their treatment in these areas was developed and distributed. The data were collected and translated to percentages, so each subgroup received a score on a scale from 1-100. Next, the reasons for the lowest scores were considered, and an interventional plan built.
Results
Patient satisfaction was highest in the specialties of infection control, pain management and vascular access care, and was lowest in diabetic care and transplant care. A plan for improving the scores in the lower rating subgroups has been implemented, and an additional survey will be performed at the end of the intervention.
Conclusion/Application to practice
There was a positive correlation between the function of the coordinating nurse and the high scores received in the various fields. Methods of improving the scores in the lowest rating subgroups must be determined and implemented.
O 62 / P 182
Anxiety, depression and quality of life in patients undergoing chronic haemodialysis; observational cross section study
A. Masià1
1Haemodialysis, Clinica Girona, Girona, Spain
Background
Patients undergoing chronic haemodialysis treatment can suffer different stressful and threatening situations. The impact of emotional disorders can be a determinant to the progress of the chronic illness.
Objectives
1.Describe quality of life and the level of anxiety and depression. 2.Explore the correlation between anxiety and depression with quality of life levels. 3.Analyse the predictor factors between quality of life and anxiety and depression.
Methods
This was a quantitative, cross-sectional study. 138 patients were interviwed in Spain. The Kidney Disease Quality of Life short form (KDQOL-SF) questionnaire and the Hospital Anxiety and Depression Scale (HADS) were used for the data collection.
Results
The results show that 15.9% of patients suffer clinical depression and 19.6% suffer clinical anxiety. The levels of quality of life are significantly below the average population. Findings suggest that anxiety and depression have a negative correlation with quality of life levels. The ANOVA studies between anxiety and depression and quality of life show significant differences with nearly all the scales of quality of life.
Conclusion/Application to practice
patietns'
An initial and on going evaluation of patients emotions should be performed. It is fundamental that nursing care planning is constant to improve quality of life and avoid emotional disorders, considering a holistic view of the patient. A nurse-led nephrology nursing practice program should be considered, offering social choices and psychological support based on an individualised evaluation of the needs.
O 63 / P 095
Ischemic hand in dialysis patients: a survey about prevalence, clinical signs and symptoms
I. Sinisi1, M. Orlando1, D. Camarella1, R. Capoferri2, A. Pizzo2, M.T. Parisotto3
1NephroCare Italia, Simone Martini Dialysis Unit, Milan, Italy; 2NephroCare Italia, Nursing Coordination, Naples, Italy; 3Fresenius Medical Care, Nursing Care Coordination, Bad Homburg, Germany
Background
Ischemic Hand (IH) is a peculiar complication among dialysis patients. Its mechanism is based on reduced blood flow of the arterial tree below the elbow where the AV Fistula may trigger the syndrome.
Objectives
To assess prevalence of IH and the role of nurses in the prevention of complications.
Methods
We promoted a national survey to investigate IH prevalence in setting of patients on RRT, evaluating early and over time clinical signs. The survey included 41 dialysis units, collecting information on 2,082 patients.
Results
Early signs of IH were detected in 45 patients out of 2,082 (2.2%). 73% perceived pain during dialysis. Pharmacological pain control was requested by 22% of patients, low temperature of the hand was perceived by 64%; 33% needed to wear a glove; 62% experienced skin-colour change after cannulation for dialysis; 33% had advanced lesions (skin lesions, necrosis in 14 out of 45 patients) In addition, 41 interviewed clinicians underlined a high or very high clinical importance in 36% and 17% of the cases. Moreover, they detected an insufficient understanding of strategies to follow in 51%; lack of available experts in 37.8% and the necessity of a vascular surgeon in 64.5%.
Conclusion/Application to practice
This survey showed that IH is not a rare disease and underlines the critical role of nurses in detecting and following early
clinical signs of this potentially complication.
O 64 / P 077
Awareness of renal nurses in identification and education of patients with inherited renal diseases
F. Sharif1, N. Alqaissi2, D. Dowsett3, C. Greenway3, P. Byers3, M. Bishop4, A. Cullimore1, N. Richards1, M. Richards1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates; 2Nursing, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates; 3Health Faculty, De Montfort University, Leicester, United Kingdom; 4HEE Genomics Education Programme, NHS Birmingham, Birmingham, United Kingdom
Background
Genetic disorders in the United Arab Emirates are common. Increased awareness of the importance of early identification of patients with genetic disorders has provided the disorders a high level of prominence in primary health care settings. Nevertheless, there is empirical evidence indicating that there is a low level of understanding of inherited diseases among nurses.
Objectives
This study explored how renal nurses identify patients with or at risk of inherited renal diseases and the nurses’ awareness of support services available for patients and their families.
Methods
A descriptive phenomenological study approach, with semi-structured interviews was used to collect data from paediatric renal nurses working within SEHA Dialysis Services.
Results
All paediatric dialysis nurses responded to the survey. They identified polycystic disease, Alports syndrome and congenital nephrotic syndrome as the commonest genetic disorders in their practice. Other conditions such as neurogenic bladder and diabetes were incorrectly mentioned as was the idea that 60+% of all patients had an inherited disorder. Whilst all nurses were aware of the possibility of transmission to children and the concept of a carrier status none were able to correctly describe the inheritance of any of the conditions and the likelihood of an affected child being born from affected parents. All correctly identified consanguineous mariage as the cause for the high prevalence of such conditions within Abu Dhabi. Few support services are available.
Conclusion/Application to practice
The findings presented in this study indicate that there is a need to provide genetic training and education to renal nurses with regards to inherited renal disorders.
BIOGRAPHY OF THE SPEAKER
O 65 / P 190
Strict monitoring of isoagglutinins levels is required for ABO-incompatible living-donor kidney transplantation
C. Couat1, N. Kamar1, A. Allal1, C. Leroux-Biben1
1Department of Nephrology and Organ Transplantation, University Hospital Center, Toulouse, France
Background
Due to the shortage of organs from deceased donors, kidney transplantation from living donors has been developed. Besides standard kidney transplantation from living donors, HLA-incompatible and ABO-incompatible (ABOi) kidney transplantation have been developed. Hence, French authorities allowed ABOi transplantation in 2011.
Objectives
Since 2011, the Department of Nephrology and Organ Transplantation (Toulouse University Hospital) has performed desensitization protocols to enable ABOi transplantation.
Methods
Desensitization protocols included apheresis sessions (immunoadsorption), rituximab, and intravenous immunoglobulins. The number of apheresis sessions was chosen according to the isoagglutinin level needed for ABOi transplantation. Isoagglutinin levels were also determined daily within the first days post-transplantation, weekly during the first month, and then monthly for 1 year. An increased isoagglutinin level prompted physicians to modify immunosuppression and/or to conduct immunoadsorption sessions to avoid acute rejection.
Results
Between March 2011 and December 2015, 55 ABOi kidney transplantations were performed in our institution. Only three graft losses occurred. Of these, only one was related to chronic antibody-mediated rejection. Monitoring isoagglutinin levels allowed us to determine the best pre- and post-transplant therapeutic options.
Conclusion/Application to practice
Monitoring isoagglutinin levels is mandatory when performing successful ABOi living-donor kidney transplantation.
BIOGRAPHY OF THE SPEAKER
O 66 / P 078
Interconnected care in haemodialysis: patient, nurse and informal caregiver
V. Henriques1, A. Vieira1, F. Vieira1, J. Fazendeiro Matos2, M.T. Parisotto3
1NephroCare Braga, Fresenius Medical Care, Braga, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3Care Value Management EMEA, Fresenius Medical Care, Bad Homburg, Germany
Background
In the context of Health-Related Quality of Life, it is mandatory to ascertain what perceptions individual patients have when it comes to their own health and not purely rely on the traditional clinical measures. This concept covers several scientific areas and research fields such as social integration and support, satisfaction with life and physical condition, affective and relational capacity, network backup of all players involved in the world of healthcare.
Objectives
• Gain a comprehensive understanding on how the informal caregiver (IC) and nurses interrelate with the rest of the network of haemodialysis patient's relationships.
• Identify the importance of IC such as firefighters and taxi drivers.
Methods
A group of 112 haemodialysis patients undergoing treatment in our clinic were assessed. Surveys were carried out and data was collected from May 12 until June 13.
A qualitative instrument, the "Sickness Impact Profile" (SIP) Portuguese Translation, was used and analysed. SIP is behaviourally based and measures sickness related dysfunction and outcome of health care services.
Results
Our outcomes highlighted the importance of the support received from health professionals and caregivers, their loved ones and the techniques employed during haemodialysis treatment. An equally important finding is related to the IC such as the role of the taxi driver who revealed themselves as privileged element and connecting link between the different actors.
Conclusion/Application to practice
The IC, who is very rarely spoken about, proved to be a key player, exercising a therapeutic role thanks to their ability to help, the chance to observe and establishing trust with the dialysis patient, family and clinical staff.
O 67 / P 043
Haemodialysis — Rethinking our environmental responsibilities
A. Bastar1
1Fresenius Nephrocare Romania, Bucuresti, Romania
Background
As global efforts to combat climate change and carbon generation accelerate, the environmental impact of dialysis practice will come under increasing regulatory focus. That is why each of us has the responsibility to protect the environment as much as possible and optimize resource consumption.
Objectives
Our objectives are to minimize the negative effects and reduce consumption of natural resources, to raise awareness of all employees.
Methods
We reduced the water consumption by using post-dilution haemodiafiltration, with an automatic adjustment of the relation of dialysate flow rate / blood flow rate to 1.2.
We implemented Kaizen by training and involving employees in order to improve the daily activities and we raised the employees’ awareness towards the importance of environmental protection.
We reduced contaminated waste by separating domestic, plastic waste: reduce, re-use, recycle – always look for ways to use fewer resources. We implemented specific emptying procedures for haemodialysis and HDF circuits.
Results
We reduced the amount of contaminated waste/treatment from 1.2 to 0.9 kg during one month for each patient. We have minimized the risks for the company, employees, environment and patients with internal directives and compliance with legal requirements and optimized processes and results thus achieving economic objectives.
Conclusion/Application to practice
Protecting the environment is a priority of the entire staff of our dialysis unit in order to ensure a high quality and safe treatment with minimum impact on the environment.