End-stage renal disease is a health problem that requires long-term and costly care. Nurses are the predominant caregivers in hemodialysis units delivering the dialysis prescription and associated nursing care which may include pre-, intra- and post-hemodialysis care. Nursing interventions have a great impact on reducing risk for complications and potential to promote health of end-stage-renal disease patients. Despite the availability of hemodialysis nursing care practice guidelines for nurses in the renal unit of the Defence Services General Hospital, there is still need to implement the best practice guideline into clinical practice.
The aim of this project was to enhance patient safety in hemodialysis nursing care practices and to ensure this practice will be performed according to the best available evidence.
This project adopted a pre- and post-implementation audit approach. It utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The project utilized thirteen audit criteria that are considered the best practice standards.
The findings of pre- and post-implementation audit showed that the compliance rates for six criteria had resulted in 100% following implementation of key strategies. Use of sterile technique with arteriovenous fistula needle insertion and maintenance of prescribed blood flow rate had resulted in high compliance in the post-implementation audit. The remaining five criteria showed increased compliance in the post-implementation audit.
This audit project was the first quality improvement initiative at the renal unit of the Defence Services General Hospital. This project has made a significant improvement in establishing evidence-based practices for implementing standard hemodialysis care practice among the nurses. Audit results and feedback following completion of the project indicated that the changes implemented were beneficial to both nurses and chronic hemodialysis patients.
1 Assistant Lecturer, Military Institute of Nursing and Paramedical Sciences, Mingaladon, Yangon, The Republic of the Union of Myanmar
2 The Yangon Centre for Evidence Based Health Care: an Affiliate centre of The Joanna Briggs Institute, Myanmar
War War Minn
Commencement date: May 2013
Completion date: October 2013