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Management of non-adherence to fluid intake restrictions in hemodialysis patients in a tertiary hospital: a best practice implementation project

Jia, Shoumei; Huang, Bihong; Chu, Yuanqian; Lu, Yuhua; McArthur, Alexa

JBI Database of Systematic Reviews and Implementation Reports: August 2016 - Volume 14 - Issue 8 - p 309–322
doi: 10.11124/JBISRIR-2016-003046

Background: Non-adherence to fluid-intake restrictions is one of the most common problems for hemodialysis (HD) patients. A combined approach that involves patients, healthcare professionals and caregiver inputs based on best practice is important for enhancing adherence within a busy health system.

Objectives: The aim of this project was to promote evidence-based practice in the management of fluid-intake restrictions among HD patients in a HD center.

Methods: Six evidence-based criteria developed by the Joanna Briggs Institute were used as a basis for audits undertaken in the Hemodialysis Center of Huashan Hospital, Shanghai, mainly focusing on nurse education, fluid-intake management by patients and the role of caregivers in assisting with fluid-intake management by patients. The project included three phases and was conducted over 5 months. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice.

Results: Results from pre- and post implementation audits indicated that the compliance rates of four criteria reached 100% after the implementation of various strategies. One criterion (patients’ self-monitoring) resulted in a compliance rate of 73.33%. One other criterion (patients’ medical documentation) was maintained at 100% compliance. Patients’ adherence to fluid intake, knowledge and attitude to self-management also improved significantly in the post implementation audit.

Conclusion: This project achieved a significant improvement in evidence-based practice for the management of non-adherence to fluid-intake restrictions in HD patients. An increase in the number of HD patients found to be adherent to fluid-intake restrictions was reported during this process.

1School of Nursing, Fudan University, Shanghai, China

2The Fudan Evidence Based Nursing Center: a Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China

3Hemodialysis Center, Huashan Hospital, Shanghai, China

4The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia

Correspondence: Shoumei Jia,

There is no conflict of interest in this project.

© 2016 by Lippincott williams & Wilkins, Inc.
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