Escape to Patient Safety Project: A Nursing Proposal.

ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the dialysis setting. This article describes an education initiative based on the escape room methodology to provide a fresh approach on dialysis curriculum.

Fistula first breakthrough initiative: targeting catheter last in fistula first.

An arteriovenous fistula (AVF) is the optimal vascular access for hemodialysis (HD), because it is associated with prolonged survival, fewer infections, lower hospitalization rates, and reduced costs. The AVF First breakthrough initiative (FFBI) has made dramatic progress, effectively promoting the increase in the national AVF prevalence since the program's inception from 32% in May 2003 to nearly 60% in 2011. Central venous catheter (CVC) use has stabilized and recently decreased slightly for prevalent patients (treated more than 90 days), while CVC usage in the first 90 days remains unacceptably high at nearly 80%. This high prevalence of CVC utilization suggests important specific improvement goals for FFBI. In addition to the current 66% AVF goal, the initiative should include specific CVC usage target(s), based on the KDOQI goal of less than 10% in patients undergoing HD for more than 90 days, and a substantially improved initial target from the current CVC proportion. These specific CVC targets would be disseminated through the ESRD networks to individual dialysis facilities, further emphasizing CVC avoidance in the transition from advanced CKD to chronic kidney failure, while continuing to decrease CVC by prompt conversion of CVC-based hemodialysis patients to permanent vascular access, utilizing an AVF whenever feasible.

Factors associated with long-term antibody production induced by hepatitis B vaccine in patients undergoing hemodialysis: a retrospective cohort study.

STUDY OBJECTIVE: To assess the influence of various clinical factors on antibody production induced by hepatitis B vaccine in patients receiving hemodialysis up to 24 months after vaccination. DESIGN: Retrospective cohort study. SETTING: Outpatient dialysis center. PATIENTS: Adult patients undergoing hemodialysis who received a three-dose series of intramuscular hepatitis B vaccine 40 microg at time 0, 1, and 6 months, according to protocol. MEASUREMENTS AND MAIN RESULTS: Antibody to hepatitis B surface antigen (anti-HBs) titers were monitored quarterly, and booster doses were given according to protocol. Patients with anti-HBs of at least 10 mIU/ml were considered seropositive. Clinical variables--age, diabetes mellitus status, serum albumin level, and equilibrated Kt/V (eKt/V; Kt/V is a measure of urea clearance during dialysis, used to quantify the delivered dose of hemodialysis)--were compared between seropositive and seronegative patients 12 months (cohort 1) and 24 months (cohort 2) after vaccination. In cohort 1 (66 patients), 24 (36.4%) were seropositive at 12 months. In cohort 2 (40 patients), 15 (37.5%) were seropositive at 24 months. Comparison of seropositive and seronegative patients revealed no statistically significant differences in mean age, sex, serum albumin level, or eKt/V. However, at 24 months, patients with diabetes were 2.5 times more likely to demonstrate seropositivity than those without diabetes (60% vs 24%, respectively, p=0.02). CONCLUSION: Long-term seroprevalence induced by hepatitis B vaccine was low in our patients 12 and 24 months after vaccination. These results were comparable to previously reported long-term results. Larger, prospective studies would be needed to confirm the finding that patients with diabetes had superior hepatitis B vaccine-induced antibody production at 24 months.

Hepatitis B vaccination: addressing a drug-related problem in hemodialysis outpatients with a collaborative initiative.

UNLABELLED: The CDC recommends that all hemodialysis (HD) patients be vaccinated against hepatitis B virus (HBV). In 1999, only 39 of our 134 (29%) HD patients had received HBV vaccine. Since the vaccine is indicated for all HD patients, this presented a drug-related problem (DRP): indication without treatment. In response, nurses and pharmacists initiated a proactive HBV vaccination program. METHODS: An immunization protocol based on then current CDC recommendations was developed. HBV vaccine (40 mcg i.m.; at 0, 1 and 6 months) was administered to consenting HD patients. Anti-hepatitis B surface antibody (anti-HBs) titers were monitored and booster doses were given per the protocol. RESULTS: By August 2001, all consenting HD patients (n = 110) had received > or = 1 dose of HBV vaccine and 90 (81.8%) had either received a full course (> or = 3 doses) or had received > or = 1 dose and developed a positive anti-HBs titer (> or = 10 mIU/mL). Of these 90 patients, 52 (58%) developed a positive anti-HBs titer, 33 (37%) responded to < or = 3 doses, and 19 (21%) following a booster. The DRP was significantly improved. CONCLUSION: Given CDC guidelines, HBV vaccine should be offered to all HD patients. This initiative demonstrates that with concerted effort all consenting HD patients can receive HBV vaccination, thereby addressing an important DRP.