Transplant issues: infections and immunosuppressant drugs.

Patients who have had organ transplants are at risk for infection and organ rejection. Critical care nurses can improve patient outcomes by recognizing and treating infection and by familiarizing themselves with the immunosuppressant medications used in transplantation.

Changes in dialysis units' quality improvement practices from 1994 to 1996.

In 1994, the Health Care Financing Administration initiated a nationwide effort to improve care to Medicare's end stage renal disease (ESRD) beneficiaries by reshaping the manner in which the ESRD Network Organizations measure and assess the quality of dialysis services. The new approach was named the ESRD Health Care Quality Improvement Program (HCQIP). It embodies themes such as the development of quality indicators and support for continuous improvement. Projects such as the ESRD Core Indicators Project and the National Anemia Cooperative Project are geared toward assisting dialysis providers to improve patient care. In an effort to document changes in dialysis quality practices associated with the ESRD HCQIP, surveys were sent by Network staff to the head nurses of all dialysis units in 1994, and a random sample of units in 1996. Analysis of the survey responses was performed identifying self-reported changes in dialysis units' quality improvement activities. Results indicate that practice changes are taking place, that they are generalizable to all dialysis units in the country, and that they are associated with improvement in patient outcomes. Trends in quality improvement activities are identified and conclusions are drawn about what impact these activities have on patient care.

The nephrology nursing practice environment: responding to changes.

In this session, Ms. Smith and Ms. Sims outlined the practice milieu for today's nephrology nurse. The speakers portrayed the end stage renal disease (ESRD) environment by defining the providers of care, outlining the changing characteristics of the recipients of care, and describing the effects of health care reform.

Nurse's role in achieving patient outcomes.

Nephrology nursing's influence on patient outcomes has as many facets as there are practice roles in nephrology nursing. These speakers discussed the impact on patient outcomes from a variety of practice perspectives. The roles of administrator, educator, staff nurse, government nurse, research nurse, and corporate nurse are each described.

Format of ANNA's long-range strategic plan.

In summary, ANNA's Long Range Strategic Plan is a working tool. This is not a document to gather dust. The format lends itself to use by a Board of Directors with information and direction flowing to the committee level and then the evaluation process sending information flowing back to the Board of Directors. This is the key to any successful strategic plan.

Nephrology nursing consult: case study. Quality assurance works.

The printout of data revised and organized according to the new tracking system was presented to the multidisciplinary team and revised from their suggestions and requests. The system in question was identified as having a statistically significant higher rate of infection than the other two in use, and the medical director agreed to eliminate this system from patient choice options. The tracking tool was then refined at the suggestion of the QA coordinator to identify repeat offenders, and the head nurse developed a special retraining program for these patients. The tool was further refined to separate new cases of peritonitis from exacerbations of continuing infection. Plans are now being made to evaluate the effectiveness of retraining on an individual basis so that viable options may be offered to those patients in whom retraining seems ineffective. QA works!