• P103: Identifying Barriers and Misconceptions to Routine Nursing Foot Care Assessment in the Hemodialysis Unit
• P104: Implementation Strategies for Evidenced-Based Interventions in Renal Transplantation Care: A Scoping Review Protocol
• P105: Use of Ultrasound Technology in Satellite Units
• P108: Prioritizing the Education and Training Needs of Hemodialysis Nurses: A Mixed Method Study
• P109: Nursing-led Education for New Hemodialysis Patient Orientation
• P110: Efficacy of Real-time Kt/v Measurement, Nursing Awareness and Patient Adherence

Taimur Qasim^a, PMP. Jason Maahs^{b ,} Gabe Lewis^c

^aCSA Group, Etobicoke, ON ^{; b}Baxter, Toronto, ON; ^cMackenzie Health, Dialysis, Richmond Hill, ON

Background

There has been an increase in planning, design and construction of dialysis centers across Canada to address aging infrastructure and the demand for dialysis services. CSA Group has several standards on various aspects of a renal program and they can be used as tools to support safe and efficient patient care.

Purpose of the project

The purpose of this presentation is to inform the audience about the topics covered by CSA standards, how they can support the daily activities of a renal program and the latest changes in the new editions of the related CSA standards.

Description

The presentation will cover details about what the latest CSA standards are, which topics they cover, how the updates address the latest industry trends and needs for patient care. The presentation will include real-life examples about how standards can be implemented by a dialysis program and the resulting benefits of doing so. The presentation will also cover the updated guidance in CSA Z8000 about the planning, design and construction of dialysis centers including outpatient, inpatient and peritoneal dialysis. Finally, information about how to engage with CSA standard development will be included with links to resources.

Evaluation/Outcomes

The primary outcome of this presentation will be an improved understanding of CSA dialysis standards, the information contained in them and where to find them.

Implications for nephrology practice/education

The implications of this presentation for nephrology practice/education are an improved understanding of which standards exist and how they can support renal providers. Additionally, audience members will have a better understanding of how to engage with CSA standards development and potential contribute to upcoming standard development projects.

Jacqueline Crandall^a-d, RN(EC) PhD CNeph(C), Jose Nino Villamater ^a,b, RN, BScN, MN; Lori Harwood ^a,b, RN(EC) PhD CNeph(C); Paula Gaspar ^a,b, RN, MScN; Barbara Wilson ^a,b, RN(EC), MScN, CNeph(C); Lidia Yanchuk ^a,b, RN, BScN, BScKin, MN(s); Julia Petrakis, RN (EC), MN-PHCNP, BScN ^a,b

^aRenal Care Program, London Health Sciences Centre, London, ON; ^bArthur Labatt Family School of Nursing, Western University, London, ON; ^cBloomberg Faculty of Nursing, University of Toronto, Toronto, ON; ^dDepartment of Thanatology, King’s University College, London, ON.

Background: Providing high-quality care to patients receiving hemodialysis requires nurses with specialized knowledge and expertise. However, the demand for qualified nephrology nurses has increased dramatically, and even more so after the impact of COVID-19 and the existing shortage of nurses. To ensure high-quality care and patient outcomes for patients who have kidney disease, both new and seasoned dialysis nurses require continued education that meets their needs.

Purpose: This mixed method study aimed to prioritize top learning needs for hemodialysis nurses who are working in a large regional renal program in Ontario and to identify the optimal methods of education delivery.

Method: After an extensive process of identifying key hemodialysis competencies in 10 domains, nurses throughout the program were asked to complete an online survey which rated each of the 81 competencies as to its perceived level of importance and the nurse’s current level of ability on a five-point Likert scale, Very Low (1) to Very high (5). Top learning priorities were ranked according to Borich’s needs assessment model, and mapped on the Locus of Focus model and the Importance-performance analysis. Comparisons between the three methods identified top learning priorities. Focus groups are also being conducted asking nurses about the best methods of education delivery.

Results: In total, ninety-three nurses participated in the on-line survey. The top learning priorities and the best learning methods identified by nurses will be shared within this presentation.

Conclusion: Hemodialysis nurses require continued education to meet their learning needs and to optimize patient care.

Implications for nephrology care: The priority learning needs and nurses’ perceptions on how best to meet these needs will be compilated into a set of recommendations that will be used to design an integrated and sustainable hemodialysis nursing continuing education program.

Ethan Holtzer, MHSc, CHE, Director, Dialysis Management Clinics (DMC)

This session is designed to empower advocates and healthcare professionals in the quest to enhance treatment options for kidney patients. This talk will delve into the key barriers and catalysts influencing change in healthcare, providing a clear roadmap for advocating effectively. Attendees will learn actionable strategies for driving innovation and access to cutting-edge therapies, and will explore inspiring success stories involving Hemodiafiltration (HDF), anti-itch therapies (DFK), and Sustainable Kidney Care. Gain the tools and knowledge needed to become a proactive change maker in the field of nephrology.

Billie Hilborn, RN, CNeph(C), BScN, MHSc (Bioethics), PhD

York University, Nursing, Ontario, Ontario

Background

Patient-centred care provides benefits for patients and nurses, however a gap was noted about this topic in the nephrology nursing literature. Therefore a study was undertaken to examine whether the philosophical ideals of patient-centred care consistently align with the everyday reality of hemodialysis nursing.

Purpose of Study

The study purpose was to describe the experiences and perspectives of hemodialysis nurses of their provision of patient-centred care.

Methods

A qualitative interpretive description design was used, with purposive sampling of hemodialysis nurses from hospital and satellite hemodialysis units in urban and rural  Ontario. Semi-structured interviews were held, and transcripts were inductively analyzed.

Results

Ten RN participants from urban and rural in-centre and satellite hemodialysis units described experiences of providing patient-centred nursing care. One notable patient-related detour that nurses needed to navigate when providing patient-centred hemodialysis care was frequent experiences of patients not adhering to their prescribed treatment regimen, particularly not following fluid restrictions and requesting shortened hemodialysis treatments. The concepts of compliance, adherence, and concordance were reviewed, and non-adherence was considered from the angle of patient decision-making as they self-managed their chronic illness and treatment burden. Hemodialysis nurses navigated patient non-adherence through a patient-centred approach by listening to them, providing education, respecting their choices, and being flexible.

Conclusions

Patient-centred hemodialysis nursing care can help support patients as they manage their treatment regimen burden. Reconsidering patient non-adherence as decision-making may prevent tension in the patient-nurse therapeutic relationship.

Implications for nephrology care

Implications for nephrology nursing education, practice, policy, and future research will be identified.

Andrea, Karger, Registered Nurse

Grand River Hospital, Home Hemodialysis, Kitchener, Ontario

Background

In the world of hemodialysis, it is well known that home is best. The ability to tailor your dialysis to both your lifestyle and your goals of care has many benefits. However, only 17% of the patients dialyzing in Ontario, participate in a home program.

Historically, home dialysis programs have been reserved for the “perfect” patients and many were ineligible for these programs due to perceived excluding barriers. In accordance with the Ontario Renal Network’s (ORN) guidelines for safe, equitable and patient-centered care, Grand River Hospital has put a significant focus on breaking down these barriers and encouraging more patients to participate in a home dialysis therapy.

Purpose of the project

The purpose of this presentation is to encourage a broader look at who is an appropriate patient for the home programs. This presentation hopes to inspire other programs to also expand their criteria for admission into their home programs. Ultimately, we hope to improve the lives of our patients and ensure that we are offering inclusive care that aligns with the patient’s goals for treatment.

Description

In this presentation, we will explain the common barriers that were often faced by patients and describe some of the initiatives that have been put in place to overcome these challenges. We will present a case study on one patient that we were able to successfully train and launch home with a diagnosis of calciphylaxis. This patient was able to dialyze more frequently at home and also self-administer her own sodium thiosulphate. We will discuss what went well and also some of the challenges that we are still working through.

Evaluation/Outcomes

This patient was able to remain in her home for an additional year of her life before she became unwell. This patient lived a significant distance from the hospital and did not drive. Normally, she would not have been considered a candidate for a home program due to her calciphylaxis. Being able to dialyze in her home, however, provided her with a greater quality of life. It also took some burden off of her family as they no longer needed to drive long distances to the dialysis centre. It was challenging to secure a pump and tubing for the administration of sodium thiosulphate. This pump needed to have hard limits to ensure that the medication was not given too quickly. Grand River hospital fostered a working relationship with our community partners to rent this equipment. There were also concerns about the price of this medication. It took a considerable amount of work and research by our pharmacist, to ensure that the patient did not have to pay for this medication.

Implications for nephrology practice/education

At Grand River Hospital we believe that anyone who wants a home therapy should have the opportunity to try. A strong focus as the future of our renal care will be on a movement to home therapies. All patients should be given the opportunity to dialyze at home without barriers and our focus is what we need to do, as health care professionals to ensure that this happens in a safe and inclusive way.

Keiji, Hayashi, RN, BSN, CNeph(C)

Unity Health, Nephrology, Toronto, Ontario

Background

Arteriovenous graft (AVG) failures can arise from various causes, often identified through careful assessment and imaging techniques. Bedside ultrasound, duplex imaging, and interventional radiology are commonly employed to determine the cause of failure. While most causes can be identified and treated through interventional radiology, in rare cases – such as graft delamination – bedside ultrasound and duplex imaging may be more effective in detecting the issue. Moreover, interventions such as angioplasty and thrombectomy performed in interventional radiology may inadvertently exacerbate unidentified graft delamination. Therefore, bedside ultrasound can serve as a valuable tool for hemodialysis nurses and vascular access nurses in assessing vascular access and identifying atypical complications, such as AVG delamination.

Purpose of the project

This project aims to educate hemodialysis nurses and vascular access nurses about AVG delamination, highlighting their vital role in its detection and prevention.

Description

The presentation will feature case study reviews, guidelines on assessing AVG delamination, strategies for prevention, and the nursing role in the management of this complication.

Evaluation/Outcomes

The anticipated outcome is for nurses to effectively identify AVG delamination utilizing bedside ultrasound.

Implications for nephrology practice/education

Increasing awareness of the potential for graft delamination can lead to improved patient outcomes in cases of graft complications.

Majeedah, Belding, MSc, RD

Royal Victoria Regional Health Centre, Dialysis, Barrie’ Ontario

Background: Patients affected with chronic kidney disease (CKD) experience an increased cardiovascular risk compared to those with normal renal function. High plasma homocysteine (Hcy) levels are a risk factor for mortality and vascular disease in observational studies of patients with CKD; and are higher in CKD patients than the general population. Plasma levels of Hcy depend on several factors, such as genetic alteration of methionine metabolism enzymes or deficiency of vitamin B12, vitamin B6 or folic acid. Folate and vitamin B12 supplementation is recommended for people with CKD to reduce mortality and prevent progression of end –stage renal disease (ESRD). However, effective vitamin B12 supplementation dosages are not clearly established. Potential overdosage-related toxicity could result in exacerbation of ESRD in individuals with CKD. One proposed mechanism is that cyanocobalamin supplementation therapy is metabolized to active methylcobalamin, releasing small amounts of cyanide which could accumulate in CKD.

Purpose of the project: Evaluate the impacts of vitamin B12 supplementation on CKD patients. While the appropriate range of B12 levels in CKD remains to be defined adequately, the author aims to determine best practices based on the consensus from the current evidence available.

Description: A systematic review to find relevant published and unpublished evidence related to safe levels of plasma Vitamin B12 levels in CKD patients providing evidence for best practices.

Evaluation/outcome: Vitamin B12 supplementation has been show to lower plasma total Hcy in some studies. However, over several studies CKD participants with Vitamin B12 therapy had an increased reduction in renal function, higher rate of MI, stroke, and mortality. Vitamin B12 concentrations >550 pg/mL trended towards higher risk of mortality across all levels of adjustment.

Implications for nephrology practice/education: Vitamin B12 should be included in ongoing assessment in CKD patients, which may be a change in current practice.

Theresa Krepelka^a, RN, MN, CNeph(C), Brendan McCormick^b, MD, FRCPC

^aThe Ottawa Hospital Regional Nephrology Program, Ottawa, ON; ^bDivision of Nephrology, University of Ottawa and The Ottawa Hospital, Ottawa, ON.

Background:  In 2018 the Ontario Renal Network (ORN) began allocating funding for community home peritoneal dialysis (PD) assistance directly to eligible regional renal programs rather than flowing funding through Homecare agencies.  The Ottawa Hospital (TOH) Home Dialysis Unit (HDU) took this opportunity to revamp delivery of home PD services in the Champlain region.

Purpose of the project:

The objective was to provide assisted PD care to patients in their homes using the TOH’s own staff and move to a community-based model of care.  Historically, assisted PD care was provided by community agency nurses who were trained by the regional program.  It was anticipated that having specialized HDU nurses visiting patients regularly would improve communication, promote timely preventive interventions, improve quality of PD assistance, improve psychosocial support to patients and their families, and allow for continuous training in the home to promote eventual independence.

Description: In June 2018 TOH HDU expanded from 12 to 18 full time registered nurses and began 35 to 45 daily assisted PD visits.  These visits would support cycler set up, connection, disconnection, and dressing changes, among other PD related care. In addition, for all 180 prevalent PD patients every 2^nd clinic visit was converted to a virtual visit with the nursing assessment provided in the patient’s home.

 Evaluation/outcome:

The new model has been a success and since implementation the number of patients requiring assistance has fallen, the program’s technique failure rate has decreased, and the prevalent number of patients on PD has increased.  All patients starting PD at TOH are assured of home assistance if it is required, and the program is no longer dependent on agency community nursing support.

Implications for nephrology practice/education:

The TOH model serves as a template for other renal programs who are interested in enhancing community support for their PD patients.

Roxanne Krystia RN, BScN, C Neph(C),  Marketing Manager for Clinical Operations and Services, Baxter Corporation

Remote Patient Monitoring in peritoneal dialysis offers a transformative approach to enhancing patient outcomes through data and proactive care management. Remote Patient Monitoring and Analytics is an innovative clinical decision-support module that transforms extensive peritoneal dialysis (PD) treatment data into actionable insights for healthcare providers. The module offers visualized trends, notifications of therapy changes, and detailed guidance on patient adherence, catheter function, and alarm trends. By monitoring key treatment metrics over 7 to 180 days, Remote Patient Monitoring and Analytics enables clinicians to proactively identify potential therapy issues and provide timely interventions. This system addresses the three leading causes of PD dropout—adherence, catheter issues, and alarm disturbances—by providing comprehensive analytics and evidence-based guidance. The platform facilitates efficient patient monitoring by converting complex data into simplified metrics, supporting better patient outcomes in home-based PD therapies. This presentation will explore the features of Remote Patient Monitoring, analytics, highlight clinical benefits, and discuss case studies demonstrating its impact on improving patient care in peritoneal dialysis

Shauna M. Grant MN, RN, CCSNE

Nova Scotia Health Learning Institute for Healthcare Providers, Foundations of Nephrology Nursing Program, Halifax, NS

Background

Hemodialysis patients are at risk of experiencing serious, often life-threatening intradialytic complications such as severe hypotension, hemorrhage, anaphylaxis, and cardiac arrest. Management of these high-acuity, low occurrence (HALO) events requires a rapid, coordinated team response. Simulation-based education (SBE) has emerged as a valuable tool for training healthcare providers in managing such events.

Purpose of the Project

This project aimed to create opportunities for novice hemodialysis nurses to learn and practice management of four HALO presentations using high-fidelity simulation, thereby increasing their clinical and team role competence.

Description

As the clinical coordinator of the NS Renal Program’s orientation process, the writer developed an education day that focused on hemodialysis emergencies. The session consists of practice of micro-skills necessary for the management of intradialytic complications such as management of hypotension, use of air removal kits, establishing team roles, and use of the defibrillator. Following this, the learners participate in 3-4 simulated cases inclusive of a structured debrief. The scenarios include hypotension, line separation, anaphylaxis, and cardiac arrest. Over the course of one year, 17 novice dialysis nurses participated in these sessions in the simulation lab.

Evaluation/Outcome

Overall, 98% of participants stated they were “satisfied” or “very satisfied” with the experience.

Learner quotes:

“I feel better prepared for emergencies that might happen in center”.

“I learned what to do on the actual scene, proper steps and also essential steps to do/observe when complications arise”.

Evolving from this project was subsequent in-situ application in four hemodialysis units, with a mixture of both novice and more experienced staff. One satellite unit identified the need to develop a coordinated response to HALO events that enlists staff from other units in the facility, as well as the need to have an AED “live’ on their unit.

Implications for Nephrology Practice/Education

This project has the potential to increase individual and team competence in responding to intradialytic HALO events; improve patient outcomes, minimizing psychological impact on dialysis co-patients.

Additionally, there are many potential system implications such as optimizing the capacity of small teams in satellite units which in turn can enhance patients’ access to treatment that is closer to their homes. Other effects include identifying latent system weaknesses such as access to equipment, set up of unit, and suboptimal facility response.

Vanessa Godfrey, MScN, BScN, CNeph(c), RN, Ashmeet Hunjan, MSc, BScN, RN, Kim Johnston (Cordell), MN, RN, Shiny Hilariyos, CNeph(c), RN, Aakash Shah, RPN, Manreet Jhajj, BScN, RN

William Osler Health System, Renal Program, Brampton, Ontario

Background

Individuals with diabetes and end-stage renal disease (ESRD) are at high risk for developing complications of the lower limb such as ulcers and amputations. Early detection, referral and treatment of foot ulcers in the hemodialysis patient population will improve quality of life and may consequently lower amputation rates. Preliminary findings from a Registered Nurses of Ontario (RNAO) gap analysis conducted by a renal program at a large community hospital revealed gaps in in-center hemodialysis assessment and management of patients lower limbs. Furthermore, the RNAO gap analysis conducted revealed an absence of a standard foot care assessment tool that reflects all foot care needs of outpatient hemodialysis patients. It also identified gaps in nursing competency and lack of standardized criteria for referrals to appropriate wound and foot care services.

Purpose of the project

The purpose of this quality improvement project is to help mitigate gaps in foot care, promote early identification of foot abnormalities, improve the referral process and to enhance patient and nursing education.

Description

To achieve project goal, a strategic approach was utilized. Firstly, nursing competency of foot care and related complications was increased through consultation with wound care experts, educational videos and educational reference tools. An existing nursing documentation tool was revised into an evidence-based standardized document which reflects the RNAO best practice recommendations from “Assessment and Management of Foot Ulcers for People with Diabetes.” This assessment tool was created in collaboration with our multidisciplinary team members including a professional nursing practice leader, clinical nurse specialist and nurse practitioner from the hospital’s wound care clinic, clinical nurse educators, hemodialysis nurses (who completed 16 hour RNAO best practice workshops) and nephrologists. The foot assessment tool includes components to evaluate patient skin conditions, pain, presence of ulcers, nail health, peripheral neuropathy, sensation, peripheral arterial disease, and bone deformity. Secondly, the use of an improved and more efficient electronic hospital wound clinic referral process was implemented to replace the previous paper-based referral system

Evaluation/Outcomes

Pre and post-implementation survey data was collected from 73 nursing staff to investigate the effectiveness of the foot assessment tool. Pre-implementation, 46% of nursing staff found the previous foot assessment tool did not consistently lead to early referrals and follow-ups. After the implementation of the foot assessment and electronic referral system, 81% of the nurses reported using this tool increased in number of referrals. Furthermore, nurses reported having an increased knowledge of early signs and symptoms of foot abnormalities. Greater awareness of patient educational needs and increased utilization of existing patient education tools was reported by 75% of the nurses surveyed. Using Electronic Referrals improved quality of communication with hospital wound clinics and increased efficiency and timeliness of referrals.

Implications for nephrology practice/education

In conclusion, the integration of this foot assessment tool, improved referrals process and patient and staff education provided have resulted in positive outcomes. Future strategies to be implemented include; monitoring number of lower limb abnormalities referred and collecting data regarding amputation rates, patients and nephrologists perspectives. For sustainability, continuously promoting patient and nurse education as well as ongoing nursing compliance audits will remain imperative.

Jovina Concepcion Bachynski,^a,b MN-NP(Adult), RN(EC), CNeph(C); Lenora Duhn,^b PhD, RN; Idevania G. Costa,^b,c PhD, MN, RN, NSWOC; and Pilar Camargo-Plazas,^b PhD, RN

^a University Health Network, Toronto General Hospital, Toronto, Ontario; ^b School of Nursing, Queen’s University, Kingston, Ontario            ; ^c School of Nursing, Lakehead University, Thunder Bay, Ontario

Background: Kidney supportive care (KSC) improves the quality of life for people receiving dialysis through early identification and treatment of symptoms and vital communication about what is meaningful in life and death through advance care planning (ACP). Despite the crucial role nephrology nurses have in providing quality KSC in dialysis settings, evidence indicates ACP is underused and often initiated too late in this population. This delay or lack of engagement in KSC by the nurses may result in patients receiving care that is incongruent with their values, wishes, or preferences.

Purpose of Study: The study purpose was to construct a substantive grounded theory about the experiences of nephrology nurses’ practice in KSC in Canadian dialysis settings.

Methods: Using Charmaz’s constructivist grounded theory method, 23 nephrology nurses working in hemodialysis and peritoneal settings from three Canadian provinces were recruited. Participants underwent two intensive semi-structured interviews. Concurrent data collection and comparative data analysis, with memo-writing and researcher reflexivity, were completed to aid the construction of codes, categories, and concepts leading to the theory.

Results: The substantive grounded theory titled “Breaking Through the Glass Ceiling—Having That Conversation” involves three stages of engagement (Transactional, Intentional, and Actional) to describe nurses’ practice patterns in communicating with patients about their goals of care. This engagement is predicated on a boundary between nurses’ professionalism and familiarity with patients, amid the influence of multi-dimensional contextual factors, notably the discomfort with having ACP-related conversations.

Conclusion: Nephrology nurses are essential in goals-of-care conversations and require a systematic training approach to improve their communication skills and level of comfort to discuss KSC with patients and families.

Implications for nephrology care: Increased comfort and confidence in nephrology nurses’ communication skills should lead to the prioritization of KSC by normalizing ACP conversations as part of routine care.

Emma Karimi ^a, RN, MScN, CNeph(C), Theresa Krepelka ^a, RN, MN CNeph(C), Cheryl Tuddao ^a, RN, MAN, CNeph(C), Emma Fernando ^a, RN, MSN, CNeph(C) , Janet Graham^a , RN MHScN, CNeph(C), Dana Foisy ^a , RN, BScN, MHS, C Neph C)

^a Nephrology Department of the Ottawa Hospital

Background:

Thrombotic occlusion of central venous catheters (CVCs) poses a common challenge in nephrology practice, leading to complications such as inadequate blood flow and inability to perform dialysis. Among thrombolytic agents, Alteplase has gained prominence for its efficacy in restoring catheter function and improving patient outcomes.

Purpose of the Project:

This literature review aims to examine the cumulative efficacy, rapid restoration, and first-dose efficacy of Alteplase in treating occluded catheters. Additionally, it explores the administration protocols, comparative effectiveness of various type of administration, and recommendations from key guidelines such as Kidney Disease Outcomes Quality Initiative (KDOQI). By synthesizing existing evidence, this review seeks to explore the efficacy of Alteplase in hemodialysis.

Description:

This review provides an in-depth examination of research, comprising clinical trials, observational cohorts, and guideline suggestions, centering on the effectiveness and safety of Alteplase in treating dysfunctional catheters. It evaluates critical aspects such as efficacy and speed of recovery under different administration methods.

Evaluation/Outcome:

Alteplase demonstrates significant efficacy in restoring catheter function, with studies reporting restoration rates ranging from 75% to 83% after one or two doses. The efficacy has been observed in short term and long term dwell and rapid restoration within 30 minutes. This study is highlighting the potential for timely intervention. Adherence to recommended administration protocols contributes to successful outcomes while minimizing the risk of complications.

Implications for Nephrology Practice/Education:

This review underscores the importance of integrating Alteplase into evidence-based practices for managing occluded central venous catheters in nephrology settings. Healthcare providers can leverage Alteplase’s rapid restoration and high efficacy to minimize catheter-related complications and optimize dialysis outcomes. Additionally, education and training programs should emphasize proper Alteplase administration techniques and adherence to guideline recommendations to ensure safe and effective use in clinical practice. Quality improvement initiatives related to Alteplase use should be initiated in clinical setting as part of evaluation of clinical learnings.

Catherine Conlin, RN, Jessica Tuazon, RN, Vascular Access Coordinator

Halton Healthcare Services, Nephrology, Oakville, Ontario

Background: Cannulating a new arteriovenous fistula (AVF) or graft (AVG) is fraught with challenges. New vascular accesses often present with small diameters; the fragile walls may succumb to infiltration with the use of traditional steel needles. Further, in the beginning, patients may sometimes forget to keep the affected arm immobile to prevent such infiltration.

Purpose of the Project: The purpose of the project was to find ways to reduce the number of infiltrations, thereby prolonging the life of vascular accesses.

Description: In 2023, the institutional renal program introduced plastic cannulae to the cannulation protocol for new AVF/AVG. Patients are cannulated with 16-gauge plastic cannulae for six treatments, after which they are cannulated with 15-gauge plastic cannulae for three more treatments. Thereafter, the need for a plastic cannula is evaluated for each vascular access—where possible, patients would transition to cannulation with steel needles. Patients identified as being restless were maintained on plastic cannulae.

Evaluation/Outcomes; Overall, there was a decrease in infiltration events since the new protocol was implemented in October 2023.

Implications for nephrology practice/education: Use of the plastic cannula has mitigated the risk of infiltration in restless patients and those with new vascular accesses. In this single-centre experience, training and mentoring staff on plastic cannula cannulation remains vital to the success of the project.

Rinu Powell, MD, FRCPC, DRCPSC, Associate Professor, The Ottawa Hospital

Kidney transplantation is a life-saving treatment for patients with end-stage renal disease, offering improved quality of life and long-term survival compared to dialysis. Nurses play a critical role throughout the transplantation process, from preoperative assessment to postoperative care and long-term management. This talk will provide an overview of the key concepts and clinical considerations in kidney transplantation for nurses. Topics covered will include patient selection criteria, the surgical procedure, immunosuppressive therapy, and common post-transplant complications. By the end of this session, participants will gain a clear understanding of the care of kidney transplant recipients, specifically the nurse’s role in optimizing transplant patient care. 

Sean Hastings RN, CDE, Allie Roberts RN, CDE

Diabetes Program /Nephrology/ Renal Transplant, St. Joseph’s Healthcare, Hamilton, ON

Background

When you should refer a patient to a CDE (Certified Diabetes Educator) if you find any gaps in their diabetes education such as health teaching, glucose meters, insulin administration, diabetes management during times of illness, etc. Or if the Nephrology team needs assistance with the inpatient’s diabetes medication, insulin adjustments, or controlling glucose spikes.

Purpose of the project

To help fill in knowledge gaps staff may have regarding diabetes management in the in-patient nephrology program. To know the reasons why to refer patients to see a Certified Diabetes Educator and the services we can provide.

Description

To go through role of Certified Diabetes Educator and how we assist patients/staff with diabetes management. Will review oral antihyperglycemic agents and other medications available to patients in end-stage renal disease. Plan to review technologies available to assist patients with their diabetes management (such as insulin pumps, continuous glucose monitor). Will examine real-life case studies from our program to facilitate discussion and learning

Evaluation/Outcomes

Utilized similar presentation to our nephrology nurses, residents and clinical clerks and have received feedback about improved knowledge base and comfortability with diabetes management.

Implications for nephrology practice/education

Improved glycemic control while nephrology patients are admitted facilitates quicker discharge home and better health outcomes while admitted as well in the long-term.

Primrose Mharapara^a MScN, NP-PHC, CNephc, PhD ©, Joanne Olson^a, PhD, RN, FAAN, Sofia B. Ahmed^b, MD, MMSc, FRCPC, Kara Schick-Makaroff^a, PhD, RN

^aUniversity of Alberta, Faculty of Nursing, Edmonton, Alberta; ^bFaculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta

Background

Depression prevalence rates are as high as up to 40% in individuals on hemodialysis (HD). Depression impacts health, medical therapy adherence, and leads to multiple hospital admissions of those on HD, in turn decreasing overall quality of life (QOL). Nephrology nurses are in an ideal position to play a vital role in addressing depression and can contribute to improved health outcomes and enhanced QOL for individuals on HD. However, nephrology nursing knowledge around depression care is not well studied.

Purpose of Study

The purpose of this review was to explore the knowledge dialysis nurses utilize in the care of HD patients living with depression.

Methods

We conducted an integrative literature review guided by the research question: “What knowledge do dialysis nurses draw upon when caring for individuals with depression and receiving HD?”. We performed an exploration of MEDLINE, EMBASE, PsychINFO, CINAHL, Cochrane Central Register of Controlled Trials, and Scopus to identify eligible studies.

Results

Nine studies were included and we determined that nephrology nurse’s knowledge is informed by the nursing process, primarily in assessment and intervention/management, with minimal explicit description of theory in HD and depression care.

Conclusion

There is evidence in the literature to suggest that nephrology nurses are essentially informed by the nursing process, primarily in assessment and intervention/management, with minimal explicit description of theory in HD and depression care. The knowledge derived from this study can be utilized by nephrology nurses to provide for depression care in nephrology settings.

Implications for nephrology care

The findings of this study highlight knowledge that informs nephrology nurses in their care of individuals on HD who also experience depression. A holistic nursing approach recognizes the physiological, psychological, spiritual, and cultural dimensions of each individual, and when addressed by nurses may significantly improve the overall QOL of individuals undergoing HD.

Liliana Bayona, RPN, Arti Parpia, RD, Charina Villar, RN, Nellie Cadaweng, RN

St. Michael’s Hospital, Hemodialysis, Toronto, Ontario

Background – Providing regular foot assessments to patients during dialysis treatment plays a crucial role in the prevention and early detection of diabetic foot ulcers, infections and lower extremity amputation. Routine foot assessments by nurses are often missed or incomplete.

Purpose of the study – To identify the barriers and misconceptions that prevent completion of routine foot assessments by nurses in a timely manner.

Methods – We conducted a survey to hemodialysis nurses, which asked questions regarding barriers to completing routine foot care assessments, knowledge regarding benefits of routine foot care and suggestions for improvement.

Results – 31 nurses completed the survey. The most common reasons for not completing foot care assessments included patient refusal (77.4%), workload constraints (70.9%), time constraints (58.1%) & other team members are already looking at patients’ feet (i.e. foot care nurse, chiropodist) (38.7%). Only 67.7% of staff correctly answered the foot care knowledge question. Suggestions for improvement included having a dedicated staff for foot care assessments, providing education and case studies to nurses, addressing workload issues, and clarifying orders for foot assessments.

Implications for nephrology practice/education – Patient refusal, time/workload constraints, and role expectation were highlighted as key reason for incomplete foot care assessments. Strategies to improve foot care assessment compliance include providing educational in-services to staff, emphasizing the importance of foot care assessments to patients, and simplifying documentation and orders. In addition, staffing adjustments will be implemented to improve workload constraints. Foot care audits will be conducted to track foot care assessment completion and evaluate the implementation of strategies for improvement mentioned above.

Erin McConnell, RN, BScN, Audrey Steenbeek, RN, PhD, Christine Cassidy, RN, PhD

School of Nursing, Dalhousie University, Halifax, NS

Background: Kidney transplantation is a pivotal time of change and presents numerous challenges for renal transplant recipients (RTRs) and their families as they adapt to life after transplantation. Evidence-based interventions (EBIs) in renal care include treatments and programs that effectively improve RTR outcomes. Implementation strategies can support EBI implementation, adoption, and sustainability into practice.

Purpose of Study: The proposed scoping review will map and synthesize all levels of evidence on implementation strategies used to implement EBIs in RTR care.

Methods: This scoping review will follow the JBI Methodology for scoping reviews. Included sources must discuss implementation strategies to support the implementation of EBIs into inpatient and outpatient RTR care. Databases and grey literature to be searched include CINAHL, EMBASE, PubMed, Google Scholar, and relevant websites located through Google search. Two independent reviewers will screen titles, abstracts, and full texts, as well as extract data with conflict resolution through discussion and/or a third reviewer. Directed content analysis will guide the coding of implementation strategies to the Expert Recommendations for Implementing Change (ERIC) taxonomy and contextual determinants to the Consolidated Framework for Implementation Research (CFIR). Finally, the ERIC-CFIR matching tool will be employed to understand if the appropriate strategies were selected to address the identified determinants.

Results: Findings will be presented in tabular and visual format, accompanied by text.

Conclusion: The proposed scoping review will be part of a multi-phase doctoral study. The findings will provide insight for healthcare professionals caring for RTRs and guide their selection of implementation strategies to support EBI uptake.

implications for nephrology care: By gaining a better understanding of the current strategies and determinants of EBI uptake in the RTR setting, healthcare professionals can choose the optimal strategies to bridge the formidable evidence-to-practice gap. Findings from this review may be transferrable to other areas of renal care.

P105: Use of bedside ultrasound technology in TOH satellite hemodialysis units Not Confirmed

Dana Ross^a, RN, C-Neph C, VAC coordinator, Dianne Silverson^b, RN C-Neph C, TL, Krista St-Jean^c, RN C-Neph C CF

^aTOH|Vascular Access, Ottawa, Ontario; ^bHGH Satellite of TOH, Hemodialysis, Hawkesbury, Ontario; ^cCornwall Satellite, Hemodialysis, Cornwall, Ontario

Background

Bedside point of care ultrasound for cannulation has been in practice at The Ottawa Hospital for many years but only available at the Main campus sites. Two of our largest outlying Satellite units have just acquired a new handheld version its use to be implemented in June 2024.

In dialysis, vascular access and its adequate function remains a very important outcome measure with significant impact on pt’s long term health, wellbeing and morbidity.

Purpose

We would like to study pt experience, as well as staff, around successful cannulation comparing before the use of ultrasound and after.

Using bedside ultrasound as an extra “tool”, in addition to our base clinical and physical assessment, to evaluate and assess AVF’s/AVG’s, to hopefully aid in early detection of any complications or issues such as slow/ failure to mature, stenosis, thrombosis, aneurysm vs pseudoaneurysm.

Description

We will give the patients a small survey to complete before we implement ultrasound and 3 months after. As well as survey the nurses around if they feel it has added to their skills re: successful cannulation.

For staff, with having adequate training,  to use the bedside ultrasound in “real time” for cannulation guidance and assessment of potential problems, as well as reducing fistula/graft trauma, as well helping to determine fistula/graft patency, depth, size of vessel, direction and length; and of course use with cannulation of new fistula/graft’s as well as difficult or complicated AVF/grafts to optimize success of cannulation, reducing trauma, and potentially burden of travel to main sites for ultrasound assessment maintaining overall health of the vessel… leading to increased patient satisfaction, comfort, and confidence reducing patient stress.

Evaluation/outcome

Evaluation will be done post initiation of ultrasound use. Our hope is to find that the use of bedside ultrasound, being an additional non-invasive tool to use, will increase both the patient and staff cannulation experience with goal of: improving cannulation by reducing cannulation attempts; increasing accuracy of cannulation, and assisting in selecting better sites.  In return, resulting in improving patient overall cannulation experience, reducing AVF trauma, and therefore reducing cannulation anxiety and stress and increased patient comfort.

Implications for Nephrology practice/education:

Developing an education plan/session to adequately train staff on use of bedside ultrasound to improve vascular access related outcomes. Providing adequate time, support and opportunity to develop the skill of the operator and developing local expertise to optimize the quality of images and overall success of ultrasound use which will save not only time in cannulation in the long run but improve AVF/AVG health and maintenance.

Jacqueline Crandall^a-d, RN(EC) PhD CNeph(C), Jose Nino Villamater ^a,b, RN, BScN, MN; Lori Harwood ^a,b, RN(EC) PhD CNeph(C); Paula Gaspar ^a,b, RN, MScN; Barbara Wilson ^a,b, RN(EC), MScN, CNeph(C); Lidia Yanchuk ^a,b, RN, BScN, BScKin, MN(s); Julia Petrakis, RN (EC), MN-PHCNP, BScN ^a,b

^aRenal Care Program, London Health Sciences Centre, London, ON; ^bArthur Labatt Family School of Nursing, Western University, London, ON; ^cBloomberg Faculty of Nursing, University of Toronto, Toronto, ON; ^dDepartment of Thanatology, King’s University College, London, ON.

Poster Presented by: Melissa Al-Jaishi, RN, BScN, MLIS, MSN(c), London Health Sciences Centre, Renal, London, Ontario

Background: Providing high-quality care to patients receiving hemodialysis requires nurses with specialized knowledge and expertise. However, the demand for qualified nephrology nurses has increased dramatically, and even more so after the impact of COVID-19 and the existing shortage of nurses. To ensure high-quality care and patient outcomes for patients who have kidney disease, both new and seasoned dialysis nurses require continued education that meets their needs.

Purpose: This mixed method study aimed to prioritize top learning needs for hemodialysis nurses who are working in a large regional renal program in Ontario and to identify the optimal methods of education delivery.

Method: After an extensive process of identifying key hemodialysis competencies in 10 domains, nurses throughout the program were asked to complete an online survey which rated each of the 81 competencies as to its perceived level of importance and the nurse’s current level of ability on a five-point Likert scale, Very Low (1) to Very high (5). Top learning priorities were ranked according to Borich’s needs assessment model, and mapped on the Locus of Focus model and the Importance-performance analysis. Comparisons between the three methods identified top learning priorities. Focus groups are also being conducted asking nurses about the best methods of education delivery.

Results: In total, ninety-three nurses participated in the on-line survey. The top learning priorities and the best learning methods identified by nurses will be shared within this presentation.

Conclusion: Hemodialysis nurses require continued education to meet their learning needs and to optimize patient care.

Implications for nephrology care: The priority learning needs and nurses’ perceptions on how best to meet these needs will be compilated into a set of recommendations that will be used to design an integrated and sustainable hemodialysis nursing continuing education program.

Vivian Ho RN, Lily Zhang RN, Virgina Anderson RN, Wen Jin RN, Arti Parpia RD

St. Michael’s Hospital, Hemodialysis, Toronto, Ontario

Background

Starting hemodialysis is a life-changing event, often triggering anxiety and fear. Research indicates that educating new patients can enhance care experiences and overall well-being. In the absence of a transitional care unit, we aimed to streamline orientation for new dialysis patients.

Purpose of study

This project aims to improve patients’ experiences by addressing their needs, delivering information and fostering a supportive environment for a smooth transition onto hemodialysis.

Methods

Nurses provided written and verbal education on five topics within the first six weeks of dialysis: dialysis complications, catheter/fistula care, target weight, eating during dialysis and hepatitis B vaccination.  Patient knowledge on these five topics was evaluated and compared to see the impact of nursing-led education and patient satisfaction level at dialysis start and six weeks after. Nurses were encouraged to regularly check-in on patients’ adjustment and coping.

Evaluation & Outcomes

Patients who started hemodialysis between January to March 2024 participated in the study (n=10). 90% received education on all 5 topics within their first six weeks. Patients received a knowledge score of 68% at the dialysis start and 57.5% after 6 weeks of hemodialysis. Overall satisfaction questions indicated that patients felt that 75% of the time, nurses always explained things in a way they could understand. Only 38% of patients felt the nurse always spent enough time with them.

Conclusion & Implications for Practice

Pre and post-knowledge surveys demonstrated that patients’ knowledge surrounding key hemodialysis topics did not improve with nursing-led education in the current format. Allocation of dedicated time for nurses to provide education may result in further retention of information and improve the overall care experience. Further study is required to evaluate the impact of having dedicated nursing time for new hemodialysis patients.