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P101: Sharing practices and standards to improve sustainability of home hemodialysis globally

Angela Robinson, Renal Nurse, CNeph(C) – Northern Health Authority, Prince George, BC (Poster Presenter)

Ethel Macatangay, MSHM, BScN, RN, CNeph(C) – Scarborough Health Network, Scarborough, ON

Laura Thompson, Renal Nurse – City Hospitals, Sunderland, Tyne and Wear, UK

Carol Rhodes, Renal Nurse – Shared Care/Home Hemodialysis, Royal Derby Hospital, Derby, UK

Julie de Angelis, Renal Nurse – ATUP-C, Marseille, France

Heta Sinikka Kuohula, Renal Nurse – Kuopio University Hospital, Kuopio, Finland


SIGNhd Global (Special Interest Group of Nurses for Home Hemodialysis) is a vendor-sponsored nursing interest group of home hemodialysis nursing professionals from Canada, UK, France, Finland, and the USA. Our group was established in November 2018, and together our goal is to improve service delivery and treatment options for patients on home hemodialysis, and their partners and caregivers globally to stimulate home hemodialysis growth.

By using the formula Home Dialysis Growth = (New Patients + Maintenance) – Loss, and through our discussions and shared experiences, we found globally that there are similar issues with service delivery and population increase in the following areas of home therapies:

  1. Sustainability of services
  2. Expansion and maintenance of the home hemodialysis population
  3. Production of robust systems to support its availability to a wider population


In conclusion, we found that varying financial models and aspects within the healthcare systems influence service, delivery, and available resources. Home hemodialysis nurses within each of their organizations can make a huge impact by adopting practice recommendations by our global collaboration in order to promote home hemodialysis as an accessible and safe option, and have a positive impact on its growth.

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P102: The open referral model: A partnership approach to supporting increased patient complexity


Ethan Holtzer1, MHSc, CHE (Poster Presenter)

Paula Catros1, BScN, RN, CNeph(C)

Alison Allan1, BScN, RN

Heather Reid2, MHSc, BScPT

Michelle Thornley2, BScN, RN

Joanne Wilvert2, BScN, RN

Emily Harrison2, BHScN, RN, CNeph(C)

Rishita Peterson2, MN, RN (Poster Presenter)

Michelle Donoghue2, BScN(C), RN, CNeph(C)

1Dialysis Management Clinics, Markham, Pickering, Peterborough, ON

2Department of Nephrology, Lakeridge Health, Oshawa, ON,/p>


In Ontario, there are two primary community dialysis settings: hospital satellite and independent dialysis clinics. Among these clinics, only nine sites offer an open referral model, allowing patients to dialyze in their community while retaining their original nephrology care team. In analyzing the patient demographic at three of these clinics, the overall complexity of these community patients has increased and now matches the average patient demographics of a chronic hemodialysis patient in Ontario. This increase is likely a result of the strategic growth of home modalities and ongoing capacity pressures at hospital renal programs.

A growing patient complexity has highlighted the importance of establishing strong partnerships with local renal programs, in particular ensuring patient access to emergency, interprofessional, and non-direct care services. This presentation will focus on how a partnership with a local renal program facilitated a 50% increase in physician presence and addressed the 85% of patients who either never saw or only saw when needed a renal dietitian, pharmacist, or social worker. Analyzing both the needs of these patients, as well as the strategies to assist them, will help to highlight the supports required for the growing complexity of patients dialyzing at open referral model clinics.

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P103: Say NO to transmission: Only you can protect you

Alicia Moonesar1, MScN, NP-PHC, DNP© – Humber River Hospital, Toronto, ON (Poster Presenter)

Stella Salamat1, MSN, RN – Humber River Hospital, Toronto, ON (Poster Presenter)

Audrey Gyles1, MSN, RN – Humber River Hospital, Toronto, ON (Poster Presenter)


Purpose: The purpose of this quality initiative is to prevent and reduce contamination related transmission of microorganisms relative to healthcare associated-infection in the in-centre hemodialysis (ICHD) patient population.

Description: Hemodialysis patients are susceptible to infectious diseases due to their reduced immunity and risk of exposure to microorganisms (Park et al. 2018). Contact transmission is the main route of microorganism transmission among the ICHD population. It is, therefore, imperative to protect patients and staff from potential contamination. An initial audit of the cleaning and disinfecting processes of ICHD machines and stations by nurses and hemodialysis assistants was completed with permission using the BC Renal – Dialysis Station Routine Disinfection Checklist. Practice gaps were identified with routine cleaning and disinfecting of dialysis machines and stations. A new hemodialysis policy alongside a “Dialysis Station Cleaning and Disinfecting Checklist” (DSCDC) was developed for staff following the audit using feedback from the health care team. The policy and DSCDC highlight the use of personal protective equipment, hand hygiene, isolation strategies, and the cleaning and disinfection of hemodialysis machines and stations. Staff education will be provided on the new process. Post education, three- and six-month trials of the new policy and DSCDC will be implemented in anticipation of reducing contamination related transmission of microorganisms among ICHD patients and gaining feedback.

Outcomes: To reduce contamination-related transmission of microorganisms among ICHD patients as it pertains to healthcare associated-infection by means of staff education on the correct technique of cleaning and disinfecting hemodialysis machines and stations. Evaluation will encompass ongoing DSCDC audits.

Implications for nephrology practice: To develop provincial guidelines on cleaning and disinfecting dialysis stations for ICHD programs in Ontario.


BC Provincial Renal Agency. (2016). Checklist for dialysis station routine disinfection. Retrieved from

Park, H. C,. Lee, Y,. Yoo, K. D,. Jeon, H. J,. Kim, S. J,. Cho, A., … Lee, S. (2018). Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities. Kidney Research and Clinical Practice, 37(1), 8-19.

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P104: Citrate used as an anticoagulant for needling in hemodialysis

Jennifer Larson, BSN, RN, CNeph(C) – St. Paul’s Hospital, Saskatoon, SK

Alara Procyshen, BSN, RN, CNeph(C) – St. Paul’s Hospital, Saskatoon, SK

Paulo Bautista, BSN, RN, MAN, CNeph(C) – St. Paul’s Hospital, Saskatoon, SK

Sodium citrate 4% used to prevent clotting when needling AVF/AVGs. In our facility, we had two practices to help prevent clotting within the needles. We would flush heparin 1:1000 through the needle and then withdraw the solution leaving drops clinging to the lumen of the tubing. We would also alternatively fill the needle with normal saline prior to needling.

Due to a constant concern regarding supply of heparin, our unit converted to Dalteparin, which resulted in the removal of heparin from our unit, and conversely, removed our ability to use heparin to prevent clotting in the needles.

Our normal needling practice is to needle with a syringe attached to the needle, but the needle is dry and we fill it with blood once positioning is confirmed.

The purpose of our literature review was to see if anyone else had ever used citrate to prevent clotting and to gather literature about the safety of the use of citrate for this purpose, as well as for other uses of citrate, and volume used and safety of use.

The purpose of our poster presentation will be to detail our experience in using citrate as an anticoagulant when needling and provide some information on the safety of this practice. This could have implications for other units needing an alternative to heparin, or just a safer product than heparin.

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P105: Surviving to thriving – A patient’s perspective of transitioning to home therapy

Rhonda M. MacNeil, BScN, RN, CNeph(C) – Alberta Kidney Care South, Medicine Hat, AB

Surviving defined is to remain alive after the cessation of something. Thriving, however, means to prosper, flourish, or be successful. This poster presentation will follow three gentlemen as they transitioned from surviving with hemodialysis to thriving with a home dialysis therapy. As an outside observer, the author was able to witness them flourishing in their journey to regain independence and, while doing so, we all gained so much more.

This poster presentation will share the decisions and information utilized to personalize the journey to home therapy. It will answer some questions for those thinking about going home. Am I too old to do home hemodialysis? Will I still be able to referee basketball with PD? Will I be able to travel? Can I still garden?

Three gentlemen were interviewed, and through this process, we discovered why they chose to change to a home-based dialysis therapy. What influenced their decision to change modality? What struggles did they have transitioning and how did they overcome barriers? Benefits will be identified from their perspective, as well as valuable insight that can be shared with others who may be reluctant to make the switch to home. What helped them succeed? What resources can the health care team provide to support their journey? As a patient educator, the pride in watching them continue to THRIVE is empowering.

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P106: Patient-reported outcomes in home dialysis: Development of workshops for multidisciplinary clinicians

Kara Schick-Makaroff1, PhD, MN, RN

Robin Cohen2, PhD

Rick Sawatzky3, PhD, MN, RN

Frances Reintjes4, BScN, BScSpec, RN

Joanna Czupryn1, BS

Elizabeth Kusi-Appiah1, MN, BScN

Rita Iradukunda1, BScN, RN

Loretta Lee5, BScN, RN

Simon Palfreyman1, PhD, RN

Patricia Silbernagel1, MSc, MB

Amynah Mevawala1, PhD(c)

Scott Klarenbach6, MD, MSc, FRCPC

1Faculty of Nursing, University of Alberta, Edmonton, AB

2Division of Palliative Care, Departments of Oncology and Medicine, McGill University; Lady Davis Institute for Research, Jewish General Hospital, Montreal, QC

3School of Nursing, Trinity Western University, Langley, BC; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

4Alberta Kidney Care North, Alberta Health Services, Edmonton, AB

5Patient Collaborator and Co-Chair of Patient Advisory Committee, ePRO Kidney (electronic Patient-Reported Outcomes in Clinical Kidney Practice)

6Faculty of Medicine & Dentistry, Division of Nephrology, University of Alberta, Edmonton, AB


Purpose: The Canadian Institute for Health Information emphasizes the need for integration of patient-reported outcomes (PROs) into clinical care to improve health outcomes and deliver person-centred care. Our purpose was to understand the educational needs of a multidisciplinary team in home dialysis and develop workshops to support routine utilization of PROs.

Method: This qualitative inquiry involved nurses, physicians, dieticians, social workers, and people on peritoneal and home hemodialysis in Alberta Kidney Care North where PROs were collected as part of standard care. Data were collected through six clinician focus groups (n=29), six patient focus groups (n=27), and seven patient interviews (n=7). Participants were asked about their current use of PROs, how PROs could be utilized, barriers in practice, and areas in which they needed support. Interpretive description was used as an approach to analysis.

Results: Neither patients nor clinicians had previously received systematic training on the use of PROs, nor did they know how to use PRO scores. Four areas of educational need were identified:

  1. PRO use and interpretation in clinical practice (e.g., introduction of PROs to patients, workflow, consideration of longitudinal trends)
  2. Patients valuing of, and relationship to, the use of PROs in their own care
  3. Strategies for PROs to support communication/coordination within the team (clinicians, patients, referrals)
  4. Routine integration of PROs as a fundamental change to practice

Conclusion/Implication: These data have informed the co-design by practitioners and researchers of workshops currently being offered to clinicians as an intervention over the next year of our study.

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P107: Improvements in quality of life and outcome in patients using HDx dialyzers compared to high flux dialyzers

Lok Yick, BScN, RN – In-center Hemodialysis, Scarborough Health Network – General Hospital, Scarborough, ON

Betty Choi, BScN, RN, CNeph(C) – In-center Hemodialysis, Scarborough Health Network – General Hospital, Scarborough, ON


Purpose: Within hemodialysis, there are various types of dialyzer used in treatments. The most commonly used dialyzer is the high flux dialyzer. Many patients experience multiple symptoms during and after dialysis, which include fatigue, pruritis, diarrhea, and restless leg syndrome. These symptoms are detrimental to the physical, emotional, and social aspects of their daily life. With new technology and improvements, a new type of dialyzer, HDx, that targets clearance of middle size molecules was developed in an attempt to improve the patients’ quality of life. We will be evaluating how HDx dialyzer affects each patient’s quality of life and outcome.

Method: Patient selection for the switch to the HDx dialyzer is done in collaboration with the nephrologists. Two criteria are considered when switching patients from high flux dialyzers to HDx dialyzers: poor outcome from dialysis and dialysis-induced symptoms. Patients are asked to complete a survey regarding their change in quality of life after switching dialyzers.

Results: Data collected from surveys and bloodwork have shown improvements in patients from using the HDx dialyzers.

Conclusion: HDx dialyzers have been shown to increase in the quality of life and decrease in dialysis-related symptoms on a daily basis. The HDx dialyzers can be considered as a dialyzer option in the Scarborough Health Network (SHN) nephrology programs for patients meeting the criteria.

Implications for nephrology care: In order to continue to support and improve hemodialysis patient outcomes, our hospital program will continue to use HDx dialyzers for patients who meet the selected criteria.

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P108: From caring to sharing – A multidisciplinary approach to supporting renal patients

Susan E. Roussy – BScN, RN, CPL Ambulatory Hemodialysis, Lakeridge Health, Oshawa, ON

Michelle K. Donoghue – RN, CPL Regional Nephrology Program, Lakeridge Health, Whitby, ON


Previously, caring for patients on dialysis tended to focus on the clinical components of care. Health care models shifted from a provider focus to patient-centered models of care. The focus of the clinical practice leader continues to be to facilitate the paradigm shift from “caring tosharing.” This journey is also supported by the Ontario Renal Network (ORN) as they enable renal programs to practice more person-centred care (PCC).

Recognizing the impact of chronic kidney disease on patients, utilizing the results of the ORN’s patient surveys, and feedback from the program’s Patient and Family Advisory Council, an initiative was identified to address a gap in the care planning for in-centre hemodialysis patients.

The initiative should utilize an approach that included both the identification of medical goals as well as patient goals. The best patient care occurs when true inclusiveness is a fundamental philosophy. This inclusiveness means listening to, informing, empowering and involving patients in their plan of care. Historically, the opportunities to include both nursing and allied health input into the patient’s care plan were limited to formal multidisciplinary meetings. The development of consistent standardized multidisciplinary rounding was identified as an option to the meetings, and was intended to develop and incorporate an inclusive model of care planning to improve our PCC. This practice initiative was implemented to empower patients and family to actively share their individual vision and goals of care. It has been well received and is moving us forward from a “caring to sharing philosophy.”

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P109: Adopting palliative care in the dialysis unit

Terri McAuslan, RN – Satellite Dialysis Unit, Bluewater Health, Sarnia, ON

Terri Pask, BScN, RN – Palliative Care, Bluewater Health, Sarnia, ON


At our community hospital, in a program unique in Ontario, the Regional Renal Team has invited the hospital’s palliative care team to expand their care to the outpatient dialysis unit in support of patients with advanced chronic kidney disease.

Patients are gently introduced to the hospital’s use of the palliative approach for people who may not be considered “end-of-life”. They have an opportunity to meet with the palliative care physicians and nurse to assess their individual needs and discuss options to ensure quality of life, including symptom management. Pain relief during dialysis is an issue for many patients whose pain is significantly aggravated by sitting for three to four hours.

From June 2017-February 2019, approximately 90 patients have benefited greatly from this approach. Those patients who have chosen to end dialysis and become “end-of-life” patients have experienced a smooth transition, since they already know the palliative care team, and vital conversations about goals of care, substitute decision makers, and power of attorney have already taken place.

The Renal Network team strongly believes in palliative care, and this outstanding collaboration between the two teams has exceeded our expectations. Key quotes from Renal Network leaders and palliative care team leaders will illustrate this point. This presentation will also describe the integration process of the palliative care service, early successes, and lessons learned. Data will be shared from early outcome measures, including palliative physician referrals, required symptom management, care planning, and transitions of care.

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P110: Journey of the peritoneal dialysis (PD) catheter – From creation to termination

Mina Kashani, BHScN, RN, CNeph(C) – Department of Nephrology, St. Michael’s Hospital, Toronto, ON

Niki Dacouris, BSc – Department of Nephrology, St. Michael’s Hospital, Toronto, ON

Our hospital is a tertiary care centre located in downtown Toronto. Our home dialysis program offers home PD and home emodialysis (HD) as well as facility-based HD and nocturnal HD. We follow over 100 patients on PDs. Both laparoscopic and interventional radiologic (IR) PD catheter insertions are performed in our program. Initially, only IR insertions were offered; laparoscopic insertions were introduced as of January 2012 in our program to provide another option with fewer limitations.

In order to evaluate PD catheter outcomes between the two methods, we created a database to capture the journey for our PD catheters (all events and procedures from the time of insertion). Data can be easily exported and trends can be observed over time. Capturing the data also enables us to have a better understanding of what some of the issues may be that could lead to PD catheter malfunction and/or failure. The database structure can serve as a template for other programs/sites lacking electronic capture in this area. Furthermore, it has proven to be a useful tool in research projects. Current areas of interest in our program include the following:

  1. Comparison of the outcomes of laparoscopic and interventional insertions
  2. Success or failure rates of PD catheter insertions
  3. Reasons for malfunction and their intervention (e.g., peritonitis, PD leak, in-flow and/or outflow obstructions, hernia, manipulation, and revision)
  4. Examination of the causes of PD catheter failure (i.e., mechanical failure or membrane failure)

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P111: Compassionate Tums® initiative in dialysis patients

Jaclyn Tran1, BScPharm, ACPR

Annette Veith1, PPA

Olexiy Rusalovsky1,2, BScPharm Candidate

Marsha Wood1, NP

Tabassum Quraishi1, MBBS, MHA, MSc (CH&E)

Carolyn Bartol1, BScN, RN, CNeph(C) (Poster Presenter)

Anastasia Kleronomos1, PDt

Tracy Gower1, P.Dt

Pamela Dill1, PDt

Angela Shorter1,BScN, RN

Kenneth West1,3, MD, FRCPC

Steven Soroka1,3, MD FRCPC

Jo-Anne Wilson1,2,3, PharmD, ACPR


1Nova Scotia Heath Authority Renal Program

2College of Pharmacy, Faculty of Health Professions, Dalhousie University

3Division of Nephrology, Department of Medicine, Nova Scotia Health Authority

Patients on dialysis with chronic kidney disease may develop mineral bone disease (CKD-MBD). As part of CKD-MBD, patients develop hyperphosphatemia, which is associated with increased morbidity and mortality. Although phosphate binders are essential in the management of hyperphosphatemia, calcium (Ca)-based phosphate binders are not covered under the Provincial Formulary.

The Renal Mineral Bone Quality Team developed an interdisciplinary initiative to provide Compassionate Tums® to patients who identified cost as a barrier to compliance with Ca-based phosphate binders. Patients who were dispensed Compassionate Tums® in the first eight months of this project (October 5, 2017 to June 15, 2018) were reviewed. Serum phosphate levels were compared before and after they had been provided with a three-month supply. A total of 39 patients received Compassionate Tums® during the project evaluation period. The mean phosphate level before enrollment was 2.3 mmol/L versus 1.9 mmol/L after enrollment (p = 0.0054). A majority (68%) demonstrated a reduction in serum phosphate.

The team identified several benefits to patients, primarily a significant reduction in phosphate levels after enrollment. Other benefits include a reduction in financial burden, reinforcement of education on phosphate binders, and improvement in drug access.

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P112: Supportive care pilot program

Nancy Hemrica, BScN, RN – Kidney/Urinary Program, St. Joseph’s Healthcare, Hamilton, ON

Debra Filmore – Kidney/Urinary Program, St. Joseph’s Healthcare, Hamilton, ON

Brooke Cowel, BScN, RN – Kidney/Urinary Program, St. Joseph’s Healthcare, Hamilton, ON


As we worked to support the Ontario Renal Network’s (ORN) strategic plan to implement a palliative approach to care, we noted a gap in service for those patients choosing conservative renal care instead of a renal replacement modality. We recognized this patient population could benefit from some crisis management and end-of-life planning as well as support to stay well for as long as possible. Home and community care is often challenging for patients and families to navigate, and many experience a delay in service involvement until the patient is in crisis. We wanted to find a way to provide for more upstream care that would support a patient at all points in their end-stage renal disease (ESRD) journey.

We began a unique partnership with the seven hospices within our general community that agreed to be the point of contact for the patients. Each hospice offers a variety of day wellness programing that help to engage and offer a social outlet for patients and their families as well as the support of a nurse and palliative physician for more focused care. The patient still receives the specialized renal care from our regional centre and their nephrology team, and now they have an extra layer of support from our community partners to ensure we have created complete wraparound care.

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P113: Home hemodialysis – A choice to make!

Meenakhsi Sudarshan, C.dt – Renal Engineering Technologist, Home Hemodialysis Program, Toronto General Hospital, University Health Network, Toronto, ON

Tosin Afolabi, CET – Renal Engineering Technologist, Home Hemodialysis Program, Toronto General Hospital, University Health Network, Toronto, ON

Fabian Tobin, CET – Dialysis Technologist, Home Hemodialysis Program, Toronto General Hospital, University Health Network, Toronto, ON


Goal: The focus of the presentation is to identify, assess, and measure the quality of life of patients in home hemodialysis (HHD) program at UHN. This poster will also discuss in detail how quality of life differs between patients undergoing home versus in-centre hemodialysis.

Introduction: The nephrology program at the Toronto General Hospital (University Health Network [UHN]) is a leader in the field of kidney failure, having the world’s largest home and nocturnal dialysis programs, and a thriving home peritoneal dialysis program. These programs offer new freedom and hope for patients, enabling them to tailor their dialysis treatment to their home environments. This method of dialysis also provides the best dialysis outcomes for patients with chronic renal failure. The home hemodialysis program at UHN is committed to increasing the number of patients on home dialysis through its unique technical support system.

Description: The cost of hemodialysis is a concern as the prevalence of end-stage renal disease (ESRD) increases. Although HHD has been described as less expensive than in-center hemodialysis, the proportion of patients performing HHD has been increasing. UHN has been providing HHD treatments to more than 100 patients consistently for the past 10 years.

The authors will discuss UHN’s newly-introduced Innovation Clinic, which offers easy transition for patients on home hemodialysis from hospital training to set-up at home, and the second machine policy, which would allow patients to have an additional dialysis machine at their cottage property for a limited period of time. In addition, the authors will highlight the critical and challenging aspects of covering a vast geographical area by the technical department. Finally, there will be a focused discussion on how the home hemodialysis technical department at UHN has simplified the process of the initial home assessment, and the installation and maintenance of equipment.


The authors will evaluate of the patient’s quality of life through the following means:

  • Technical visits made by renal engineering technologists during the year
  • Frequency of emergency or hospital visits by home hemodialysis patients
  • Use of the continuous on-call technical support by the technical department
  • Coordination of services with patient’s routine work or school life to accommodate their needs

Conclusion: Innovative services provided by UHN’s technical department have the potential to help patients achieve quality of life and lead normal lives as they undergo home hemodialysis.

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P114: Reminiscence Therapy (RT)

Kathleen M Gerrior, RN, CNeph(C), GNC(C) – Renal Unit, Nephrology Department, Kingston Health Science Centre, Kingston, ON


Introduction: At the Belleville Dialysis Clinic (BLDU) in Belleville, Ontario, the average age of patients is 75 years. Reminiscence therapy (RT) is a non-pharmacological intervention that improves self-esteem and provides the older patient with a sense of fulfillment and comfort as they look back at their lives.

Purpose of the project: RT is the importance of spending time talking to the patients about their enjoyable recollection of past events. The sharing of these experiences with an attentive listener allows both parties to achieve a connection and rapport. In turn, this connection fosters a relationship in which reminiscing helps individuals feel better about the present and more hopeful about the future.

Description: I have chosen nine patients (10% of the patient population) to interview. I have asked open-ended questions such as, “Where were you born?” Follow-up questions included: “Do you have siblings?” and “Are you married?” The intent is for the patients to share their thoughts and feelings. Dr. Robert Butler (gerontologist, author on healthy aging, and first director of the National Institute on Aging) had previously stated that “people like to talk about the past”, but if the memory is sad or difficult, we can learn to allow time for silences and emotion with active listening. Reminiscing is really good old-fashioned storytelling, which, as a form of communication, should never go out of style.

Evaluation/Outcomes: I have observed staff and patients reminiscing enjoyably common subjects from their earlier years. The sense of fulfillment and comfort has been demonstrated by laughter. I have also observed active listening demonstrated by a close encounter interview to assist through a difficult situation.

Implications for practice: The practical application of this project has been utilized to reduce stress in a difficult situation, be it distraction during an initial cannulation or reviewing life events in end-of-life discussions.

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P115: Improving patient and visitor hand hygiene rates and reducing clutter to reduce harm withdrawn

Nma Jerry, RN, Multi-Organ Transplant Unit, Toronto General Hospital, University Health Network, Toronto, ON (Poster Presenter)

Robyn Huizenga, RN, Multi-Organ Transplant Unit, Toronto General Hospital, University Health Network, Toronto, ON (Poster Presenter)

Alicia Jones, MN, RN, Advanced Practice Nurse Educator, Multi-Organ Transplant Unit, Toronto General Hospital, University Health Network, Toronto, ON


Complications associated with hospital-acquired infections (HAIs) are a major cause of morbidity and mortality for hospitalized patients (World Health Organization, 2017). Transplant patients are particularly vulnerable to the spread of infection, making infection prevention and control (IPAC) an important area of focus when working with this patient population (Fishman, 2017). Despite ongoing interventions to reduce the spread of HAIs, the multi-organ transplant (MOT) unit at Toronto General Hospital (TGH) continues to experience a heavy burden of isolated patients.

Over the past year, MOT nurses took on the challenge of tackling hospital-acquired infections by addressing non-conventional risks factors that potentiate the spread of infection. The primary interventions included improving patient and family member hand hygiene rates, as well as addressing unit clutter, which prevents thorough environmental disinfection. Although much attention has been focused on improving the rates of healthcare provider hand hygiene, efforts to directly involve patients in their own hand hygiene have remained relatively absent in IPAC initiatives. Despite this under-representation, the literature strongly recommends the need for programs that engage patients in hand hygiene. Patients’ hands are an important medium for spreading pathogens and can transmit HAIs by coming in contact with healthcare workers, their environment, and susceptible areas on their own body, including the mouth, surgical sites, wounds, and intravascular devices. Low rates of patient and family member hand hygiene prompted the initiation of several interventions on the transplant unit, including the implementation of a new admission package designed to prompt staff to engage patients and their visitors in key IPAC education at the time of admission.

In addition to patient and family member engagement in IPAC initiatives, a quality improvement project aimed at addressing unit clutter was launched. Thorough disinfection of surfaces in acute care settings is linked to lower rates of hospital-acquired infections (Daniels, Earlywine, & Breeding, 2019). Clutter prevents the proper disinfection of surfaces and can pose a significant infection risk for hospitalized patients. The objectives of this project were to “shine the light on the environment” by increasing the awareness of how the environment plays a significant role in the spread of HAIs. Staff and patients were engaged in decreasing the amount of severely cluttered rooms, and the waste generated by clutter was highlighted. Data collection evaluating project impact indicates increased awareness of the importance of engaging patients and families in IPAC initiatives.

Engaging patients and family members in infection control ensures that they have the knowledge and support available to protect themselves and others from infection. Doing so aids in the health promotion and improved well-being of the patient population, as well as reducing the significant financial burden associated with high isolation rates.


Daniels, T., Earlywine, M., & Breeding, V. (2019). Environmental services impact on healthcare–associated Clostridium difficile reduction. American Journal of Infection Control, 47(4), 400–405.

Fishman, J.A. (2017). Infection in organ transplantation. American Journal of Transplantation, 17(4), 856–879.

World Health Organization. (2017). The burden of health care-associated infection worldwide. Retrieved from http://www.who. int/gpsc/country_work/burden_hcai/en/