Thursday October 25, 1430-1515

1A (English) I need a vacation! Supporting home hemodialysis patients who want to travel with their dialysis system

Mary L. Lewis, BScN, C Neph(UK), Vancouver BC
Sarah Thomas, BSN CNeph(C), Vancouver BC

Home hemodialysis (HHD) is a well-established treatment option. Dialysing in the home allows patients to live their lives as normally as possible.

In spite of the benefits and freedom that HHD offers, Canadian patients have not been able to travel with their HHD system until this past year. Vacations and work trips can take many months of advanced planning to secure a dialysis spot and destinations are limited. Furthermore significant out of pocket costs are often incurred by the patients.

This presentation will share the recent travel experiences of several HHD patients who have travelled with their portable dialysis system: biking in Hawaii, wine tasting in France or just indulging in a long weekend away without the usual diet and fluid restrictions. Car, RV, Cruise Ship and Air travel options will be described.

The British Columbia Provincial Renal Agency (BCPRA) HHD travel document written to safely and effectively manage travelling HHD patients will be outlined. Tips and advice from the Canadian Air Transport Association (CATSA), the US Board of Transport and how to deal with the airlines will be shared.

Most of the patient stories are positive and heartwarming; the pitfalls will also be shared. Overall the presentation will highlight the importance of offering patient choice and the freedom to travel.

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Thursday October 25, 1430-1515

1B (French) En route vers l’autonomie : de l’adolescence à l’âge adulte pour un meilleur accompagnement

Danielle Boucher, IPSN, M.SC., D.E.S.S., CNeph(C), Ste-Brigitte-de-Laval QC
Liane Dumais, IPSN, M.SC., D.E.S.S., Ste-Brigitte-de-Laval QC

L’adolescent cheminant vers l’âge adulte doit relever de nombreux défis et le développement de l’autonomie en est un de taille. L’adolescent atteint d’une maladie chronique comme l’insuffisance rénale est confronté à cette m ême réalité. Il doit en plus composer avec les exigences de traitement de la maladie. Les enjeux développementaux de ces derniers sont nombreux et doivent passer par la consolidation de leur identité en intégrant la maladie comme une part d’eux-m êmes.

La non-adhésion au traitement est un problème important chez les adolescents insuffisants rénaux. Selon la littérature, elle est influencée par de nombreux facteurs dont les caractéristiques de la maladie et de son traitement, le contexte familial mais aussi par la capacité de l’adolescent à devenir autonome. Malheureusement, celui-ci progresse plus lentement vers le développement de son autonomie.

Les infirmières ouvrant auprès de cette clientèle, doivent comprendre cette réalité afin de mieux les accompagner dans l’acquisition de leur autonomie, notamment lors de la transition du milieu de soins pédiatrique aux soins adultes.

Dans ce contexte de recherche identitaire et de développement de l’autonomie, le jeune majeur atteint d’insuffisance rénale doit en plus apprendre à naviguer dans un système de soins adulte avec une dispensation de soins et de services plus fragmentée. Devrions-nous revoir nos façons de faire auprès de ces jeunes adultes dans nos cliniques? Comment faire la transition du milieu de soins pédiatrique aux soins adultes?

La littérature révèle des pistes de solutions afin d’améliorer l’approche auprès de cette clientèle et conséquemment favoriser une meilleure adhésion au traitement.

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Thursday October 25, 1430-1515

1C (English) The Integration of LPNs in a Hemodialysis Unit: Building on the Foundations Laid before Us

Sheriane Cowie, BscN, RN, Montreal QC

“It has been seen from research that patients do benefit from appropriate staff mix, as do health care facilities.” (CNA, 2005) Centers across Canada have integrated licensed practical nurses (LPN’s) in their hemodialysis (HD) centers as a response to the declining numbers of registered nurses (RNs), and the increased acuity of patients (CNA, 2005). In our center, the increase in patient acuity and work load for the nurses has resulted in a decrease in completed nursing assessments, nursing follow-ups, and positive patient outcomes. The desire to augment quality of care in our center was the impetus for adopting a collaborative practice by introducing LPN’s.

A pilot project was initiated in February 2017. At the outset we met with the nursing staff to get their feedback. Their responses were predominantly favorable. In preparation for the project we reviewed the literature, visited centers functioning in a mixed skills environment, and consulted the agreement between our two orders. 8 LPN’s were trained, 2 did not meet the criteria. With the remaining 6 we commenced the project. Initially we encountered resistance from a few nurses, however one month into the project the LPN’s were widely accepted and even embraced. On November 28, 2017 we presented our project to our nursing director, showing the projected improvements in nursing and patient outcomes. The response was favorable, the LPN’s should be integrated in our department by April 2018.

References

Canadian Nurses Association. (2005). Nursing staff mix: A literature review. Retrieved from http://www.cna-aiic.ca

Centre Hospitalier de l’Université de Montréal. (2008). Programme régional élargi en réorganisation du travail : Projet de réorganisation de travail en hémodialyse hospitalière 2002-2008.

Chow J, Miguel SS. (2010). Evaluation of the implementation of Assistant in nursing workforce in haemodialysis units. International Journal of Nursing Practice 2010; 16: 484–491

College of Nurses of Ontario, Practice Guideline. (2014). RN and RPN practice: The client, the nurse and the environment retrieved from http://www.cno.org/globalassets/docs/prac/41062.pdf

College of registered Nurses of Nova Scotia/ College of Licensed Practical Nurses of Nova Scotia (2012). Guidelines: Effective utilization of RNs and LPNs in a collaborative practice environment. Retrieved from http://www.clpnns.ca/wp-content/uploads/2013/05/EffectiveUtilizationofRNsandLPNs.pdf

Ordre des infirmières et infirmiers auxiliaire du Québec. (2011). Activités professionnelles de l’infirmière auxiliaire. Retrieved from https://www.oiiaq.org/files/publication/Activites_Pro_Inf_Aux.pdf

Ordre des infirmières et infirmiers de Québec/Ordre des infirmières et infirmiers auxiliaire du Québec (2014). Entente entre l’ordre des infirmières et infirmier du Québec (OIIQ) et l’ordre des infirmières et infirmiers auxiliaires du Québec (OIIAQ) sur la nature des actes pouvant être poses par les infirmières auxiliaires dans un service d’hémodialyse. Retrieved from https://www.oiiq.org/documents/20147/1306047/oiiq_entente_activites_oiiq_oiiaq_hemodialyse_20140620.pdf/66344205-7298-740d-ec78-e55c3b6de33d

The Registered Practical Nurses Association of Ontario. (2014) It’s all about Synergies. Understanding the role of the registered practical nurse in Ontario’s Health care system. Retreived from http://www.rpnao.org/sites/default/files/file/RPNAO_6006_RoleClarityBrochure_Final-online.pdf

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Thursday October 25, 1430-1515

1D (English) Creating an Opportunity to Improve Outcomes through a Joint Initiative to Develop a Standardized Preceptor/Mentor Workshop for Hemodialysis (HD) Nurses

Lezlie Lambert-Burd, B.Ad.Ed, BScN, RN., CNeph(C) – St. Catherines ON

Can a joint initiative between two partner organizations develop a standard learning opportunity for HD nurses that will improve outcomes for mentors and mentees?.

The literature shows that a successful orientation has the capacity to empower nurses, increase retention rates, ensure patient safety, and improve positive patient outcomes (Bally, 2007). Training for preceptors or mentors themselves will support and improve instruction and confidence during orientation for both the preceptor and preceptee (Squillaci, 2015). Furthermore, effective orientation may increase overall job satisfaction, thus improving retention and ultimately reducing program costs (Grindel, 2004).
An opportunity was seized and an integrated project to develop and deliver a preceptor to mentor full day workshop for HD nurses at both partner organizations using a standardized approach was achieved. The aim was to provide nurse preceptor/ mentors with the opportunity to cultivate their knowledge, skills and attitudes/abilities to support new learners and further develop a toolbox of useable resources to support knowledge translation in their precepting roles. A priority goal was to utilize the RNAO Practice Education in Nursing (2016), in the development and implementation of the preceptor/ mentor workshop.
Data was captured both pre and post workshop with a follow up survey at 6 months to assess impact and implementation of new knowledge into practice. The data was able to demonstrate measurable improvement with learning outcomes and staff satisfaction with an integrated workshop experience.
Creating an opportunity for professional development within a program may positively impact healthcare organizations, cultivate collegial learning environments, and ultimately improve nursing care.

Bally, J.M.G. (2007). The role of nursing leadership in creating a mentoring culture in acute care environments. Nursing Economics, 25(3), 143-147.

Grindel, C.G. (2004). Mentorship: a key to retention and recruitment. Med. Surg. Nurse, 13(1), 36-37.

Registered Nurses’ Association of Ontario (RNAO), (2016). Practice Education in Nursing. Toronto, ON:Registered Nurses Association of Ontario.

Squillaci, L. (2015). Preceptor training and nurse retention. Project study in partial fulfillment for degree of doctorate of nursing practice. Retrieved from scholarworks

http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1302&context=dissertations

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Thursday October 25, 1530-1615

2A (English) Providing Hemodialysis Services in a Rehabilitation/Complex Care Setting

Lori Harwood, RN(EC) PhD CNeph(C), London ON
April Mullen, RN BScN MHM, London ON
Janice Qubty, RN BScN, London ON
Kyle Goettl, RN BScN Med IIWCC, London ON
Elizabeth Clinton, London ON

Each week inpatients from our local rehabilitation institute are transported to our incentre unit for hemodialysis (HD) treatments. Inter-facility medical transportation is costly and patients tell us the travel time increases their fatigue, delays their rehabilitation and impacts on their quality life. To improve the patient experience, create efficiency and reduce travel costs, the Renal team and teams from the rehabilitation centre are collaborating to provide HD services at the rehab centre. HD on-site should save patients/families time and energy, improve the patient experience and decrease overall transportation costs. This presentation will discuss the implementation of the new unit, describe how the unit operates and also present preliminary findings from a research-based evaluation. This qualitative, theory-driven, patient-oriented research proposes to evaluate the patient experience, economic impact and operational evaluation of this initiative. The qualitative study will investigate complexities and nuances associated with the program which is currently lacking in the literature. Interviews will be conducted with patients and caregivers to understand the patient/caregiver experience. HD staff will participate in a focus group and the rehabilitation staff will be surveyed to gather their perceptions of how this service influences the patient’s rehabilitation and quality of life as well as the impact and challenges to the healthcare providers role.

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Thursday October 25, 1530-1615

2B (French) Le rôle de l’eau pour l’hémodialyse

Léo Sauriol, Technologue en Génie Biomédical en dialyse depuis 2004, Lachine QC
Rachelle Stiven, Technologue en Génie Biomédical en dialyse depuis 2015, Lachine QC
Mohammed Amri, Technologue en Génie Biomédical en dialyse depuis 2016, Lachine QC

  • D’hier à aujourd’hui ; l’eau utilisé pour les thérapies d’hémodialyse et d’hémodiafiltration.
    • Pourquoi?
    • Comment?
  • La norme de qualité d’eau à respecter aujourd’hui pour l’hémodialyse.
  • La norme de qualité d’eau à respecter aujourd’hui pour l’hémodiafiltration.
    • Théorie versus réalité de la norme pour l’hémodiafiltration
    • Les étapes pour se rendre à la réalité
  • Étude de cas : L’implantation d’un système de purification qui respecte les normes d’aujourd’hui quant à la qualité de construction et d’eau produite (hémodiafiltration) à l’hôpital Général de Montréal.
    • Le devis technique
      • L’évaluation des besoins
      • L’étude des normes en vigueur
      • S’informer sur les certifications détenues tel que Building Owners and Managers Association (BOMA), Leadership in Energy and Environmental Design (LEED) ou Hospitals for a Healthy Environment (H2E)
      • Observation des nouvelles tendances par exemple en Europe
      • L’art de boucher les “ trous ” lors de l’écriture
    • Problèmes rencontrés
      • Choix du soumissionnaire
      • Rénovations de la salle (retards)
      • Erreur d’analyse lors de la certification du nouveau système d’eau
    • Mise en route du nouveau système de traitement d’eau sur la vieille boucle de distribution d’eau comme plan de contingence après qu’il ait été certifié
    • L’installation d’un système temporaire dans la nouvelle salle d’eau rénovée afin de certifié la nouvelle boucle
    • Le transfert des générateurs de dialyse sur la nouvelle boucle
    • Le transfert du système d’eau dans la salle rénovée et son branchement sur la nouvelle boucle

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Thursday October 25, 1530-1615

2C (English) Employment Patterns After Kidney Transplantation: Rates, Contributing Factors, and Outcomes

Olusegun Famure, MPH, MEd, CHE, Toronto ON
Jayoti Rana, BSc MPH, Toronto ON
Monika Ashwin, BSc, Toronto ON
Yanhong Li, BSc, MSc, Toronto ON
S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto ON

Background: The costs of productivity lost in transplant patients poses a concern, as a significant number of patients are of working age. Furthermore, healthcare and public health literature highlight the relationship between a lack of secure income and poor health outcomes. However, few studies have examined predictors of paid employment post-transplant and the impact of employment status on clinical outcomes.

Objective: (1) To investigate the rates and predictors of post-transplant employment status; (2) to examine the association between post-transplant employment status and clinical outcomes in kidney transplant recipients (KTR).

Methods: A retrospective cohort study was conducted in adult patients undergoing a kidney transplant between 1-Jan-2007 and 31-Dec-2014, with follow up until 31-Dec-2015 at the Toronto General Hospital. Employment status and clinical data were obtained from paper and electronic charts. The Kaplan-Meier product limit method was used to assess time to return to work and time to total graft loss from the transplant date. Multivariable Cox proportional hazards models were fitted to examine independent predictors of post-transplant employment and the association between employment status and total graft loss.

Results: Among the 1069 KTR in the study cohort, the mean age was 50.7 (+ 13.6) and 60.2% were male. A total of 319 KTR returned to work over the first-year post-transplant (cumulative probability 30.4%). Significant independent predictors of employment within the first-year post-transplant included pre-transplant employment status, age at transplant, length of stay in hospital after transplant, physical disability, and private drug coverage. After adjusting for relevant covariates (including comorbid conditions), being employed (vs. not employed) post-transplant was associated with a significantly lower risk of total graft loss (HR 0.29 [95% CI: 0.17, 0.50]).

Conclusion: Although transplantation improves working capacity in end-stage renal disease patients, post-transplant employment status was impacted by other factors, including pre-employment status. These findings support the need for pre- and/or post-transplant interventions to improve participation in paid work following kidney transplantation.

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Thursday October 25, 1530-1615

2D (English) Using Technology to Guide the Future of Vascular Access

Deidra Goodacre, RN, BSN, CNephC, Prince George BC

Purpose: Emphasis on transplant and PD as first choice modalities has led to a change in our hemodialysis client population in BC. The population is aging and cardiac and vascular comorbidity is increasing. In BC, we’re attempting to maintain a high level of fistula prevalence, but fistulas are becoming more difficult to create, cannulate and maintain. We’ve developed a course which intends to meet the new needs in our program by increasing the knowledge and cannulation skill level of dialysis nurses using innovative, engaging teaching techniques, and ultrasound technology, and we’d love to share it with CANNT attendees.

Description: We’ll discuss the successes, challenges and lessons learned after running the course in two separate health regions. We will provide practical tips and resources for renal programs wanting to implement a course of their own. Handouts/resources will include: education funding proposal template, three easy-to-follow lesson plans with links to videos and power point presentations, pre and post tests, and sample case studies.

Evaluation/Outcomes: Pre and post course knowledge evaluations, nurse feedback, client feedback, and peer feedback will be discussed.

Implications for nephrology practice/education: There is very little practical information available in the way of ultrasound teaching for hemodialysis nurses and for this reason, expensive ultrasounds are often found collecting dust in the corner of the dialysis unit. This course intends to fill the knowledge gap by providing a lesson plan framework and resources that can be used and implemented by any hemodialysis educator or vascular access nurse.

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Thursday October 25, 1530-1615

2E (French) La littératie en néphrologie: une approche pour se réinventer : résultats d’une étude clinique

Julie Dupont, IPS néphrologie, M. Sc., DESS, Québec QC

Le but de l’étude était d’évaluer le niveau de littératie en santé des patients adultes atteints d’insuffisance rénale chronique au CHU de Québec-Université Laval.

Cette étude de cohorte unicentrique tranversale avait un échantillon de 353 patients : 152 en pré-dialyse, 157 en hémodialyse hospitalière, 32 en dialyse péritonéale et 12 en hémodialyse à domicile. 2 outils auto-administrés ont été utilisés : le Brief Health Literacy Screen (BHLS), librement traduit et le Health Literacy Questionaire (HLQ) en version française validée (9 domaines de la littératie étudiés).

Selon le BHLS, les patients dialysés à domicile ont un niveau de littératie plus élevé comparé aux 2 autres groupes (p <0.001). Pour le HLQ, les patients dialysés à domicile, comparés aux autres groupes, se sentent plus soutenus et compris par les professionnels de la santé (p <0.001), évaluent mieux l’information sur leur santé (p <0.001) et la comprennent mieux leur permettant de savoir agir (p <0.001).

Les patients en dialyse à domicile ont un niveau de littératie plus élevé. La majorité de la population autochtone n’a pas pu participer à l’étude par limitation du français parlé ou écrit.

Prendre conscience du niveau de littératie des patients permettra d’adapter les interventions et le matériel d’enseignement afin de mieux répondre aux besoins des patients, d’augmenter leur capacité d’auto-soins et de favoriser l’accès à la dialyse autonome. Une attention particulière devra être apportée à la clientèle autochtone afin de cerner leur niveau de littératie et de s’adapter à leur réalité.

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Thursday October 25, 1625-1710

3A (French) L’épuisement professionnel et l’empowerment des infirmières travaillant en hémodialyse au Québec

Christina Doré, RN, candidate au PhD, Laval QC
Linda Duffet-Leger, PhD, Calgary AB
Mary McKenna, PhD, Université du Nouveau-Brunswick

La profession infirmière est reconnue pour être stressante avec des taux élevés d’épuisement professionnel. La recherche indique que l’empowerment est une stratégie positive pour soutenir la pratique et le bien- être au travail des infirmières et que les sites Web professionnels pourraient favoriser leur empowerment et réduire leur risque d’épuisement. Actuellement, aucune information ne permet d’évaluer la gravité de l’épuisement professionnel ou le statut d’empowerment des infirmières en hémodialyse au Québec. La présentation a pour but de rapporter les résultats d’une étude mixte: une enqu ête quantitative en ligne auprès de 308 infirmières en hémodialyse a démontré que 38% avaient des niveaux élevés d’épuisement émotionnel, 69% des niveaux modérés d’empowerment structurel et 64% des niveaux modérés d’empowerment psychologique. L’empowerment structurel et psychologique étaient significativement liés à l’épuisement professionnel. Ensuite, une approche participative utilisant des groupes de discussion avec un total de sept infirmières en hémodialyse et des consultations auprès d’un comité aviseur a permis de formuler des recommandations sur les exigences à inclure dans un site Web. Les résultats indiquent qu’un futur site Web professionel pour les infirmières en hémodialyse devrait inclure: des informations professionnelles, de la formation continue, des informations sur les habitudes de vie saine et le réseautage. Dans l’ensemble, cette recherche a des implications importantes pour les infirmières, la pratique et la recherche. Globalement, les niveaux d’épuisement étaient élevés chez les infirmières d’hémodialyse au Québec, semblables à d’autres résultats nord-américains; et les infirmières d’hémodialyse étaient en faveur de la création d’un site Web pour répondre à leurs besoins professionnels et personnels.

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Thursday October 25, 1625-1710

3B (English) Implementing Meaningful Use of Electronic Information Systems in Nephrology Care: Clinical Decision Support for Acute Kidney Injury

Meha Bhatt1; Eleanor Benterud1; Indraneel Datta2; Elijah Dixon2; Sharon Falk3; Sonia Ficaccio-Scarcelli3; Jennifer Landry1; Anthony MacLean2; Evan Minty1; Gregory Samis2; Rohan Lall2; Neesh Pannu4; Matthew T. James1,5.
1Department of Medicine, University of Calgary, 2Department of Surgery, University of Calgary, 3Alberta Health Services, 4Department of Nephrology, University of Alberta, 5Department of Community Health Sciences, University of Calgary.

Electronic medical records (EMRs) are increasingly available and can be leveraged to improve patient care. A prominent target for electronic clinical decision support has been acute kidney injury (AKI), a common complication in hospitalized patients associated with kidney failure and mortality. Although there is understanding of risk factors for AKI progression, translation of this knowledge into care has been limited. Decision support may address these evidence-care gaps if incorporated into practice.

An AKI clinical decision support initiative was developed to improve recognition and management on surgery units in Alberta. The initiative includes: electronic alerting upon AKI onset, formal educational outreach, resources for management, and feedback on quality indicators to evaluate and refine care.

Electronic decision support for AKI was implemented following an established change management framework. Site-specific implementation strategies were co-developed with end-users to optimize integration into workflow, and are being evaluated continuously through interviews. End-user involvement and training sessions increased awareness and supported uptake of the tools.

Decision support for AKI has the potential to improve patient care but can have significant effects on workflow and processes for end-users. A multi-faceted approach, consisting of stakeholder engagement and educational outreach in conjunction with electronic tools can facilitate successful implementation into clinical practice.

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Thursday October 25, 1625-1710

3C (English) Development of an Early Hospital Readmission Risk-Prediction Model for Kidney Transplant Recipients

Olusegun Famure, MPH, MEd, CHE, Toronto ON
April Huang, BSc, BScN, Toronto ON
Jayoti Rana, BSc, MPH, Toronto ON
Franz-Marie Gumabay, BSc, Toronto ON
Pei Xuan (Rachel) Chen, BSc (c), Toronto ON
Robin Huizenga, BScN, Toronto ON
S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto ON
Dr. Sunita Singh, MD, MSc, FRCPC, Toronto ON

Purpose: Early hospital readmissions (EHR) confer high costs to the healthcare system and are associated with suboptimal outcomes in kidney transplant recipients (KTRs). Current literature focuses on identifying explanatory factors for EHRs and few studies provide implications for clinical practice. We aim to develop an EHR risk prediction model to use as a tool that can be integrated into clinical practice to reduce future EHRs.

Methods: We conducted a single-centre, retrospective cohort study, including adult KTRs transplanted between July-1st-2004 and December-31st-2014 at Toronto General Hospital and were followed for at least 30 days from transplantation admission discharge. EHR risk prediction models were developed using stepwise backward logistic regression and compared for predictive ability using ROC curves. Bootstrapping was used to internally validate the final EHR risk prediction model.

Results: In our cohort of 1381 KTRs, 267 experienced at least one EHR post-transplant. Our most parsimonious model consisted of 12 variables, such as age and resulted in a moderate predictive value (ROC=0.65). However, no recipient, donor and transplant risk factor was highly predictive of EHR. Internal validation resulted in a lower predictive value (ROC=0.61).

Conclusion: The predictive accuracy value of our model could possibly be improved by adding variables such as patients’ socioeconomic factors and surgical complications during transplant admission.

Implications for Care: The risk prediction model provides a uniform method to assess and predict EHR in Canadian KTRs. The ability to identify patients who are at higher risk of experiencing EHR will allow practitioners to deliver individually-tailored interventions and reduce future readmissions.

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Thursday October 25, 1625-1710

3D (English) Home Dialysis Training Videos

Rachel Tong, RN, Toronto ON
Sukhjeet Samra, RN, Toronto ON

Purpose: The purpose of this project is to provide educational videos to supplement peritoneal dialysis training at the Home Dialysis Unit.

Our program serves patients from diverse cultural backgrounds, socioeconomic status, information retention ability and different literacy levels. Current teaching methods are patient specific and include use of a written manual, hands-on-practice, and demonstrations. We believe the addition of step-by-step instructional videos will enhance learning and can provide visual repetition that patients can access at their own convenience.

Description: We will start this project by creating two instructional videos on exit site care and carrying out a Continuous Ambulatory Peritoneal Dialysis (CAPD) exchange. Patients and their caregivers will be able to access these videos through the St. Michael’s Hospital Home Dialysis website, or they can be given to them in a DVD or USB format.

Outcomes: By implementing the use of these videos we aim to increase patient satisfaction and comfort, as well as to ensure patients follow proper technique in doing their peritoneal dialysis routine. We hope to achieve this by providing material to supplement hospital training and for patients to review procedures at home.

Implications for Nephrology Education: Exit site infections can lead to peritonitis, infection of the peritoneal membrane. Repeated peritonitis leaves the peritoneal membrane scarred, which then negatively impact the efficacy of peritoneal dialysis. Infections remain a frequent cause of peritoneal dialysis failure. Developing methods to maintain optimal technique in doing peritoneal dialysis will improve patient outcomes.

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Thursday October 25, 1625-1710

3E (English) Interprofessional Shadowing Between the Hemodialysis Unit and Laboratory

Billie Hilborn, RN, CNephC, BScN, MHSc, Toronto ON
Jhanvi Solanki, RN, MScN, MBA, Toronto ON
Elizabeth McLaney, BA, MEd, BScOT, OT Reg. (Ont), Toronto ON
Anne Marie Phillips, BSc, ART (Hematology), MLT, Toronto ON
Neil Lund-Walker, MLA, Toronto ON
Irene Alao, RN, BScN, Toronto ON
Melissa Adamson, RN, BScN, Toronto ON

Successful collaborative practice between disciplines relies on quality working relationships (Laflamme, 2017). The purpose of this project was to foster high quality, person-centred care by learning together across professions. The two main goals included enhancing the culture of collaboration and interprofessional competencies between the laboratories and nursing with attention to role clarification and interprofessional conflict resolution while supporting ongoing quality improvement.

A shadowing experience was designed for nursing and laboratory services in four dyad pairs, with one pair being from Specimen Management in the Lab and the Hemodialysis Unit. One member from each department spent 2.5 hours shadowing in the other department. A set of questions was prepared for reflection before and after the shadowing, plus another group for asking during the experience.

Anticipated outcomes included improved ability for dyads to describe common work flow tasks and priorities, identify challenges and competing demands for their partner’s profession, and relate the impact of their professions work on their partner’s. This will improve existing relationships and promote interprofessional collaboration between the Laboratories and Hemodialysis Unit.

Implications for Nephrology Practice/Education: When collaboration between the laboratories and Hemodialysis Unit is not optimal there can be negative impact on patient experience such as having repeated specimens drawn for testing, inefficiencies due to repeating work processes and reporting of critical results, wasted resources such as test tubes and reagents, and siloed work that limits improvement opportunities. This project will hopefully promote a positive impact.

References

Laflamme, L. (2017). Enhancing perioperative patient safety: A collective responsibility. Operating Room Nurses Association of Canada (ORNAC) Journal, December, 13-33.

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Friday October 26, 1100-1145

4A (English) Transplant 101; Is My Patient a Candidate for Transplantation

France Martineau, BscN, LcScEd, RN, Montreal QC

This presentation will be an introduction to the Transplant world and an interactive discussion with the audience.

Question 1: Is my patient on the Transplant list?

  • Have we talked about transplant to my patient?
  • Is there a reason that can explained why my patient doesn’t know anything about transplant (cancer, age, compliance, etc.)
  • Why my patient is on dialysis for so many years?

Question 2: When should we talk about transplant to the patient and when should we refer the patient for transplantation?

Question 3: Is transplant improves long term survival compared to dialysis?

  • What are the benefits? the risks?

Question 4: Are all patient candidates for transplant?

  • Case review of patient declined by our center.
  • Data review of past 5 years (# Transplant, # referrals, who are the deceased donor accepted by our center).

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Friday October 26, 1100-1145

4B (French) L’intégration d’infirmiers auxiliaires à l’unité d’hémodialyse : s’appuyer sur les fondements qui s’offrent à nous

Sheriane Cowie, BscN, RN, Montreal QC

« Les études ont démontré que les patients ainsi que les centres de soins de santé tirent avantage d’un mélange approprié de personnel » (CNA, 2005). Partout au Canada, des centres de santé ont ajouté à leurs centres d’hémodialyse (HD) des infirmiers et des infirmières auxiliaires autorisés (inf. aux.) comme solution au nombre décroissant d’infirmiers autorisés (IA) et à la sévérité de l’état des patients de plus en plus importante (CNA, 2005). Dans notre centre, l’augmentation de la sévérité de l’état des patients et de la charge de travail des infirmiers a provoqué une diminution dans le nombre d’évaluations infirmières terminées, de suivis infirmiers, ainsi que de résultats positifs pour les patients. Comme nous voulions améliorer la qualité des soins de notre centre, nous avons décidé d’adopter un modèle de pratique collaborative en y introduisant des infirmiers et des infirmières auxiliaires autorisés.

Un projet pilote a été lancé en février 2017. Au début, nous nous rencontrions avec le personnel infirmier afin de recevoir leurs commentaires. En général, ceux-ci étaient positifs. Dans le but de nous préparer pour le projet, nous avons passé en revue les publications pertinentes, nous avons visité des centres qui avaient adopté un modèle de personnel mixte et nous avons consulté l’entente entre nos deux ordres. Huit (8) infirmiers auxiliaires furent formés et deux (2) ne satisfirent pas aux critères. Nous avons donc commencé le projet avec les six infirmiers restants. Initialement, nous avons rencontré de la résistance de la part de quelques infirmiers, mais après un mois du projet, les infirmiers auxiliaires étaient généralement acceptés et même appréciés. Nous avons présenté notre projet le 28 novembre 2017 à notre directeur du personnel infirmier afin de lui montrer les améliorations prévues tant au niveau des infirmiers que des résultats des patients. Les résultats du projet furent bien reçus et il a été décidé que les infirmiers auxiliaires seraient intégrés à notre département d’ici avril 2018.

References

Canadian Nurses Association. (2005). Nursing staff mix: A literature review. Retrieved from http://www.cna-aiic.ca

Centre Hospitalier de l’Université de Montréal. (2008). Programme régional élargi en réorganisation du travail : Projet de réorganisation de travail en hémodialyse hospitalière 2002-2008.

Chow J, Miguel SS. (2010). Evaluation of the implementation of Assistant in nursing workforce in haemodialysis units. International Journal of Nursing Practice 2010; 16: 484–491

College of Nurses of Ontario, Practice Guideline. (2014). RN and RPN practice: The client, the nurse and the environment retrieved from http://www.cno.org/globalassets/docs/prac/41062.pdf

College of registered Nurses of Nova Scotia/ College of Licensed Practical Nurses of Nova Scotia (2012). Guidelines: Effective utilization of RNs and LPNs in a collaborative practice environment. Retrieved from http://www.clpnns.ca/wp-content/uploads/2013/05/EffectiveUtilizationofRNsandLPNs.pdf

Ordre des infirmières et infirmiers auxiliaire du Québec. (2011). Activités professionnelles de l’infirmière auxiliaire. Retrieved from https://www.oiiaq.org/files/publication/Activites_Pro_Inf_Aux.pdf

Ordre des infirmières et infirmiers de Québec/Ordre des infirmières et infirmiers auxiliaire du Québec (2014). Entente entre l’ordre des infirmières et infirmier du Québec (OIIQ) et l’ordre des infirmières et infirmiers auxiliaires du Québec (OIIAQ) sur la nature des actes pouvant être poses par les infirmières auxiliaires dans un service d’hémodialyse. Retrieved from https://www.oiiq.org/documents/20147/1306047/oiiq_entente_activites_oiiq_oiiaq_hemodialyse_20140620.pdf/66344205-7298-740d-ec78-e55c3b6de33d

The Registered Practical Nurses Association of Ontario. (2014) It’s all about Synergies. Understanding the role of the registered practical nurse in Ontario’s Health care system. Retreived from http://www.rpnao.org/sites/default/files/file/RPNAO_6006_RoleClarityBrochure_Final-online.pdf

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Friday October 26, 1100-1145

4C (English) The Role of Water in Hemodialysis

Léo Sauriol, Technologue en Génie Biomédical en dialyse depuis 2004, Lachine QC
Rachelle Stiven, Technologue en Génie Biomédical en dialyse depuis 2015, Lachine QC
Mohammed Amri, Technologue en Génie Biomédical en dialyse depuis 2016, Lachine QC

  • From past to present: The use of water in hemodialysis and hemodiafiltration therapy.
    • Why?
    • How?
  • Today’s water quality standards for hemodialysis.
  • Today’s water quality standards for hemodiafiltration.
    • Theory versus reality when talking about hemodiafiltration standards
    • Steps for meeting reality
  • Case study: Setting up a purification system at the Montreal General Hospital that meets today’s standards for build and water production quality (hemodiafiltration).
    • Technical specifications
      • Needs assessment
      • Current standards analysis
      • Get updated on any certification that has been obtained such as the Building Owners and Managers Association (BOMA), the Leadership in Energy and Environmental Design (LEED) or the Hospitals for a Healthy Environment (H2E) certifications.
      • Discerning new trends, for example in Europe.
      • The art of “filling the gaps” when writing.
    • Encountered problems
      • Choice of bidder
      • Room renovations (delays)
      • Analysis mistakes when certifying the new water system
    • Connecting the new water treatment system on the old distribution lines as a contingency plan after it’s certified
    • Installing a temporary system in the newly renovated water room to certify the new line
    • Transferring the dialysis machines to the new line
    • Transferring the water system to the renovated room and the old connections to the new line

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Friday October 26, 1100-1145

4D (English) From Cannulation to Complications: Integrating a Learner-Centered Approach to Delivering Hemodialysis Nursing Orientation

Guylaine St-Cyr, RN, MN, CNeph(C), Ottawa ON

The Ottawa Hospital’s Nephrology program identified the need to enhance the content and delivery of the hemodialysis nursing orientation to improve nurse retention and preparation. Practicing hemodialysis skills in the clinical environment early on in orientation was found to be anxiety provoking for the newly hired nurse, as well as for the patient. Learner and staff feedback underlined that the environment was not conducive to learning and teaching methods were outdated.

A literature review highlighted a gap between the status quo and best practices for adult learning. In January 2017, the Nephrology program shifted the second week of hemodialysis orientation to a simulation center to foster a safe learning environment. New hires now engage in a full week of active hands on learning prior to practicing skills in the clinical environment with the aim of increasing their self-confidence. Additionally, a 3-month post-orientation workshop involving high fidelity simulation and advanced hemodialysis skills was implemented as part of a quality improvement project.

The simulation environment provides innovative opportunities for teaching and assessing clinical competencies in preparation for clinical practice in the hemodialysis unit. This presentation will outline the process for development and implementation of the revised curriculum using evidence based resources. Perceived benefits for both the new hires and the patients will be highlighted.

Important step towards advancing the use of simulation methods in hemodialysis orientation to increase self-confidence for new hires and ultimately translating to improved patient safety and satisfaction.

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Friday October 26, 1100-1145

4E (French) Évaluer la thérapie d’hémodialyse étendue (HDx) en comparaison à la thérapie HD conventionnelle relativement aux résultats cliniques et aux résultats des patients

Sandra Lagacé, Resource Nurse, CNeph(C), Moncton NB
Chantal Leblanc, RN

Objectifs d’apprentissage :

  1. Réviser la clairance des molécules de tailles moyennes et grandes ainsi que son importance.
  2. Discuter des résultats de six mois de thérapie HDx à l’hôpital Dr Georges-L.-Dumont.
  3. Réviser les résultats et les implications de la thérapie HDx sur les résultats cliniques.

Les solutés urémiques comprennent des molécules de tailles moyennes et grandes (MM) qui sont insuffisamment éliminées par l’hémodialyse à haut débit (HD) à cause de leurs tailles (> 15 kilodaltons [kDa]). De tels solutés sont associés à de l’inflammation, à des troubles du système immunitaire ainsi qu’à de mauvais résultats pour les patients de dialyse. 1–5

La thérapie HDx a récemment été introduite sur le marché. Cette thérapie fait utilisation de membranes à seuil de coupure moyenne, qui comportent des tailles de pores plus efficaces que les membranes à haut débit. De cette façon, la perméabilité est plus semblable à la membrane glomérulaire naturelle du rein ainsi qu’à sa capacité d’élimination des molécules de tailles moyennes et grandes.

La présentation expliquera les besoins non satisfaits relatifs à la clairance des molécules de tailles moyennes et grandes lorsqu’un traitement HD conventionnel est utilisé, discutera de l’introduction de la nouvelle technologie HDx à Dr Georges-L.-Dumont ainsi que de son utilisation auprès de 10 patients pendant six mois.

La présentation sera libre de toute sorte de sollicitation commerciale et ne comportera aucune référence négative à une autre compagnie ou à ses produits ou services.

References

Assi LK, et al. PloS ONE. 2015; 19 :e0129980.

Hutchinson CA, et al. Mayo Clinic Proc. 2014; 89 :615-622.

Cohen G, et al. J AM Soc Nephrol. 1995; 6:1592-1599.

Cohen G, et al. Kidney Int Suppl. 2001; 78:S48-S52.

Desjardins L, et al. Toxins. 2013; 5 :2058-2073.

Presented by Baxter Corporation

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Friday October 26, 1400-1445

5A (English) Creating Meaningful Experiences for Grieving Family Members in Adult Critical Care Areas

Wendy Sherry, Nurse Clinician, Montreal QC

Hospital end-of-life care (EOL) rituals and the creation of keepsakes are often completed in neonatal and pediatric critical care units (Kobler, Limbo, & Kavanaugh, 2007). However, EOL needs in adult critical care units are scarce despite the 2001 recommendations by the Society of Critical Medicine (Troug, et al., 2001). At the MUHC, the nurse clinicians for organ & tissue donation create keepsakes through interactive family activities such as making handprints, drawing pictures, writing letters / poems etc. The presentation will demonstrate a need for research on EOL care practices in adult critical care units as anecdotal evidence demonstrates a positive effect on the grieving process. Utilizing Wright and Bell’s Belief and Illness Model (2009), cultural values, religious beliefs and family needs are explored in order to develop tailored therapeutic interventions to create a meaningful bedside experience for family members.

Presentation Objectives:

  • To provide an overview of MUHC Nurse Clinician Organ & Tissue Donation EOL bedside practices.
  • To compare current adult critical care EOL care standards with the interactive family activities practiced by nurses working in organ and tissue donation.
  • To promote reflection on the usual standard of adult EOL care in critical care areas.

Synopsis:

MUHC Nurse Clinicians for Organ and Tissue Donation include additional interactive family activities not typically incorporated into adult critical care end-of-life practices. An exploration of cultural values, religious beliefs and lived family experiences is carried out in order to develop tailored therapeutic interventions to create a meaningful bedside experience for family members. The presentation will promote reflection on the usual end-of-life care standards in adult critical care units.

References

Kobler, K., Limbo, R., & Kavanaugh, K. (2007). Meaningful moments: The use of ritual in perinatal and pediatric death. MCN: The American Journal of Maternal Child Nursing, 32, 288-297. doi:10.1097/01.NMC.0000287998.80005.79

Troug, R. D., Cist, A. F. M., Brackett, S. E., Burns, J. P., Curley, M. A. Q., Danis, M., . . . Hurford, W. E. (2001). Recommendations for end-of-life care in the intensive care unit: The ethics committee of the society of critical care medicine. Critical Care Medicine, 29(12), 2332-48. Retrieved from http://www.learnicu.org/Docs/Guidelines/End-of-LifeCare.pdf

Wright, L. M. & Bell, J. M. (2009). Beliefs and illness: A model for healing. Calgary, AB: 4th Floor Press Inc.

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Friday October 26, 1400-1445

5B (French) J’ai besoin d’un rein : comment en parler avec mes proches?

Liane Dumais, IPSN, M. Sc., D.E.S.S., Québec QC

Le don vivant est une option thérapeutique avantageuse pour le candidat à la greffe rénale. Les bienfaits sont multiples pour le receveur et ont été largement démontré en terme de meilleur fonctionnement et de survie du greffon, de qualité de vie améliorée et la possibilité d’une greffe préemptive afin d’éviter la dialyse.

Toutefois, le patient est souvent réticent à solliciter ses proches pour un don vivant. Il ne sait pas comment aborder ce sujet ou ne veut tout simplement pas l’aborder.

La littérature nous apprend que la crainte de porter préjudice à la santé d’un proche, d’un refus, le manque de connaissances sur le sujet et les croyances personnelles en lien avec le don vivant constituent des barrières fréquemment évoquées par le patient.

L’infirmière, en raison de son lien de proximité avec le patient, peut jouer un rôle important dans cette démarche. Elle est souvent mal à l’aise à aborder cette question et ne peut ainsi aider adéquatement le patient à discuter de ce sujet avec ses proches. Comment outiller les infirmières afin d’actualiser leurs connaissances et leurs compétences pour en parler avec le patient et mieux le soutenir dans sa démarche auprès de ses proches?

Afin de répondre à cette question, une revue de littérature sera présentée et permettra d’identifier les interventions et les approches qui aideront l’infirmière à outiller le receveur afin d’aborder ses proches pour ce type de don.

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Friday October 26, 1400-1445

5C (English) A Comparison of Temporal Artery Thermometers with Internal Blood Monitors to Measure Body Temperature During Hemodialysis

Meaghan Lunney
Bronwyn Tonelli
Rachel Lewis
Natasha Wiebe
Chandra Thomas
Jennifer MacRae
Marcello Tonelli

Background: Thermometers that measure core (internal) body temperature are the gold standard for monitoring temperature. Despite that most modern hemodialysis machines are equipped with an internal blood monitor that measures core body temperature, current practice is to use peripheral thermometers. A better understanding of how peripheral thermometers compare with the dialysis machine thermometer may help guide practice.

Method: The study followed a prospective cross-sectional design. Hemodialysis patients were recruited from 2 sites in Calgary, Alberta (April – June 2017). Body temperatures were obtained from peripheral (temporal artery) and dialysis machine thermometers concurrently. Paired t-tests, Bland-Altman plots, and quantile-quantile plots were used to compare measurements from the two devices and to explore potential factors affecting temperature in hemodialysis patients.

Results: The mean body temperature of 94 hemodialysis patients measured using the temporal artery thermometer (36.7 °C) was significantly different than the dialysis machine thermometer (36.4 °C); p < 0.001. The mean difference (0.27 °C) appeared to be consistent across average temperature (range: 35.8–37.3 °C).

Conclusion: The survey results suggest that patients with CKD in Ontario are not consistently receiving integrated care.

Conclusions: Temperature measured by the temporal artery thermometer was statistically and clinically higher than that measured by the dialysis machine thermometer. Using the dialysis machine to monitor body temperature may result in more accurate readings and is likely to reduce the purchasing and maintenance.

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Friday October 26, 1400-1445

5D (English) Dying with Dignity: A Hemodialysis Medical Assistance in Dying (MAID) Case

Primrose Mharapara, RN (EC), MScN, PHC-NP, CNephC, Toronto ON

The goal of patient care in nephrology is to achieve good quality of life for patients with chronic life limiting illness. End-stage renal disease (ESRD) is associated with limited life expectancy, high morbidity and burden of symptoms. Dialysis is often burdensome and increasingly patients, families and healthcare teams express doubts about the quality of life of individuals with multiple other health problems (Brown, Chamber & Eggeling, 2008). Among patients on dialysis, survival rates and complexity of comorbidities are increasing; in addition, withdrawal from dialysis is becoming a more common cause of death in these patients. The prognosis and outcome of this patient population can be difficult to predict. This unknown aspect in health care can be emotionally taxing to the patient and his/her family and presents unique medical and ethical challenges (Rupesh et al., 2017). End of life care is multifaceted and may include palliative care, psychological support, spiritual care and MAID. MAID is available for patients meeting specific eligibility requirements to decrease suffering from grievous and irremediable medical conditions of the right to life, liberty and security of the person. This case of a vintage hemodialysis patient will exhibit patients’ perspectives of suffering and inability to cope, demonstrate the UHN MAID process and role of an interdisciplinary team and provide an ethical framework for decision making during end-of-life care.

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Friday October 26, 1400-1445

5E (French) Augmenter l’accès à la dialyse péritonéale par l’ajout d’un nouveau mode d’installation des cathéters en angioradiologie: résultats d’une étude rétrospective

Julie Dupont, IPS néphrologie, M. Sc., DESS, Québec QC

L’étude décrit les résultats cliniques et complications associés à l’installation des cathéters de dialyse péritonéale (DP) en angioradiologie au CHU de Québec-Université Laval.

Cette étude rétrospective unicentrique regroupe tous les patients ayant eu un cathéter de DP en angioradiologie entre janvier 2014 et août 2016 (n = 27). L’incidence cumulative des complications immédiates (<24h), précoces (<7 jours) et à 3 mois sont répertoriées pour les hémorragies, infections, fuites, cathéters dysfonctionnels et mal positionnés.

Aucune complication immédiate sérieuse ni hémorragie n’ont été observées. Il y a eu 4 infections de site d’émergence du cathéter. 3 patients ont fait une péritonite plus d’un mois après l’insertion du cathéter et traitées efficacement par antibiotiques. 4 patients ont eu un mauvais positionnement du cathéter : 3 cas résolus par laxatifs et un par repositionnement en angioradiologie. Les patients ont débuté la DP un mois après l’installation du cathéter. À 3 mois, 3 patients ont eu des fuites (péri-cathéter, scrotale, pleurale), mais 25/27 patients étaient en DP.

L’étude démontre donc un haut taux de succès et un faible taux de complications avec l’installation des cathéters de DP en angioradiologie.

L’introduction de cette technique a probablement contribué à l’augmentation de la prévalence en DP dans notre centre passant de 60 à 70 patients. Puisque cette technique est plus économique et moins invasive que la chirurgie, elle devrait être utilisée pour l’installation des cathéters de DP chez les patients non-compliqués.

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Friday October 26, 1630-1715

6A (French) Transplantation 101 : est-ce que mon patient constitue un candidat pour une greffe?

France Martineau, BscN, LcScEd, inf., Montréal QC

La présentation suivante servira à titre d’introduction au monde de la transplantation et comme base pour lancer une discussion interactive avec le public.

Question 1 : Est-ce que mon patient se situe sur la liste de transplantations?

  • Est-ce que nous avons discuté de la possibilité de transplantation avec le patient?
  • Est-ce qu’il existe une raison qui explique pourquoi mon patient ne connaît rien au sujet de la transplantation (cancer, &acird;ge, observance, etc.)?
  • Pourquoi mon patient est-il sous dialyse depuis autant d’années?

Question 2 : Quand devrions-nous discuter de la transplantation avec le patient et quand devrions-nous aiguiller le patient vers la transplantation?

Question 3 : Est-ce que la transplantation améliore la survie à long terme comparativement à la dialyse?

  • Quels sont les risques et les avantages?

Question 4 : Est-ce que tous les patients constituent des candidats à la transplantation?

  • L’étude de cas d’un patient a été déclinée par notre centre.
  • Examen des résultats des cinq dernières années (nombre de transplantations, nombre d’aiguillages, les identités des donneurs décédés qui ont été acceptés par notre centre).

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Friday October 26, 1630-1715

6B (French) Le rôle du technicien de Génie Biomédical en Dialyse

Léo Sauriol, Technologue en Génie Biomédical en dialyse depuis 2004, Lachine QC
Rachelle Stiven, Technologue en Génie Biomédical en dialyse depuis 2015, Lachine QC
Mohammed Amri, Technologue en Génie Biomédical en dialyse depuis 2016, Lachine QC

  • Entretiens préventifs et correctifs des générateurs de dialyse, du système de purification d’eau et des chaises utilisées par les patients.
    • Effectuer les entretiens correctifs des hémodialyseurs en atelier ou dans l’unité?
      • Pourquoi?
      • Comment?
    • Les entretiens préventifs…pourquoi?
    • Les entretiens correctifs et préventifs du système de purification d’eau
      • Pourquoi?
      • Comment?
  • Relation avec les infirmiers(ères), les préposés(es) et les patients
    • Une bonne communication est essentielle car le personnel soignant connait les patients et peuvent nous fournir d’importantes informations.
      • Fuite de sang
      • Présence d’une maladie infectieuse
      • Quel est exactement le problème qu’elles ont observé
      • De notre côté, il est primordial de tenir les infirmières et préposées au courant des problèmes qui ont un impact sur leur travail et des solutions mises en place.
    • Plusieurs fois par semaine voire jour nous sommes appelé dans l’unité pour répondre à des questions.
    • Dans le cas des patients, il faut être à l’écoute et expliquer ce qu’on fait lorsqu’on travail près d’eux ou s’ils nous le demande.
  • Acquisition de matériels
    • Recherches afin d’obtenir la meilleure proposition qui comble le besoin au meilleur prix
  • Renouvellement des équipements
    • Faire connaître les besoins de renouvellement des équipements (désuétudes, bris fréquents et autres raisons)
    • De concert avec l’ingénieur Biomédical ou le Spécialiste
      • Écrire le devis technique
      • Évaluer les soumissions reçues
      • Répondre aux questions techniques reçues lors de l’appel d’offre

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Friday October 26, 1630-1715

6C (English) The Perceptions of Wellbeing in Patients Receiving Hemodialfiltration Treatments

Roch Beauchemin, Inf, BSc. N, MSc. N, IPSN, Montreal QC
Nancy Filteau, Inf, Bsc. N. MSc.A, Montreal QC
Andréa Laizner, BSc. N, MSc, A, Ph.D., Montreal QC
Daniel Nagel, BSc.N, MSc.N, Ph.D., Montreal QC

Introduction: Heodialfiltration (HDF) is a treatment that associaltes hemodialysis and hemofiltration. This treatment filters more uremic toxins than conventional hemodialysis. This combined treatment can decrease some of the negative effects of hemodialysis such as amyloidosis. The perception of the well-being in patients receiving HDF is little known and not well documented.

Objectives of the presentation: We will present the results of a quantitative-descriptive study on the perception of well-being in patients receiving HDF treatment.

Methodology: 60 minutes interviews were done with 10 patients aged between 42 and 75 years. The sample had three women and seven men of which five were francophone and five were anglophone. The interviews were transcribed and the members of the team analyzed the data and underlined the themes from them.

Results: Hope, wanting to function normally, unrealized projects, belief and destiny, and influence of the caregivers on thoughts and perceptions are the five themes that were identified. A conceptual frame emerged. It shows the relationship between the different dimensions of the meaning of well-being with the themes to show the different perceptions and also understand the perception of well-being for those patient receiving HDF treatments.

Conclusion: The results of the study show the complexity of the topic. Well-being is multi-dimensional. This shows that the nurse’s approach to patients receiving HDF treatments must be individualized. There needs to be more research on this subject.

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Friday October 26, 1630-1715

6D (English) Are we There Yet…Challenges of Transition to Adult Care

Paule Comtois, BScN, Montréal QC

According to the Canadian Pediatric Society, 15 % of youth have a chronic condition in North America.

We have been looking at transition to adult care for the last 20 yrs. There is a better understanding of the reasons why and how it can be done. But the real challenge remains to bring our young adults to develop their independence in order to have them take over the responsibility of their care. A chronic illness should not stop our patients from becoming young adults that have a fulfilling life and control over their illness.

What are the barriers to transition to adult care? We will explore the impact on the family, the Pediatric and Adult team. Different transition models have been developed to support our teenagers acquire the milestones required to become responsible of their health. Which one should be used? Is there a one size fits all?

Whether we are form the Pediatric, Adult team or a family member, we should all work towards a common goal; a successful transition for our patients. Let’s make it happen.

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Friday October 26, 1630-1715

6E (English) Supporting Culturally Diverse Families involved in the Deceased Donation Process

Wendy Sherry, Nurse Clinician, Montreal QC

Many people assume they are culturally sensitive because they are polite and respectful to people with different ethnocultural backgrounds; or they get along well at work with colleagues who are members of a different ethnocultural community. However, providing culturally congruent care to patients and families with diverse cultural backgrounds and who are involved in the deceased organ and tissue donation (OTD) process can be challenging (Guido, et al, 2009; Høye & Severinsson, 2008; Pearson et al., 2001). In 2010, the Expert Panel on Global Nursing created a set of universal transcultural standards to guide nursing care practice. These standards, Leininger’s (1988) Theory of Culture Care Diversity and Universality, discussions with members of key ethnocultural communities, nurses, and expert clinicians in the field of OTD, informed the creation of a nursing resource manual for critical care nurses caring for culturally diverse families involved in the OTD process. Participants’ cultural self-knowledge will be evaluated with a self-assessment checklist (available in English and French), and the contents of the critical care nursing resource manual will be presented. The manual was created in partial fulfillment of a graduate degree in Nursing (Sherry, 2014).

Synopsis: The objective of this presentation is to promote reflection of cultural awareness and to demonstrate how nursing care is impacted when supporting culturally diverse families involved in the deceased organ and tissue donation process. A review of the developed nursing resource manual for critical care nurses caring for ethnocultural families involved in donation process will be presented. In addition, a checklist designed to measure cultural competence (English and French) will be provided to promote discussion.

References

Expert Panel on Global Nursing and Health. (2010). Standards of practice for culturally competent nursing care: Executive summary. Retrieved from Retrieved from http://www.tcns.org/files/Standards_of_Practice_for_Culturally_Compt_Nsg_Care-Revised_.pdf

Guido, L. D. A., Linch, G. F. D. C., Andolhe, R., Conegatto, C. C., & Tonini, C. C. (2009). Stressors in the nursing care delivered to potential organ donors. Revista Latino-Americana de Enfermagem, 17, 1023-1029.

Høye, S., & Severinsson, E. (2008). Intensive care nurses’ encounters with multicultural families in Norway: An exploratory study. Intensive and Critical Care Nursing, 24, 338-348. doi 10.1016/j.iccn.2008.03.007

Leininger, M. M. (1988). Leininger’s Theory of Nursing: Cultural Care Diversity and Universality. Nursing Science Quarterly, 1, 152-160. doi: 10.1177/089431848800100408

Pearson, A., Robertson-Malt, S., Walsh, K., & Fitzgerald, M. (2001). Intensive care nurses’ experiences of caring for brain dead organ donor patients. Journal of Clinical Nursing, 10, 132-139. doi: 10.1046/j.1365-2702.2001.00447.x

Sherry, W. (2014). Development of a resource manual for critical care nurses caring for culturally diverse families involved in the organ and tissue donation process – A practicum report submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Master of Nursing. St. John’s, NFLD: Memorial University of Newfoundland.

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Saturday October 27, 1015-1100

7A (French) La perception du Sentiment de bien-être des patients recevant des Traitements d’hémodiafiltration

Roch Beauchemin, Inf, BSc. N, MSc. N, IPSN, Montreal QC
Nancy Filteau, Inf, Bsc. N. MSc.A, Montreal QC
Andréa Laizner, BSc. N, MSc, A, Ph.D., Montreal QC
Daniel Nagel, BSc.N, MSc.N, Ph.D., Montreal QC

Introduction : L’hémodiafiltration (HDF) est un traitement qui associe hémodialyse et hémofiltration. Ce traitement permet de filtrer davantage de toxines urémiques que la dialyse traditionnelle. Cette association peut ainsi diminuer certains des effets négatifs de l’hémodialyse, comme l’amyloïdose. La perception du sentiment de bien-être chez les patients recevant les traitements d’HDF est peu connue ni bien documentée.

Les objectifs de la présentation : Nous présenterons les données d’une étude qualitative descriptive qui avait pour but d’exploré la perception de bien-être des patients recevant des traitements d’hémodiafiltration.

Méthodologie : Des entrevues d’une durée de 60 minutes ont étés conduites auprès de 10 patients âgés entre 42 et 75 ans. L’échantillon comprend trois femmes et sept hommes, parmi lesquels cinq étaient francophones et cinq étaient anglophones. Ensuite, les entrevues furent transcrites et les membres de l’équipe de recherche ont analysé les données et ressorti les thèmes principaux des entrevues.

Résultats : Espoir, but de fonctionner normalement, attentes non-réalisées, croyance et destinée, et influence des soignants sur les pensées et perceptions sont les cinq thèmes principalement abordés par les participants. Un cadre conceptuel émergea de l’analyse. Il met en relation les différentes dimensions de la signification du bien-être avec les thèmes pour illustrer les diverses perceptions et ainsi comprendre le sentiment de bien-être chez les patients sous traitement d’HDF.

Conclusion : Les résultats de l’étude démontrent la complexité de ce sujet. Le bien-être est multidimensionnel. Ceci indique que l’approche infirmière aux personnes recevant des traitements d’HDF doit être individualisée et la recherche doit continuer.

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Saturday October 27, 1015-1100

7B (English) The Role of the Biomedical Engineer Technician in Dialysis

Léo Sauriol, Technologue en Génie Biomédical en dialyse depuis 2004, Lachine QC
Rachelle Stiven, Technologue en Génie Biomédical en dialyse depuis 2015, Lachine QC
Mohammed Amri, Technologue en Génie Biomédical en dialyse depuis 2016, Lachine QC

  • Preventive and corrective maintenance of the dialysis machines, the water purification system and the chairs used by the patients.
    • Corrective maintenance of the hemodialyzers externally or in the units?
      • Why?
      • How?
    • Preventive maintenance… Why?
    • Preventive and corrective maintenance of the water purification system
      • Why?
      • How?
  • Relationships with the nurses, attendants and patients
    • Good communication is key because the caregivers know the patients well and may give us important information.
      • Blood leakage
      • Presence of an infectious disease
      • What exactly is the problem that they observed?
      • For our part, it’s essential to keep the nurses and attendants up-to-date on the problems that have an impact on their work as well on the solutions that have been put in place.
    • Many times per week, or even per day, we’re called to the unit to answer questions.
    • It’s important to listen to the patients and to explain to them what we’re doing when we’re working nearby or when they ask us.
  • Equipment procurement
    • Search for the best option that meets the need at the best price.
  • Equipment renewal
    • Share needs for equipment renewal (obsolescence, frequent breaking or other reasons)
    • Together with the biomedical engineer or specialist
      • Write out the technical specifications
      • Examine that submissions that were given in
      • Answer the technical questions that were asked during the tender process

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Saturday October 27, 1015-1100

7C (French) Sommes-nous arrivés? Les défis de la transition vers les soins adultes

Paule Comtois, BScN, Montréal QC

Selon la Société canadienne de pédiatrie, 15 % des jeunes ont une condition chronique en Amérique du Nord.

Nous étudions la transition vers les soins adultes depuis les 20 dernières années. Nous comprenons mieux aujourd’hui les raisons pour lesquelles la transition devrait être effectuée ainsi que les manières de la faire. Cependant, le plus grand défi demeure d’aider nos jeunes adultes à développer leur indépendance afin qu’ils prennent les reins et la responsabilité de leurs propres soins. Une maladie chronique ne devrait pas empêcher nos patients de devenir de jeunes adultes qui mènent une vie satisfaisante et qui contrôlent leur maladie.

Quels sont les obstacles d’une transition vers les soins adultes? Nous explorerons l’impact sur la famille, sur l’équipe de pédiatrie et sur l’équipe de soins aux adultes. Différents modèles de transition ont été développés pour soutenir nos adolescents afin qu’ils puissent acquérir les outils dont ils ont besoin pour assumer la responsabilité de leur santé. Quel modèle devrait être utilisé? Est-ce qu’un même modèle peut convenir à tous les patients?

Que nous fassions partie de l’équipe de pédiatrie, de l’équipe de soins aux adultes ou que nous soyons un membre de la famille, nous devrions tous travailler vers le même objectif : la transition réussie de nos patients. Faisons-en une réalité.

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Saturday October 27, 1015-1100

7D (English) Quality of Life in Kidney Transplant Patients: A 5-Year Review

Olusegun Famure, MPH, MEd, CHE, Toronto ON
Jaya Manjunath, BSc (c) J, Toronto ON
Anastasia Kalantarova, Toronto ON
Jayoti Rana, BSc, MPH, Toronto ON
S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto ON

Background: Transplantation success is evaluated by graft and patient survival. Quality of life, (QoL), which assesses overall health by evaluating physical, emotional, and social wellbeing, is potentially another useful metric to assess successful transplantation.

Objectives: To assess changes in QoL in kidney transplant recipients (KTR) post-transplantation.

Methods: A QoL Assessment Survey, comprised of the Kidney Disease and QoL Short Form, End-Stage Renal Disease (ESRD)–Symptom Checklist, and an adherence questionnaire, was offered to all adult KTR at Toronto General Hospital transplanted between 2007-2016 at baseline and 1-year post-transplant. Survey responses were used to calculate mean scores for six categories of QoL: Physical Functioning (PF), Role-Physical (RP), General Health (GH), Social Functioning (SF), Role-Emotional (RE) and Emotional Well-being (EW). We used paired student’s t-test to compare QoL mean scores at baseline and 1-year post-transplant and unpaired student’s t-test to compare QoL mean scores 1-year post-transplant to the general Canadian and ESRD populations.

Results: Of 879 KTR, 343 patients completed a baseline and a 1-year post-transplant QoL Assessment Survey. Compared to baseline, the PF, RP, EW and SF QoL mean scores significantly decreased at 1-year post-transplant. In comparison to the general Canadian population, KTR at 1-year post-transplant had significantly lower mean scores for all QoL categories except for EW (p<0.0001), but significantly higher mean scores for all QoL categories in comparison to ESRD patients (p<0.0001).

Implications in Nephrology Care: The QoL Assessment Survey evaluates overall health of KTR and demonstrates the ability to assess transplant success beyond graft and patient survival.

Source of Funding: None.

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Saturday October 27, 1015-1100

7E (English) Conservative Kidney Management: An alternative care pathway to dialysis

Betty Ann Wasylynuk, RN, BScN, Edmonton AB
Janice McKenzie, RN, MScN, Edmonton AB
Sara N. Davison, MD, MSc, Edmonton AB

The prevalence of advanced chronic kidney disease for patients 75 years and older continues to climb worldwide with dialysis often being the default modality option. Unfortunately, many of these older patients suffer from functional disability, cognitive impairment and/or high levels of comorbidity and dialysis may not provide them with either a survival or quality of life advantage. Alberta’s Kidney Health Strategic Clinical Network™ (KHSCN) strives to optimize kidney care and outcomes across all ages and stages of kidney health. As a result, in partnership with the KHSCN, and using state of the art implementation science, we developed a provincial Conservative Kidney Management (CKM) pathway aimed at providing sustainable, high-quality and evidence-based care for patients who are unlikely to benefit from dialysis and have chosen a conservative approach to care.

The purpose of this presentation will be to describe Alberta’s CKM pathway: its purpose, development, implementation, and evaluation, including feedback from CKM patients and renal staff providing CKM care. Lastly, participants will receive a guided tour of the publicly accessible and interactive CKM website (www.ckmcare.com).

Upon completion of the presentation, participants will learn that CKM is an alternative care pathway for patients who are unlikely to benefit from dialysis.

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Saturday October 27, 1110-1155

8A (English) Optimizing PD through Adapted APD

Nicole Gagné, infirmière CNeph(C), Boucherville QC

APD is the modality of choice for many patients, but standard APD prescriptions do not always provide optimal results. Can we do better by fully individualizing PD prescriptions? Come and learn how Adapted APD can improve your patients’ ultrafiltration, clearances and comfort.

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Saturday October 27, 1110-1155

8B (English) Using a Telehome Monitoring and Communication Platform to Enhance Nursing Support and Practice for Home Based Renal Replacement Therapy

Jo-Anne McMullen, RN CNeph(C), London ON

As the use of home based therapies increases, nursing practice struggles to find ways to support the growing number of patients. The CONNECT Trial, a multi-centre randomized controlled trial, aims to leverage past research and clinical expertise to seamlessly integrate modern technology into peritoneal dialysis care delivery, optimizing nursing practice and enhancing patient care. In June 2016 we began to evaluate the impact of a mobile and browser-based home dialysis management platform on patient engagement, clinical outcomes, and operational efficiency in peritoneal dialysis clinics. Interim results of this trial demonstrate that the integration of the platform has greatly improved quality of care delivered to patients by enabling healthcare team members to identify and intervene early in clinical situations through real time access to data from the home as well as improved communication methods, including messaging and picture sharing. In addition, we will explore how the use of the platform has identified opportunities for patient re-education, increased patient confidence, and reduced feelings of isolation to empower patients to better manage their self-care. This study explores the significant positive impact that a home dialysis management platform can have on patient health outcomes and confidence by establishing a new and innovative way of providing care to patients.

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Saturday October 27, 1110-1155

8C (English) Improving access to peritoneal dialysis by adding a new means of catheter insertion in angioradiology: Results from a retrospective study

Julie Dupont, IPS néphrologie, M. Sc., DESS, Québec QC

The study describes the clinical results and the complications associated with peritoneal dialysis (PD) catheter insertion in angioradiology at the Laval University’s university medical centre in Quebec.

This single-centre retrospective study groups together all the patients that had a angioradiology PD catheter between January 2014 and August 2016 (n=27). The cumulative incidence of immediate (<24h) and early (<7 days) complications, as well as complications at 3 months, are categorized for hemorrhages, infections, leaks, dysfunctional catheters are catheters that weren’t well positioned.

No serious immediate complication, nor hemorrhage, was observed. There were 4 infections of the exit area of the catheter. 3 patients suffered peritonitis more than one month after the catheter was inserted but were successfully treated with antibiotics. 4 patients’ catheters were wrongly positioned: 3 of the cases were solved with laxatives and in one case the catheter was repositioned in angioradiology. Patients started the PD one month after the catheter was installed. At 3 months, 3 patients had had leaks (around the catheter, scrotal, pleural), but 25/27 were in PD.

The study therefore had a high rate of success and a low rate of complications regarding PD catheter insertion in angioradiology.

This new technique being introduced to our centre probably contributed to its increased prevalence of PD, where we passed from 60 to 70 patients. Since the technique is less expensive and invasive than surgery, it should be used for PD catheter insertion for patients with no complications.

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Saturday October 27, 1110-1155

8D (English) Development of a 44 hour Ambulatory Blood Pressure Monitor Training Program

Cheryl Ralph, RN BScN CNephC, Ottawa ON
Cindy Cockram, RN CNeph, Ottawa ON
Barbara Drodge, RN, Ottawa ON
Swapnil Hiremath, MD, MPH, Ottawa ON
Marcel Ruzicka, MD, PhD, FRCPC, Ottawa ON

Purpose: Hypertension is widely prevalent in the hemodialysis population and the leading modifiable factor for cardiovascular outcomes. Unlike blood pressure (BP) measured during dialysis, ambulatory BP represents superior measurement of true BP load.

Description: We started 44 hour ambulatory blood pressure measurement at our tertiary care dialysis unit in 2012. Herein we describe our 5 year experience with 44 hour ABPM in regard to patient acceptance and nursing implications.

Outcomes: 44 hour Ambulatory Blood Pressure Monitoring (ABPM) was pioneered at a tertiary care in centre hemodialysis unit. It is well tolerated by patients, with an overall completion rate around 70%. In many cases, this assessment improved overall BP control, led to avoidance of unnecessary escalation of BP lowering medications thereby preventing potentially dangerous hypotensive episodes during and in between HD treatments and in other patients allowed up-titration of BP lowering drugs as the results identified sustained high BP load.

The Civic Campus hemodialysis Unit serves as the centre for ABPM for our regional program.

44-hour ABPM requires sophisticated equipment, which was provided by the Nephrology program as well as trained personnel to administer this test. Lack of well trained professional personnel is the major limiting factor to administering this test at any given dialysis shift on any given day.

Implications: This Presentation addresses this gap and focuses on the development of a pragmatically structured training program for ABPM for a core group of dialysis nurses in our dialysis unit and making ABPM widely available to hemodialysis patients within our regional program.

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Saturday October 27, 1400-1445

9A (English) Can Nursing procedures have an influence on improved anaemia control?

Maria-Teresa Parisotto, Bad Homburg Germany

Introduction: Most patients who require haemodialysis have a variety of serious health problems, one of them anaemia, a common complication of both renal failure and haemodialysis. Dietary restrictions, poor absorption or removal of iron and vitamins by haemodialysis can contribute to anaemia. The haemodialysis procedure itself leads to a loss of 300 to 600 grams of haemoglobin (Hb) per year due to blood retention in the dialysis lines and filters.

Objectives: To maintain an adequate level of haemoglobin and a high quality of care by optimising the blood reinfusion at the end of treatment.

Methods: 840 haemodialysis patients were followed up from December 2011 to September 2013. Results on haemoglobin level and erythropoiesis stimulating agents (ESA) consumption were compared before and after the blood reinfusion optimization.

Results: At baseline (Dec 2011), with ESA and iron doses of 1.87 ± 1.87 mcg/Kg/month, 2.21 ± 2.42 mg/Kg/month respectively, the haemoglobin level was 11.25 ± 1.24 g/dL. While in December 2012, with ESA and iron doses of 1.21 ± 1.31 mcg/Kg/month and 3.18 ± 2.17 mg/Kg/month respectively, the haemoglobin level was 11.34 ± 1.22 g/dL vs September 2013 (ESA and Iron doses of 1.39 ± 1.43 mcg/Kg/month and 1.98 ± 2.13 mg/Kg/month respectively) the haemoglobin level was 11.22 ± 1.18 g/dL (p=0.57 NS).

Conclusion: The analysis demonstrated that by performing a proper reinfusion procedure it is possible to reduce the quantity of residual blood in the extracorporeal circuit, thereby reducing anaemia risks and increasing safety, while optimising costs.

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Saturday October 27, 1400-1445

9B (French) S’adapter à nos patients, de la littératie à l’enseignement : une avenue se conjuguant au présent et au futur pour améliorer les soins!

Julie Dupont, IPS néphrologie, M. Sc., DESS, Québec QC

Cette présentation repose sur une revue de littérature et présente les concepts de littératie en santé dans le domaine de la néphrologie ainsi que la pédagogie de l’adulte (andragogie) dans le but d’améliorer les soins offerts aux patients par des enseignements adaptés.

Plusieurs études rapportent différents niveaux de littératie dans les diverses clientèles néphrologiques. Les concepts généraux, les données probantes en néphrologie ainsi que des pistes d’action concrètes pour inclure les concepts de littératie au quotidien seront présentés.

L’androgogie est une science comprenant plusieurs théories d’apprentissage. Certaines d’entre elles sont à la base de guides de pratique clinique pour la formation des patients en dialyse péritonéale comme celui de l’International Society of Peritoneal Dialysis (ISPD). Des types et théories d’apprentissage seront exposés en lien avec les patients insuffisants rénaux en plus des nouvelles lignes directrices pour l’enseignement en dialyse péritonéale. Des outils facilement intégrables au quotidien seront aussi décrits pour déterminer les types d’apprentissage des patients.

Cliniquement, comprendre la capacité des patients à obtenir, décoder et utiliser l’information permet d’ajuster les soins pour améliorer la capacité d’auto-soins des patients. L’enseignement aux patients fait partie du quotidien des infirmières en néphrologie. Connaître des notions d’apprentissages chez les adultes permet d’adapter le matériel et d’invidualiser les méthodes d’enseignement utilisées en identifiant le type d’apprentissage des patients.

La recette du futur : s’adapter, intégrer la littératie et individualiser nos approches pour mieux répondre aux besoins des patients dans le présent.

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Saturday October 27, 1400-1445

9C (English) Clinical Outcomes of Home Hemodialysis with Low Dialysate Volume

Julien Gautier, Engineer in Biology, Biomechanics and Biomaterials, Université de Technologie de Compiègne, France; Director, International Marketing, NxStage Medical, Inc.
Sharon Fairclough, RN, BN, CNeph(C), MN(c); Clinical Educator, NxStage Medical Canada, Inc.
Sharon Joy Dubiel, BScN, M.A.(ed); Clinical Educator, NxStage Medical Canada, Inc.
Eric Weinhandl, Adjunct Assistant Professor, University of Minnesota, College of Pharmacy, Department of Pharmaceutical Care and Health Systems, Minneapolis, MN; Clinical Epidemiologist and Statistician, NxStage Medical, Inc.

Purpose: The Canadian Agency for Drugs and Technologies in Health recommends self-care home-based dialysis in patients diagnosed with end-stage kidney disease, either with home hemodialysis (HHD) or peritoneal dialysis. We evaluated outcomes on HHD with a transportable device that employs low dialysate volume (LDV).

Methods: We collected data from HHD patients at 9 centers in western Europe. We recorded hemodialysis prescription, biochemical, and medication data at HHD initiation and at 6 and 12 months thereafter.

Results: The cohort comprised 182 patients. Ranges of age, body mass index, and Charlson score were 15-84 years, 13.3-50.8 kg/m2, and 2-11 points, respectively. Mean training duration was 18.9 sessions. Most (93.4%) patients were prescribed 5 or 6 sessions/week, and session duration was commonly 2.0-3.5 hours; mean dialysate volume was 23.9 L/session. Mean ultrafiltration (UFR) rate declined from 6.9 to 6.6 mL/hour/kg between HHD initiation and 12 months, with a halving of patients with UFR ≥10 mL/hour/kg. Mean standardized Kt/V was 2.6 at all times; the majority of patients had standardized Kt/V between 2.4 and 3.0 at 12 months. Serum concentrations of bicarbonate, potassium, calcium, phosphorus, albumin, and hemoglobin were stable. The percentage of patients using no antihypertensive medications steadily increased from 27% at HHD initiation to 36% at 6 months and 42% at 12 months.

Conclusions: HHD with LDV is viable for a wide array of patients. Increased treatment frequency, low ultrafiltration intensity, stable biochemistry, and reduced medication use are observed.

Implications: HHD with LDV presents features likely to lead to better clinical outcomes.

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Saturday October 27, 1400-1445

9D (French) Le donneur vivant non compatible : quelles sont les options?

Liane Dumais, IPSN, M. Sc., D.E.S.S., Québec QC

Pour une majorité d’insuffisants rénaux chroniques au stade terminal de la maladie, la greffe rénale est le mode de suppléance qui améliore considérablement leur qualité de vie.
Selon la littérature, la transplantation rénale à partir d’un donneur vivant présente de nombreux avantages dont la diminution de la durée d’attente pour un rein, la possibilité d’une greffe préemptive afin d’éviter la dialyse et un meilleur fonctionnement et survie du greffon. En outre, la promotion du don vivant s’inscrit dans une volonté provinciale d’augmenter le nombre de transplantation en provenance de ce type de donneur. (Projet don vivant de rein, Ministère de la santé et des services sociaux, 2016). Quelles sont les options du receveur lorsque le donneur vivant potentiel qui s’est manifesté est incompatible?

Cette présentation abordera les thèmes suivants afin de d’informer et de sensibiliser les infirmières en regard des options possibles, qui à son tour pourra renseigner le receveur et ses proches:

  • L’augmentation de la sensibilité des techniques d’identification des anticorps
  • Le test de compatibilité croisé virtuel (“ cross match virtuel ”)
  • Les antigènes permis en présence d’anticorps pour faciliter l’accès à la transplantation chez les receveurs sensibilisés
  • La greffe ABO incompatible et la désensibilisation HLA
  • Le programme canadien de “ don croisé de rein ”.

L’infirmière en néphrologie pourra ensuite renseigner le receveur.

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Saturday October 27, 1400-1445

9E (English) A First User Experience of New Remote Monitoring Technology in Peritoneal Dialysis – Leveraging Timely Sharesource Data to Effectively Manage Patients at Home and Ease Their Transition Into PD

Karen Eyolfson, RN, CNeph (C), Winnipeg MB
Kim Bomak, RN, BSN, Winnipeg MB

There are many considerations and steps involved when starting a patient on Peritoneal Dialysis. A few big considerations are to smoothen the transition, increase patience confidence in self-management of disease and effectively troubleshoot any clinical or technique issues through the first three months on PD.

Our program was the first in Manitoba to evaluate a new technology in APD cyclers that allows for two-way, web based remote monitoring connection between the patient and the clinic. This remote monitoring software allows for daily overview of patient’s treatments to be visible to the clinic, flag alerts when deviation occurs to the prescribed treatment regime, and for remote patient cycler programing.

Currently we have approx. 12 patients on PD using this new cycler. The initial experience that we would like to outline is: – increased visibility to treatment data, timely identification of potential problems such as low drain alerts, and effective troubleshooting of issues by leveraging the Sharesource data.

The presentation will also include some case studies showing the benefits of Sharesource in effectively managing patients at home and easing their transition to PD.

Presented by Baxter Corporation

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