Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group.

Antibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology and the US Centers for Disease Control and Prevention created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with ß-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration among the Centers for Disease Control and Prevention; American Society of Nephrology; other professional societies such as infectious diseases, hospital medicine, and vascular surgery societies; and dialysis provider organizations can improve antibiotic use and the quality of care for patients receiving maintenance hemodialysis.

Innovation in COVID-19 Response: ANNA COVID-19 Surge Support Process and Map.

The COVID-19 pandemic began with uncertainty in how to care for patients and protect staff. The American Nephrology Nurses Association (ANNA) immediately recognized the need to provide its members and others in the nephrology community with as much information as possible. Resources were collected and disseminated in many forms (e.g., publications, webinars, virtual conference sessions). As COVID-19 surges began occurring across the country and staffing reached a crisis level, ANNA collaborated with other organizations to find potential solutions. One solution developed by ANNA was the ANNA COVID-19 Surge Support Process and Map - a process to connect the areas in high need with skilled and available staff. This article describes the ANNA COVID-19 Surge Support Process and Map, which has continued to help address COVID-19 staffing challenges.

Factors Related to International Travel for Transplantation Among U.S.-Listed Kidney Transplant Candidates.

Factors related to travel for transplantation were examined using data from the Scientific Registry for Transplant Recipients. Candidates who traveled abroad for a kidney transplant had higher odds of being male, Asian or Hispanic, college-educated, employed, privately insured, and a non-U.S. citizen/non-U.S. resident. Candidates with a body mass index greater than 30, a calculated panel reactive antibody (cPRA) greater than 80%, and a history of more than two years of hemodialysis or peritoneal dialysis had lower odds of traveling abroad for a kidney transplant. Geographically, candidates listed in the northeastern region of the United States (New York and Western Vermont) had the highest odds of traveling abroad for a kidney transplant. Findings of this study can be used to guide practice and education with transplant candidates, and to direct further investigation in this understudied but growing area of transplantation.

The Health and Safety of Nephrology Nurses and the Environments in Which They Work: Important for Nurses, Patients, and Organizations.

Nurse health and safety and the environments in which nurses work impact nurses, patient safety and quality of care, and organizational outcomes. In January 2018, we conducted a comprehensive national assessment of the overall health and safety of nephrology nurses and their work environments as a follow-up study to the 2014 study on Patient Safety Culture in Nephrology Nurse Settings conducted by American Nephrology Nurses Association. This article presents initial broad findings of this national study. Results identified a number of opportunities for improvement in nephrology nurse work environments, especially in the areas of staffing, optimizing the knowledge and skills of registered nurses, and mental and physical health.

Fluid and Electrolyte Management Across the Age Continuum.

Optional function of body systems depends upon fluid and electrolyte balance; however, across the lifespan, disorders of fluid and electrolytes offset this, and the causative factors are varied. Nurses play a major role in the management of fluid and electrolyte balance. This article focuses on the role total body water content, plasma proteins, kidney function, and drug metabolism have on the age-related physiology impacting fluid and electrolyte balance, and on nursing implications.

Current State-of-Practice: Transportation for Patients with End Stage Renal Disease.

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease,transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described.

Patient Handoffs: What They Are and How They Contribute to Patient Safety.

Communication and patient handoffs during transitions in care have been increasingly investigated due to their relationships with patient safety, quality of care, and efficiency. Handoffs occur at two points in the delivery of nursing care: nurse transitions in care and patient transitions in care. This article explores the accepted definitions, best practices, and evidence related to patient handoffs and patient safety.

Patient Handoffs in Nephrology Nurse Practice Settings: A Safety Study.

Research investigating patient handoff processes has inundated the safety literature, but not in nephrology nurse practice settings. Effective patient handoffs are essential for maintaining patient safety by avoiding errors related to poor information exchange. This mixed methods research study investigated the process of patient handoff across nephrology practice settings and the implications for patient safety and nursing practice. Findings indicate there are too frequently issues with handoffs of patients with chronic kidney disease who must move between many different healthcare providers and healthcare settings. Nephrology nurses reported thar the use of multiple methods for handoff communications and practice sites having differing hours of operation present challenges to practitioners, which result in information too often "falling through the cracks."

Using Evidence-Based Practice to Move Beyond Doing Things the Way We Have Always Done Them.

Contemporary health care demands better care for individuals with kidney disease. In the quest for the Triple Aim of health care--improving the experience of care, improving the health of populations, and reducing per capita costs of health care--nephrology nurses can no longer afford to practice the way we have always done. Instead, it is critical to consider the best available evidence, personal expertise, and patient/family preference when engaging in clinical decision-making. This article provides the steps to develop an evidence-based project to address a clinical problem.

Hemodialysis catheter outcomes pilot study: no dressing coverage with prescribed showering.

This six-month prospective, multi-site study incorporated no dressing coverage over hemodialysis central venous catheter exit sites and compared the outcomes of two groups of patients receiving incenter hemodialysis: a shower group and a non-shower group. Outcomes included exit site infection rates, tunnel infection rates, and catheter-related bloodstream infection rates. The study enrolled 40 patients--31 patients in the shower group and nine patients in the non-shower group. The study was initially designed as a randomized controlled study, but after a month of enrolling patients, most patients insisted on being in the shower group. Results for both groups demonstrated infection rates that were not statistically different and were below levels reported in other studies. The qualitative satisfaction in ability to shower by patients in this study was an additional important finding.

Does the direct application of povidone-lodine hasten hemostasis of the cannulation site after the removal of hemodialysis needles?

Historically, povidone-iodine has had multiple uses in the care of patients receiving hemodialysis and peritoneal dialysis due to its broad antimicrobial properties. Anecdotally, nephrology nurses and technicians have used preparation pads impregnated with povidone-iodine at hemodialysis cannulation sites after removing the needle post-treatment to hasten the clotting time at the site. This article explores the literature related to the use of povidone-iodine in the process of hemostasis after the removal of hemodialysis cannulation needles and also discusses the potential risks of using povidone-iodine in the patient population with renal failure.

Is intravenous ascorbic acid an effective and safe option for increasing hemoglobin levels in patients with a hyporesponse to epoetin alfa?

Despite the use of epoetin alfa, over one-third of patients with end stage renal disease have persistent anemia. The nephrology literature cites various erythropoietin adjuvants that may have the potential to improve the efficiency of anemia management, and one option is ascorbic acid. This article reviews the published data on the effectiveness of intravenous ascorbic acid in increasing the hemoglobin levels of patients with hyporesponse to epoetin alfa, as well as adverse effects of the administration of intravenous ascorbic acid specifically in relation to hyperoxalemia.

Transformative learning during nursing education: a model of interconnectivity.

Higher education strives to transform students by opening their minds to different world views. This study investigated the transformative experiences of students using narrative analysis methodology to describe the experience of learning during nursing education. Phases of Transformative Learning Theory guided the analysis of narratives. The study yielded 5 narrative threads: 1) the multi-faceted process of learning, 2) experiential learning, 3) human interactions as central to defining nursing and caring, 4) personal life experiences intertwining with nursing, and 5) transformative learning. Results indicated that students perceived the greatest learning and transformation through experiential learning with humans. Such experiences included caring for immigrants, children in lower socioeconomic environments, and patients with a variety of physical and mental health needs in numerous settings. Other participants described personal experiences that took on new meaning or contributed to learning as a result of academic experiences. Some students entered with a personal history of service and charity work that provided a foundation for their educational experiences.