Right TraC™ Post-Hospitalization Care Transitions Program to Reduce Readmissions for Hemodialysis Patients.

BACKGROUND: Hemodialysis (HD) patients have high hospitalization rates. This nonrandomized trial tested the effect of a bundle of renal-specific "Right TraC™" strategies on 30-day all-cause readmission rates and, secondarily, 90-day readmissions and overall admissions among HD patients. METHODS: Twenty-six Fresenius clinics in West Virginia, Ohio, and Kentucky participated in the interventions. Eighteen matched clinics served as controls; intervention clinics also served as their own controls. We deployed the intervention in 3 incremental phases focused on patient information exchange, post-hospital follow-up, and telephonic case management. Thirty-day hospital readmissions per patient year (ppy) were calculated by dividing the total number of readmissions within 30 days of index admission by the total number of patient-years in baseline (2012) and remeasurement (2014) periods. We also compared readmission rates from 2010 to 2015. We used repeated measures Poisson regression to compare outcomes between groups and time periods. RESULTS: From 2012 to 2014, 30-day all-cause readmissions ppy declined for Right TraC clinics (from 0.88 to 0.66 [p < 0.001]; for controls, from 0.73 to 0.61 [p = 0.16]). Difference in change between groups was nonsignificant (p = 0.26). Overall admissions ppy declined: for Right TraC clinics from 2.51 to 1.97 (p < 0.001); for controls from 2.14 to1.92 (p = 0.21); difference in change between groups was significant (p = 0.01). For 2010, 2011, and 2012, Right TraC clinic 30-day readmissions ppy were unchanged: 0.89, 1.00, 0.88 (p = 0.61 and p = 0.49); they declined to 0.66 (p < 0.001) in 2014 (intervention year); rose to 0.70 (p = 0.06) in 2015 (interventions discontinued). CONCLUSION: We conclude that Right TraC interventions may have been helpful in reducing hospital readmission rates.

Nursing Care for Patients with Biological Arteriovenous Grafts.

Patients receiving hemodialysis are challenged with maintaining adequate vascular access. Nephrology nurses are on the forefront of daily care, assessment, and monitoring of patients' vascular accesses for hemodialysis. This article discusses the literature and manufacturer information to support best nursing practices.

Learning why patients with central venous catheters resist permanent access placement.

Central venous catheters (CVCs) are a well-known risk to patients on hemodialysis due to their higher morbidity and mortality compared to fistulas or grafts. One factor in the prevalence of CVCs is patients eligible for permanent access who refuse referral and permanent access placement. Objectives of this study were to identify reasons patients resist permanent access placement and develop potential strategies for intervention. A survey was distributed to Fresenius Medical Care North America (FMCNA) outpatient dialysis facilities (approximately 1600 facilities) requesting voluntary participation in documenting reasons given by patients for resisting permanent access placement. From the patient survey results, responses were collected and ranked from most frequent response to least frequent response. A collaborative workgroup of nephrology nurses and social workers reviewed the survey results. The patient survey provided 1573 responses. The three most frequently provided reasons were 1) a previous negative surgical experience, 2) having a permanent access placed in the past that did not work, and 3) cannulation fear and/or pain concerns. The workgroup identified best practices from clinics with low CVC rates and reviewed professional literature as a guide for development of potential strategies for intervention by the nephrology nurses and interdisciplinary team. Using a patient survey as a means to learn reasons why patients resist permanent access placement can be of value to the healthcare team in the development of potential strategies for interventions to reduce CVC utilization and thereby improve patient outcomes.

Venous needle dislodgement in patients on hemodialysis.

Venous needle dislodgement is a potential serious complication of hemodialysis therapy. In 2012, the American Nephrology Nurses'Association (ANNA) created a collaborative special project workgroup to review venous needle dislodgement occurrence, consequences, and recommended practices, and to develop strategies and resources on venous needle dislodgement to be used by nephrology nurses and other healthcare professionals, as well as by patients and their families. The ANNA Venous Needle Dislodgement Special Project Workgroup conducted a literature review and also surveyed nephrology nurses about their experiences with venous needle dislodgement and their recommendations for needed resources. This article discusses the results of the literature review and survey, and provides resources on venous needle dislodgement, including a venous needle dislodgement risk assessment tool, education materials, and practice recommendations.