A quality initiative--can we reduce the incidence of hypotension during hemodialysis?

"Dialysis-related side effects have been identified as an important cause of reduced dialysis efficiency" (Donauer, Kolblin, Bek, Krause & Bohler, 2000, p. 115). Certain patients experience symptomatic hypotension with hemodialysis treatments, adding to patient discomfort and morbidity, and preventing optimal fluid removal. These symptoms require prompt nursing interventions to mitigate potentially severe complications. Technology today allows for continuous non-invasive monitoring of blood volume during the hemodialysis treatment, automatic measurement and recording of blood pressure, and the use of sodium modelling and ultrafiltration (UF) profiles. As a teaching strategy, as well as a quality improvement initiative, a task force of volunteer staff nurses was established to monitor selected patients, utilizing this technology, in an effort to reduce episodes of hypotension and improve patient outcomes. A special project team was recruited, in-services on blood volume monitoring, sodium and UF profiling were held for all staff, and tools to assess the current status of the patient and monitor progress were designed and implemented. Patients who were followed reported feeling better and experienced fewer hypotensive episodes. These outcomes are likely a result of several factors including: intensive monitoring by a consistent group, review and analysis of dialysis records every two weeks, implementation of several interventions (such as instituting sodium ramping, changing UF profiles, changing antihypertensive medication, and/or patient education), and evaluating these changes within two weeks.