Care Of Renal Patients Research Articles

A review of guidelines for nutrition care of renal patients

The third edition of the Guidelines for Nutrition Care of Renal Patients has been developed to follow the American Dietetic Association's Medical Nutrition Therapy (MNT) Protocol format and to further assist dietitians in providing optimal and consistent care to renal patients. The guidelines define the level, content, and frequency of nutrition care that is appropriate based on the best available scientific information and expert opinion. Seven separate guidelines, primarily written for care provided in the outpatient setting, are defined in the publication. Each guideline focuses on a different patient population and/or treatment modality for renal disease: Pre–End-Stage Renal Disease, Hemodialysis and Peritoneal Dialysis, Hospitalized Dialysis, Transplantation, Acute Renal Failure, Enteral/Parenteral Nutrition Support, and Pregnancy in Renal Disease. The Guidelines for Nutrition Care of Renal Patients, Third Edition is meant to support and assist dietitians as providers of MNT in kidney disease, to provide uniform treatment care guidelines and nutritional status identification criteria for all aspects of kidney disease and its complications, and to help secure the dietitian as the provider of these services for optimum cost-effective care. The guidelines should help to increase effectiveness of care by promoting consistency among practitioners and should facilitate the measurement of the quality and effectiveness of care. © 2002 by the National Kidney Foundation, Inc.

Basic tools to integration in management and continuous quality improvement: protocols and procedures

In order to support interested colleagues with the concepts of Continuous Quality Improvement (CQI) and Clinical Standards for Nephrology Practice, a package of education support has been set up. We enhance the use of procedures, protocols, working plans, guidelines and nursing care plans as instruments of organisational integration. For the nursing care of renal patients in HD and PD we believe that all the procedures and protocols (P&P) above could have an important impact in the renal nursing practice. We propose that group members run a programme which is presented and implemented as a modular package including, theoretical knowledge, setting up working groups involved in literature revision, evaluation of defined P&P after a period of implementation, final implementation & periodic evaluation.

The Effect of Blood Draw Methodology on Selected Nutritional Parameters in Chronic Renal Failure

The reliability and validity of any clinical laboratory test is directly affected by the integrity of the blood specimen obtained for analysis. Renal failure patients undergo a high number of laboratory tests, primarily to monitor the quality of care. Subsequent tests to confirm laboratory abnormalities are costly and place the patient at unnecessary risk for additional blood loss. Three of the four Health Care Financing Administration core clinical outcome indicators have nutritional implications and use laboratory values as part of review criteria: adequacy of dialysis, albumin, and anemia. National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI) Clinical Practice Guidelines have recommended standardized predialysis and postdialysis blood draw procedures to increase accuracy for adequacy of dialysis. The National Committee on Clinical Laboratory Standards publishes peer-reviewed guidelines for venipuncture. Together, the adoption of these standards would minimize preanalytical variation and improve the data used to monitor the quality of care in renal patients.

The Future of End-Stage Renal Disease Care: Nephrology Enters a New Millennium

There are many challenges facing the discipline of nephrology as we enter the next millennium. There will be a continuing increase in the number of patients requiring renal replacement therapy, with older, sicker patients predominating. At the same time the available workforce to provide care to these patients is not growing quickly enough to keep up with the demand. In the broader health care delivery system, consolidation of services, vertical and horizontal integration, a continued move to for-profit entities, and constant pressure on cost containment will increasingly characterize the immediate future. The rapidity with which health care delivery and financing are changing will make it difficult for patients and health care professionals alike, but it will also offer opportunities. In nephrology, development of a collaborative model of care has already begun and will be an important part of the response to this changing care environment. Collaborative care and the application of the principles of chronic disease management to renal patients will provide the best opportunities to capitalize on new technologies and treatments as they become available and to streamline and improve the care delivery process. This should lead to improved quality of care for renal patients, while constraining costs and providing for continued professional growth and satisfaction.

Toward global advancement of medicine: The International Society of Nephrology experience

Since its foundation in 1960, the International Society of Nephrology (ISN) has pursued the worldwide advancement of education, science and patient care in nephrology. This goal was achieved by means of the Society's journal and the organization of international congresses and symposia. In order to better reach its colleagues and patients in economically less developed countries, the ISN expanded its activities as of 1980 by a large number of specific programs aimed at these regions. The first phase of activities included teaching programs, fellowship and visiting scholar programs, and the provision of travel grants to enhance accessibility to the ISN congresses. A second phase consisted of the creation of a library enhancement program, a commission on acute renal failure and--to improve the organization and efficiency--a central commission on global advancement of nephrology (COMGAN). Currently, a third phase has been entered in which all activities have been intensified: (1) under the guidance of COMGAN, supported by a large number of teaching programs and fact finding missions; (2) by establishing a renal sister program; and (3) by initiating commissions on informatics and on clinical trials. As a result, the ISN has reached most parts of the world, previously deprived of contact with renal science and renal patient care. The fellowship program now counts 160 fellows, who spend one or two years in training. The library enhancement program reaches 218 institutions worldwide. ISN membership has soared over the past two years with over 2,500 new members, mostly in the developing countries. They receive Kidney International and other relevant forms of information. Thus far, 135 pairs of renal units in developing and developed countries have been linked for support on a more continuous basis. ISN-sponsored congresses, symposia, and courses are being held in increasing numbers in the developing world. In many of its activities, the ISN closely collaborates with sister organizations, which also contribute financially. In total, the ISN spends annually over $1 million US from its own budget on the programs described above. The various programs and initiatives are proving helpful in advancing renal medicine in areas in need. Expansion into supporting similar programs within other medical subspecialties is being explored.

Use of Standing Orders for Care of Renal Patients

Use of Standing Orders for Care of Renal Patients

Organisation and change in renal work: a study of the impact of a computer system within two hospitals

AbstractRenal units exist primarily to dialyse patients with end stage renal failure (ESRF) and to train them to dialyse themselves. An important aspect of the care of renal patients is the regular monitoring and recording of their condition by the nurses and doctors. In consequence, the renal units possess an extensive set of records on each of their dialysis patients. This paper reports on a study of two renal units and the consequences of the introduction of a computerised patient data system. This system was designed to ease the burden on the nurses of manually maintaining the patient records as well as improve the access and analysis of the clinical data for the doctors. The concern of the paper is not whether the system was accepted or rejected but how it came to be utilised and why. Using an approach informed by labour process analysis, this study demonstrates the ways in which the clinical division of labour, in particular the relations between doctors and nurses, shaped the ways in which the computer system was utilised.