AIM & OBJECTIVE: To evaluate the impact a nurse prescriber led protocol compared to a traditional physician led non-protocol based approach had in maintaining targeted haemoglobin levels in patients on maintenance haemodialysis.
BACKGROUND: Anaemia is a common complication of chronic kidney disease and has a profound impact on the patients’ wellbeing. Current practices place a greater emphasis on the decision-making role of nurses in renal anaemia management. The introduction of nurse prescribing in this area is a relatively new concept.
DESIGN: A retrospective cohort design, covering an eight-month period pre and post the introduction of a nurse prescriber led anaemia protocol; study adheres to the STROBE Statement.
METHODS: Using a non-probability convenience sample, data extracted from the medical records and electronic patient records system (eMed) related to 74 patients at a single outpatient haemodialysis centre located within an acute general teaching hospital. The primary outcome was patients’ haemoglobin level pre and post introduction of the protocol. Secondary outcomes included erythropoietin-stimulating agent and iron dosage, and Serum Ferritin and Transferrin Saturation levels.
RESULTS: There was no statistically significant differences between pre and post protocol serum haemoglobin level and erythropoietin-stimulating agent dosage. Under the management of the nurse prescriber, patients experienced a significant improvement in Serum Ferritin and Transferrin Saturation levels and required significantly less intravenous iron dosage.
CONCLUSION: This study, the first of its kind, found that patients receiving haemodialysis experience a significant improvement in iron indices while receiving a significantly lower amount of intravenous iron when managed by a nurse prescriber. Furthermore, the nurse prescribers’ decision-making capacity is as effective as a physician led non-protocol based approach in achieving haemoglobin target levels.
RELEVANCE TO PRACTICE: Nurse prescribers have a role in implementing a safe, standardised and sustained approach to anaemia management in outpatient haemodialysis settings without compromising patient care.
Reference:George, S. and McCann, M. (2020) A nurse prescriber led protocol for anaemia management in established haemodialysis patients: a retrospective study. Journal of Clinical Nursing. April 8th. doi: 10.1111/jocn.15275. [Epub ahead of print].