I conducted my nursing practice in a hospital dialysis unit. It comprised of an outpatient
unit and that department accessed the patients' lifeline. Lifesaving treatment was performed in
the unit. Also called renal replacement therapy, dialysis is a procedure entailing the excess
contaminants, liquids, solutes, and fluids getting extracted from the blood of certain individuals
whose kidneys are unable to operate and naturally execute this action. Furthermore, this
treatment actually replaces the work that can be performed by the kidneys. It is one of the major
complicated processes for individuals and there are various other problems that need to be
discussed in relation to this process. Access patency is one of the key concerns
A concern for people ailing from chronic hemodialysis is the maintenance and prevention
of their access clotting. Individuals suffering from End-Stage Renal Disease (ESRD) require the
Renal Replacement Therapy (RRT) which is the bloodstream access they need to perform the
hemodialysis procedure. Most individuals have the initial access hemodialysis catheter (CVC),
which can be positioned in subclavian, femoral artery or jugular. There are several catheter-
related concerns that include elevated bloodstream infection risk, reduced blood flow rates
(BFR) that decrease the amount of processed blood, and this increases the clotting incidences.
Removing the catheter is the initial priority after a patient is put on dialysis with
permanent treatment such as grafting or fistula. If the access is transformed to fistula or graft it is
important to conduct maintenance to ensure that optimum BFR can be sustained. If the BFR does
not have the appropriate blood volume then the complications including clotting or stenosis will
occur and this will affect the patient's general health. When the blood pressure of the patient is
observed with frequent clotting is getting low continuously then it would be helpful to be able to
trend the incidences and early interventions can be used to prevent the clotting of the access.
Repeated episodes of clotting because of the low flow of the blood in the access and this
happens due to hypotension as this is the major factor through which this can happen. It is one of
the most significant factor associated with risk that graft being more susceptible than fistulas due
to its composition’s nature. Formation of clots in arteriovenous grafts is due to the flow as low as
600ml/min, where flows can be much lower approximately about 300ml/min, before the
formation of clot. There is an effect on the outcomes of patients because of the low flows as
there will be a decrease of blood volume being processed for treatment. The reason why the less
blood cleaned is because of the less blood flowing through the dialyzer and it will create
symptoms like fluid overload, uremia and hyperkalemia (Needleman & Hassmiller, 2015).
The reason of this proposal in to create a plan in which blood pressure trends of the
patients can be monitored and it is associated with frequent incidents of thrombosis (clotting).
Data can be gathered because of these trends which will allow for early interventions in the
prevention of further clotting episodes. There are many benefits for the patients because of this
such as the patients will have treatment of better quality and fewer incidences of thrombosis
delaying treatments. It will effect on the overall better patient’s outcomes. If there was any
program in which the blood pressure of the patient were interfaced into new (TAC) Total Access
Care Program then we would be this much able to monitor trends in patency of the access and
see trends denoting issues of worsening of clotting or stenosis and provide prior intervention
(Kossman & Scheidenhelm, 2015). If there was any way through which we collating the blood
pressure and BFR into the TAC program and compiling the trends that it might be possible for us
to predict a clotting incident on the rise and provide prior intervention such as angioplasty to
reopen the access. This will help the patient through various ways as it can prevent the patients
from having delays in treatment, missing treatments and improve the overall quality outcomes
for the future.
For this stakeholders are those who are responsible for the completion of this project
(McGonigle & Mastrian, 2018). In this case that would be nursing informaticist’s unit manager,
nursing staff and data specialists. Stakeholders are also the ones who design the project and their
impact is very much on its implementation. They are also responsible for the time required to
complete this project and budget. The aim related to patient’s outcome is the reduction of
thrombotic events and continuity of care. This would be created by the nursing staff who are
already working with the patients, they will coordinate with the data specialists and nursing
informatics to develop a program that could interface blood pressures monitored (both pre and
post treatment) for the particular specified time as well as BFR maintained during the treatment.
This would then utilized to predict potential who are prone to developing clotted accesses and
the incidences of thrombosis. This would allow for early intervention such as decrease the
potential for poor treatments, angioplasty or missed treatments.
The technologies that can be used in the program are chairside program interfacing with
E-Cube or EHR. In every patient’s HER there is a TAC program that used to monitor the access
of each patient. Free text informational data such as BFR and blood pressure would be collected
then interpreted into trends by a computer program within E-Cube (Karp et al., 2019). It is
updated with clotting, surgeries, patient’s appointments and procedures etc. with that there
should be another program alongside that compares the correlation BFR along with incidents of
access clotting and compares the blood pressures. With this quantitative data analysis, this data
and information will look at correlation and relationships related to an outcome. (McGonigle et
al., 2018). Topredictive trends can be monitored by looking at correlation between decreased
BFR, blood pressures and clotting. It will allow it for early interventions.
Executive sponsor are the ones through which design team would be composed.
Executive sponsors can be unit manager and someone who has the ability to remove barriers and
authority to remove barriers. Another person who can be an executive sponsor is a team leader
inside the unit of dialysis. Expectedly they are the charge team leader and charge nurse because
they are the ones with intimate knowledge about the project and have time for that. They also
know about all the components related to project. This can also be someone who is good at
managing day to day task of the project and has the ability to effectively coordinate with the
technical expert and which would be a data specialist, they can also work along with the nurse
informatics and would be the clinical leader (Hussey et al., 2015). In the position of clinical
leaders nurse informatics fits as they can be in charge of planning the design of project based on
the data, purpose of project and source. They will take care of patient’s privacy and security and
integrate overall best practice. They can make such programs through which they can transfer
data from one system to another and easily maintain a workflow.
If we utilize the knowledge based on the nurse informaticist and applying knowledge in a
purposeful way then it would be possible that the quality of care will be improved for patients of
dialysis prone to thrombosis (Lee et al., 2017). Working as a team we can show how data
specialists and nursing informaticist are an important part as they use their specific skill sets and
it can be beneficial for overall quality of patient care.
Hussey, P., Adams, E., & Shaffer, F. A. (2015). Nursing informatics and leadership, an essential
competency for a global priority: eHealth. Nurse Leader, 13(5), 52-57.
Lee, T. Y., Sun, G. T., Kou, L. T., & Yeh, M. L. (2017). The use of information technology to
enhance patient safety and nursing efficiency. Technology and Health Care, 25(5), 917-
Karp, E. L., Freeman, R., Simpson, K. N., & Simpson, A. N. (2019). Changes in efficiency and
quality of nursing electronic health record documentation after implementation of an
admission patient history essential data set. CIN: Computers, Informatics, Nursing, 37(5),
Kossman, S. P., & Scheidenhelm, S. L. (2015). Nurses' perceptions of the impact of electronic
health records on work and patient outcomes. CIN: Computers, Informatics,
Nursing, 26(2), 69-77.
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
Needleman, J., & Hassmiller, S. (2015). The Role Of Nurses In Improving Hospital Quality And
Efficiency: Real-World Results: Nurses have key roles to play as hospitals continue their
quest for higher quality and better patient safety. Health Affairs, 28(Suppl3), w625-w633.