Developing a Novel Dialysis Educational Resource for Nephrology Fellows: The Vital Signs of Dialysis

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Developing a Novel Dialysis Educational Resource
for Nephrology Fellows The Vital Signs of
Dialysis

• Karla N. Vital, MD
• Assistant Professor, Department of Internal
  Medicine
• Associate Director, Nephrology Fellowship Program
• University of Texas Medical Branch, Galveston

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Background

• Dialysis renal replacement therapy used when
  kidney function is lost
• Comprised of several different modalities
• Subject of dialysis not typically emphasized
  during medical school or residency
• Nephrology Fellows asked for pocket-sized
  references to help guide them in the area of
  dialysis

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Nephrology Fellowship Program

• Two-year fellowship after completion of Internal
  Medicine residency program
• Five fellows at a time, alternating between two
  and three new fellows annually
• Trainees with diverse background - from
  institutions throughout the country and overseas
• Beginning Fellows often experience apprehension

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Web-based resources

• Numerous web-based resources exist for healthcare
  professionals specialized in kidney disease
• Organizations provide online tools for
• frequently used calculations
• patient education
• links to current practice guidelines
• Overwhelming to determine appropriate resources
  for patients and physicians

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Vital Signs of Dialysis

• Educational resource that covers the basics of
  dialysis
• Extremely portable
• Details the various dialysis modalities
• Discusses issues unique to patients with kidney
  failure
• Highlights recommended web-based resources for
  further review

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Research Questions

• Does this resource make learning about dialysis
  easier?
• Does the utility of this tool differ depending on
  the users stage of training?
• Is the portability of this resource a feature
  that distinguishes it from other pre-existing
  tools?
• Does this resource improve the fellows self-
  reported level of confidence?

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Table of Contents

• 1) Indications for Dialysis
• 2) Vascular Access for Dialysis
• 3) Hemodialysis
• 4) Peritoneal Dialysis
• 5) Home Hemodialysis
• 6) Slow Dialysis Modalities / CVVHD
• 7) Sample Dialysis Prescriptions

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Table of Contents

• 8) Dialysis Complications (Acute/Chronic)
• 9) Nutrition Other Special Considerations
• 10) Frequently Used Calculations
• 11) Web Resources for Physicians
• 12) Patient Education Resources

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(2) Vascular Access

• Arteriovenous Fistula is the preferred access
• Fistula First campaign
• Surgical connection between an artery and a vein
• Lowest complication rate
• 6-12 week maturation time

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(2) Vascular Access

• AV graft (synthetic)
• Ready for use in 2-3 weeks
• Useful if veins prohibit AV fistula development
• More infections than AV fistulas, but less than
  permanent catheters
• Tend to clot more often than AV fistulas

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(2) Vascular Access

• Tunneled Dialysis Catheter into tip of Right
  Atrium (Permcath)
• Used as temporary Access or if permanent access
  is not an option
• Highest Rates of Infection, and Vessel Stenosis

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(10) Frequently Used Calculations

• URR (1 post dialysis BUN /predialysis BUN)
• Free H20 Deficit TBW x sNa/1401
• GFR/Cockcroft-Gault (140-age) x wgt in kg/Scr
  in mg/dl x 72 x .85 in women
• Change in sNa infusate Na Infusate K
  serum Na/ TBW 1
• FeNa 100 x (Una/Ucr)/ (Pna/ Pcr)

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(11) Physician Resources

• Downloadable GFR Calculators at
  www.nkdep.nih.gov/professionals/gfrcalculators
• Patient brochures and fact sheets
• Usually free up to 50 copies (Spanish available)
• KDOQI guidelines (dialysis access/adequacy,
  management of chronic diseases that commonly
  affect dialysis patients) http//www.kidney.org/p
  rofessionals/kdoqi/index

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(12) Patient Education Resources

• Information free resources on kidney disease
  dialysis
• http//www.aakp.org/ (American Association of
  Kidney Patients)
• http//www.akfinc.org/ (American Kidney
  Foundation)
• http//www.kidney.org/ (National Kidney
  Foundation)
• http//catalog.niddk.nih.gov/ (NIDDK
  Clearinghouses Publications Catalog) (Kidney and
  Urologic Diseases Materials)

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Methodology

• A confidence assessment questionnaire
• assess user-rated improvements upon completion of
  materials
• agreement or disagreement to 12 questions
• 5-pt Likert-scale (pychometric response scale)

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Sample Questionnaire

• Overall, this resource was useful to my learning
• This resource was a useful overview to
  understanding dialysis
• This resource would have been more helpful if
  provided earlier during my training
• I have used this resource while performing my
  clinical duties
• I feel more confident after completing this
  pamphlet
• This resource was overly simplified

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Sample Questionnaire

• This resource was too comprehensive
• This resource was more useful than other existing
  handbooks of dialysis
• This resource would be more useful in PDA format
• I would use this resource outside of the UTMB
  setting
• I would recommend this resource to new fellows
  entering the program
• I would recommend this resource to residents
  interested in Nephrology

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Evaluation

• The confidence assessment questionnaire will be
  administered annually, at the completion of the
  first and second year of fellowship
• Survey Forms will be provided biannually,
• to assist with content revision based upon the
  fellows feedback

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Considerations

• Small sample size
• Variation of knowledge base between 1st- and
  2nd-year fellows
• Does this educational resource transfer to
  various system-based practices?
• Is the data easily viewed in print as well as PDA
  format ?

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Suggestions to Date

• Nephrology Phone Number and Pager List
• Kidney Biopsy Assembly List
• Procedural Log
• Commonly Used Nephrology ICD-9 Codes
• Outpatient Dialysis Unit Considerations

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Conclusions

• Preliminary data will be available when the
  graduating fellows complete their clinical duties
  in June 2007
• Data from the first year fellows will be
  available in July 2007 when they transition into
  their second year of fellowship training

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The Evolution