Implementation of a Standardized Guideline Improves Nurses’ Practice in Management
and Prevention of Intradialytic Hypotension in Renal Dialysis Centre

By Mak Yuen Man, Karen, RN, BSc, MSc, FHKAN

Purpose

The aim of this project is to implement a standardized guideline for the nursing management and prevention of Intradialytic Hypotension (IDH) and to gauge its impact on nursing knowledge of IDH and the incidence of IDH in the Renal Dialysis Centre.

Background

IDH is one of the most common complications during hemodialysis. Without a standardized guideline, management of IDH depends on the nurses’ own experience and is made according to the nephrologist’s plan of care. Implementation of a standardized guideline may allow for early detection and management of IDH, which would minimize this potential complication during hemodialysis.

Methods

Two surveys were conducted before and after the intervention was implemented. A pre-implementation survey focused on nurses’ knowledge and practice regarding IDH. The post-implementation survey primarily addressed patient outcome, nurses’ knowledge, practice improvement, and satisfaction/acceptance after guideline implementation.

Results

Baseline data was collected from 276 treatments delivered prior to standardized guideline implementation. After guideline implementation, 261 treatments were delivered during data collection. After the guideline was implemented, the IDH occurrence rate decreased from 13.8% to 7.7%, and the percentage of patients requiring early termination of treatment was reduced from 29% to 20%. All participating nurses agreed that they have confidence in providing suitable strategies to manage and prevent IDH after the intervention was applied.

Discussion

Nurses’ knowledge and practice patterns can be aligned to those recommended in the literature. The intervention can reduce IDH occurrence frequency and improve patient outcomes. However, the short project period may limit the generalization of findings. Hence, a periodic review process is recommended.

Implications/Conclusion

Nurses’ perceptions were positive; many nurses agreed that the guideline provided a framework for management and effective prevention of IDH. Participants noted that they could implement the guideline with their routine work without additional skills necessary. This had a positive impact on the confidence of nurses in managing IDH, especially for those nurses with less
experience.