Authors (including presenting author) :
Wong WM (1), Hui YH (2), Chan WH(1), Wong SHS(1), Chung SKQ(1)
Affiliation :
(1) Department of Medicine & Geriatrics, United Christian Hospital (2) Nursing Services Division, United Christian Hospital
Introduction :
Dialysis-induced hypotension (DIH) is a major complication of haemodialysis (HD) and it is a serious clinical problem which happened in 15-30 or even 50% of dialysis sessions. Most importantly, DIH may leads to fall causing poor patient’s outcome and quality of life. It also increases mortality in the dialyzed population. Prevention of DIH is vital to enhance our patients’ safety to reduce their mortality.
Objectives :
1)To provide quality and appropriate nursing management to ensure patient safety after HD. 2)To arouse nurses’ awareness to DIH
Methodology :
A new guideline was set up for the care of post HD patients which included: (1) Nursing assessment after HD; (2) Patient education; (3) Care on post HD patients’ discharge. Total 70 HD patients were reviewed from June 2018 to September 2018. All of them needed to measure BP post HD according to old guideline with addition of standing BP measurement before ambulation. It aimed at prevention of fall and assessment for any discomfort. Thus, the significant postural hypotension and symptoms could be observed and fall could be prevented timely. Nurses focused on the post HD patient education to patients and significant others about the continuity of care at home. A questionnaire was also conducted to assess the perception of nurses after the study period.
Result & Outcome :
It was reported that 56.9% of patients (standing BP) have Systolic BP (SBP) dropped >20mmHg after HD. Most of them (96.9%) with SBP dropped >20mmHg post HD were asymptomatic. Only 3.1% of patients were found to have hypotension with symptoms and needed further assessment and treatment. Most of the nurses (95.5%) recognized the new guideline could prevent patients’ fall post HD. They also agreed the new HD record could facilitate them to monitor patients’ BP and condition (81.8%). There was no fall incident recorded during the study period. Nurses have the primary responsibility to prevent, detect, and provide emergency interventions for DIH. Therefore, the proactive nursing management to measure standing BP of post HD patients before ambulation helps nurses more easily to identify patients with DIH or symptoms. This approach may be effective to prevent post HD fall to enhance patients’ quality of life.
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