From Good to Best: An Education Strategy to Match an Acuity-Adaptable Care Delivery of Renal Transplant Patients

Thursday, 10 July 2008: 8:30 AM
Rizalina M. Bonuel, MSN, RN, CCRN, CNS, APRN-BC , Education Service Line, Michael E. DeBakey Veterans Affair Medical Center, Texas, TX
Alma Degracia, MBA, RN, CCRN , Multi-Organ Transplant Unit, The Methodist Hospital, Houston, TX
Samir Patel , Department of Pharmacy, The Methodist Hospital, Houston, TX
Cheryl Hood , Nurse Practitioner Program Department, The Methodist Hospital, Houston, TX

Learning Objective 1: 1. Describe a Kidney Transplant Nursing CORE Curriculum to match a novel care delivery in the management of renal transplant patients.

Learning Objective 2: 2. Discuss the evidence-based nursing outcomes of the educational strategy.

To improve our renal transplantation outcomes, our Multi-Organ Transplant unit embarked on a novel evidence-based care delivery called Acuity-Adaptable Care Delivery. Four Acuity-Adaptable patient rooms were developed within the 30-bed unit. Acuity-Adaptable Care delivery means keeping the patient in the same room from admission to discharge and the level of care is brought to the patient. When a potential kidney transplant patient is admitted to the unit, the patient returns to the same room post transplantation from Perioperative Anesthesia Care Unit (PACU). To prepare for changes in patient acuity, nursing staff competency will also be addressed to include hybrid nurses who possess critical-care and acute-care skills. An educational strategy was developed through transdisciplinary collaboration with Nursing Executive champion, Clinical Nurse Specialist, Transplant Clinical Pharmacist, Transplant Physician Assistant, Nursing Director and a Clinical Development Specialist. The one-week didactic core curriculum includes the following:

2006 Advance Cardiac Life Support certification guidelines.

12 LEAD ECG

Acute Renal Failure

Treatment Consideration of End-Stage Renal Disease

Ethical Consideration of Renal Transplantation

Hemodynamic Monitoring

Physiologic Roles of Fluid and Electrolytes

Arterial Blood Gas Interpretation

Glucose Control

Post-Operative Management of Renal transplant Patient

Transplant Pharmacology

Chronic Allograft Nephropathy

Complication of Renal Transplant and

Transplant Infectious Diseases.

After the one-week classroom instruction, a three month clinical rotation to different Intensive Care units was scheduled. A graduated program allowed the nurse to complete identified ICU competencies. Eleven seasoned transplant nurses completed the program and three months post educational program completion, staff eagerly tested their new learned skills to their renal transplant patients. After six months of operation, the acuity-adaptable care delivery has shown improvement in the length of stay and cost in renal transplantation outcomes.