OBJECTIVE:To evaluate the outcomes of and barriers to implementing standard guidelines (Caring for Australasians with renal impairment [CARI]), using iron management in patients having dialysis as an example. DESIGN AND SETTING:On-site review of iron management processes at six Australian dialysis units varying in size and locality. Patients' iron indices and haemoglobin levels were obtained from the Australian and New Zealand Dialysis and Transplant Registry. PARTICIPANTS:Patients with chronic kidney disease who were dependent on dialysis. MAIN OUTCOME MEASURES:Processes for assessing indices of iron stores and iron supplementation; comparison with target indices in the CARI guidelines. RESULTS:There was considerable variability among the units in achievement of haemoglobin and iron targets, with 25%-32% of patients achieving haemoglobin targets of 110-120 g/L, 30%-68% achieving ferritin targets of 300-800 microg/L, and 65%-73% achieving transferrin saturation targets of 20%-50%. Implementation barriers included lack of knowledge, lack of awareness of or trust in the CARI guideline, inability to implement the guideline, and inability to agree on a uniform unit protocol. Factors associated with achieving the CARI guideline targets included nurse-driven iron management protocols, use of an iron management decision aid, fewer nephrologists per dialysis unit, and a "proactive" (actively keeping iron levels within target range) rather than "reactive" (only reacting if iron levels are out of the range) protocol. CONCLUSIONS:Variability in achievement of iron targets, despite the availability of a clinical practice guideline, may be explained by variability in processes of care for achieving and maintaining adequate iron parameters.

译文

目的:以透析患者的铁管理为例,评估标准指南(护理患有肾功能不全的澳大利亚人[CARI])的结果和障碍。
设计与设置:对六个澳大利亚透析单位的铁管理流程进行现场审查,这些单位的大小和位置各不相同。患者的铁指数和血红蛋白水平从澳大利亚和新西兰透析与移植注册处获得。
对象:依赖于透析的慢性肾脏病患者。
主要观察指标:储铁量和补铁指标评估过程;与CARI指南中的目标指标进行比较。
结果:各单位在实现血红蛋白和铁目标方面存在很大差异,其中25%-32%的患者达到110-120 g / L的血红蛋白目标,30%-68%的患者达到300-800 microg /的铁蛋白目标L和65%-73%达到20%-50%的转铁蛋白饱和度目标。实施障碍包括缺乏知识,缺乏对CARI准则的认识或信任,无法实施该准则以及无法就统一的单位协议达成共识。与实现CARI指导方针目标相关的因素包括护士驱动的铁管理方案,铁管理决策辅助工具的使用,每个透析部门的肾脏病医生较少以及“主动”(将铁水平保持在目标范围内)而非“反应性”(仅在铁含量超出范围时反应)。
结论:尽管有临床实践指南,实现铁靶的可变性仍可以通过达到和维持适当铁参数的护理过程中的可变性来解释。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录