Transcript Ward control alignment for Patient`s Anemia: Planning, constructing

Ronice Wagner1 Igor Semhaev1
Department of Nephrology and Hypertension, Rabin Medical
Center, Beilinson Hospital, Israel 1
1
Erythropoietin is a glycoprotein hormone that
controls and regulates red blood cell production. It
is produced and secreted in the kidney. Chronic
renal failure is associated with various degrees of
anemia due to erythropoietin deficiency resulting
from multiple factors
2





Decreased erythropoietin production as a result of kidney
damage.
Decreased RBC lifespan secondary to uremia.
Reduced bone marrow response to circulating
erythropoietin.
Ongoing blood losses from dialyzer and tubing, blood
sampling, gastrointestinal blood loss, and blood losses at
the time of dialysis needle placement and removal.
Depletion of iron stores precedes impaired production of
iron-containing proteins, the most prominent of which is
hemoglobin
3
Till the end of 2009 our patients received monthly prescriptions for
medications and were required to purchase them personally.

The reasons that this procedure was never smooth
and effective were :

Physician’s decisions were based on narrow scope of data.

Delays in delivering reports to the physicians.

Patients were unreliable in purchasing and delivering medications on-time.
4
In order to reduce the burden and relieve the
patients from this tedious procedure we decided
to make the ward responsible for the monthly
drug supply.
5
On December 2009 a new role was established :
Anemia Coordinator
6
Anemia
IV Fe
EPO
‫נוכחי‬
100mgx2m
100mgx2m
‫לא מקבל‬
100mgx2m
100mgx2m
100mgx1w
100mgx2m
‫נוכחי‬
rec6000ux1w
mir100mqgx2m
‫לא מקבל‬
‫הפסקה זמנית‬
ara20mqgx1m
epr6000ux3w
rec10000ux1w
‫לא מקבל‬
rec10000ux2w
rec10000ux2w
‫העמסת ברזל‬
100mgx2m
100mgx2m
100mgx2m
‫הפסקה זמנית‬
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
2011
Hb
Ferritin% Sat. Transferin
Iron
1247.8
0.5376
125
96
654
0.2705
132
51
0.2949
178
75
249.6
0.3322
255
121
813.9
0.3885
182
101
320.9
0.0993
134
19
1126.7
0.2278
169
55
0.4724
163
110
667.8
0.3352
142
68
ara40mqgx1m
517.4
0.1783
212
54
epr4000ux1w
ara100mqgx4m
epr5000ux1w
rec5000ux2m
6000ux1w
ara50mqgx2m
rec10000ux1w
rec5000ux3w
rec6000ux1w
721.9
0.3824
119
65
575.1
0.2972
212
90
850.2
0.3189
169
77
284.5
0.1581
186
42
423.4
0.194
184
51
0.1687
195
47
407.4
0.1917
168
46
339.6
210
210
60
1343.5
Diabetes
Sex
HbA1c m\f
10.5
8.8
11.6
14.2
10.9
11.9
9.1
13.5
6.9
9
8.8
10.9
11.8
12.1
12.8
10.4
11.9
10
9.8
10.8
m
10.1
f
m
6.4
6.2
m
m
m
4.5
5.3
9.1
m
m
f
f
m
f
8.6
f
m
m
f
m
m
m
m
Year
Patient's
Month
Patient's name
of birth Identity no'
1935
1939
1950
1962
1953
1924
1933
1955
1951
1942
1947
1961
1977
1925
1960
1969
1949
1963
1935
1927
7
Doctor's Name
2011
Anemia
Month
IV Fe
New
EPO
New
Date of
change
IV Fe
Present
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
100mgx2m
EPO
Present
Ferritn % Sat. TransferinIron Hb
ara40mqgx2m
ara100mqgx4m
epr5000ux1w
ara50mqgx2m
ara50mqgx1w
rec4000ux2w
mir120mqgx1m
ara30mqgx1m
‫מחקר‬
ara40mqgx2m
rec4000ux3w
ara100mqgx1w
ara30mqgx3m
‫לא מקבל‬
ara100mqgx1w
Identity card
Patient's
no'
Name
mir200mqgx2m
8
9
Create a registration form which checks indicates and updates
the expiring dates of drug supply confirmation, given by the
Central Pharmacy:
December
November
October
September
August
July
June
May
April
March
February
January
District,
Identity
card
Name
7.5.11
6.8.11
28.2.11
8.9.11
16.12.10
6.8.11
29.4.11
2011 Ronice
10
1. Fill in the new Laboratory Results in the Monthly
table , Personal physicians’ table and Ward
Medication Supply List .
2. Give every physician his personal patients list. Get
new medical orders and add them to the patient's
files.
3.Send the corrected Ward Medication Monthly Supply
List to the Central Pharmacy
4.Upon medical supply arrivel, store it according to the
hospital and medical regulations.
5. Give proper instructions and guidance to the ward
team.
11
Since appointing an Anemia
Coordinator we have observed –
1.Improved stability in ward Hemoglobin.
12
% Saturation
Mean Saturation levels during activity period of Anemia
Coordinator.(n=100 - 110)
29
27
25
23
21
19
17
15
Mar-10 Apr-10 May-10 Jun-10
Jul-10
Aug-10 Sep-10
Oct-10 Nov-10 Dec-10
Jan-11
Feb-11 Mar-11
13
No. of P.C
350
300
250
200
No. of P.C
150
100
50
0
2011
2010
2009
2nd' year
1st' year
Previous
14
Observing the positive results of the
new method we recommend other
units to implement this
management concept
in order to improve
Anemia Alignment.
15
‫לכל המעוניינ‪/‬ת בטבלאות המצורפות‬
‫מוזמנ‪/‬ת לפנות במייל‪:‬‬
‫‪[email protected]‬‬
‫‪[email protected]‬‬
‫‪16‬‬