title: Anaemia management protocols in the care of haemodialysis patients: examining patient outcomes.
abstract: OBJECTIVE
  To determine whether the use of a nurse-driven protocol in the haemodialysis setting is as safe and effective as traditional physician-driven approaches to anaemia management.
  
  
  BACKGROUND
  The role of haemodialysis nurses in renal anaemia management has evolved through the implementation of nurse-driven protocols, addressing the trend of exceeding haemoglobin targets and rising costs of erythropoietin-stimulating agents.
  
  
  METHODS
  Retrospective, non-equivalent case control group design.
  
  
  METHODS
  The sample was from three haemodialysis units in a control group (n = 64) and three haemodialysis units in a protocol group (n = 43). The protocol group used a nurse-driven renal anaemia management protocol, while the control group used a traditional physician-driven approach to renal anaemia management. All retrospective data were obtained from a provincial renal database. Data were analysed using chi-square tests and t-tests. Patient outcomes examined were haemoglobin levels, transferrin saturation levels, erythropoietin-stimulating agents use and intravenous iron use. Cost comparisons were determined using average use of erythropoietin-stimulating agents and intravenous iron.
  
  
  RESULTS
  Control and protocol groups reached haemoglobin target levels. In the protocol group, 75% reached transferrin saturation target levels in comparison with 25% of the control group. Use and costs for iron was higher in the control group, while use and costs for erythropoietin was higher in the protocol group. The higher usage of erythropoietin-stimulating agents was potentially related to comorbid conditions amongst the protocol group.
  
  
  CONCLUSIONS
  A nurse-driven protocol approach to renal anaemia management was as effective as the physician-driven approach in reaching haemoglobin and transferrin saturation levels. Further examination of the use and dosing of erythropoietin-stimulating agents and intravenous iron, their impact on haemoglobin levels related to patient comorbidities and subsequent cost effectiveness of protocols is required.
  
  
  CONCLUSIONS
  Using a nurse-driven protocol in practice supports the independent nursing role while contributing to safe patient outcomes.
authors: Northern Renal Program, Prince George, BC, Canada. sushila@shaw.ca
authors: Sushila
authors: S
authors: Saunders
authors: Martha L P
authors: ML
authors: MacLeod
authors: Vince
authors: V
authors: Salyers
authors: Peter D
authors: PD
authors: MacMillan
authors: Malcolm R
authors: MR
authors: Ogborn
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000451:nursing / Q000628:therapy*; D016022:Case-Control Studies; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa
keywords: erythropoietin-stimulating agents; haemodialysis; haemoglobin; iron; nurse-driven protocols; renal anaemia