Effective Adherence Contest to Improve Albumin, Phosphorus, and Fluid Levels in Pediatric Hemodialysis Unit
Abstract:Low serum albumin, high serum phosphorus, and fluid overload are common issues in dialysis patients. This can be attributed to many causes such as inadequate understanding and lack of accountability in the patients' care. These abnormal levels contribute to increased medical complications and increased mortality. Objective:
(i) Improve patient education of albumin, phosphorus, and fluid maintenance. (ii) Improve patients' albumin, phosphorus, and fluid levels by 25 percent. Methods:
A baseline level was collected on all patients by averaging last 3 laboratory findings. All patients were educated recognizing several different learning styles. Educational posters were displayed, one-on-one education was provided, as well as educational games on the role of albumin, phosphorus, and fluid. Patients were also educated on the role of diet in these levels. Positive reinforcement, peer pressure, and intensive team approach were used through the 8-week incentive contest. Feedback on progress was provided in written and verbal format. Prizes were awarded for best shift levels and shift with most improvements. Results:
Levels measured at the end of the educational period and contest showed a 71% improvement in albumin levels, 52% improvement in phosphorus levels, and a 42% improvement in fluid levels. Conclusion:
Significant improvements found in all areas are attributed to three factors: education, consistent, individual, intensive attention, and incentives. Peer pressure was found not to be as effective but that individual tracking for incentives may be more effective if done ongoing. Our follow up several months later found a slight decrease in improvements, and we recognize a need for an ongoing intervention. Yet, we found an overall improvement of level of understanding and commitment to their overall health.
Document Type: Research Article
Publication date: January 1, 2004