IDWG Management: 12-Week Hemodialysis Education Program

Introduction and Project Objectives

Intradialytic weight gain (IDWG) has become a major problem for patients with End Stage Renal Disease (ESRD) who are dependent on hemodialysis. This issue has resulted in increased complications and hospitalizations among ESRD patients, underscoring the need for effective IDWG management programs driven by nursing staff.

This project proposes an intervention geared toward improving IDWG management for these patients by 10% through a 12-week educational program. The paper demonstrates how the project was implemented in a 19-chair dialysis clinic that operates 6 days per week in order to accommodate 150 hemodialysis patients. The discussion includes a description of the proposed change, the rationale for selecting it, implementation methods, and expected results. Evaluation of baseline data collected from patients during implementation and conclusions based on the collected data are also provided.

The objective of this CNL Internship Project is to coordinate a plan of care that focuses on enhancing intradialytic knowledge and outcomes for hemodialysis patients admitted to the clinic. Specifically, the project seeks to improve IDWG management in patients dependent on hemodialysis by 10% through a 12-week educational program. This project aims to improve intradialytic knowledge and outcomes through patient education regarding target weight and a better understanding of the impact of lifestyle behaviors on health and overall well-being.

Patient Population and Clinical Setting

The actual population for this project consists of patients suffering from End Stage Renal Disease (ESRD) aged between 22 and 96 years. This condition represents the stage at which the kidneys can no longer function effectively and require dialysis or transplantation in order to sustain life. Because this type of kidney failure is permanent and cannot be reversed, patients depend on dialysis or transplant for the kidney to function adequately.

The setting for the project is a 19-chair dialysis clinic that operates 6 days per week in order to accommodate 150 hemodialysis patients. This clinic is situated near a major metropolitan memorial medical center.

Implementation Methods and Change Theory

The implementation of the project involved the application of Kotter's Eight-Step Model, a change management theory that was selected for its effective applicability to the proposed educational project (Mento, Jones, & Dirndorfer, 2002). The project management team developed the project plan, tested a random sample of patients, developed educational materials, and conducted staff training on using those materials. Educational questionnaires were then administered to patients, and facility-wide education of the patient census commenced.

This was followed by patient evaluations regarding their experience with the project, administration of post-education questionnaires, assessment of the project's success, and necessary adjustments based on patient needs and survey results. Patient re-education was also carried out to reinforce the educational materials, and follow-up of patient knowledge on IDWG was conducted with both staff and patients.

The baseline data for conducting this educational project indicated a 49.6% overall intradialytic weight gain (based on 150 patients' data) at the clinic prior to patient education. This baseline figure demonstrated the need for the project, as nearly half of the 150 hemodialysis patients admitted at the clinic had experienced increased hospitalizations and complications. Developing an effective project to reduce these hospitalizations and complications was therefore essential.

Evaluation of Outcomes and Survey Results

Prior to the implementation of this educational project, the clinic's overall intradialytic weight gain stood at 49.6% (based on 150 patients' data). The education project focused on enhancing IDWG knowledge, fluid management, and target weight awareness, with the goal of producing a significant decrease in intradialytic weight gain — which is associated with increased complications.

Based on the data collected, the overall intradialytic weight gain at the facility decreased significantly by Week 10, falling from 49.6% to 36.2%. However, the initial weeks of implementation were characterized by minimal decreases of less than 1%. This minimal early decrease is attributed to the fact that Weeks 2 and 3 were devoted to administering testing, surveying, and education rather than measuring behavioral change. The weekly progression was as follows:

Pre-education: 49.6% — Week 3: 48.2% — Week 4: 47.6% — Week 5: 45.2% — Week 6: 39.8% — Week 7: 36.5% — Week 8: 40.2% — Week 9: 36.6% — Week 10: 36.2%

Through the project, patients demonstrated increased understanding of normal or target weight, fluid storage in the body, steps to take if target weight is not within the normal range, symptoms of poor fluid control, and ways to enhance control of fluid and sodium levels. However, there was little change in patients' understanding of why fluid management is a problem when suffering from ESRD, and in their recognition of the need for measures beyond dialysis treatment alone to control fluid and sodium levels.

The data exceeded initial projections. Within the first 10 weeks, the project resulted in a 13.4% decrease in intradialytic weight gain — surpassing the projected 10% goal set for Week 12. Based on this data, an educational project is effective in lessening IDWG for hemodialysis-dependent patients (Barnett et al., 2008, p. 300; Lingerfelt & Thornton, 2011, p. 483). In addition, it is important to continue educating patients regarding the limitations of dialysis treatment alone in controlling fluid and sodium levels, and to reinforce patients' active role in their own self-management.

The patient survey data, collected from 150 patients across 4 shifts and 20 chairs, further illustrated specific areas of knowledge gain and remaining gaps. Selected pre- and post-education survey results are summarized below:

Question 1 — What is your normal or target weight?
Pre: 127 correct (85.2%) | Post: 143 correct (96.0%)

Question 2 — How does your body obtain fluids and sodium?
Pre: 142 correct (95.9%) | Post: 142 correct (95.9%)

Question 3 — Where is most fluid stored in the body?
Pre: 79 correct (56.0%) | Post: 101 correct (71.6%)

Question 4 — If your target weight is not in the normal range, what is the first thing you should do?
Pre: 66 correct (52.0%) | Post: 72 correct (56.7%)

Question 5 — What are the symptoms of poor fluid control?
Pre: 12 correct (8.2%) | Post: 17 correct (11.4%)

Question 6 — Why is fluid management a problem when your kidneys are not working well?
Pre: 115 correct (85.8%) | Post: 117 correct (87.3%)

Question 7 — Dialysis treatments alone can control your fluid and sodium levels.
Pre: 131 correct (89.1%) | Post: 132 correct (89.8%)

Question 8 — What are ways that can help you control your fluid and sodium levels?
Pre: 44 correct (30.1%) | Post: 59 correct (39.9%)

These results confirm that knowledge gains were most pronounced for questions related to target weight identification and fluid storage, while awareness of self-management strategies beyond dialysis showed the smallest improvement — indicating priority areas for continued patient education.

References

Barnett, T., Li, Y. T., Pinikahana, J., & Si-Yen, T. (2008, February). Fluid compliance among patients having haemodialysis: Can an educational programme make a difference? Journal of Advanced Nursing, 61(3), 300–306.

Lingerfelt, K., & Thornton, K. (2011). An educational project for patients on hemodialysis to promote self-management behaviors of end stage renal disease. Nephrology Nursing Journal, 38(6), 483–489.

Mento, A., Jones, R., & Dirndorfer, W. (2002). A change management process: Grounded in both theory and practice. Journal of Change Management, 3(1), 45–70. Retrieved from EBSCO Host, AN 7329277.