Use of an RN-Initiated Protocol for Recognition, Management, and Documentation of Intradialytic Hypotension in Patients with End Stage Kidney Disease on In-Center Hemodialysis: A Quality Improvement Project

Although intradialytic hypotension (IDH) is the most fre-quent complication of hemodialysis (HD), there is currently no standardized definition or uniform practice recommen-dations for response. A quality improvement project includ-ed nine registered nurses (RNs) and 96 adult patients receiving HD at a 30-station Midwest urban dialysis clinic. The project focused on development of an evidence-based RN-initiated protocol, RN education, and implementation of the RN-initiated protocol to recognize, treat, and document IDH. IDH was recognized in 7.02% of dialysis treatments, with protocol use doubling from Week 1 to Week 8. Most IDH episodes were resolved after one (36%) or two (49.33%) 10-minute ultrafiltration (UF) pauses with interventions. The use of an RN-initiated IDH protocol standardized care and led to positive patient outcomes in this dialysis clinic.