A nurse prescriber‐led protocol for anaemia management in established haemodialysis patients: A retrospective study

Aim and objective To evaluate the impact of a nurse prescriber‐led protocol compared to a traditional physician‐led nonprotocol‐based approach had on maintaining targeted haemoglobin levels in patients on maintenance haemodialysis. Background Anaemia is a common complication of chronic kidney disease and has a profound impact on the patients’ well‐being. Current practices place a greater emphasis on the decision‐making role of nurses in renal anaemia management. The introduction of nurse prescribing in this area is a relatively new concept. Design A retrospective cohort design, covering an eight‐month period pre‐ and post introduction of a nurse prescriber‐led anaemia protocol; study adheres to the STROBE Statement. Methods Using a nonprobability convenience sample, data extracted from the medical records and electronic patient records system (eMed) related to 74 patients at a single outpatient haemodialysis centre located within an acute general teaching hospital. The primary outcome was patients’ haemoglobin level pre‐ and post introduction of the protocol. Secondary outcomes included erythropoietin‐stimulating agent and iron dosage, and serum ferritin and transferrin saturation levels. Results There were no statistically significant differences between pre‐ and post protocol serum haemoglobin level and erythropoietin‐stimulating agent dosage. Under the management of the nurse prescriber, patients experienced a significant improvement in serum ferritin and transferrin saturation levels and required significantly less intravenous iron dosage. Conclusions This study, the first of its kind, found that patients receiving haemodialysis experience a significant improvement in iron indices while receiving a significantly lower amount of intravenous iron when managed by a nurse prescriber. Furthermore, the nurse prescribers’ decision‐making capacity is as effective as a physician‐led nonprotocol‐based approach in achieving haemoglobin target levels. Relevance to clinical practice Nurse prescribers have a role in implementing a safe, standardised and sustained approach to anaemia management in outpatient haemodialysis settings without compromising patient care.