1. IV C.E.R.A. (Continuous Erythropoietin Receptor Activator) Maintains Stable Hgb Levels After Converting Directly from IV Darbepoetin Alfa in Patients witb CKD on
Dialysis
Sergy Nildtin, University ot Aiberta Hospital, Edmonton, Aiberta, Canada; Susan Fieet, Queen Eiizabeth it Heaith Science Center, Haiitax, Nova Scotia, Canada; Aian
McMahon, University ot Aiberta Hospitai, Edmonton, Aiberta, Canada; Steven Soroi<a, Queen Elizabeth it Health Science Center, Haiitax, Nova Scotia, Canada
Purpose: C.E.R.A., an innovative erythropoietic agent with a iong haif-iife, is in deveiopmenf to provide correction of anemia and maintenance of stable Hgb ieveis at
extended administration intervals in patients with CKD. Conversion to C.E.R.A. directiy from other erythropoietic agents needs to maintain stable iHgb Ieveis in order to
minimize the impact on nursing time required for monitoring and dose adjustment. This study assessed the efficacy of iV C.E.R.A., administered 1x/2wi<, in maintaining
stabie Hgb levels in patients converted from IV darbepoetin aifa given Ix/wk or 1x/2wi<.
Sample: Oiaiysis patients aged =18 years with stable baseiine Hb concentration (10.5-13.0 g/dL), adequate iron status, and receiving continuous, stabie IV darbepoetin
aifa therapy Ix/wk or 1x/2wi<.
Metbods: Patients were randomized to receive iV C.E.R.A. 1x/2wk (n=157) or to continue on-going dose of iV darbepoetin alfa (n=156) for 52 weeks (28-wk titration, 8-
wkevaiuation, 16-wk foliow-up). Dose adjustments were made no more frequentiy than 1x/4wkto maintain Hgb ieveis within I.Og/dLof baseline vaiues and within 10.0-
13.5 g/dL
Results: No significant differences in mean Hgb ieveis were observed between treatment groups at baseiine and during evaiuation and follow-up (see Tabie 1). Anaiysis
of intra-patient variabiiity confirmed that the degree of Hgb control was comparable in each group (see Tabie 1).
iV darbepoetin alfa 1x/wk or 1x/2wk IV C.E.R.A. 1x/2wk
Hgb level (g/dL; mean ± SD):
Baseline 11.93 ±0.66 12.01 ±0,68
Evaiuation period 11.69±1.16 12,01 ±1,19
Foiiow-up 11.70 ±0.99 11,67±1,16
Intra-patient variability (mean of tbe Hgb SDs ± SD):
Evaiuation period 0.53 ± 0.33 0,63 ± 0,43
Eoiiow-up 0,66 ± 0,39 0,71 ± 0,49
Conclusions/Nursing implications: Administration of iV C,E,R,A, twice monthly maintains stable and sustained Hgb ieveis in patients converted directly from darbepo-
etin aifa 1x/wk or 1x/2wk, Patients may therefore be switched to C,E,R,A, with no short-term or iong-term impact on Hgb controi.
Cross Training: A Path to the Development of a Comprehensive A Time and Motion Study of Anemia Management in Hemodialysis
Nephrology Nurse Patients
Jacqueline E. O'Donneil, BSN, RN, CNN, CNP, The Chiidren's Hospitai ot Jeanne Rogers, RN, CNN, Satellite Healthcare, inc.. Mountain View, CA;
Philadelphia, Philadelphia, PA Sheiia Doss, RN, CNN, CCRA, Sateilite Healthcare, Inc.; Brigitte Schiller,
MD, Satellite Heaithcare, Inc.,; Erwin De Cock, MSc, United BioSource
The nursing shortage has affected ail ciinicai areas nationwide. Specialty Corporation, Barceiona, Spain; Michaei del Agüita, PhD, Roche
nursing areas such as pédiatrie diaiysis have been more susceptible to Laboratories, inc., Nutley NJ; Allen R. Nissenson, MD, FACP, David Geften
staffing shortages due to the smaii pooi of nurses from which they can Schooi ot Medicine, UCLA, Los Angeies, CA
recruit, A teann of leadership nurses developed a creative staffing solution
with a dual purpose at one pédiatrie hospital to solve their staffing probiem Treating anemia in hemodiaiysis patients with in-center administration of epo-
and to develop expert nephroiogy nurses in inpatient care, outpatient dial- etin aifa (EPO) can be labor-intensive. This muiticenter observationai activity-
ysis care, and acute hemodiaiysis, in order to fuifiil the staffing needs in based costing anaiysis evaiuated the time and costs of administering EPO thrice
their diaiysis unit, they decided to provide a cross training opportunity for weekiy. It aiso modeled the potential time and cost savings with continuous ery-
inpatient nephrology nurses to the diaiysis unit. The program provided thropoietin receptor activator (C,E,R,A,), a novei agent administered at once-
supplemental staffing to the dialysis unit by training a pooi of nurses to be monthiy intervais. At each of five hemodiaiysis centers, heaithcare personnel
assigned to the dialysis unit during periods of high patient census and/or were interviewed, and a research nurse conducted time and motion observa-
tions to determine minutes and seconds spent on pre-defined anemia manage-
high patient acuity. The inpatient nurses became expert pédiatrie nephrol-
nient tasks, inciuding EPO preparation, administration, and record-keeping for
ogy nurses in all areas of nephrology patient care and served as an invaiu-
individuai patients. Use of supplies (excluding EPO) was recorded. Labor costs
abie resource to nurses, physicians, patients, and famiiies throughout the were computed from time using wage and benefit rates. Costs are reported in
hospitai. Through this unique eross training experience a partnership was year 2006 doiiars. Average time and costs were caicuiated per patient per EPO
forged between the inpatient nephroiogy nurses and dialysis nurses that session, per year, and for all patients per year at each ceriter Up to 30 observa-
resulted in positive nursing and patient outcomes. tions were collected at each center where patients received an average of 13
EPO sessions per month. Average time for observed tasks was 2,35 min/pt per
EPO session (95% Ci: 2,04 to 2,67 min). This represents an average of 364 min
spent on each patient per year When annuaiized for aii the patients treated at
each of the dialysis centers (n = 47 to 143), the totai time spent ranged from
309 to 822 hours per year, or 539 hours for an average 89 patients (95% Ci:
467 to 612 hours), Totai annuai cost ranged from $17,279 to $47,366 and cost
for an average 89 patients was $35,116 (95% CI: $32,655 to $37,687). Once-
monthiy C,E,R,A, modeied at 100% uptake would result in a greater than 10-foid
reduction in time and a simiiar drop in corresponding costs associated with ane-
mia treatment management. Time savings are the major contributor to total cost
savings. The second component of total cost, non-drug supply costs, are aiso
reduced greater than 10-fold with C,E,R,A, Once-monthiy C,E,R,A, can reduce
the time burden of anemia management for nurses, making time avaiiabie for
other important aspects of patient care.
NERHROLOGYNURSING JOURNALD March-April2007a VoL 34, No. 2 145

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