Ronice Wagner1 Igor Semhaev1

Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Israel 1

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Erythropoietin is a glycoprotein hormone that controls and regulates red blood cell production. It is produced and secreted in the kidney. Chronic renal failure is associated with various degrees of anemia due to erythropoietin deficiency resulting from multiple factors

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Decreased erythropoietin production as a result of kidney damage.

Decreased RBC lifespan secondary to uremia. Reduced bone marrow response to circulating

erythropoietin. Ongoing blood losses from dialyzer and tubing, blood

sampling, gastrointestinal blood loss, and blood losses at the time of dialysis needle placement and removal.

Depletion of iron stores precedes impaired production of iron-containing proteins, the most prominent of which is hemoglobin

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Till the end of 2009 our patients received monthly prescriptions for medications and were required to purchase them personally .

The reasons that this procedure was never smooth and effective were :

Physician’s decisions were based on narrow scope of data.

Delays in delivering reports to the physicians.

Patients were unreliable in purchasing and delivering medications on-time.

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In order to reduce the burden and relieve the patients from this tedious procedure we decided to make the ward responsible for the monthly drug supply.

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On December 2009 a new role was established:

Anemia Coordinator

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2011AnemiaMonthPatient's namePatient'sYearSexDiabetesHbEPOIV Fe

Identity no'of birthm\fHbA1cIronTransferin% Sat.Ferritinנוכחינוכחי1935m10.5961250.53761247.8rec6000ux1wהפסקה זמנית1939f10.18.8511320.2705654mir100mqgx2m100mgx2m1950m11.6751780.2949לא מקבל1962m6.414.21212550.3322249.6100הפסקה זמניתmgx2m1953m6.210.91011820.3885813.9ara20mqgx1m100mgx2m1924m11.9191340.0993320.9epr6000ux3wלא מקבל1933m4.59.1551690.22781126.7rec10000ux1w100mgx2m1955m5.313.5100לא מקבלmgx2m1951f9.16.91101630.4724rec10000ux2w100mgx1w1942f9681420.3352667.8rec10000ux2w100mgx2m

1947m8.8542120.1783517.4ara40mqgx1mהעמסת ברזל1961f10.9651190.3824721.9epr4000ux1w100mgx2m1977f8.611.8902120.2972575.1ara100mqgx4m100mgx2m1925m12.1771690.3189850.2epr5000ux1w100mgx2m1960m12.8421860.1581284.5rec5000ux2m1969f10.4511840.194423.46000ux1w100mgx2m1949m11.9471950.1687ara50mqgx2m100mgx2m1963m10461680.1917407.4rec10000ux1w100mgx2m1935m9.860210210339.6rec5000ux3w100mgx2m1927m10.81343.5rec6000ux1w100mgx2m

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Anemia2011 Doctor's Name

MonthPatient'sIdentity cardEPOIV FeDate ofEPOIV FeNameno'HbIronTransferin% Sat.FerritnPresentPresentchangeNewNew

ara40mqgx2m100mgx2mara100mqgx4m100mgx2mepr5000ux1w100mgx2mara50mqgx2m100mgx2mara50mqgx1w100mgx2mrec4000ux2w100mgx2m

mir120mqgx1m100mgx2m

ara30mqgx1m100mgx2m100mgx2mמחקרara40mqgx2m100mgx2mrec4000ux3w100mgx2mara100mqgx1w100mgx2m

ara30mqgx3m100mgx2m100mgx2mלא מקבל

ara100mqgx1w mir200mqgx2m

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Ronice 2011 10

Create a registration form which checks indicates and updates the expiring dates of drug supply confirmation, given by the

Central Pharmacy:

1 .Fill in the new Laboratory Results in the Monthly table , Personal physicians’ table and Ward Medication Supply List.

2 .Give every physician his personal patients list. Get new medical orders and add them to the patient's files.

3.Send the corrected Ward Medication Monthly Supply List to the Central Pharmacy

4.Upon medical supply arrivel, store it according to the hospital and medical regulations.

5 .Give proper instructions and guidance to the ward team.

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Since appointing an Anemia Coordinator we have observed –

1.Improved stability in ward Hemoglobin.

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21

23

25

27

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Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

% SaturationMean Saturation levels during activity period of Anemia

Coordinator.(n=100 - 110)

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Observing the positive results of the new method we recommend other

units to implement this management concept

in order to improveAnemia Alignment.

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לכל המעוניינ/ת בטבלאות המצורפות מוזמנ/ת לפנות במייל:

ronisv@clalit.org.ilronisvagner@gmail.com

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