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Kidney Week

Abstract: TH-PO340

The Effects of Objective Structured Clinical Examination on Home Hemodialysis Transition

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Cheng, Xin Bo (Justin), University Health Network, Toronto, Ontario, Canada
  • Alrowiyti, Ibrahim M., University Health Network, Toronto, Ontario, Canada
  • Chan, Christopher T., University Health Network, Toronto, Ontario, Canada
Background

Home hemodialysis (HHD) augments quality of life and improves several clinical outcomes in patients with end-stage kidney disease. However, patients are required to learn a complex medical task and are obligated to demonstrate competency of training. We hypothesize that Objective Structured Clinical Examination (OSCE) is a feasible strategy to enhance training and improve patient and provider confidence.

Methods

From 2017 to 2021, 58 patients completed HHD training at University Health Network. Each patient completed an OSCE for formative assessment and a final OSCE for summative evaluation. The OSCE comprised of 94 or 85 items, depending on vascular access. Targeted training was provided after the first OSCE on identified areas of improvement.
25 of 58 consented and completed an optional Likert Scale survey (1 to 10) assessing confidence in seven categories, as seen in Figure 1. These include three routine practices of ultrafiltration (UF) target, HHD access, and machine set up followed by three advanced actions of alarm and complication management, and safety. A final item, readiness to go home, served as a global assessment. Patients and training nurses completed the surveys, scoring from 1 to 10, before and after each OSCE. Within subject differences were assessed by paired Student t test.

Results

The mean OSCE score increased from 96.2 (+/- 5.7) after the first OSCE to 98.2 (+/- 3.1) % after the second OSCE (p > 0.05). The patient mean score for home readiness increased from 8.0 (+/- 1.8) after the first OSCE to 9.5 (+/- 1.0) after the final OSCE (p < 0.05). Similar trends were observed from the nurse trainers, with their mean home readiness score increased from 6.6 (+/- 1.8) to 8.9 (+/- 1.1) (p < 0.05) after the OSCE process.
Individually, there was an increase in patient confidence in all categories. Confidence in ultrafiltration target, dialysis access, and machine setup improved by 0.68, 0.40, and 0.36 respectively (p < 0.05). Confidence in advanced components including alarm troubleshooting, complication management, and safety increased by 0.84, 1.04, and 0.72 respectively (p < 0.05).

Conclusion

We demonstrated that OSCE is an implementable training strategy, which is associated with augmented home readiness and confidence scores in our patients and nurse trainers. We speculate that assurance of training may reduce patient burnout.

Figure 1. Patient and nursing reported confidence scores.