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Where we are What's new? |
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The CARI GuidelinesBackgroundCARI (Caring for Australasians with Renal Impairment) is a national evidence-based project that commenced in 1999 with funding from the pharmaceutical industry. The two bodies responsible for the CARI Guidelines are the Council of the Australian and New Zealand Society of Nephrology (ANZSN) and Kidney Health Australia (KHA). The aim of the CARI Guidelines is to improve the health care and outcomes of paediatric and adult renal patients by helping clinicians and nurses to adhere to evidence-based medical practice as often as possible. It is anticipated that the guidelines will serve as both a valuable educational resource and a means of enhancing the quality, appropriateness, consistency and cost-effectiveness of renal health care. The Guidelines were initially developed for use in Australia but they are now also used in New Zealand. PublicationsBy the end of 2002, a total of 11 Practice Guidelines had been researched and written, with 3 Guidelines published in a Supplement to Nephrology in October 2004 under the topics 'Urine Protein as Diagnostic Test', 'CMV Disease and Kidney Transplant' and 'Evidence for Peritonitis Treatment and Prophylaxis'. In 2005, 2 Supplements were published totalling 47 Guidelines. The guidelines came under the topics 'Acceptance Onto Dialysis', 'Dialysis Adequacy (Haemodialysis)', 'Dialysis Adequacy (Peritoneal Dialysis)', 'Deceased Kidney Donor Suitability', 'Evaluation of Renal Function', 'Lipid-lowering Therapy' and 'Nutrition and Growth in Kidney Disease'. The latest CARI publication includes recommendations under the topics 'Prevention of Progression of Kidney Disease', 'Bone Disease' and 'Biochemical and Haematological Targets'. Further Guidelines currently being worked on are 'Kidney Stones' and 'Calcineurin Inhibitors in Renal Transplantation'. Guidelines on 'Renal Vasculitis' will also be developed during 2006-07. The CARI Guidelines development and review process has been revised to include:
ImplementationThe CARI Guideline Implementation projects are researching the best evidence-based methods of the implementation of evidence into action for patients at all stages of chronic kidney disease. Implementation of the Iron Guideline (Phase 1): Commenced 2004An audit of iron management processes was completed for 6 units from around Australia. The units were: Monash Medical Centre (Melbourne), Royal Melbourne Hospital (Melbourne), Western Sydney Area Health Service (Sydney), Central Coast Area Health Service (Sydney), Central Sydney Area Health Service (Sydney), and Canberra Hospital (Canberra). Data was also retrieved from ANZDATA on each unit's iron and haemoglobin levels. Iron levels varied quite markedly between the units and so did iron management practices. Links were made between high percentage in target iron range and positive iron management practices. One major finding indicated that nurse-managed iron protocols resulted in high levels of patients in target iron range. Barriers to improved iron levels have been documented for the units and these results have been released to the units and the resultant impact of this discussed with key stakeholders. A manuscript regarding the first stage of this project has been submitted for publication. Iron Management (Phase 2)We are now working with the 6 units and encouraging, following and documenting the change process in each unit as they act on the results of the audit for their unit. This phase of the project will enable CARI to map out further implementation strategies for other Guidelines. Systematic Review of Implementation of Evidence in Chronic Kidney DiseaseWe are currently underway with a systematic review of the implementation of evidence in the renal field. We will be looking at any project that gives details of the implementation methods used and provides before and after results. We will not limit the review to randomised controlled trials. We hope that this review will give us some insight as to the best methods of implementation in the renal field and how to move implementation of evidence in chronic kidney disease forward in Australia. Future ResearchA qualitative research project to ascertain the research priorities for consumers, policy makers and service providers in chronic kidney disease will be commenced in early 2006. The findings will be written up and submitted for publication. In addition, a number of articles about the CARI Guideline development process in comparison with others and a quality appraisal of selected Guidelines will be written in 2006. Staff |