Protocol-based nurse coordinator management of ambulatory tacrolimus dosing in de novo renal transplant recipients-A single-center experience with a large African American population

Clin Transplant. 2019 Oct;33(10):e13701. doi: 10.1111/ctr.13701. Epub 2019 Sep 12.

Abstract

Introduction: Transplant nurse (RN) coordinators review tacrolimus levels frequently and would be capable of making dose adjustments autonomously if not limited by their license. Collaborative practice agreements could be an answer; thus, the aim of this evaluation was to determine if an RN-driven protocol could be used safely and effectively to manage tacrolimus in ambulatory kidney transplant (KTX) recipients.

Methods: This was a retrospective review of all solitary adult KTX recipients between August 1, 2016, and July 29, 2017. The primary objective was to evaluate protocol adherence and frequency of use, and secondary objectives were to evaluate the utility of the protocol both overall and based on ethnicity.

Results: A total of 173 patients were included in the evaluation (59% African American [AA], 41% non-African American [non-AA). RN coordinators followed the protocol for 75% of tacrolimus adjustments; however, they only responded to 27% of the overall levels. There was no difference in 180-day tacrolimus-associated readmission (15% AA vs 5% non-AA, P = .06), biopsy-proven acute rejection (4% AA vs 7% non-AA, P = .363), or hyperkalemia (34% AA vs 32% non-AA, P = .87) between groups.

Conclusions: Transplant nurse coordinators are capable of accurately following a protocol for tacrolimus dosage adjustment in a large, racially diverse kidney transplant center.

Keywords: collaborative drug therapy; kidney transplant; nurse driven; protocol.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Black or African American / statistics & numerical data*
  • Delivery of Health Care, Integrated / statistics & numerical data
  • Disease Management
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / drug therapy*
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology
  • Graft Rejection / pathology
  • Graft Survival / drug effects*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Incidence
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Nursing Care / statistics & numerical data*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • South Carolina / epidemiology
  • Tacrolimus / administration & dosage*
  • Young Adult

Substances

  • Immunosuppressive Agents
  • Tacrolimus