DescriptionPurpose of Project: This DNP project was a program evaluation to determine whether or not heart transplant recipients are referred with the right indications and at the right time to a nephrologist based on current International Society of Heart and Lung Transplantation (ISHLT) guidelines. The recommendations made at the first nephrology consultation were reviewed. At the conclusion of the program evaluation, the collected data was shared with the DNP project site to provide evidence-based practice recommendations.
Methodology: A retrospective chart review was conducted of all orthotopic heart transplant recipients transplanted between January 2018 and December 31, 2019. Data was retrospectively collected from recipients’ time of transplant up to and including 24 months after transplant. Data was analyzed utilizing SPSS.
Results: A total of 71 charts were reviewed and 29 recipients met the ISHLT guidelines for referral to a nephrologist. There were 10 recipients out of 29 not appropriately referred to a nephrologist, 34.5%. Of the 19 recipients who were appropriately referred, 15 recipients had nephrology provider consultation notes in their chart. Medication management was recommended in 73.3% of provider notes and diagnostic testing was recommended in 86.7% of provider notes. Both follow up with the nephrology team and the heart transplant team were recommended in 100% of provider notes.
Implications for Practice: The recommendation from this study is to create an evidence-based clinical practice protocol for appropriate nephrology referral. Findings add to the general body of knowledge regarding kidney injury after orthotopic heart transplantation.