The “To Pee or Not to Pee” project is a quality improvement project at Royal Inland Hospital initiated by the Renal Program in October 2016. The project involved units that care for renal patients. The goal was to decrease adverse medication events for renal inpatients with a GFR <30 ml/min, by increasing nursing knowledge and awareness of renal specific medications. The problem was identified by Renal nurses whose patients were not receiving certain medications, receiving the wrong dosages, receiving too much fluid, or receiving medications at the wrong time. Medical unit staff did not always know what the medications were for or why they might be important.

A staff survey showed an improvement in confidence when managing medications for renal patients. The percentage of those who did not feel confident dropped from 38% to 19%, those who felt somewhat confident increased from 59% to 69%, and those who felt confident increased from 0% to 12%. The baseline survey showed an overwhelming 98% interest in more education.

Short, on-the-fly education sessions were held on medical floors where it was convenient for unit staff, educators and charge nurses to attend. Lanyard cards and large posters were developed to remind staff to think critically about fluid and medications for their renal patients, among other safety issues. The follow up survey showed the posters were well received.

Short, stand-up sessions on units while staff are working were much more successful than longer sessions held elsewhere. Having a take-away, like the lanyard card, was helpful and having a poster with more details helped give staff a reference they could go to after the education session. Educating nursing educators was important for sustainability because they continue to support staff and add the information to orientation for new staff. Involving the renal educator helped keep the information up-to-date and ensured renal staff were aware of the education, too.

To Pee or not to pee? what GFR are we?