| Sumario: | Background: The use of thrombolytic alteplase in hemodialysis patients presents significant challenges, including overuse for non-thrombotic issues, underuse for thromboprophylaxis, and delayed recognition of persistent catheter dysfunction. Variability in medication administration indicates a gap between evidence and practice, hindering measurements of effectiveness of alteplase and care. The kidney program in Central-West Ontario, serving more than 600 hemodialysis patients, recently revised its alteplase policy. Addressing barriers is essential for effective practice change. Purpose of the Project: Utilizing implementation science frameworks, this initiative demonstrated bridging the knowledge-to-practice gap in nephrology through the implementation of the alteplase policy rollout. This project identified multi-level barriers and facilitators, customized knowledge tools to local contexts, and tailored interventions with the overall aim of improving hemodialysis catheter performance and cost-effectiveness in alteplase use. Description: The Knowledge-to-Action (KTA) framework guided the knowledge synthesis and translation process, while the Consolidated Framework for Implementation Research (CFIR) helped identify barriers and co-design strategies. Tailored implementation strategies included championship, strategic education, health information system and workflow modifications, a new automatic alteplase alert system, and leadership engagement, to ensure participation, adoption of interventions, and facilitate behavioral changes. Evaluation/Outcomes: The next step involves conducting an implementation evaluation of the policy rollout, using qualitative and quantitative data from surveys, interviews, audits, and medication records. The analysis will focus on implementation outcomes, including adoption, fidelity, and stakeholder engagement, during the rollout and the three months following implementation. Pre- and post-comparisons of clinical outcomes will include catheter function indicators and costs measured six months before and after rollout. Expected outcomes are no change or improved catheter function indicators and reduced costs. Implications for Nephrology Practice: The frameworks guided the alteplase project in bridging evidence-practice gaps, promoting knowledge utilization, and enhancing clinical decision-making. These strategies may inform future kidney care initiatives in similar contexts.
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