Providing guidance to patients with Hepatic Encephalopathy who are on the waiting list for liver transplantation: a quality improvement project

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M. Heida, J. van der Wal, G. Drent

Chair(s): M.J.C. Wessels & J.M. Wierdsma

Thursday 9 march 2017

9:48 - 10:00h at Willem Pijperzaal

Categories: Parallel - Verpleegkundig

Parallel session: Parallelsessie X – Verpleegkundig

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Hepatic encephalopathy (HE) is a severe complication in patients on the waiting list for liver transplantation. HE often affects patients with decompensated liver cirrhosis. It is a neuropsychiatric syndrome caused by a high level of ammonia in the blood, which crosses the blood-brain barrier. Mental and neuromuscular symptoms are present in patients with HE. Teaching patients and their caregivers how they can recognize the first symptoms of HE can prevent both worsening of the condition and hospitalization. At present, patients and their caregivers are concerned about HE because they are unaware of the symptoms of the condition.

The main goal of this study is to provide guidance to patients and their caregivers on how to manage HE. Furthermore, nurses require clinical training that helps them to inform and instruct patients and their caregivers about HE.

Patients and their caregivers were interviewed about recognizing symptoms of HE and about their knowledge of appropriate actions. The nurses from the ward were invited to fill out a survey on knowledge of HE and skills they require to teach patients and their partners.

A total of ten patients and their caregivers were interviewed. Patients with a first episode of HE were concerned about the symptoms and had little knowledge of HE. Patients who had been through multiple episodes of HE had some knowledge of the  symptoms. Most caregivers saw a difference in the behavior of patients with HE, but were not able to connect this altered behavior to HE. They all stated that while an information leaflet on HE would be informative, they also wanted to learn how to manage its symptoms and how to prevent deterioration. Fifteen nurses (65%) from the ward filled out the survey. Respondents indicated they were in need of clinical training on managing HE as well as information on causes, symptoms, and treatment options. Based on these results, a clinical training was prepared and an information leaflet was designed, including a diary (weight, frequency of defecation) and a number connection test to assess the degree of HE.

The conclusion of this study is that providing information about HE helps patients and their caregivers to gain a sense of control and to prevent worsening of the condition. A follow-up study will be performed to verify whether this information leaflet increases knowledge, improves quality of life, and decreases the number of HE episodes.