Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting, PhD, DNP, APRN, CPNP-PC, PMHS, FNP-C


Cathy Koetting, PhD, DNP, APRN, CPNP-PC, PMHS, FNP-C

Nancy Magnuson, DSN, APRN, PCNS, FNP-BC

Rodnette Alban MSN, RN, CDN


Problem: The purpose of this project is to implement the Recova® tool to adjust estimated dry weight supporting interdisciplinary team management of fluid overload in dialysis patients. Fluid overload can lead to high rates of morbidity and mortality. A total sample of 26 hemodialysis patients in an outpatient clinic located in a metropolitan city in a midwestern state was included in the project. Data collected shows there was poor knowledge familiarity with how fluid should be managed in patients suffering from chronic kidney disease. The nurses utilized the Recova tool for a period of 8 weeks to help aid in estimated dry weight adjustments in the clinic.

Methods: The quality improvement project used an observational descriptive design. The IHI module of change PDSA cycle was the framework used for the study.

Results: A total of 26 hemodialysis patients (N=26) treatment data for a period of 8 weeks was analyzed. The results of the monthly means (January (M=.16, SD=1.85), (February (M=.58, SD=2.5) and March (M=.40, SD=2.6) indicated a decrease in post-weight variances from estimated dry weights when compared to baseline data. However, the results were not statistically significant evidenced by p < .05. ). Results indicated that there were improvements in clinical quality scores which were evident by an overall decrease in previously high clinical quality scores.

Implications for practice: Having a standardized validated decision aid tool, recognized, and used by staff in outpatient settings is crucial to fluid management and prevents fluid overload, hemodynamic instability, and hospitalizations.