1. Ronice Wagner 1 Igor Semhaev 1 Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Israel 1 1

2. Erythropoietin is a glycoprotein hormone that controls and regulates red blood cell production. It is produced and secreted in the kidney. Chronic renal failure is associated with various degrees of anemia due to erythropoietin deficiency resulting from multiple factors 2

3.  Decreased erythropoietin production as a result of kidney damage.  Decreased RBC lifespan secondary to uremia.  Reduced bone marrow response to circulating erythropoietin.  Ongoing blood losses from dialyzer and tubing, blood sampling, gastrointestinal blood loss, and blood losses at the time of dialysis needle placement and removal.  Depletion of iron stores precedes impaired production of iron-containing proteins, the most prominent of which is hemoglobin 3

4.  Till the end of 2009 our patients received monthly prescriptions for medications and were required to purchase them personally. The reasons that this procedure was never smooth and effective were :  Physician’s decisions were based on narrow scope of data.  Delays in delivering reports to the physicians.  Patients were unreliable in purchasing and delivering medications on-time. 4

5. In order to reduce the burden and relieve the patients from this tedious procedure we decided to make the ward responsible for the monthly drug supply. 5

6. On December 2009 a new role was established : Anemia Coordinator 6

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10. Name Identity card District,JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 7.5.11 6.8.11 28.2.11 8.9.11 16.12.10 6.8.11 29.4.1 1 Ronice 201110 Create a registration form which checks indicates and updates the expiring dates of drug supply confirmation, given by the Central Pharmacy:

11. 1. Fill in the new Laboratory Results in the Monthly table, Personal physicians’ table and Ward Medication Supply List. 2. Give every physician his personal patients list. Get new medical orders and add them to the patient's files. 3.Send the corrected Ward Medication Monthly Supply List to the Central Pharmacy 4.Upon medical supply arrivel, store it according to the hospital and medical regulations. 5. Give proper instructions and guidance to the ward team. 11

12. Since appointing an Anemia Coordinator we have observed – 1.Improved stability in ward Hemoglobin. 12

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15. Observing the positive results of the new method we recommend other units to implement this management concept in order to improve Anemia Alignment. 15

16. לכל המעוניינ / ת בטבלאות המצורפות מוזמנ / ת לפנות במייל : ronisv@clalit.org.il ronisvagner@gmail.com 16