Key elements enthusiasm for Multidisciplinary team improving patient ▪ Nephrologists outcomes ▪ Nurses ▪ Social workers data tracking continuous ▪ Dietitians protocols review of ▪ Technicians data ▪ Administrators 51
Common issues Peritonitis Malnutrition Fluid retention ✓ Implementing CQI at a PD center improve dialysis outcomes Adapted from Mujais S, Story K. Kidney Int 2006; 70 [Suppl 103]: S21-26 Campos A, et al. Port J Nephrol Hypert 2015; 29(4): 41-48 Fang W, Ni Z and Qian J. Perit Dial Inter 2014; 34: pp. S35-S42 Yu Y, Zhou Y, et al. Perit Dial Inter 2013; 34: pp. S43-S48 52
Working time Indirect Continuing Direct education Time Nursing Vacation /sick Training care Peritonitis &ESI days Phone call/ Patient Meetings with recording Admission rate team Routine CQI retraining Ordering clinic visit/PET supplies /labs/ tube Computer changing paperwork Home visit 53
Nursing Time Time to treat Peritonitis &ESI 6 or 8hrs shift 4-5 hours / episode (assess, Rx, follow-up, retrain) 300 patients x 0.45 peritonitis/yr = 135 episodes/yr 135 x 4.5 hours = 608 hr or 76 days / yr (3.8 months /yr) If reduce peritonitis to 0.36/yr (20% less) = 90 episodes / yr 90 x 4.5 hours = 405 hr or 51 days (2.6 months /yr) 240-260 15days to Working days other activities
Impact of quality/CQI initiatives Better evidence Better translation Better Quality Better Outcomes CQI Infection per period Peritonitis rate in Australia 2005-2014 (ANZDATA Registry) Possible causes of the occurrence of peritonitis Qamar M, et al. Advances in peritoneal dialysis Conference on Peritoneal Dialysis 2009; 25: 76-79 Wang J, et al. Ren Fail. 2014;36(7):1029-32. Nataatmadja M, Cho Y, Johnson DW. PDI 2016;36(5):472-7. 55
Improving patient outcomes **Saves time - Less time “putting out fires”… (providing care for complications) - More likely to provide care which reduces the risks of complications • CQI is a Continuous process • No unit is so good that it can not further improve • Implementing CQI at a PD center can optimize management procedures and significantly improve dialysis outcomes 56
Paradigm shift: the three critical elements ✓ Optimized PD prescription with; • Non-glucose based PD solution • Automated PD (+ Remote management) • Pre-dialysis education changes the distribution of dialysis modality significantly, as 50% of informed patients choose home dialysis. • Close collaboration among nephrology professionals, patients and providers is required to make home therapy a reality for any interested patient. ➢ Choice of PD should be personalized, considering risk of infection, feasibility, other co-morbidities, availability of service/ assistant and other aspects or needs of patients and care takers ✓ PD-First policy: A sustainable and affordable policy solution for ESRD
THANK YOU Baxter Confidential — Do not distribute without prior approval | 58
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