Structured re-training to reduce peritonitis in a pediatric peritoneal dialysis program: a quality improvement intervention
Background Decline in skills and knowledge among patients and/or caregivers contributes to peritoneal-dialysis (PD)-related peritonitis. Re-training is important, but no guidelines exist. We describe the implementation of a structured re-training program to decrease peritonitis rates. Methods This i...
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Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2021-10, Vol.36 (10), p.3191-3200 |
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Sprache: | eng |
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Zusammenfassung: | Background
Decline in skills and knowledge among patients and/or caregivers contributes to peritoneal-dialysis (PD)-related peritonitis. Re-training is important, but no guidelines exist. We describe the implementation of a structured re-training program to decrease peritonitis rates.
Methods
This is a prospective quality improvement study involving pediatric patients on long-term home automated PD at National University Hospital, Singapore, between 2012 and 2018. With increasing peritonitis rates, systematic root cause analysis was performed, and based on the contributory factors identified, a structured re-training program was implemented from 2015. This was conducted in 5 cycles, each consisting of 4 modules (hand hygiene, exit site care, peritonitis, and PD troubleshooting).
Results
Peritonitis rates were analyzed in 2 phases: Phase 1 (2012–2014) when no re-training was performed and Phase 2 (2016–2018) after re-training was instituted. Fifty-nine patients were included. Of these, 45 patients were in Phase 1, 32 in Phase 2, and 18 in both phases. Peritonitis rates decreased from 0.37 ± 0.67 episodes per patient-year in Phase 1 to 0.13 ± 0.32 episodes per patient-year in Phase 2. After adjusting for age at kidney failure onset, PD vintage, years of nursing experience, and the average patient-to-nurse ratio over the study period for each patient, the adjusted peritonitis rates decreased by 0.38 episodes per patient-year (95% CI, 0.09 to 0.67,
p
= 0.011) from Phase 1 to Phase 2.
Conclusion
Despite an improvement in staffing ratio, peritonitis rates only improved significantly after intensive structured re-training was instituted. |
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ISSN: | 0931-041X 1432-198X |
DOI: | 10.1007/s00467-021-05039-2 |