QIP - Adequacy Improvement · 2015-01-07 · QUALITY IMPROVEMENT DIRECTOR NORTHWEST RENAL NETWORK...
Transcript of QIP - Adequacy Improvement · 2015-01-07 · QUALITY IMPROVEMENT DIRECTOR NORTHWEST RENAL NETWORK...
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BARBARA BRECKLER RN BSN QUALITY IMPROVEMENT DIRECTOR
NORTHWEST RENAL NETWORK
QIP - Adequacy Improvement
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February 2013
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Objectives
Provide an overview of:
Definition and measurement
Prescription Sampling Technique
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Adequacy Definition and Measurement
Adequacy:
A term referring to the effectiveness of removing
“wastes” from a patient’s blood during treatment.
Studies have shown that more dialysis
is better for our patients.
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Adequacy Definition and Measurement cont.
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QIP Adequacy Measure for cy 2013 is
Kt/V > 1.2 for HD
2006 KDOQI Guidelines
recommend a spKt/V dose target of
1.4 with a minimum of 1.2
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Adequacy Definition and Measurement cont.
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Kt/V is a mathematical description equaling
the intake of protein and removal of urea during dialysis
to determine if patients are receiving enough dialysis:
K= dialyzer urea clearance
t= length of time of dialysis treatment
V= volume of urea distribution
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Disclaimer
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Always
follow your companies policy and procedures
along with Nephrologist’s orders.
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Prescription
Many Prescription Factors Impact Kt/V
Prescribed Kt/V EDW
BFR Access Function
Needle Size Dialyzer
DFR Liters Processed
Time on Dialysis
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Prescription
Prescribed Kt/V
It is an estimate of what the patients Kt/V should be, based on the dialysis prescription.
It is the physician’s aim for adequate dialysis
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Prescription
Estimated Dry Weight
If the patient is an amputee- Is it documented accurately?
Is the patient consistently coming off dialysis above or below their EDW?
Amputation and EDW affect the “V”
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Prescription
Heparin
Are you using a heparin bolus?
If so, are you waiting at least 5 minutes to initiate dialysis?
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Prescription
Blood Flow Rate
Maximize prescribed BFR based on- access type and maturation:
Mature AVF/AVG: BFR 400-450 ml/min
CVC: manufacturer’s recommendations (350 ml/min)
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Prescription
Access Function
Questions to answer:
CVC: Minimum BFR achieved? Is a thrombolytic needed?
AVF/G: Are you able to achieve prescribed BFR? Recirculation? Prolonged bleeding post treatment?
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Prescription
Needle Size
Gauge Suggested BFR ml/min
Anticipated pre-pump pressure mm/Hg
17 200-250 -150
16 250-350 -200
15 350-450 -220
14 >450 -260
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Prescription
Dialyzer
Is the dialyzer the correct size? *
Considerations include: surface area + clearance.
Loss of surface area due to leaks or clotting?
* Larger is not always better.
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Prescription
Dialyzers
For patient’s who don’t respond to conventional interventions, consider:
in-series dialyzers
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Prescription
Dialysate Flow Rate
Is the dialysis solution flow rate less than prescribed?
Dialysis solution flow rate affects the clearance of small solutes (urea).
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Prescription
Liters Processed
BFR x Treatment time / 1000
If less than prescribed:
Evaluate Access Function Time on Dialysis
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Prescription
Time on Dialysis
Time incorrectly calculated
Time not adjusted for interruptions in treatments
Premature disconnection
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Sampling Technique
Dilution of BUN sample with Saline Drawing pre-dialysis BUN after initiation
of dialysis Drawing post dialysis BUN before the end of
dialysis treatment Drawing post-dialysis BUN more than 5 minutes
after the end of treatment
Sampling errors can cause inaccurate Kt/V
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Northwest Renal Network
Mission Statement:
The mission of Northwest Renal Network is to promote optimal dialysis and transplant care for
kidney patients in Alaska, Idaho, Montana, Oregon and Washington.