Speaker discusses application of continuous quality improvement theory to peritoneal dialysis
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KANSAS CITY, Mo. — Continuous quality improvement theory with patients on peritoneal dialysis may improve quality of care and clinical outcomes, but there are many challenges to implementation, according to a speaker at the Annual Dialysis Conference.
Organizational constraints that may arise are a lack of interest, as it is difficult to monitor the progress of changes made within an institution. A lack of understanding of continuous quality improvement (CQI) theory and the plan-do-study-act (PDSA) cycle, measurement errors and fallacy of expertise are other challenges to implementation. A speaker here said it is important to fully understand the PDSA cycle, know that failure is typical and to expect barriers along the way.
“You need to do a stakeholder analysis. You need to identify who’s important within your institution and grow those partnerships early on. There are internal stakeholders, connected stakeholders, as well as externals stakeholders,” Bourne Auguste, MD, MSc, FRCPC, assistant professor in the department of medicine at the University of Toronto, said in his presentation. “You need to build a team and you need to have regular meetings. You need to cultivate a culture of quality improvement within your institution by going to meetings and visual motivation — that’s also very important as well.”
Meeting regularly to review data helps to enhance workflow in the institution and creates a culture of quality improvement, according to Auguste. Auguste noted the use of visual motivation in his institution involves boards that display the CQI and help show transparency, opportunities for improving the CQI and showing failures.
Future directions for CQI may involve identifying areas of PD growth within the program at an institution and developing peer support groups for patients.
Auguste said early exposure to home dialysis experts in a clinic allows for potential PD patients to be influenced to adopt PD and home dialysis as a whole, while making the transition to PD more comfortable with familiar and trusted clinicians. Holding educational events may help to educate patients about PD and their future experiences with this therapy.
“You cannot fix what you do not understand. You cannot be a hero in CQI,” Auguste said. “If you have a plan with your PDSA cycles, some things are a bit off. It’s not right. You need to have roadblocks along the way. Disappointing PDSA cycles are usually the most informative, so don’t ignore it. Use it as a golden opportunity.” – by Erin T. Welsh
Reference:
Auguste, B. CQI theory applied to PD. Presented at: Annual Dialysis Conference, Feb. 8-11, 2020; Kansas City, Missouri.
Disclosure: Auguste reports no relevant financial disclosures.