Abstract
Background and Aims
In January 2016 we initiated in our dialysis unit a Patient Safety Program (PSP) with the following goals: risk management, improvements in patient care and quality of hemodialysis. The program was based on four pillars: 1 - Individualized care through a Singular Therapeutic Plan (STP); 2 -Practices of processes surveillance and monitoring; 3 - Effective communication program (ECP), valuing the intensive and continuous education of the whole team and 4 –Technological management. The first results in the year of implementation were presented at the 54th ERA-ADTA Congress, Madrid 2017 (MP524). We analysed these established indicators results through three years of the program, comparing them to those found in 2015. The aim of this study is to verify the degree of response of the proposed model over time, and achieve the objectives set monthly (M), quarterly (Q) and annually (A): Hospitalization rate <5% (M); Seroconversion Rate of Viral Hepatitis, 0% (A); Mortality rate, < 5% (A); Patient with hemoglobin values> 10 g/dl, 80% (M); Patient with serum albumin>3 mg%, 90% (Q); SpKt/V ≥ 1.4, 80% (M); Patients with normal serum values of P3+, 60% (M); Rate of infections related to health care, < 5% (A).
Method
We conducted a longitudinal study in the period 2016-18, where we analysed the indicators stipulated. We systematically and continuously apply policies, procedures and conducts in the assessment of risks and events. We compared the results found to those collected in 2015. In the statistical analysis, we used in the indicators collected monthly the median ± standard error, as a measure of central trend and Wilcoxon-Mann-Whitney Test for analysis of the samples. In the annual indicators, we used linear correlation coefficient.
Results
Among the 240 patients studied in a chronic dialysis program in the studied period, there was no exclusion of patients due to the etiology of kidney disease, presence of comorbidities, gender or age. The percentage of patients with Hemoglobin levels >10g/dl was 68±2.0 in 2015, and 71±1.8, 72±2.4, 76±1.4 from 2016 to 2018, respectively, with statistical significance only in 2018 when compared to 2015, p=0.01. The percentage of SpKt/V ≥ 1.4 in 2015 was 72±2.5, with an increase in 2016, 74±2.5, without statistical significance, in 2017 it was 80±2.4 with p=0.01 and in 2018 82±1.9, p=0.002. In the Patients with normal serum values of P3+ index, we observed in 2015 the percentage of 55±2.9, 2016 63±2.4, 2017, 68±2.0, and 2018 73±1.9 statistical significance in the last two years, p<0.05 and p=0.001, respectively.. There was no seroconversion to Hepatitis C in the whole period. Patient with serum albumin rate >3 mg% was achieved in the three years of the 2016-18 program, 92%, 91% and 95%, respectively, with statistical significance only in 2018, p=0.01, when compared to 2015, 85%. The Hospitalization rate was achieved in the three years of the study, 5% in 2016, and 4% in the following two years, r=0.92. Mortality rate decreased over the PSP, reaching the target in 2018, r=0.69. Finally, the Rate of infection related to healthcare we observed a progressive drop during the program, 8% in 2015, 6% in 2016 and 2017 and reached the target in 2018, 5%, r=0.85.
Conclusion
The Patient Safety Program brings good results in the quality of treatment and consequently decreases comorbidities, hospitalizations and mortality. The results become more evident over time because the improvement of many indicators depends on the direct and continuous work with each patient, and with incessant training of all professionals involved. We strongly believe this program will keep improving all those indicators, especially mortality rate, as patients will benefit clinically, in a cardiovascular standpoint, from P3+, albumin and haemoglobin normal levels over time.
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