1. Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric in-centre haemodialysis unit: a quality improvement project
- Author
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Snauwaert, Evelien, Wagner, Stéphanie, Jawa, Natasha A., Bruno, Valentina, McKay, Ashlene, Kirpalani, Amrit, Nemec, Rosaleen, Teoh, Chia Wei, Harvey, Elizabeth A., Zappitelli, Michael, Licht, Christoph, and Noone, Damien G.
- Subjects
Male ,medicine.medical_specialty ,Quality management ,medicine.medical_treatment ,Intra-dialytic hypotension ,Retrospective data ,Renal Dialysis ,Risk Factors ,Humans ,Medicine ,Quality improvement ,Risk factor ,Child ,Adverse effect ,Retrospective Studies ,business.industry ,Quality Improvement ,Sick child ,Haemodialysis ,Nephrology ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Dialysis unit ,Kidney Failure, Chronic ,Original Article ,Female ,Hemodialysis ,Hypotension ,business ,Fluid volume - Abstract
Background Intra-dialytic hypotension (IDH) is the most common serious adverse event in paediatric haemodialysis (HD). Repeated IDH results in chronic multi-organ damage and increased mortality. At the Hospital for Sick Children, Toronto, retrospective data from all in-centre HD sessions revealed frequently occurring IDH events (16.5 ± 5.6% of HD sessions per week). Based on literature review and clinical expertise, fluid volume management was selected as a potential modifiable risk factor to decrease IDH. Root causes identified as contributing to IDH were incorporated into a Paediatric haemodialysis fluid volume management (PedHDfluid) program using the Model for Improvement methodology including rapid cycles of change. Methods Multiple measures were evaluated including (i) Outcome: IDH events per number of HD sessions per week; (ii) Process: number of changes to estimated dry weight per number of HD sessions per week; (iii) Balancing: time spent on dry weight meeting per week. Data was analysed using statistical process control charts. We aimed to decrease IDH in our dialysis unit to
- Published
- 2021
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