Learning Objective #1: Understand the process of Continuous Quality Improvement(CQI)

Learning Objective #2: Understand the application of the CQI process as a framework to improve and continually evalute the quality of care given to patients

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When the acute dialysis program became an in-house operation, the development and implementation of a CQI program was a priority. Quality indicators were identified. Clotting in the dialyzer, treatment delays and catheter-related infections were tracked. Based on our CQI data, it was clear from the beginning, that there was a high incidence of dialyzer clotting particularly on our patients on Extended Daily Dialysis (EDD) who were on Heparin-free dialysis. Heparin-free dialysis is prescribed for high bleeding risk patients and for patients with heparin-induced thrombocytopenia. There was a need to explore an effective way to maintain patency and longevity of the extracorporeal circuit as clotting not only results to blood loss but to loss of treatment time which affects the efficiency and adequacy of the dialysis therapy. Our policy on no-Heparin dialysis was modified. Hourly saline flushes was changed to a more aggressive every-15-to-30 minute flushes. In addition, “heparin rinse” or priming the extracorporeal circuits with 5000 units of heparin added to 1-liter bag, except for HIT positive patients, was immediately implemented. After 2 months, clotting in the dialyzer on Extended Daily Dialysis was significantly reduced from 24% to 2%. Conclusion: CQI in the acute dialysis setting is critical for a continuous cycle of evaluating and improving patient outcomes. Through the process of CQI, we were able to identify dialyzer clotting with our EDD as a quality of care problem and implemented a solution that was effective.