FP707LONG TERM OUTCOMES OVER 2 YEARS FOLLOWING A DIALYSIS ADEQUACY QUALITY IMPROVEMENT INITIATIVE

Abstract

Introduction and Aims: Dialysis adequacy is an essential measure of quality of care in dialysis and has been shown to correlate with clinical outcomes such as hospitalisations and mortality. Evidence based guidelines recommend that haemodialysis (HD) patients should achieve a urea reduction ratio (URR) of more than 65%. UK Renal Registry data shows wide variation in the number of patients who achieve target URR in HD units. In May 2010 the Salford Renal Network implemented an ambitious programme to uplift attainment of key quality of care indicators in our renal network to within the top 10% in the UK; dialysis adequacy was a clinical target in 2 phases of improvement in 2010-2012. Methods: Our network implemented a quality improvement programme using a collaborative methodology. We set four teams a different clinical indicator to work on over 12 month cycles for 2 successive years, guided by an improvement framework and QI facilitation input. Two units worked to improve attainment of target URR. Unit A participated in phase 1 and developed a package of successful changes following plan-do-study-act (PDSA) testing that was used as the basis for improvement by Unit B in phase 2. We analysed the long-term outcomes in these 2 units for a further 2 years until May 2014. Results: Both units were successful in achieving their aim of >90% of patients achieving target URR>65% at the end of their improvement year. In addition, both units sustained the improvements with no additional resource input for 2 years after the end of the formal collaborative. Changes that were introduced included protocolised nurse-led changes to dialysis prescriptions, multidisciplinary review of dialysis adequacy & vascular access, saline circulation pre-dialysis, a nurse-led anticoagulation protocol, URR sampling protocol, and monthly URR reports. Conclusions: Longer term outcomes from QI interventions are underreported, with limited evidence demonstrating the sustainability of successful QI projects. We tested and implemented multifaceted interventions to improve dialysis adequacy to within the top 10% achieved in the UK in 2 units within our haemodialysis network. Implementing evidence-based changes led by frontline staff trained in using QI techniques has enabled improvements to dialysis adequacy to be sustained without additional resource input for 2 years after completion of a formal QI intervention, improving long-term quality of care for our patients. (Table Presented).