CLINICAL AUDIT COMPLIANCE TO GUIDELINES ON MANAGEMENT OF

Document Sample
CLINICAL AUDIT COMPLIANCE TO GUIDELINES ON MANAGEMENT OF Powered By Docstoc
					CLINICAL AUDIT : COMPLIANCE TO GUIDELINES ON
MANAGEMENT OF PERITONITIS AMONG PATIENTS ON
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)
CY YUNG, MKF LEE, TH KWAN, TC AU, ML SZETO.
Department of Medicine, Tuen Mun Hospital.

Background: Peritonitis is the leading cause of hospitalization among CAPD
patients. It has been the major reason for transfer to hemodialysis and
catheter loss. Hence, prompt and effective management on CAPD-related
peritonitis is of utmost importance.
Aim: To assess the compliance rate to treatment guidelines on CAPD-related
peritonitis.
Standard statement : Patient with CAPD-related peritonitis should receive
standard treatment established by the renal unit.
Methods: The Peritonitis Treatment Protocol was jointly validated by renal
physicians and nurses. It was based on recommendations on CAPD-related
peritonitis implemented by international authority. A self-developed chart,
which contains 9 items for evaluation, was used as the audit form. The 9 items
were the essential steps involved in the management of CAPD-related
peritonitis.
Results: 25 patients were enrolled between March and May 2000. The overall
compliance rate was 86%. The item with the lowest compliance rate was the
prescription of loading dose of cephazolin, one of the 2 empirical antibiotics
used. One patient was given a wrong dose while the other was given another
cephalosporin. In 3 patients, no cephalosporins was given; instead they were
given vancomycin without any accountable reason. Other items of low
compliance rates included failure to give heparin and to change transfer set.
Improvement measures were implemented to enhance the compliance rate,
namely: (I) the importance of adherence to the Peritonitis Treatment Protocol
was emphasized at the departmental meeting; (ii) poster was put up at each
medical ward as note of reminder; (iii) the nursing staff of medical wards were
educated about the Peritonitis Treatment Protocol by the nurse specialist. Re-
audit was carried out from June to July 2000 and 28 patients were enrolled.
The overall compliance rate has now reached 98%.
Conclusion: The adoption of a uniform peritonitis treatment protocol will
ensure proper and standardized management among CAPD population. This
plays a key role in the context of continued quality improvement and
maintenance of quality patient care.

				
DOCUMENT INFO