Structured re-training to reduce peritonitis in a pediatric peritoneal dialysis program: a quality improvement...

Area of Science:

• Nephrology
• Pediatric Dialysis
• Quality Improvement

Background:

• Peritoneal-dialysis (PD)-related peritonitis is a common complication.
• Declining patient and caregiver skills contribute to peritonitis.
• Lack of standardized re-training guidelines hinders effective intervention.

Purpose of the Study:

• To implement and evaluate a structured re-training program for pediatric patients on home automated PD.
• To reduce the incidence of PD-related peritonitis.

Main Methods:

• Prospective quality improvement study (2012-2018) at National University Hospital, Singapore.
• Root cause analysis identified factors contributing to increasing peritonitis rates.
• A 5-cycle, 4-module re-training program (hand hygiene, exit site care, peritonitis, PD troubleshooting) was implemented in 2015.

Main Results:

• Peritonitis rates decreased from 0.37 episodes/patient-year (Phase 1: 2012-2014) to 0.13 episodes/patient-year (Phase 2: 2016-2018).
• Adjusted peritonitis rates showed a significant decrease of 0.38 episodes/patient-year (p=0.011).
• Improvement occurred despite concurrent enhancements in patient-to-nurse staffing ratios.

Conclusions:

• Intensive, structured re-training is crucial for reducing PD-related peritonitis.
• The program demonstrated significant effectiveness in improving patient outcomes.
• This highlights the importance of ongoing education and skill reinforcement in PD management.