Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric...

Area of Science:

• Nephrology
• Paediatric Medicine
• Clinical Quality Improvement

Background:

• Intra-dialytic hypotension (IDH) is a common, serious adverse event in paediatric haemodialysis (HD), leading to organ damage and mortality.
• Retrospective data showed IDH occurred in 16.5% of weekly HD sessions at a major children's hospital.
• Fluid volume management was identified as a key modifiable risk factor for IDH.

Purpose of the Study:

• To decrease IDH events in paediatric HD sessions to below 10% within 6 months.
• To implement and evaluate a Paediatric haemodialysis fluid volume management (PedHDfluid) program.
• To identify and address root causes of IDH through systematic fluid management.

Main Methods:

• Utilized the Model for Improvement methodology with rapid cycles of change.
• Implemented a multifaceted dry weight assessment protocol, multidisciplinary meetings, and an electronic health record tool.
• Analyzed data using statistical process control charts, monitoring IDH events, dry weight changes, and meeting times.

Main Results:

• IDH events decreased significantly from 16.5% ± 5.6% to 8.8% ± 3.3% of HD sessions per week.
• Observed more frequent adjustments to estimated dry weight.
• Increased multidisciplinary awareness of fluid removal goals and strategies.

Conclusions:

• A multidisciplinary approach integrating regular assessment, guidelines, and systematic discussion can sustainably reduce IDH events.
• An embedded electronic health record tool aids in assessment and data gathering for fluid management.
• The PedHDfluid program demonstrates effectiveness in improving safety during paediatric haemodialysis.