Construction of nursing-sensitive quality indicators for hemodialysis vascular access: a Delphi study

The aim of this study was to develop a set of quality indicators for hemodialysis vascular access nursing.

A two-round Delphi study was conducted from August to September 2025.

Based on the Donabedian structure-process-outcome theory model, this study retrieved, evaluated, and synthesized the best evidence on quality indicators for hemodialysis vascular access nursing. A questionnaire was developed through evidence-based analysis and semistructured interviews. An indicator system was established using the Delphi method, and an analytic hierarchy process (AHP) was employed to determine the weights of each indicator. A total of 16 experts from 14 hospitals across nine provinces in China completed two rounds of Delphi surveys.

After two rounds of consultation, the experts reached a consensus on the definitions of the indicators, calculation formulas, and data collection methods. They established a quality indicator system for hemodialysis vascular access nursing, which includes 3 primary indicators and 15 secondary indicators.

The developed nursing quality-sensitive indicator system for hemodialysis vascular access was constructed through a rigorous Delphi process and aligns with the practical features of hemodialysis vascular access nursing management. It may serve as a reference basis for evaluating the quality of vascular access nursing, pending further clinical validation.

This framework offers a structured approach to monitoring vascular access nursing quality. Its potential to reduce complications and improve patient outcomes requires confirmation through future clinical implementation studies.

The indicators identified in this study are highly consistent with those in clinical practice, demonstrating sensitivity and practicality. The hemodialysis centers of relevant medical institutions may consider using this quality indicator system for routine data collection. Its utility for quality improvement should be further evaluated in clinical practice.

This study was reported in line with the Conducting and Reporting of Delphi studies (CREDE) guidance on Delphi studies.