3. Nursing Quality Assurance Issues in CVVH Timothy L. Kudelka, RN, BSN Pediatric Dialysis Program C.S. Mott Children’s Hospital University of Michigan

4. What Is Quality?  The Institute of Medicine defines quality as the degree to which health services for individuals or populations achieve a desired outcome and is consistent with current professional knowledge.

5. What is Quality Assurance?  A process for improvement.  To prevent and correct identified problems.  A multidisciplinary team working together to provide the highest quality health care by meeting or exceeding the expectations of the customers we serve.  To assure that procedures, methods, and systems have an effective impact and are cost effective.

6. Existing Standards Acute Dialysis Quality Initiative (www.adqi.net) The Joint Commission on the Accreditation of Healthcare Organizations(JCAHO) The Food and Drug Administration.

7. Continuous Quality Improvement  Standards and guidelines are ways to improve quality on a large scale.  Continuous quality improvement (CQI) is a way to build standards and guidelines into daily practice.

8. Continuous Quality Improvement CQI has three main parts: Quality planning Quality control Quality improvement Tools used in CQI (PDCA)Plan,Do,Check,Act Priority rating scale

9. Quality Planning Involves planning processes and procedures to achieve desired outcomes, or goals for patients and staff. All problems are seen as a chance for improvement.

10. Quality Control Checks to see that the goals are met. In CRRT there are many aspects of care that are checked as part of quality control including:

11. Monitoring electrolytes Fluid status Maintaining anticoagulation Blood loss Heat loss Immobility Accurate prescription Access Documentation

12. Quality Improvement If the desired goals are not met for each area, quality improvement is used to study how tasks are done and how to improve them. When a problem is identified, an on going cycle of improvement begins.

13. Method or Tool P - Plan D - Do C - Check A - Act

14. Plan Collection of information or data Design or redesign policies, procedures services or products Specify objectives or degree of improvement.

15. DO Deliver care, perform policy or procedure in limited trial run Do a pilot test of the plan to see how it works.

16. Check The third step is to Check to see if the plan works. Obtain judgments of improvement and determine if solution or change has been successful.

17. Act CQI is a continuous full circle. Implement solutions, change, modify tests, revise standards. (develop standards) and incorporate revision in to day-to- day practices. Communicate.

18. A Powerful Quality Tool

19. The Opportunity The CQI approach is versatile and can be applied to any problem for which data can be collected. Nursing should be and usually is the lead in coordinating a CQI team. CQI is the perfect tool to address troubleshooting issues in CVVH.

20. Benefits

21. Prevent and correct identified problems. Assure patient care is of the highest quality, meeting community, national and international standards. Engage and organize individuals closest to the work process to improve.

22. Benefits To assure that procedures, methods, and systems are cost effective. Performance standards designated by regulatory and accrediting agencies are consistently met.

23. Benefits To assure that patient care, practice and professional performance are regularly, validly and reliably evaluated. Performance results are tracked by a valid measurement tool.

26. Thanks to: Dr. Timothy E. Bunchman MD Dr. Patrick D. Brophy MD University of Michigan Pediatric Dialysis Team. Pediatric Critical Care Nursing. My wife.