¿Qué indicadores son considerados por enfermería para conseguir una diálisis perfecta en el paciente en hemodiafiltración en línea?

Abstract

Both the guides and the instructions of the Spanish nephrology society's quality management group offer a series of indicators for measuring quality in the provision of haemodialysis.
The aim of this study was, after identifying the main indicators of optimal dialysis in the view of nurses, to assess each dialysis session objectively, in the conviction that knowing what went right and wrong in each session would give us proposals for improvement, earlier than with the indicators in common use.
To this end, a survey was conducted among nursing staff (n=26) asking them to list the 10 parameters they considered fundamental to a successful dialysis session. The 10 most-cited items were used to draw up the data gathering sheet, with yes/no responses.
For each patient (n=160) 3 consecutive sessions were assessed (n=480 sessions), involving the same treatment pattern.
The nurse conducting the sessions was unaware which sessions were to be assessed, nor did they know the identity of a second assessing nurse, whose job would be to mark each of the items yes or no. 1 point was given for each objective achieved. The maximum score for each patient was 30 points (10 per session), except in those with tunnelled catheters, for whom it was 27 points (10 per session), as haemostasis is not assessed.
The result was that 41.3% of the sessions conducted got the top score (42.1% with arteriovenous fistula and 35.1% with tunnelled catheter, p=0.043). The percentage score was 88.7 ± 11.9%, the percentage being significantly higher with AVF than with a catheter (89.9 ± 9.9 versus 79.7 ± 19.4, p<0.001). No differences by sex, age, aetiology or length of admission were detected.
30 patients (18.8%) got the maximum score in all three sessions. El 77.7% of patients (124) scored over 85%, and 87.1% of patients over 80%.
In barely 42.5% was there a full recovery of the clean circuit in all three sessions (60.5% of the sessions). 50 patients (31.2%) displayed symptoms during dialysis in at least one session, though only 15.2% of the sessions were symptomatic, implying that the symptoms were clustered in the same patients.
All the other items were checked over 90% of the sessions, with KT compliance particularly high at 96.3% and reinfusion volume at 92.7%, probably because in 92% of cases optimum blood flow was achieved and the prescribed time was achieved in 95% of sessions.
We can therefore conclude that objective assessment of each dialysis session, with the intention of optimising them, provides us with valuable real-time information, and therefore serves to confirm what we were doing right and highlight opportunities for improvement in aspects in which our performance is weaker. The involvement of nephrological nurses in this cycle of improvement will have a positive impact on the classic quality indicators which are regularly measured, anticipating the solution before the problem is reported.