Authors (including presenting author) :
Chan ML, Leung J, IP J, Ho E, Yeung S, Tsang S
Affiliation :
Haemodialysis Centre, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Peritonitis is one of the major clinical complications of peritoneal dialysis (PD). According to ISPD guideline 2016, the peritonitis rate should be no more than 0.5 episodes/patient-year. With an increasing trend of peritonitis events, a quality improvement programme- Peritonitis Remission Programme (PRP) was launched since October 2020 in Tseung Kwan O Hospital Renal Day Centre.
Objectives :
1.To reduce peritonitis rate by PRP 2.To promote patient empowerment 3.To enhance patient safety
Methodology :
Two groups with high peritonitis rate (1. age >70; 2. age 50-70 with history of peritonitis at 2-4 years post PD training) were targeted. During the half-day PRP, participants were assessed on bag exchange technique, home environment, physical and social condition by renal nurses. Knowledge on PD and complications management was reinforced according to a pre-set template. Re-education and revision were provided to participants throughout the bag exchange procedure. For participants with home setting or personal ability problems, CNS or OT would be referred for home visit or cognitive and hand function re-assessment. An evaluation form was given and collected at the end of the program. All participants were monitored for outcome of peritonitis at 3-, 6- and 12-month post PRP.
Result & Outcome :
From Oct 2020 to Oct 2021, 46 patients were enrolled. Median age was 66-year-old (range, 51 - 82). Female to male ratio was 15:31. Majority (78.3%, n=36) performed self PD. Some participants (26.1%, n=12) had history of peritonitis. With the PRP, 84.8% patients were found to have problems in bag exchange procedure, 41.3% had home setting problem and 39.1% had personal ability problem. At 3-month evaluation, 40 patients (87%) remained peritonitis free. The return rate of the evaluation forms was 84.8%. Majority (95.7%) rated ≥ 4 /5 for overall satisfaction rate. Over 80% of participants agreed to participate in PRP yearly. After PRP, participants’ awareness and knowledge on peritonitis were enhanced significantly (p<0.00001). The overall peritonitis rate was decreased from 0.4 episodes/patient-year in 2020 to 0.35 in 2021. The implementation of PRP was effective to reduce the overall peritonitis rate. Patient empowerment could improve safety and strengthen the capacity for self-disease management. Finally, the practice of PRP for yearly basis is highly recommended.
