Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Pediatr Nephrol. 2021 Oct;36(10):3191-3200. doi: 10.1007/s00467-021-05039-2. Epub 2021 Apr 2.
Decline in skills and knowledge among patients and/or caregivers contributes to peritoneal-dialysis (PD)-related peritonitis. Re-training is important, but no guidelines exist. We describe the implementation of a structured re-training program to decrease peritonitis rates.
This is a prospective quality improvement study involving pediatric patients on long-term home automated PD at National University Hospital, Singapore, between 2012 and 2018. With increasing peritonitis rates, systematic root cause analysis was performed, and based on the contributory factors identified, a structured re-training program was implemented from 2015. This was conducted in 5 cycles, each consisting of 4 modules (hand hygiene, exit site care, peritonitis, and PD troubleshooting).
Peritonitis rates were analyzed in 2 phases: Phase 1 (2012-2014) when no re-training was performed and Phase 2 (2016-2018) after re-training was instituted. Fifty-nine patients were included. Of these, 45 patients were in Phase 1, 32 in Phase 2, and 18 in both phases. Peritonitis rates decreased from 0.37 ± 0.67 episodes per patient-year in Phase 1 to 0.13 ± 0.32 episodes per patient-year in Phase 2. After adjusting for age at kidney failure onset, PD vintage, years of nursing experience, and the average patient-to-nurse ratio over the study period for each patient, the adjusted peritonitis rates decreased by 0.38 episodes per patient-year (95% CI, 0.09 to 0.67, p = 0.011) from Phase 1 to Phase 2.
Despite an improvement in staffing ratio, peritonitis rates only improved significantly after intensive structured re-training was instituted.
患者和/或护理人员技能和知识的下降导致腹膜透析（PD）相关腹膜炎。再培训很重要，但目前尚无相关指南。我们描述了实施结构化再培训计划以降低腹膜炎发生率的情况。
这是一项涉及新加坡国立大学医院 2012 年至 2018 年期间接受长期家庭自动化 PD 的儿科患者的前瞻性质量改进研究。随着腹膜炎发生率的上升，进行了系统的根本原因分析，并根据确定的促成因素，从 2015 年开始实施了结构化再培训计划。该计划分为 5 个周期，每个周期包括 4 个模块（手卫生、出口部位护理、腹膜炎和 PD 故障排除）。
分析了 2 个阶段的腹膜炎发生率：未进行再培训的第 1 阶段（2012-2014 年）和实施再培训后的第 2 阶段（2016-2018 年）。共纳入 59 例患者，其中 45 例患者处于第 1 阶段，32 例患者处于第 2 阶段，18 例患者同时处于两个阶段。腹膜炎发生率从第 1 阶段的每位患者每年 0.37 ± 0.67 次下降到第 2 阶段的每位患者每年 0.13 ± 0.32 次。调整每个患者在研究期间的肾衰竭发病年龄、PD 年限、护理经验年限以及每位患者的平均护士与患者比例后，第 1 阶段至第 2 阶段的调整后腹膜炎发生率下降了 0.38 次/患者/年（95%CI，0.09 至 0.67，p = 0.011）。
尽管人员配备比例有所改善，但在实施强化结构化再培训后，腹膜炎发生率才显著改善。
