Assessment of the quality indicators relating to structure of care can be achieved through review of department policies and case review. Is the departmental policy being followed? Are renal replacement therapy orders (prescriptions) clear and appropriate?
Many renal replacement therapy machines will save numerical data that can be interrogated by company representatives. This can provide average filter lifespan, downtime and delivered effluent dose for assessment against care process indicators with very little effort. Excessive downtime can be due to problems with venous catheters, anticoagulation, blood pump speed, fluid exchange rates and filter type. An iterative process of optimisation through plan-do-study-act cycles can improve each component and overall patient care.
Continuous surveillance of negative outcome measures can be achieved through incident reporting and investigation. Root cause analysis methodology with chronological details can often identify substandard care and contributory causes for events.5 A ‘five whys’ investigation can assist with identifying the modifiable underlying factors, which can be mapped on a Fishbone Kawasaki diagram.5
