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What Patients Need to Understand About Quality Assurance in the Dialysis Center
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By Deborah Flowers, RN, BSN Quality assurance and continuous quality improvement (QA/CQI) are critical components in the hemodialysis (HD) center. Correctly implemented and managed, QA/CQI not only improves outcomes that have been established by the Centers for Medicare and Medicaid Services (CMS), the End-Stage Renal Disease (ESRD) Networks, and the individual dialysis companies, it also improves the quality of life for the HD patient. "Inadequate Use of the QA/CQI Tool" Dialysis center staff members often consider this QA/CQI process simply a reporting device, not a data-based tool that should be examined, utilized, and can potentially lead to process improvement. At times, dialysis centers not only lack a process for this very important task, the center staff often incorrectly interpret the data or do not gather the data at all. The problem of inadequate use of the QA/CQI tool should be important to every person involved in the life of a dialysis patient. This includes the nurse, physician (nephrologist), Chief Executive Officer (CEO) of the dialysis company, the general population (as taxpayers), the patient's family members, and the most important person of all, the dialysis patient him/herself. In order to help dialysis patients live to their optimal health levels, it is not only necessary, but imperative, that the dialysis company understand the direct balance between the QA/CQI process and the safety and quality of patient care! "A New Attitude" Dialysis companies and their staff need to take on a new attitude in relation to their quality improvement. In order for this new culture to be successful, there must be teamwork, leadership, and education. The other important factor in this is to empower certain individuals such as the staff member and the center Director. This new paradigm needs to blossom from the staff outward to the management. Each person in the dialysis center needs to "own" the charge of quality improvement. Review, Monitoring, and Evaluation Two items that should be addressed when discussing QA/CQI are: (1) What needs to be reviewed, monitored, and evaluated, and (2) Who will need to be reviewing those things. According to past surveys of dialysis centers and quality standards, the items that need to be reviewed are: Growth and capacity of the center; Patient mortality; Patient satisfaction; Patient services committee findings; Clinical standards and outcome goals such as adequacy of dialysis, nutrition, bone disease, anemia, blood pressure, serum sodium bicarbonate, vascular access, and patient treatment adherence; Hospitalization trends; Infection control; Adverse occurrence reporting; Physical systems review; Safety program review; Policy and procedures; Management; Audit tool review; Labor trends; and General discussion area.
Roles of the Staff Members The following people need to not only participate in the QA/CQI process, they also need to be empowered to "own" their particular areas. They must understand the importance of the program and how their thorough, consistent monitoring, evaluation, and follow-through will improve the life of the patient. Members of the QA/CQI team will need to assume the following roles: Medical Director; CEO of the center; Clinical coordinator (or charge nurse); QA/CQI coordinator; Anemia manager; Biomedical technician; Vascular access coordinator; Dietitian; Social worker; Safety/hazardous communication director; Reuse technician; Infection control coordinator; Training/in-service coordinator; Facility maintenance manager; and Peritoneal and home or acute dialysis representatives, if these programs are available in the facility.
Specific Accountability Tools The reporting of these areas will consist of each member of the QA/CQI team having an individual tool that is specific to their area of accountability. A simple example of this is in the bone management area. The bone management data will be reported during the QA/CQI meeting. The individual names of the patients will not be discussed at that time, however, due to patient confidentiality. But, in order for improvement to actually occur, during some venue, both the overall and individual patient data will need to be reviewed to determine why the goal is not being met, and a plan to implement how to achieve the goal will need to be established. Conclusion The quality assurance/continuous quality improvement program is not only very important in order to ensure that quality dialysis is being delivered to the hemodialysis patient, it is also an obligation that the dialysis community owes to the patient. The provider of this life-saving service must strive to improve the lives of the patient and ensure that the established goals are met. Even though there will be many man-hours required to develop, implement, train, and monitor for the success of the program, it is one program that must be in the forefront of the dialysis center from the President/CEO of the company to each staff member at the individual facility. Patients need to understand the QA/CQI program that is implemented in the center where they dialyze and how they fit into that program. They should feel free to ask questions about the overall quality of care that is provided by the dialysis staff. They have the right to know what the quality of care is they are receiving! About the Author Deborah Flowers, RN, BSN, is a Regional Quality Administrator for a dialysis provider. The dialysis company where she is employed understands and appreciates the importance of quality assurance/continuous quality improvement. Debbie is married with two grown children and lives in northern Kentucky.
Last Updated August 2007
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