Renal clinic quality improvement education initiative

ABSTRACT

Background: Benefits of timely CKD modality education include increased knowledge and home dialysis. At our centre, attendance of scheduled CKD 4/5 patients to education sessions was low. This quality improvement study was initiated and aims to increase the prevalent percentage of CKD 4/5 patients who received CKD modality education from 40% to 55% over one year. Methods: Outcome measure was prevalent weekly percentage of CKD 4/5 patients who completed education. Process measures were 1) weekly percentage of scheduled patient education attendance and 2) weekly number of incident CKD 4/5 patient education referrals by nephrologists. Ishikawa diagram was utilized to determine system gaps and develop changes to test in plan-do-study-act (PDSA) cycles. Changes tested were a) NPs tracking weekly class attendance, b) NP reminder calls, c) information letter mailed to patients, d) referral data presented to nephrologists, e) reminder emails to nephrologists on education eligible patients. Discussion with primary care colleagues and 5-whys tool resulted in developing an information webpage for patient education including NPs' zoom recorded sessions. Median outcome and processes were calculated and plotted on run charts. Results: Prevalent percentage of CKD 4/5 patients educated decreased from 40.6% to 29.4%. All referred patients have not yet been educated due to COVID19 and number of new patients increased over time. Median weekly session attendance increased from 60-67% with PDSA cycles a-c (Figure 1). Monthly incident education referral number increased from 5-18/month. Conclusions: Weekly session attendance and incident education referrals increased. Prevalent percent patients educated deceased but number of incident referrals increased. To provide a virtual information option for patients with barriers to attending sessions and for use during COVD19 pandemic, the webpage described is a helpful resource developed as a result this project. We anticipate this tool will increase the outcome and both process measures over time.