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Nursing Quality Assurance Issues in CVVH - PowerPoint PPT Presentation

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Nursing Quality Assurance Issues in CVVH. Timothy L. Kudelka, RN, BSN Pediatric Dialysis Program C.S. Mott Children’s Hospital University of Michigan. What Is Quality?.

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Nursing Quality Assurance Issues in CVVH

Timothy L. Kudelka, RN, BSN

Pediatric Dialysis Program

C.S. Mott Children’s Hospital

University of Michigan

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What Is Quality?

The Institute of Medicine defines quality as the degree to which health services for individuals or populations achieve a desired outcome and is consistent with current professional knowledge.

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What is Quality Assurance?

  • A process for improvement.

  • To prevent and correct identified problems.

  • A multidisciplinary team working together to provide the highest quality health care by meeting or exceeding the expectations of the customers we serve.

  • To assure that procedures, methods, and systems have an effective impact and are cost effective.

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Existing Standards

  • Acute Dialysis Quality Initiative (

  • The Joint Commission on the Accreditation of Healthcare Organizations(JCAHO)

  • The Food and Drug Administration.

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Continuous Quality Improvement

Standards and guidelines are ways to improve quality on a large scale.

Continuous quality improvement (CQI) is a way to build standards and guidelines into daily practice.

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Continuous Quality Improvement

  • CQI has three main parts:

    • Quality planning

    • Quality control

    • Quality improvement

  • Tools used in CQI

    • (PDCA)Plan,Do,Check,Act

    • Priority rating scale

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Quality Planning

  • Involves planning processes and procedures to achieve desired outcomes, or goals for patients and staff.

  • All problems are seen as a chance for improvement.

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Quality Control

  • Checks to see that the goals are met.

  • In CRRT there are many aspects of care that are checked as part of quality control including:

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  • Monitoring electrolytes

  • Fluid status

  • Maintaining anticoagulation

  • Blood loss

  • Heat loss

  • Immobility

  • Accurate prescription

  • Access

  • Documentation

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Quality Improvement

  • If the desired goals are not met for each area, quality improvement is used to study how tasks are done and how to improve them.

  • When a problem is identified, an on going cycle of improvement begins.

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P - Plan

D - Do

C - Check

A - Act

Method or Tool





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  • Collection of information or data

  • Design or redesign policies, procedures services or products

  • Specify objectives or degree of improvement.





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  • Deliver care, perform policy or procedure in limited trial run

  • Doa pilot test of the plan to see how it works.





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  • The third step is to Checkto see if the plan works.

  • Obtain judgments of improvement and determine if solution or change has been successful.





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  • CQI is a continuous full circle.

  • Implement solutions, change, modify tests, revise standards.

  • (develop standards) and incorporate revision in to day-to-day practices.

  • Communicate.





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A Powerful Quality Tool






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The Opportunity

  • The CQI approach is versatile and can be applied to any problem for which data can be collected.

  • Nursing should be and usually is the lead in coordinating a CQI team.

  • CQI is the perfect tool to address troubleshooting issues in CVVH.

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  • Prevent and correct identified problems.

  • Assure patient care is of the highest quality, meeting community, national and international standards.

  • Engage and organize individuals closest to the work process to improve.

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  • To assure that procedures, methods, and systems are cost effective.

  • Performance standards designated by regulatory and accrediting agencies are consistently met.

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  • To assure that patient care, practice and professional performance are regularly, validly and reliably evaluated.

  • Performance results are tracked by a valid measurement tool.

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Thanks to:

Dr. Timothy E. Bunchman MD

Dr. Patrick D. Brophy MD

University of Michigan Pediatric Dialysis Team.

Pediatric Critical Care Nursing.

My wife.