O29
SUSTAINED IMPROVEMENT IN PD PERITONITIS RATES OVER 18 MONTHS
FOLLOWING COMPLETION OF A FORMAL QUALITY IMPROVEMENT
COLLABORATIVE PROJECT
S Youssouf, A Nache, A Carney, N Chappell, J Collier, L Crosby, H Hannay, A Hughes,
K Kirkwood, A Knaggs, L Lappin, A Macguffie, J Martin, C Teal, J Hegarty, D Lewis
Department of Renal Medicine
Salford Royal NHS Foundation Trust
INTRODUCTION: Peritonitis is a leading cause of treatment failure, hospitalisation,
morbidity and mortality in a peritoneal dialysis (PD) population. Our network has a large
programme of 120 patients on PD and successfully completed a 1 year quality improvement
(QI) collaborative in April 2012, reducing our peritonitis rate from 1/14 patient months to
1/22 patient months. We report a sustained improvement in our peritonitis rate over 18
months since the end of the formal collaborative project.
METHODS: Following detailed analysis of peritonitis data to better understand the causes
of peritonitis in our patients, we used a modified Institute for Healthcare Improvement
Breakthrough Series Collaborative methodology to allow frontline staff to develop and test
ideas using Plan-Do-Study-Act (PDSA) cycles and implement successful changes. Support
was provided during the collaborative project with weekly meetings with a QI facilitator and
regular learning sessions. A change package was designed to help sustain improvements after
the end of the project. No further formal QI support was invested after the 12 month
improvement period.
RESULTS: Several changes introduced during the collaborative were maintained after the
formal end of the project. These included continuous audit and tracking of peritonitis rates,
competency-based training and assessment, and a system to identify multiple peritonitis.
There were some changes that were not maintained, partly reflecting changes in staffing and
in the shape of the PD team over time. Despite this, the improvement in our peritonitis rate
was sustained, averaging 1/27 patient months by September 2013.
1-year pre
intervention
Peritonitis- per patientmonths
Episodes per year at risk
13.7
During
intervention
year
21.8
During 18
months after
end of
intervention
period
27.4
P Value
<0.01
0.88
0.55
0.44
DISCUSSION: International quality improvement initiatives have demonstrated both
sustained improvement and improvement ‘decay’ after the initiative has ended. Whilst not all
changes were maintained consistently at all times, the majority of changes in this peritonitis
reduction programme were quickly embedded into usual clinical practice. More importantly
we believe a culture shift has occurred in our thinking regarding peritonitis reflecting
avoidable harm. We demonstrate a clear and sustained improvement in our peritonitis rates
beyond a formal QI programme; this shows how allowing frontline teams to lead decisionmaking about changes to improve patient care results in improvements in hard outcomes.