O24 RAPID SUSTAINABLE IMPROVEMENT TO PRE HAEMODIALYSIS BLOOD PRESSURE CARE BY USING QUALITY IMPROVEMENT METHOD Smith, K, Moss, M, McGee, Y, Latimer, S, Botham, H, Baker, M, Lappin, L, Nache, A, Hegarty, J Salford Haemodialysis Unit, Salford Royal Foundation Trust INTRODUCTION: Cardiovascular disease is the leading cause of death in haemodialysis patients, in which hypertension is one of the most common risk factors. The Dialysis Outcomes and Practice Patterns Study (DOPPS), has reported 73% prevalence of hypertension in European dialysis patients. There have been numerous studies looking at ways of controlling blood pressure in haemodialysis patient. Despite this, controlling blood pressure in the haemodialysis patient has proven difficult, reflected in yearly Renal Registry reports with wide variation in attainment of the RA standards across the UK. PURPOSE: We sought to rapidly improve our patient’s pre dialysis blood pressure results by implementing multifaceted changes using quality improvement methods. DESIGN: Our unit participated in a quality improvement collaborative using a modified Institute of Healthcare Improvement’s Breakthrough Series methodology. This method allows frontline multidisciplinary staff working in teams to learn from each other and share their experience of improvement. Our unit was given an aim to have 60% of our HD patients achieving pre dialysis blood pressure of 140/90 within one year. We identified best practice by reviewing the literature and by communicating with good performing units. Changes were tested using by multiple PDSA cycles to help us learn the best way to design and apply ideas into practice. Successful changes were compiled into a change package which can be copied elsewhere in our renal network. DISCUSSION & FINDINGS: Our unit has implemented 9 changes throughout the year: York blood pressure protocol, nurse rounding, dialysis observation sheet, daily goals, BP multidisciplinary review, working in same team, use of blood volume sensor, staff education on salt & fluid and patient education on salt & fluid. Implementation of these changes has rapidly improved pre-dialysis blood pressure control amongst our patients. At the beginning of the project, 33.1% of our patients met the pre-dialysis BP standard, whereas a year later, 61.2% of our patients had a pre-dialysis BP below 140/90. The improvement remains sustainable at 8 months post project with 59.3% of our patients were within the standard. Mean systolic Mean systolic P value Mean diastolic Mean diastolic P BP before BP post BP before BP post value intervention intervention intervention intervention Salford Renal 152 (SD 26.4) 130 (SD 0.001 82 (SD 17.4) 73.4 (SD 15.4) 0.003 Unit 23.5) Non-intervention 149 (SD 25.2) 146 (SD 0.434 78 (SD 17.5) 77 (SD 13.5) 0.918 unit 23.6) The improvement in blood pressure was not associated with an increase in symptomatic hypotensive events (5.1 pre v 5.3 post events per week, p=0.5). It is also associated with a 25% reduction in total BP medications (from 137 pre to 102 post). CONCLUSION: Rapid sustainable improvement to blood pressure is achievable using quality improvement methods. Quality improvement makes the frontline staff own the problem and use their know-how to find the best way to implement changes. The reduction of BP was not associated with more hypotensive episodes as frontline staff addressed the patient holistically by improving education, discontinuing medications and using appropriate technology.