Authors (including presenting author) :
Lok WP(1), Chan SK(1), Cheung WY(1), Lee SW(1), Tsang KY(1), Wong KW(1)
Affiliation :
(1)Department of Medicine, Yan Chai Hospital
Introduction :
End stage renal failure (ESRF) was a global medical issue, inclusive Hong Kong. The incidence of treated ESRF in Hong Kong was progressively increased. Most of ESRF patients are on continuous ambulatory peritoneal dialysis (CAPD) treatment as Hong Kong practices “PD-first” policy (Leung, Cheung & Li, 2015). Thus, many ESRF patients require intermittent peritoneal dialysis (IPD) in hospital before their CAPD training.
In the past, IPD patients would admit to general medical wards in YCH and undergo the continuous cycling peritoneal dialysis (CCPD) by manual bag exchange for about 20-30 shifts hourly. This would cost a huge workload to not only nurses but also healthcare assistants. With the opening of the new renal ward in March 2019, a drainage system had been set up. IPD patients would undergo their treatment by using the APD machine and the closed drainage system, instead of manual bag exchange.
Objectives :
To improve the efficiency and safety of intermittent peritoneal dialysis:
Boost Work Efficiency
Enhance Occupational Safety and Health
Improve infection control
Prevention of infection
Methodology :
Prevention of infection
Peritonitis was the most common complications in PD patients. Most cases of PD-related peritonitis are the result of “touch contamination”. In IPD patients with the APD machine and the closed drainage system, the number of connections was only one time. Moreover, drainage of APD machine was a closed system that could improve the rate of infection.
Result & Outcome :
Boost Work Efficiency
In the past, the whole process was carried out by manual bag exchange. The procedures took around 10 minutes and repeated in each shift. The nursing time that spent in the whole IPD process in 20 cycles was 200 minutes. Now, the nursing time spent was significantly reduced from 200 minutes to 25 minutes.
Enhance Occupational Safety and Health
Each bag of PD fluid weight around 2.2kg. During manual bag exchange, nurses or healthcare assistants require repetitive upper and lower limbs motions, manual lifting and handling. Now, 20 cycles of manual lifting and handling of PD bag were totally avoided.
Improve infection control
During manual bag exchange, PD effluent should be disposed by pouring carefully into a sluice to prevent splashing. Now, by using the new drainage system, the PD fluid effluent would be directly drained in the sewer without splashing.
The APD machine with closed drainage system can improve the efficiency and safety of IPD patient care in the clinical setting. Firstly, the system boosts staff work efficiency because the workload on peritoneal dialysis is reduced. Secondly, it can enhance OSH by reducing the frequency of bag exchange and transport. Thirdly, it runs as a closed drainage system to prevent splashing of PD effluent and hence improve infection control. At last, the system minimizes the risks of infection by decreasing the frequency of peritoneal dialysis exchange procedures.
