Clinical Initiatives

Achieving improved outcomes in fundamental clinical areas provides a foundation for the pursuit of quality. From there, tackling the more-complex clinical issues—such as fluid levels, medications, infections and diabetes—has been shown to improve primary outcomes, survival rate, patient experience and patient quality of life. 1The following clinical initiative pyramids were developed to serve as a framework for physicians to help better manage some of the most imperative complex clinical areas, and to help keep end stage renal disease (ESRD) patients healthy and out of the hospital.

Goal:

Reduce fluid-related hospitalizations, intradialytic complications and mortality while enhancing the patient experience.

Approach:

Develop fluid-related clinical care pathways to identify patients who are most at-risk for fluid-related hospitalizations. Build subsequent care processes—such as achieving target weight, obtaining accurate vitals, standardizing dialysate sodium, and restricting fluid and sodium intake—to reduce fluid overload.

Resources for Care Team Success:

Resources should include care team training, patient education materials, tools to improve weight accuracy, food diaries and fun activities or competitions that heighten patient and team engagement.

Supporting Research:

Goal:

Improve medication compliance rates, eliminate adverse interactions and reactions, and help keep patients healthy and out of the hospital.

Approach:

Provide medication management support, including targeted medication reviews and education, through a specialty renal pharmacy.

Resources for Care Team Success:

Resources should include care-team training, medication review kits, patient-education materials, mail-out review reminders and fun activities such as medication-awareness bingo.

Supporting Research:

Goal:

Address leading causes of infection, thereby decreasing infection-related hospitalizations and mortality.

Approach:

Reduce infections through prevention,surveillance and response initiatives.

Resources for Care Team Success:

Resources should include facility infection manager training and development, checklists, hand hygiene education, suspected bloodstream infection protocols, central venous catheter (CVC) care kit, personal protective equipment guidelines and organized infection-management goals—such as a competition to see which dialysis center can achieve the most-improved CVC rate.

Supporting Research:

Goal:

Help ESRD patients prevent avoidable complications from diabetes mellitus.

Approach:

Provide an opt-in diabetes management program that includes an annual eye exam, annual glucometer check and monthly foot exams.

Resources for Care Team Success:

Resources should include foot-check guides, patient education materials, care team education and center implementation protocols.

Supporting Research:

The implementation of these clinical initiatives can result in improved clinical outcomes such as these.

1Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm

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