Feb2017 Qa.docx

Quality Assurance Form Month: FEBRUARY 2017 Branch: URDANETA

Prepared by: RACHEL CALDITO FLORIDO CARL JOSEPH DELA CRUZ

NUMBER OF PATIENTS DIALYZED: New Old Transient Total for the month On 3x a week On 2x a week On 1x a week

NUMBER OF TREATMENTS Total for Current Month

1|Page

5 91 1 97 17 78 2

Number of Treatments

Emergency

0

Maintenance

731

Admitted

1

Total for Previous Month

Number of Treatments

Emergency

0

Maintenance

769

Admitted

4

COMPLICATIONS RELATED TO HEMODIALYSIS PROCEDURE Complications Hypertension

2|Page

No. Of Affected Patient 29

No. Of Episodes

Cause / Etiology Per Patient

4



3



5



6



5



2



3



1



11



7



3



3



1



4



2



3 4

 

1



4



Abecilla, Abraham – Volume Related Bajar, Rosalina – Uncontrolled Hypertension, Volume Related Balaba, Purificacion – Uncontrolled Hypertension Bruno, Armando – Uncontrolled Hypertension Bustillo, Norie – Volume Related Calub, Perlita – Uncontrolled Hypertension Carlos, Noriel – Uncontrolled Hypertension, Volume Related Casilang, Marlene – Volume Related Dela Cruz, Amelia – Uncontrolled Hypertension, Volume – Related Fructuoso, Rey – Volume Related Godoy, Lerma – Non Compliant To Medication Ibus, Benjamin – Uncontrolled Hypertension Jovelo, Merlita – Volume Related Joves, Soledad – Volume Related, Uncontrolled Hypertension Leal, Roselyn – Volume Related Murillo, Luis – Volume Related Navora, Mercy – Volume Related Ortega, Francisco – Volume Related Pagala, Marwin – Uncontrolled Hypertension, Volume Related

Hypotension

3



3



2



5



4



1



1



6



12



8



1

 Agustin, Lily Mar – Volume Related  Bajit, Neresia – Volume Related  Balberdi, Alfredo – Volume Related  Cabutotan, Isabel – Volume Related  Cabutotan, Rolando – Volume Related  Castulo, Noralie – Volume Related  Descargar, Virginia – Volume Related  Elimino, Alma – Volume Related  Fernando, Felicidad – Volume Related  Lactam, Olive Grace – Volume Related

18

1 1 1 2 1 1 1 1 1

3|Page

Pascua, Reynaldo- Volume Related Quine, Imelda – Uncontrolled Hypertension Quinto, Tom – Tom – Volume Related Rasca, Romeo - Volume Related,Uncontrolled Hypertension Remolleno, Rocel – Uncontrolled Hypertension, Volume Related Rilloma, Victor – Uncontrolled Hypertension Salvador, Elizabeth – Uncontrolled Hypertension Soria, Justino – Volume Related Tolosa, David Jones – Non Compliant To Medication, Uncontrolled Hypertension Vitug, William – Volume Related

Muscle Cramps

4|Page

1



4



2



1



12



1



1



1



1



1



1



1



1



1



1



1



1



1



1



1



1



1



Leal, Roselyn – Volume Related Lumanas, Marcelina – Volume Related Ocang, Virginia – Volume Related Ortega, Francisco – Volume Related Ramirez, Millie – Volume Related Soriano, Silverio – Volume Related Tacbas, Romeo – Volume Related Vitug, William – Volume Related

21 Agustin, Lily May – Volume Related Ancheta, Rolando - Volume Related Bajar, Rosalina – Volume Related Cabutotan, Isabel – Volume Related Cabutotan, Rolando – Volume Related Casilang, Marlene – Volume Related Decano, Arlene – Volume Related Descargar, Virginia – Volume Related Elimino, Alma – Volume Related Francisco, Dalebert – Volume Related Jovelo, Merlita – Volume Related Lactam, Olive Grace – Volume Related Leal, Roselyn – Volume Related Leonin, Jaime – Volume Related

Tinnitus Chest Pain/ Difficulty Of Breathing

Fever & Chills



2



3



2



1



1



1



1



Decano, Arlene - Hypotension

1



Joves, Soledad – Congestion

1



1 1 1

  

1



Lumanas, Marcelina – Congestion Manzano, Jude – Tachycardia Navora, Mercy – Congestion Quinto, Tom – Tom – Congestion Ramirez, Millie – High UF Goal, Heart Problem

2



1



3



1



1



1



Cabutotan, Isabel – Volume Related

1



Balaba, Purificacion – Hypertension

Ocang, Virginia – Volume Related Pascua, Reynaldo – Volume Related Quinto, Tom – Tom – Volume Related Remolleno, Rocel – Volume Related Salvador, Elizabeth – Volume Related Talon, Sergio – Volume Related Tolosa, David Jones – Volume Related

1 6

5

Nausea & Vomitting

1

Headache

4

5|Page

1

Berquid, Esther – Catheter Related Carlos, Noriel – Catheter Related Lumanas, Marcelina – Ongoing Infection Merete, Jon – Jon – Catheter Related Pagala, Marwin – Ongoing Infection

Access

1



1



2



Casilang, Marlene – Hypertension Dela Cruz, Amelia – Hypertension Fructuoso, Rey – Hypertension

NUMBER OF PATIENTS WITH PERMANENT ACCESS Number of Cause of INTERVENTION patient Failure De – Revision Insertion clotting of temp. of temp. of temp access access access

AV FISTULA AV GRAFT PERM CATH

Access

Intrajugular Permcath Femoral Total

83

-

-

-

-

-

1

-

-

-

-

-

0

-

-

-

-

-

NUMBER OF PATIENTS WITH TEMPORARY ACCESS Number of Cause of INTERVENTION patient Failure De – Revision Insertion clotting of temp. of temp. of temp access access access 4 0 9 13 -

CATHETER RELATED INFECTION Access type w/o culture w/ culture Culture(+) Culture (-) Temporary Permanent Total HEPATITIS PROFILE Reactive 5

HBsAg Anti-HBs *58 Patients – No Anti-HBs test 6|Page

Type of Patient

20

Type of Patient

-

Treatment -

Non- Reactive 92 19

Anti- HCV *24 Patients – No Anti-HCV 0 test  Anti – HBS - NR patient with ongoing Hepatitis vaccination – 9

Hepatitis B Hepatitis C Hepatitis B and C Total

Old patients

New Patients

5 5

0

73

Old pxsseroconversion 0

 Mortality for the Month – 1  Number of Hospitalizations – 1 Patients Anemia  Patients with Latest CBC – 28  Patient without Latest CBC – 69 Hemoglobin New Old level patient patient Hgb <7g/dl 0 1 Hgb 7.0 – 0 1 7.9g/dl Hgb 8.0 – 0 5 8.9g/dl Hgb 9.0 – 1 2 9.9g/dl

EPO – compliant 0

On IV iron 1

Blood Transfusion 1

0

1

0

2

5

1

1

2

0

Hgb 10.0 – 2 6 2 7 10.9g/dl Hgb ≥11g/dl 0 10 2 0 Patients on EPO – 96 Patients Patients Compliant on EPO – 7 Patients Patients Compliant on EPO but Without Latest CBC – 12 Patients Patients on IV Iron – 91 Patients Patients on IV Iron but Without Latest CBC – 46 Patients Patients with BT without Latest CBC – 2 Patients

0 0

Anemic Patients with Iron Studies - 0 NUMBER OF PATIENT NAME OF PATIENT

7|Page

TSat< 25%

0

-

TSat> 25%

0

-

 Number of patients with Iron studies – 0 Patient

Electrolyte Imbalance

ELECTROLYTES Etiology

No. of Cases

PATIENTS WITH SERUM SODIUM TEST = 10 PATIENTS



 HYPERNATREMIA

1 

Intervention

Increase intake of  food that is high in sodium Decrease hydration due to fluid restriction Severe  hyperglycemia













8|Page

Check for cardiovascular manifestations like cardiac dysrhythmia, hypertension, jugular vein distention, weight gain and edema. Check for neurologic status including level of consciousness, muscle twitching, tremor, seizure episodes and paralysis. Check for respiratory signs and symptoms like crackles, pleural effusion and edema. For patients with severe hypernatremia, encourage hospitalization for treatment. Help the patient plan meals to avoid consumption of high – sodium food items. Discuss with patients on how they could limit their fluid intake without compromising their renal status. Encourage for monthly blood chemistry tests to monitor hematologic status of the patient. Instruct the patient to report to their physicians any untoward signs and symptoms that persists for more than 24 hours.

HYPONATREMIA

2



Fluid overload













PATIENTS WITH SERUM POTASSIUM TEST = 19 PATIENTS HYPERKALEMIA



3

 

9|Page

Excessive dietary intake of potassium-rich foods Missed dialysis treatments Metabolic acidosis

Restrict fluid intake to allow the sodium to regain balance. Sodium replacement is required for patients with 125 mEq/L or less sodium level. Check for neurologic manifestations like confusion, hallucination, behavioral changes and seizure. Check for cardiovascular symptoms like orthostatic hypotension, weak, thread pulse and systolic and diastolic decrease in blood pressure for hypovolemic hyponatremia. For hypervolemic hyponatremia, look for elevated blood pressure and full, rapid pulse. Assess for gastrointestinal manifestations like nausea, vomiting, abdominal cramping and diarrhea. Instruct the client to consult their physician before taking over – the – counter and herbal medications.  Limit potassium rich foods  Encourage adequate dialysis  Collaborate to search root cause of hyperkalemia

HYPOKALEMIA

2

 

 

PATIENTS WITH SERUM CALCIUM TEST = 9 PATIENTS

HYPERCALCEMIA

 

5

  

10 | P a g e

Inadequate intake  of potassium Patients on  potassium – wasting diuretics Increased sodium intake  Insulin use

Do ECG studies for the patient. Monitor for anorexia, abdominal distention and constipation; muscle weakness and leg cramps. Educate the patients regarding food items that are rich in potassium in accordance to their health condition.  Review with the patient the alternative ways of cooking vegetables to promote nutrition retention.  Oral potassium replacement therapy is recommended for patients with 3.3 – 3.5 mEq/L potassium level. Remind the patient to take the medication with a glass of water.  Patients with less than 3.3 mEq/L is required to undergo IV potassium replacement. Prolonged  Encourage mobilization of immobilization the patient. Excessive vitamin D  Assess for renal stones or calcium tablet and renal function. Check intake for gastrointestinal and neuromuscular Intake of calcium – manifestations. containing antacids Hypophosphatemia  Watch of for ECG changes and cardiac arrest. Metabolic acidosis  Administer furosemide diluted in normal saline for severe and moderate hypercalcemia.  Use low calcium concentrate





HYPOCALCEMIA

1



    

Inadequate dietary  intake of calcium and Vitamin D Parathyroid disorders Decreased exposure to the sun  Increased serum sodium level Alkalosis Patient on repeated  blood transfusion 







PATIENTS WITH SERUM PHOSPHATE TEST = 10 PATIENTS

HYPERPHOSPATHEMIA

 

9

 

HYPOPHOSPHATEMIA 11 | P a g e

Intake of soda and  dairy products Inadequate dialysis

Excessive prolonged antacids

and  use of

Avoid calcium containing or vitamin D containing medicines. Increase intake of food that increase urine acidity for patient with renal stones. Check for neuromuscular hyper excitability as manifested by numbness and tingling of the hands, toes and lips and emotional lability. Assess for cardiac palpitation and restlessness. Perform ECG to check for dysrhythmia. Educate the patient about foods rich in calcium. Encourage adherence to oral replacement of calcium and Vitamin D. Instruct the patient to expose face and arms to the sun for several minutes each week. Teach the patients to reduce the intake of protein – rich and phosphate – rich food items. Encourage fresh blood instead of preserved ones for blood transfusion. Avoid foods high phosphorus and avoid excessive use of phosphorus containing laxatives and enema Take phosphate binders Educate the regarding

patient dietary

 

 Ca X Ph.>55

0



Increased serum sodium and calcium Decrease intake of  food rich in phosphorus High calcium,  phosphorus or both Vitamin D therapy  

TOTAL

management of hypophosphatemia. Assess for skeletal manifestations and increased cardiac and respiratory functions. Use of calcium containing phosphorus binders (Sevelamer) is mandatory when giving calcitriol. Monitor phosphorus and calcium level. Educate the patient regarding the limit of intake of calcium and phosphorus – rich food.

23

Dialysis Adequacy No. of patients 49

Kt/V <1.4

Etiology Inadequate dialysis

NUTRITIONAL STATUS BMI between 20-25

27

BMI <20

51

BMI > 25

16

WATER ANALYSIS Date of Analysis: Result of Analysis:

12 | P a g e

February 2017 Total Coliforms – <1.1 MPN/100ml Fecal Coliforms – <1.1 MPN/100ml Heterotrophic Plate count – 30 CFU/ml

CAUSE of DELAY in DIALYSIS INITIATION Nature of Delay No. of cases Patient Tardiness

3

Unavailability/Lack of staff

0

Difficulty in cannulation

0

Problems with catheter access

1

Delays in obtaining/cross matching of blood products

0

Unstable patients

0

Pending diagnostic tests

0

Others

0

Total

4

 

Technical Problems Dialyzer Re – Use Summary

Patients with Perm Catheter Access – 0

Patients in Temporary Access – 8  Agpawa, Amando  Balberdi, Alfrfedo  Berquid, Esther  Cajas, Allan  Cabutotan, Isabel  Carlos, Noriel  Dela Cruz, Amelia  Dulay, Pedro  Gulla, Samuel  Joves, Soledad  Merete, Jon – Jon  Rivera, Nellie  Rosario, Jenny Boy

13 | P a g e

Prepared by:

FLORIDO CARL JOSEPH DELA CUZ RACHEL O. CALDITO Junior Nurse II

CHECKED BY:

TRISTAN C. DELA CRUZ, RN, CNN, CCN

Nurse Manager

14 | P a g e

REVIEWED BY:

DR. MICHAEL V. FERNANDEZ

Medical Director