将网站语言切换成:中文 LOGIN

Setting up an innovative follow-up system for patients on peritoneal dialysis by using the instant communication software

Setting up an innovative follow-up system for patients on peritoneal dialysis by using the instant communication software

The Identity of The Initiator: 
Participants Category: 
Topic category: 
Region / City: 
Problem Description: 
Continuous ambulatory peritoneal dialysis (CAPD) for Chronic kidney disease (CKD) was introduced to China and Fujian Provincial Hospital in the 1970’s.  However,  due  to the  limitation of  the  equipment,  supplies  and awareness,  it  was  not  until  recent  years  that  it  became  a  practical and widespread  treatment  for  CKD  patients  with  the  rapid  development  of disposable consumables  and  the  progress of economy. Fujian Provincial Hospital is one of the peritoneal dialysis training and demonstration center
accredited by  the  Ministry of  health.  Currently,  around 256  patients on peritoneal dialysis are being followed up by our center. Most PD patients get the treatment themselves at home. Therefore, It’s especially important that the patients work closely with their health care team: nephrologists, dia lysis nurse, dialysis technician and dietitian. However, due to the lack of effective platform for communication, patient’s education and follow-up, it could be very difficult to establish a reliable follow-up system for our PD patients, especially those patients from rural areas, resulting in a high rate of lost to follow-up, high incidence of complications and mobility, and low quality of
life for the PD patients in our center.  There are total 165 patients under PD in 2012, and  less  than 50% of them could  actually  receive  appropriate follow-up care.
 
By using the root cause analysis method, we found that the traditional model of follow- up for PD patients (including telephone, regular lectures and training, questionnaire etc.) was time-consuming, inefficient and lacking of peer education among the patients. For example, the average time for each
telephone follow- up is around 30 minutes. The PD nurses should spend more than 100 working hours to perform the telephone follow-up for all the 200 patients. There is also a lot of work to do to organize a training course for 30 PD patients.  Therefore, in this project, we aim to establish an innovative model for PD patients follow-up, namely  "kidney cleaning group", by using the popular instant messaging software QQ  group, through which we can perform the PD patients follow- up care in a more effective and efficient way.
Solution: 
1. Pre-survey: Before the implementation of the new model of follow-up, we performed a random sample survey among 50 patients. More than 90% patients agreed to build a platform for the communication between patient and patient, patient and medical staff.
 
2. The establishment of QQ group " Cleaning kidney in peritoneal dialysis patients ": The head nurse of the Renal Division will establish a QQ group and become the administrator. The head nurse will make working rules for QQ group follow- up. Medical staff will write down number of QQ group 
and telephone in a card. Patients on peritoneal dialysis will be invited to join this group. If the patient cannot use the computer or is in serious condition, we will invite their relatives or nursing worker responsible for PD to join.
 
3. The follow-up management of QQ group:
 
1.PD technical guidance group: The director of the Renal Department and one attending physician will be in charge for guidance. And the doctors of the division will be the volunteer who will login in QQ group for the patients and solve questions once a week. 
 
2.Follow- up management group: The head nurse and two specialized nurse will be responsible for making the training and follow-up plan. They will announce the follow- up information in a timely manner according to the follow-up plan, and organize activities related to health education in patients on peritoneal dialysis. If the patient is unable to participate in regular activities, the managers will timely upload the health education information, and communicate with the patient using the QQ video, dialogue, file upload etc. 
 
3.Management groups of peritoneal dialysis patients:The PD patients will be divided into 5 groups. One patient who has been on dialysis for more than two years and knows standard operation well with fewer complications will be responsible for one group. There will be five groups in total. The five patients who are responsible for the management of groups will participate in organizing the education, experience sharing, communicating with medical staff, and demand feedback etc.
 
4.The establishment of PD health education materials in the file library of QQ group . Medical staff will upload and update the PD health education materials, write "Peritoneal Dialysis Guide" and answer more than 100 questions may occur in the process of peritoneal dialysis. CAPD patients can study themselves at any time.
 
5. Encourage peer education with the help of QQ group among peritoneal dialysis patients. In the QQ group, patients may exchange their experience, small skills for PD emergency incidents, peer counseling etc.
 
6 . We will establish the record of the follow- up for peritoneal dialysis patients. We will record the follow- up status and promptly notify the patients to change transfer set tube, monitor liquid exchange technique and help to
observe complications etc.
Achievement: 
 
This project mainly evaluated from the following aspects. Patient satisfaction (%), exit rate (%), peritonitis (patient months /), PD total treatment time (months), regular replacement of transfer set tube rate (%), re education rate (%), treatment compliance (%) etc. Based on before and after the implementation of instant messaging software in peritoneal dialysis patients follow-up model, the changes of above indexes have be showed in the table below:

 

 

 

 

 

 

 

 

 

 

 

 

 

established  the

established  the

 

Project

new mode

new mode

 

 

before

after

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(n=165)

(n=165)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The satisfaction degree of

90

 

 

98

patients(%)

 

 

 

 

 

 

 

 

 

 

Exit rate(%)

40

 

 

38

The rate of peritonitis

28

 

 

39

(month / time)

 

 

 

 

 

 

 

 

 

 

PD treatment time(月)

24

 

 

33

The replacement of short

90

 

 

99

tube time rate(%)

 

 

 

 

 

 

 

 

 

 

Re education training rate

10

 

 

80

(%)

 

 

 

 

 

 

 

 

 

 

The compliance of

50

 

 

90

 

Photo: