Evaluation of professional practices in the management of anemia and nutrition in peritoneal dialysis patients: About a single-center experience

Abstract

Since the French law of March 4, 2004, healthcare professionals in both the medical and paramedical fields have been participating in developing the evaluation of professional practices (EPP). This initiative forms part of a broader ongoing effort to enhance medical practices.
The EPP is an essential tool for improving the quality of care and guaranteeing patient safety. This assessment can be individual or collective. It aims to target one or more themes to correct any discrepancies between the care provided to patients and a set of standards for care and management.
We have consistently carried out EPPs since 2012, mainly on anemia and nutrition in peritoneal dialysis patients. Through this work, we wish to demonstrate our interest in conducting EPPs in the follow-up of peritoneal dialysis patients.

Introduction

The evaluation of professional practices (EPP) in medicine is an approach aimed at improving medical practices and implementing corrective and/or preventive actions, following an analysis of current practices and any deviations from the guidelines established by the Haute Autorité de Santé (HAS)[1]in France and/or learned societies. This is a global approach, as highlighted by a recently published general review[2].

Anemia and undernutrition are present in a large number of peritoneal dialysis patients, which is why personalized monitoring is necessary to adapt treatments to each patient according to indicators and clinical status.

At the heart of our nursing profession and in collaboration with other healthcare professionals, we are committed to improving patient care by carrying out various EPPs.

Our aim is to demonstrate the role of EPPs in the management of anemia and nutrition in peritoneal dialysis patients through our experience in the peritoneal dialysis unit of our hospital center.

Materials and Methods

I-Description of the population

In our hospital center, two full-time nurses are currently in charge of 38 peritoneal dialysis patients.

Our geographical area extends over a peripheral radius of more than 60 kilometers around our hospital center, with a catchment area of more than 260,000 inhabitants.

Our active file includes 12 women and 26 men, with an average age of 72.9 years. The oldest patient is 92 years old and the youngest is 49 years old, with an average technical survival of 50.55 months and an average patient survival of 39.5 months.

A total of 32 patients are treated by continuous ambulatory peritoneal dialysis (CAPD) and 6 patients by automated peritoneal dialysis (APD).

In our CAPD population, we have seven patients on pure cardiac peritoneal dialysis (with a single dialysate bag/day).

II-Assessment of professional practices

II-1- Definition

Decree No. 2005-346 of April 14, 2005, on the EPP and Art. D. 4133-0-1 in France[2]state the following: “The aim of the evaluation of professional practices re-ferred to in Article L. 4133-1-1 is the continuous improvement of the quality of care and service provided to patients by health-care professionals. It aims to promote the quality, safety, effectiveness, and efficiency of care and prevention and, more generally, public health, in compliance with ethical rules. It consists in analyzing professional practice with reference to recommendations and accord-ing to a method developed or validated by the French National Authority for Health (HAS) and includes the implementation and monitoring of actions to im-prove practices.”

EPP criteria are defined by the HAS[1]and include the following:

- Assessment of real-life professional practices

- Comparison of professional practice with expected practice (based on recommendations)

- Implementation of improvement actions designed to bring actual prac-tice into line with the expected reference practice.

The criteria can be based on the recommendations of professional societies or developed in line with the establishment’s own quality objectives.

II-2- In practice

The EPP is a tool for measuring professional practices, enabling the analysis of care after the fact to improve the quality of care and guarantee patient safety.

In particular, professionals come together around a common theme and analyze patient outcomes in relation to professional recommendations or references.

The nurse carries out daily care, evaluating and adapting it. He then communicates it to the doctor for adaptation and modification to each patient’s specific needs.

The ways in which the EPP can be implemented are diverse and evolving, depending on the objectives and expectations of the medical team and the resources of the facility.

In our case, during our EPP staff meetings, which began in 2012, in collaboration with the doctor, the peritoneal dialysis nurses, and the dietician, we share management and therapeutic decisions together, ensuring consistency in patient follow-up and increasing the cohesion of the health-care team by sharing the same objectives and using the same resources.

We also print out in advance a monitoring table of the most important parameters that we have filled in (Table I).

Table I.Monitoring table of most important parameters

Patient's name :		Age :
First name :		Date 1st session		Heart
Date of birth :		Diabetic pathology : Y/N	Y/N
Evaluator name :
Evaluation date :
Parameters	Targets	BS 1st quarter 2024	BS 2nd quarter 2024	BS 3rd quarter 2024	BS 4th quarter 2024
Pds
Hb	10 à 12
Ferritin	> 500
CSS	> 20
Alb	> 35
CRP	< 5
Npcr/6 months	> 1,1
Body fat
Lean mass
Handgrip
Treatment	Treatment 2023	1st quarter 2024	2nd quarter 2024	3rd quarter 2024	4th quarter 2024
Iron PER OS
Iron IV
EPO
Dietetic actions

This table is regularly filled in by the nurses when monitoring patients.

The criteria and targets have been defined beforehand by the physician in charge of peritoneal dialysis patients, with reference to the recommendations established for this type of population.

We review each patient’s results with the doctor. An analysis of the patient’s biological results and clinical situation is then carried out, enabling corrective action to be taken or existing therapies to be adjusted. Our peritoneal dialysis patients undergo a blood test every three months for medical consultation and a day of hospitalization every six months (including a dietetic consultation).

A posteriori, we inform patients of the various changes made to their treatment, and if necessary call them in for a day of hospitalization. Changes are recorded in the patient’s file, together with a report of the meeting held. These are signed by

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