No abstract

For 25 years, our institution specialising in the treatment of all stages chronic renal failure patients, treat 25% of its patients by peritoneal dialysis (PD), this allowing us to achieve quantitative regional goals. Peritonitis is one of the most common complications of PD. To improve the quality and safety of PD home treatment, our institution has since 2006 initiated a mortality and morbidity review in PD (MMR PD). We suggest to report on the benefits analysis observed in our practice after 3 years.Our institution MMR PD is part of our professional practices evaluation policy. The systemic analysis conducted at the MMR PD takes into account all interacting factors (organisational, technical and human) and go beyond the individual dimension. Its working rules and organisation are described in a written procedure and distributed to all involved professionals. This document specifies the MMR PD responsibility: PD referral physician, frequency of meetings: quarterly, the participating doctors and health executives, terms of case selection, conducting, monitoring improvement actions and their impacts.Over 3 years, 109 cases were analysed including 42 MMR PD for peritonitis. The research of problems encountered during the treatment of patients on PD or the answer to the question ‘how did this happen?’ conducted to the following conclusion: lack of traceability and analysis of systematic treatment problems encountered. This conclusion has helped to re-write and validate by involved professionals the peritonitis management protocol. Therefore the necessary element collection for root cause analysis has been implemented. Three large groups of peritonitis were quickly identified (95% of cases): hand carried peritonitisdigestive bacteria peritonitisrecurring peritonitis For each type of peritonitis, the causes search, the recovery analysis and the implementation of improvement actions have been completed: For hand carried peritonitisCreation a questionnaire to systematically evaluate the quality of patient handlingReassessment and early re-education of the patientChanging the autonomy treatment offer for the elderlyFor digestive bacteria peritonitis (80% are identify 48 h after diarrhoea, digestive disorders, impaction):Preventive treatment: patient education in disorders identification and eviction, antibiotic prophylaxis to be discussed.urative treatment by expanding the antibiotic spectrum for any peritonitis preceded by digestive disordersFor recurring peritonitis, after bibliography review, the most probable hypothesis is the biofilm infection around the dialysis catheter: it was decided to complete the treatment of peritonitis with intra-catheter TAUROLIDINE stasis. The MMR PD has significantly improved our PD home treatment: the peritonitis occurrence in our institution decreased from 1/26 months in 2007 to 1/39.75 months in 2009. Moreover, our results are well above the national average, in 2007 the peritonitis occurrence in France was of 1/33 months (source RDPLF). The MMR PD led to optimise an organisation that...