Development of a national system of dialysis care standards and audit
In 2003 the New Zealand National Renal Advisory Board resolved to develop standards of practice and audit for all forms of renal care. A multidisciplinary working party was formed to address dialysis standards.
Methods: Renal units were consulted and other guidelines reviewed and modified for local use or standards developed guided by expert opinion. Recommendations and standards for access to dialysis services, haemodialysis (HD) adequacy, vascular access, peritoneal dialysis catheter survival and peritonitis were agreed. Standards were also established for water/dialysate and dialysis facilities. Where possible, data being collected for ANZDATA or the New Zealand PD Register were used for audit. An audit using data at 31 December 2004 from all units has been published.
Results: There was a substantial variation between units in initial and prevalent dialysis modality. In all but two units, the use of arteriovenous fistulae or grafts for incident (standard >50%) and prevalent (standard >70%) patients was below the standard. The high rates of catheter use in prevalent patients (standard <10%; mean 27.1%; range 4.2 – 50%) are a concern. Before starting PD, 21% (standard <20%; range 5 – 37%) of patients required HD using a catheter for =< 90 days. One year first PD catheter survival was excellent (standard >80%; mean 91%). Peritonitis rates varied considerably (mean 14.2; range 10.2 - 31 months/episode).
Conclusions: Considerable variation in practice between units is apparent. Audit of agreed standards and the sharing of these results with all units have the potential for improving the care of dialysis patients.