Automating the Renal Dialysis Unit at King Saud University benefiting clinicians and patients
The Renal Dialysis Unit (RDU) at King Khalid University Hospital - part of King Saud University (KSU) in the Kingdom of Saudi Arabia - was established more than three decades ago and now has 30 hemodialysis (HD) machines, alongside 10 mobile units for inpatients.
Much of the time, dialysis is carried out as an outpatient, taking over four hours, three times a week and on a fixed schedule.
Challenges
With the HD process taking so long, time management and efficiency are key to ensure that both staff and equipment are used optimally.
The high throughput of patients increases the risk of blood stream and other infections affecting overall patient health.
Much of the time, these infections can be treated as an outpatient during HD sessions over a two-week period, but prevention is ultimately better than cure.
KSU has the added challenge of the RDU not being covered by the hospital’s wider paperless system. The lack of coordination with the electronic health record, known as eSiHi, makes communication with the lab and pharmacy difficult.
Fixing the issues
To overcome the challenges, RDU workflows were built using PowerPlan ®, as well as other tools that were available on eSiHi.
Given the need for flexibility to alter prescriptions and administered medications, Multiphase PowerPlan - multiple HD sessions in one PowerPlan - was created. Each session is a phase that can be initiated and completed on its own while also linked to the other HD sessions.
When a modification is implemented to one phase it can be copied to the following phases, or otherwise specified. A typical chronic and stable HD patient will spend a couple of months on the same prescription unless a new change appears in the lab profile. For this reason, it was built for 30 continuous HD sessions.
On top of that, a new minimal intervention policy was introduced, which allows nurses to order simple tests without needing a physician. This gives the RDU the flexibility it needs without any liability.
The outcome
Through the new process, the RDU performed 13,919 HD sessions with no reports of interruption or lost treatments. All patients received their medication from the pharmacy and no lab requests were missed.
The multiphase element also reduces the ordering time for physicians. Single sessions could take 4-5 minutes to write previously, but now sets of 30 can be ordered in 5-7 minutes. Based on the fact that the RDU sees 100 patients a month, with each taking 12 sessions; the physician used to spend 6,000 minutes per month or 1,200 hours per year prior to the process update. After the process change, the order time saving amounted to an average of 1,000 hours per year.
Patient safety has also benefited from the new process with lab data interpretations becoming easier, resulting in all medication being combined in one place. Not only does this allow physicians to see what HD medication patients are on now, it also allows them to predict trends over time.
Clinicians can also better understand how many doses of IV antibiotics or iron are given over the course of each treatment, making it is easier to optimize the treatment plan of patients.