ABSTRACT
Peer review is used increasingly in the NHS as a form of evaluation between professionals, services and organisations, and as a way of offering participants a snapshot assessment of particular health services or at points in a clinical pathway. The model outlined in this article has been developed as an aide-memoire to clinical commissioning groups, provider organisations and clinical staff for the process of gathering evidence of good assurance and governance arrangements.
Subject(s)
Benchmarking/methods , Child Welfare , Peer Review, Health Care/methods , Child , Data Collection/methods , England , Humans , Models, OrganizationalABSTRACT
The proportion of patients starting renal replacement therapy who are elderly, dependent and have multiple co-morbidities is the fastest growing chronic kidney disease (CKD) population in Canada. Most professional nephrology organizations recommend that hemodialysis patients should be encouraged to write advance directives (AD). Advance directives or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment and personal care. ACP discussions occur infrequently between the hemodialysis patient and the health care team. Failure to initiate ACP discussions is often due to barriers such as comfort level, time constraints and lack of privacy. This paper reports the results of a small (n = 30) continuous quality improvement (CQI) initiative examining the effectiveness of developing and using a pamphlet to introduce the topic of AD with hemodialysis patients and their families. In this study, it was found that many hemodialysis patients have thought about cardiopulmonary resuscitation (46.6%), mechanical ventilation (63.3%) and withdrawal of dialysis (56.6%). The majority of hemodialysis patients (70%) found that a pamphlet is helpful to introduce the topic of AD. As a consequence of this CQI initiative, our renal program has further revised the pamphlet and is beginning to incorporate its use in patient care within the hemodialysis unit.
