Quality Assurance Form Prepared by:

Month: FEBRUARY 2017 RACHEL CALDITO

Branch: URDANETA FLORIDO CARL JOSEPH DELA CRUZ

NUMBER OF PATIENTS DIALYZED:

New 5
Old 91
Transient 1
Total for the month 97

On 3x a week 17
On 2x a week 78
On 1x a week 2

NUMBER OF TREATMENTS
Total for Current Number of
Month Treatments

Emergency 0

Maintenance 731

Admitted 1

Total for Previous Number of

Month Treatments

Emergency 0

Maintenance 769

Admitted 4

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 COMPLICATIONS RELATED TO HEMODIALYSIS PROCEDURE

No. Of
No. Of
Complications Affected Cause / Etiology Per Patient
Episodes
Patient
Hypertension 29
4  Abecilla, Abraham – Volume
Related
3  Bajar, Rosalina – Uncontrolled
Hypertension, Volume Related
5  Balaba, Purificacion –
Uncontrolled Hypertension
6  Bruno, Armando –
Uncontrolled Hypertension
5  Bustillo, Norie – Volume
Related
2  Calub, Perlita – Uncontrolled
Hypertension
3  Carlos, Noriel – Uncontrolled
Hypertension, Volume Related
1  Casilang, Marlene – Volume
Related
11  Dela Cruz, Amelia –
Uncontrolled Hypertension,
Volume – Related
7  Fructuoso, Rey – Volume
Related
3  Godoy, Lerma – Non Compliant
To Medication
3  Ibus, Benjamin – Uncontrolled
Hypertension
1  Jovelo, Merlita – Volume
Related
4  Joves, Soledad – Volume
Related, Uncontrolled
Hypertension
2  Leal, Roselyn – Volume
Related
3  Murillo, Luis – Volume Related
4  Navora, Mercy – Volume
Related
1  Ortega, Francisco – Volume
Related
4  Pagala, Marwin – Uncontrolled
Hypertension, Volume Related

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 3  Pascua, Reynaldo- Volume
Related
3  Quine, Imelda – Uncontrolled
Hypertension
2  Quinto, Tom – Tom – Volume
Related
5  Rasca, Romeo - Volume
Related,Uncontrolled
Hypertension
4  Remolleno, Rocel –
Uncontrolled Hypertension,
Volume Related
1  Rilloma, Victor – Uncontrolled
Hypertension
1  Salvador, Elizabeth –
Uncontrolled Hypertension
6  Soria, Justino – Volume
Related
12  Tolosa, David Jones – Non
Compliant To Medication,
Uncontrolled Hypertension
8  Vitug, William – Volume
Related
Hypotension 18
1  Agustin, Lily Mar – Volume
Related
1  Bajit, Neresia – Volume
Related
1  Balberdi, Alfredo – Volume
Related
1  Cabutotan, Isabel – Volume
Related
2  Cabutotan, Rolando – Volume
Related
1  Castulo, Noralie – Volume
Related
1  Descargar, Virginia – Volume
Related
1  Elimino, Alma – Volume
Related
1  Fernando, Felicidad – Volume
Related
1  Lactam, Olive Grace – Volume
Related

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 1  Leal, Roselyn – Volume
Related
4  Lumanas, Marcelina – Volume
Related
2  Ocang, Virginia – Volume
Related
1  Ortega, Francisco – Volume
Related
12  Ramirez, Millie – Volume
Related
1  Soriano, Silverio – Volume
Related
1  Tacbas, Romeo – Volume
Related
1  Vitug, William – Volume
Related
Muscle Cramps 21
1  Agustin, Lily May – Volume
Related
1  Ancheta, Rolando - Volume
Related
1  Bajar, Rosalina – Volume
Related
1  Cabutotan, Isabel – Volume
Related
1  Cabutotan, Rolando – Volume
Related
1  Casilang, Marlene – Volume
Related
1  Decano, Arlene – Volume
Related
1  Descargar, Virginia – Volume
Related
1  Elimino, Alma – Volume
Related
1  Francisco, Dalebert – Volume
Related
1  Jovelo, Merlita – Volume
Related
1  Lactam, Olive Grace – Volume
Related
1  Leal, Roselyn – Volume
Related
1  Leonin, Jaime – Volume
Related

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 1  Ocang, Virginia – Volume
Related
2  Pascua, Reynaldo – Volume
Related
3  Quinto, Tom – Tom – Volume
Related
2  Remolleno, Rocel – Volume
Related
1  Salvador, Elizabeth – Volume
Related
1  Talon, Sergio – Volume
Related
1  Tolosa, David Jones – Volume
Related
Tinnitus 1
1  Decano, Arlene - Hypotension
Chest Pain/ 6
Difficulty Of 1  Joves, Soledad – Congestion
Breathing
1  Lumanas, Marcelina –
Congestion
1  Manzano, Jude – Tachycardia
1  Navora, Mercy – Congestion
1  Quinto, Tom – Tom –
Congestion
1  Ramirez, Millie – High UF Goal,
Heart Problem
Fever & Chills 5
2  Berquid, Esther – Catheter
Related
1  Carlos, Noriel – Catheter
Related
3  Lumanas, Marcelina – Ongoing
Infection
1  Merete, Jon – Jon – Catheter
Related
1  Pagala, Marwin – Ongoing
Infection
Nausea & 1
Vomitting 1  Cabutotan, Isabel – Volume
Related
Headache 4
1  Balaba, Purificacion –
Hypertension

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 1  Casilang, Marlene –
Hypertension
1  Dela Cruz, Amelia –
Hypertension
2  Fructuoso, Rey – Hypertension

NUMBER OF PATIENTS WITH PERMANENT ACCESS

Number of Cause of Type of
Access INTERVENTION
patient Failure Patient
De –
Revision Insertion
clotting
of temp. of temp.
of temp
access access
access
AV
83 - - - - -
FISTULA
AV
1 - - - - -
GRAFT
PERM
0 - - - - -
CATH

NUMBER OF PATIENTS WITH TEMPORARY ACCESS

Number of Cause of Type of
Access INTERVENTION
patient Failure Patient
De –
Revision Insertion
clotting
of temp. of temp.
of temp
access access
access
Intrajugular 4 - - - - -
Permcath 0 - - - - -
Femoral 9 - - - - -
Total 13 - - - - -

CATHETER RELATED INFECTION

Access type w/o culture w/ culture Culture(+) Culture (-) Treatment
Temporary - - - - -
Permanent - - - - -
Total - - - - -

HEPATITIS PROFILE
Reactive Non- Reactive
HBsAg 5 92
Anti-HBs
20 19
*58 Patients – No Anti-HBs test

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 Anti- HCV
*24 Patients – No Anti-HCV 0 73
test
 Anti – HBS - NR patient with ongoing Hepatitis vaccination – 9

Old pxs-
Old patients New Patients
seroconversion
Hepatitis B 5 - -
Hepatitis C - - -
Hepatitis B and C - - -
Total 5 0 0

 Mortality for the Month – 1

 Number of Hospitalizations – 1 Patients

Anemia
 Patients with Latest CBC – 28
 Patient without Latest CBC – 69
Hemoglobin New Old EPO – On IV Blood
level patient patient compliant iron Transfusion
Hgb <7g/dl 0 1 0 1 1
Hgb 7.0 –
0 1 0 1 0
7.9g/dl
Hgb 8.0 –
0 5 2 5 1
8.9g/dl
Hgb 9.0 –
1 2 1 2 0
9.9g/dl
Hgb 10.0 –
2 6 2 7 0
10.9g/dl
Hgb ≥11g/dl 0 10 2 0 0
Patients on EPO – 96 Patients
Patients Compliant on EPO – 7 Patients
Patients Compliant on EPO but Without Latest CBC – 12 Patients
Patients on IV Iron – 91 Patients
Patients on IV Iron but Without Latest CBC – 46 Patients
Patients with BT without Latest CBC – 2 Patients

Anemic Patients with Iron Studies - 0

NUMBER OF PATIENT NAME OF PATIENT
TSat< 25% 0 -

TSat> 25% 0 -

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 Number of patients with Iron studies – 0 Patient

ELECTROLYTES
Electrolyte Imbalance No. of Etiology Intervention
Cases

PATIENTS WITH  Increase intake of  Check for cardiovascular

SERUM SODIUM TEST food that is high in manifestations like
= 10 PATIENTS sodium cardiac dysrhythmia,
 Decrease hydration hypertension, jugular
HYPERNATREMIA 1 due to fluid vein distention, weight
restriction gain and edema.
 Severe  Check for neurologic
hyperglycemia status including level of
consciousness, muscle
twitching, tremor, seizure
episodes and paralysis.
 Check for respiratory
signs and symptoms like
crackles, pleural effusion
and edema.
 For patients with severe
hypernatremia,
encourage
hospitalization for
treatment.
 Help the patient plan
meals to avoid
consumption of high –
sodium food items.
 Discuss with patients on
how they could limit their
fluid intake without
compromising their renal
status.
 Encourage for monthly
blood chemistry tests to
monitor hematologic
status of the patient.
 Instruct the patient to
report to their physicians
any untoward signs and
symptoms that persists
for more than 24 hours.

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HYPONATREMIA 2  Fluid overload  Restrict fluid intake to
allow the sodium to
regain balance.
 Sodium replacement is
required for patients with
125 mEq/L or less sodium
level.
 Check for neurologic
manifestations like
confusion, hallucination,
behavioral changes and
seizure.
 Check for cardiovascular
symptoms like
orthostatic hypotension,
weak, thread pulse and
systolic and diastolic
decrease in blood
pressure for hypovolemic
hyponatremia. For
hypervolemic
hyponatremia, look for
elevated blood pressure
and full, rapid pulse.
 Assess for
gastrointestinal
manifestations like
nausea, vomiting,
abdominal cramping and
diarrhea.
 Instruct the client to
consult their physician
before taking over – the –
counter and herbal
medications.
PATIENTS WITH  Excessive dietary  Limit potassium rich
SERUM POTASSIUM intake of foods
TEST = 19 PATIENTS potassium-rich  Encourage adequate
foods dialysis
HYPERKALEMIA 3  Missed dialysis  Collaborate to search
treatments root cause of
 Metabolic acidosis hyperkalemia

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 HYPOKALEMIA 2  Inadequate intake  Do ECG studies for the
of potassium patient.
 Patients on Monitor for anorexia,
potassium – abdominal distention and
wasting diuretics constipation; muscle
 Increased sodium weakness and leg
intake cramps.
 Insulin use Educate the patients
regarding food items that
are rich in potassium in
accordance to their
health condition.
 Review with the patient
the alternative ways of
cooking vegetables to
promote nutrition
retention.
 Oral potassium
replacement therapy is
recommended for
patients with 3.3 – 3.5
mEq/L potassium level.
Remind the patient to
take the medication with
a glass of water.
 Patients with less than
3.3 mEq/L is required to
undergo IV potassium
replacement.
PATIENTS WITH  Prolonged  Encourage mobilization of
SERUM CALCIUM TEST immobilization the patient.
= 9 PATIENTS  Excessive vitamin D  Assess for renal stones
or calcium tablet and renal function. Check
intake for gastrointestinal and
HYPERCALCEMIA 5  Intake of calcium – neuromuscular
containing antacids manifestations.
 Hypophosphatemia  Watch of for ECG changes
 Metabolic acidosis and cardiac arrest.
 Administer furosemide
diluted in normal saline
for severe and moderate
hypercalcemia.
 Use low calcium
concentrate

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  Avoid calcium containing
or vitamin D containing
medicines.
 Increase intake of food
that increase urine acidity
for patient with renal
stones.
HYPOCALCEMIA 1  Inadequate dietary  Check for neuromuscular
intake of calcium hyper excitability as
and Vitamin D manifested by numbness
 Parathyroid and tingling of the hands,
disorders toes and lips and
 Decreased emotional lability.
exposure to the sun  Assess for cardiac
 Increased serum palpitation and
sodium level restlessness. Perform
 Alkalosis ECG to check for
 Patient on repeated dysrhythmia.
blood transfusion  Educate the patient about
foods rich in calcium.
 Encourage adherence to
oral replacement of
calcium and Vitamin D.
 Instruct the patient to
expose face and arms to
the sun for several
minutes each week.
 Teach the patients to
reduce the intake of
protein – rich and
phosphate – rich food
items.
 Encourage fresh blood
instead of preserved ones
for blood transfusion.
PATIENTS WITH  Intake of soda and  Avoid foods high
SERUM PHOSPHATE dairy products phosphorus and avoid
TEST = 10 PATIENTS  Inadequate dialysis excessive use of
phosphorus containing
laxatives and enema
HYPERPHOSPATHEMIA 9  Take phosphate binders

 Excessive and  Educate the patient

HYPOPHOSPHATEMIA prolonged use of regarding dietary
antacids
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  Increased serum management of
sodium and calcium hypophosphatemia.
 Decrease intake of  Assess for skeletal
food rich in manifestations and
phosphorus increased cardiac and
respiratory functions.
 High calcium,  Use of calcium containing
phosphorus or both phosphorus binders
Ca X Ph.>55 0  Vitamin D therapy (Sevelamer) is mandatory
when giving calcitriol.
 Monitor phosphorus and
calcium level.
 Educate the patient
regarding the limit of
intake of calcium and
phosphorus – rich food.
TOTAL 23

Dialysis Adequacy
No. of patients Etiology
Kt/V <1.4 49 Inadequate dialysis

NUTRITIONAL STATUS
BMI between 20-25 27
BMI <20 51
BMI > 25 16

WATER ANALYSIS

Date of Analysis: February 2017

Result of Analysis: Total Coliforms – <1.1 MPN/100ml
Fecal Coliforms – <1.1 MPN/100ml
Heterotrophic Plate count – 30 CFU/ml

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 CAUSE of DELAY in DIALYSIS INITIATION
Nature of Delay No. of cases
Patient Tardiness 3
Unavailability/Lack of staff 0
Difficulty in cannulation 0
Problems with catheter access 1
Delays in obtaining/cross matching of
blood products 0

Unstable patients 0
Pending diagnostic tests 0
Others 0
Total 4

 Technical Problems
 Dialyzer Re – Use Summary

Patients with Perm Catheter Access – 0

Patients in Temporary Access – 8

 Agpawa, Amando
 Balberdi, Alfrfedo
 Berquid, Esther
 Cajas, Allan
 Cabutotan, Isabel
 Carlos, Noriel
 Dela Cruz, Amelia
 Dulay, Pedro
 Gulla, Samuel
 Joves, Soledad
 Merete, Jon – Jon
 Rivera, Nellie
 Rosario, Jenny Boy

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 Prepared by:

FLORIDO CARL JOSEPH DELA CUZ

RACHEL O. CALDITO

Junior Nurse II

CHECKED BY: REVIEWED BY:

TRISTAN C. DELA CRUZ, RN, CNN, CCN DR. MICHAEL V. FERNANDEZ

Nurse Manager Medical Director

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