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National Kidney and Transplant Institute

East Avenue Quezon City

Philhealth Case Rate


is the New Sakto

(Decreasing the Incidence of PD


Patients being Admitted at ER due
to Missed and Inadequate PD)
Prepared by:
Israel S. Barlis, RN
Anna Armida E. Castro, RN
Ma. Lourdes P. Leuterio, RN
Mary Jane A. Magday, RN
Marilou T. Mercado, RN
Wilson A. Pelingen, RN
Vernalissa V. Relloso, RN

Peritoneal Dialysis Unit

Introduction
10 bed capacity (4 for service
patients and 6 for pay patients)
7 unit staff, 2 PD trainors and 2
CAPD coordinators
Headed by Ms. Rita Z. Blanco, RN,
CNN, MAN

Circle History

Team Bato

Word Abstract
CKD affects more than 10% of worlds
population.
The number of Filipinos suffering from
ESRD undergoing dialysis and kidney
transplant increases by 10-15% each
year. (DOH)
It has increased from 4,000 (2004) to
23,000 (2013).

Word Abstract
The best way to replace kidney
function though is to transplant
another kidney into the patient
through a surgical procedure.
On the other hand, renal replacement
therapy with adequate dialysis helps
replace sufficient kidney function for a
patient to survive.

Problem
Identification
The top three identified problems
were here as follows:
Incidence of PD patients being
admitted at the ER due to Missed
and Inadequate PD
Incidence of PD peritonitis.
Delayed Home Training

Problem
Identification

Problem
Identification

Figure 1: Incidence of patients that were admitted to ER due to Missed


and Inadequate dialysis from May to December 2013

Problem
Identification

Figure 2: Incidence of patients that were admitted to ER due to PD peritonitis


from May to December 2013

Problem
Identification

Problem
Identification

Problem
Identification
CONCLUSION
Based on the gathered data, the group
decided to prioritize the problem on the
Incidence of patients admitted to Emergency
Room due to Missed and Inadequate dialysis
because of its high prevalence and
importance patient care as well with high
feasibility and availability of tools to solve the
problem.

Understanding the Present


system

Figure 4: Process Map of


Acquisition of PD Solutions
during Discharge

Understanding the Present


system

Figure 5: Process Map PD Case rate

Understanding the Present


system

ROJECT SCOPE

INSCOPE:
PD Patients admitted at the ER due to
Inadequate or missed dialysis from May to
December 2015 and included in Philhealth
Case rate
OUTSCOPE:
Patients admitted who excluded in the
Philhealth Case rate and patients who are
having their case rate at other institutions.

Figure 5: Ishikawa diagram

Analysis of the Problem

Analysis of the
Problem

Table 3: Validation of Root causes

Analysis of the
Problem

Table 3: Validation of Root causes

Analysis of the
Problem

Analysis of the
Problem

Figure 6: Pareto Diagram

Analysis of the
Problem
FINAL OBJECTIVE STATEMENT
The unit circles objective is to reduce the
incidence of PD patients who are admitted in
the ER due to inadequate and missed PD from
35.07% to 10% by the end of September 2015.

Selection of Best Alternative


Solution

Criteria
A Appropriateness
B Feasibility
C Ease of implementation

Rating
(1) fair

(5) excellent

(3) good

Selection of Best Alternative


Solution

Criteria
A Appropriateness
B Feasibility
C Ease of implementation

Rating
(1) fair

(5) excellent

(3) good

Selection of Best Alternative


Solution

Criteria
A Appropriateness
B Feasibility
C Ease of implementation

Rating
(1) fair

(5) excellent

(3) good

Selection of Best Alternative


Solution

Criteria
A Appropriateness
B Feasibility
C Ease of implementation

Rating
(1) fair

(5) excellent

(3) good

Potential Problem
Analysis

Potential Problem
Analysis

Potential Problem
Analysis

Solution
Implementation

Solution
Implementation

Solution
Implementation

Solution
Implementation

Evaluation

Evaluation
2013

2014

2015

Evaluation

Evaluation
INTANGIBLE EFFECTS

Self Evaluation
From this quality improvement
activity, the following were achieved:
Reduction in the incidence of patients
being admitted at the ER due to
inadequate and missed dialysis.
Nursing staff in coordination with other
departments worked hand in hand to
attain the goal.

Future Planning
Create a team for home
visit.
Address the next problem
of priority (prevalence of
PD peritonitis).

References
Peritoneal Dialysis First: A Dialysis Policy for
the Philippines, Romina A. Danguilan, MD,
Glenda P. Pamugas, MD, Arlene Lamban, MD,
Leo Carlo Baloloy, MD, Rita Z. Blanco, RN,
2012
Philhealth circular 022-2015 Aug. 17, 2015
http://www.manilatimes.net/kidney-diseasephs-7th-leading-cause-of-death/77716/
http://www.abs-cbnnews.com/node/14995

Thank
You!

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