To Explore the Application of PDCA in Hemodialysis Center and Its Effect on the Maintenance of Internal Fistula

Abstract

Background. The survey found that in recent years, with the incidence of chronic kidney disease (CKD) increasing, some patients with CKD even progressed to end-stage renal disease. Luckily, progressive hemodialysis technology and nursing level can improve the quality of life and prognosis of patients. Objective. To explore the application of plan-do-check-adjust (PDCA) cycle in the management of nurses in hemodialysis center and its effect on the maintenance of internal fistula in patients. Methods. In this study, a randomized controlled trail (RCT) was used to select 90 patients who underwent maintenance hemodialysis in the hemodialysis center of our hospital from January 2018 to June 2021 as objects. They were divided into a PDCA group (with PDCA nursing management) and routine group (with routine nursing management) by random number table with each of 45 cases for 6 months to compare the differences of the internal fistula complications, internal fistula maintenance quality, patients’ microinflammatory state, and satisfaction with nursing, as well as nursing staff’s operational and theoretical performance between the two groups. Results. There was no significant difference in CRP, IL-1, TNF-α, and IL-6 levels between the two groups before intervention ( $P>0.05$ ); after that, these levels in the PDCA group were lower than those in the routine group, with statistically significant difference ( $P<0.05$ ); before intervention, there was no statistically significant difference in the qualification rate of blood flow, the awareness rate of health education, and the incidence of nursing defects between the two groups ( $P>0.05$ ); after that, the qualification rate of blood flow and the awareness rate of health education among nurses in PDCA group were higher than those in routine group, while the incidence of nursing defect accidents in the PDCA group was lower than that in routine group, and the differences were statistically significant ( $P<0.05$ ); before intervention, there was no significant difference in the complication rate between the two groups ( $P>0.05$ ); after that, the complication rate of the PDCA group was lower than that of the routine group, and the differences were statistically significant ( $P<0.05$ ); after intervention, the theoretical assessment and practical skills assessment scores of the PDCA group were higher than those of the routine group, and the differences were statistically significant ( $P<0.05$ ); after intervention, the nursing satisfaction of the PDCA group was higher than that of the routine group, and the differences were statistically significant ( $P<0.05$ ). Conclusion. The application of PDCA approach in the management of nurses in hemodialysis centers can effectively improve the quality of internal fistula management and improve the practical and theoretical level of nurses, as well as reduce the microinflammation of patients.