RHC: Our Lady of Lourdes Medical Center

Contact: Chicki Aigner
Telephone: (609)757-3776

Urea Kinetic Modeling is the measurement of the production and removal of urea (BUN) in the renal patient. Adequate dialysis relates to the amount of BUN removed during the dialysis treatment. KT/V and URR are two methods used to determine this rate of removal. Research has shown that a KT/V value of 1.2 or greater or a URR of 65 % or greater results in reduced morbidity and mortality and a sense of general well being verbalized by patients.

Our computer clinical information system is dynamically linked to all of our dialysis areas by networking real-time. This program contains a Urea Kinetic Modeling program that calculates both KT/V and URR for each of our patients. This program allows us to easily measure the quality of the dialysis therapy we are providing to the patient. In addition, dialysis treatment information is captured and stored electronically.

Implementation
For new dialysis patients a theoretical modeling process is used by our computer system to determine the initial dialysis prescription that will achieve a KT/V of at least 1.4. On an ongoing basis, all of our patients are modeled each month. Based on the patient's result, dialysis prescriptions are adjusted to achieve a KT/V of 1.4 or greater and a URR of 65 % or greater. These adjustments to the treatment may involve changing the size or type of dialyzer, the blood flow rate, the patient treatment time or assessing their access. Because adequacy of dialysis directly relates to patient outcomes and quality of care it is one of the cornerstones of our Performance Improvement (PI) Program.

Time Frame
Monthly the PI Committee meets to review our results, discuss trends and develop plans for improvement. The continuous quality improvement method we use is the Plan, Do, Check, Act (PDCA) cycle. Our PI team is multidisciplinary, is physician driven and includes nurses, dietitians and social work. The percent of our dialysis patients who have achieved a URR of 65% or greater is measured and trended over time. For patients not meeting this parameter, data is collected by the nursing associates and analyzed to identify any trends.

Financial Profile
Implementation costs for this process was minimal due to utilization of existing staff and customized software development by our Medical Director.

Outcome
Over the years we have seen improvement in our outcomes and we have raised our benchmarks. At the first quarter of 1998 91% of our patients are achieving adequate dialysis with a URR of greater than 65 %.

KT/V is a computer based mathematical formula that considers the volume of the patient (patient parameter), the kinetics or clearance of a dialyzer and the amount of treatment time (treatment parameters) as well as the patient's BUN levels to produce a value. Two blood samples for BUN are needed and are taken before and after dialysis. A KT/V of 1.2 or greater is considered adequate dialysis.

Urea Reduction Ratio (URR) is a formula that uses the pre and post dialysis BUN to calculate a number that reflects the percentage of body urea removed during a dialysis treatment. A URR of 65 % or greater is considered adequate dialysis.

These standards are set by HCFA.

Best Practice Narrative is limited to a one page summary.
Supporting data is limited to one page.