Content validation and development of a software for hemodialysis

This is a methodological study, which involved three stages: 1) survey of the theoretical framework for structuring content about clinical and quality indicators, relevant for registry in hemodialysis service and assessment of hemodialysis effectiveness; 2) content validation by judges; 3) software development. The methodology proposed by Pressman was used for its creation, which consists of five steps: communication, planning, modeling, construction, and implementation.

Results:

The software produced consists of 112 validated items, with the functionality of the system for registering and searching patients at the service, updating clinical and laboratory data as well as generating reports related to infections, vascular access implantation, adverse events, hospitalization and quality indicators.

Conclusion:

This study enabled the development of a software as a tool for compiling and organizing patient data on hemodialysis, with a view to generating information and knowledge that supports assessment and clinical decision making of nursing supported by critical judgment.

Keywords
Nursing informatics; Information systems; Software; Computer program validation; Nursing

Items for dialysis service registry		CVI
1. Number of patients undergoing conservative treatment during the month		1.00
2. Hemoglobin value of patients under conservative treatment		1.00
3. Phosphorus value of a patient under conservative treatment		1.00
4. Patients under conservative treatment referred for dialysis and with matured AVF		0.89
5. Patients under conservative treatment who abandoned treatment		0.89
6. Hospitalization of patients under conservative treatment due to clinical complications		1.00
7. Monthly number of patients on peritoneal dialysis		0.89
8. Tenckhoff catheter implantation		0.89
9. Changing the peritoneal dialysis catheter extension		0.89
10. Infection of tenckhoff catheter (signs/symptoms)		0.89
	10.1. Infection of tenckhoff catheter (access removed)	0.89
	10.2. Infection of tenckhoff catheter (laboratory tests collected)	0.89
	10.3. Infection of tenckhoff catheter (used antibiotic)	0.89
	10.4. Infection of tenckhoff catheter (result of peritoneal fluid culture/swab)	0.89
11. Peritonitis in patients with APD and CAPD		0.89
12. Hospitalization of patients on peritoneal dialysis due to clinical complications		0.89
13. Hemoglobin value in patients on peritoneal dialysis		0.89
14. Value of albumin in patients on peritoneal dialysis		0.89
15. Phosphorus value in patients on peritoneal dialysis		0.89
16. PTH value of patients on peritoneal dialysis		0.89
17. Death in patients on peritoneal dialysis		0.89
18. Patients eligible for transplant and older than 6 months on peritoneal dialysis, enrolled in the CNPDO		0.89
19. Number of patients with chronic kidney disease on dialysis		1.00
20. Number of patients with acute kidney disease on dialysis		1.00
21.Short-term central venous catheter implantation (local)		1.00
	21.1. Short-term central venous catheter implantation (reason)	1.00
	21.2. Short-term central venous catheter implantation (withdrawal date)	1.00
	21.3. Short-term central venous catheter implantation (length of use)	0.89
22. Long-term central venous catheter implantation (site, reason, date of withdrawal, length of use)		1.00
	22.1. Long-term central venous catheter implantation (reason)	1.00
	22.2. Long-term central venous catheter implantation (withdrawal date)	0.89
	22.3. Long-term central venous catheter implantation (length of use)	0.89
23. Preparation of AVF (site: brachy basic; brachiocephalic; femoral; radiocephalic; ulnar-basilic;). Manufacture of polytetrafluoroethylene (PTFE) prosthesis.		0.89
24. Short-term catheter infection/double lumen-CDL catheter (signs/symptoms)		1.00
	24.1. Short-term central venous catheter infection/double lumen-CDL catheter (access removed)	1.00
	24.2. Short-term central venous catheter infection/double lumen-CDL catheter (laboratory tests taken)	1.00
	24.3. Short-term central venous catheter infection/double lumen-CDL catheter (antibiotic used)	1.00
	24.4. Short-term central venous catheter infection/double lumen-CDL catheter (duration of antibiotic use)	1.00
	24.5. Short-term central venous catheter infection/double lumen-CDL catheter (culture result/swab)	1.00
25. Long-term central venous catheter infection/Permicath^® (signs/symptoms)		1.00
	25.1. Long-term central venous catheter infection/Permicath^® (access removed)	1.00
	25.2. Long-term central venous catheter infection/Permicath^® (laboratory tests taken)	1.00
	25.3. Long-term central venous catheter infection/Permicath^® (antibiotic used)	1.00
	25.4. Long-term central venous catheter infection/Permicath^® (length of antibiotic use)	1.00
	25.5. Long-term central venous catheter/Permicath^® infection (culture result/swab)	1.00
26. AVF infection and prosthesis (signs/symptoms, laboratory tests taken, antibiotic used, culture result/swab)		0.89
	26.1. AVF infection and prosthesis (laboratory tests taken)	0.89
	26.2. AVF infection and prosthesis (used antibiotic)	0.89
	26.3. AVF infection and prosthesis (result of culture/swab)	0.89
27. AVF thrombosis		0.89
28. PTFE prosthetic thrombosis		0.89
29.Loss of AVF		1.00
30. Other types of infection during the period (urinary tract infection)		1.00
	30.1. Other types of infection during the period (intestinal infection or abdominal focus)	0.89
	30.2. Other types of infection during the period (surgical site)	0.89
	30.3. Other types of infection during the period (skin infection: parasitic infestation or infectious cellulitis)	0.89
	30.4. Other types of infection during the period (respiratory infection/pneumonia)	0.89
31. Number of dialysis patients using a short-term central venous catheter on the last day of dialysis of the month		1.00
32. Number of dialysis patients using a long-term central venous catheter on the last day of dialysis of the month		1.00
33. Number of dialysis patients using AVF duration on the last dialysis day of the month		1.00
34. Number of dialysis patients using PTFE prosthesis duration on the last day of dialysis of the month		1.00
35. Hospitalization of dialysis patients due to clinical complications		0.89
36. Death of patients under dialysis		0.89
37. Seroconversion for positive Hepatitis C in patients undergoing Dialysis		0.89
38. Seroconversion for positive Hepatitis B in patients undergoing Dialysis		0.89
39. Hemoglobin value of dialysis patients		1.00
40.Albumin value in dialysis patients		1.00
41. Phosphorus value of dialysis patients		1.00
42. PTH value of dialysis patients		1.00
43. Ktv value of dialysis patients		1.00
44. Patients eligible for transplant and older than 6 months on dialysis, enrolled in the CNPDO		0.89
45. Matured AVF		0.78
46. Adverse events (infection and signs of infection (shaking/fever/chills)		0.78
	46.1. Adverse events (rupture of dialyzer fibers)	0.89
	46.2. Adverse events (coagulation of the extracorporeal system)	0.89
	46.3. Adverse events (breakdown of the extracorporeal system)	0.78
	46.4. Adverse events (material defect)	0.89
	46.5. Adverse events (use of inappropriate material)	0.89
	46.6. Adverse events (capillary exchange between patients)	0.89
	46.7. Adverse events (AVF puncture error)	0.78
	46.8. Adverse events (hematoma)	0.89
	46.9. Adverse events (AVF rupture)	0.89
	46.10. Adverse events (accidental disconnection of the central venous catheter with the blood line)	0.89
	46.11. Adverse events (accidental disconnection of the fistula needle)	0.89
	46.12. Adverse events (reaction to sterilizer)	0.89
	46.13. Adverse events (reaction to transfusion of blood products)	0.89
	46.14. Adverse events (reaction to medication)	0.89
	46.15. Adverse events (reaction to dressings)	0.89
	46.16. Adverse events (skin injury)	0.78
	46.17. Adverse events (related to water treatment/distribution failure)	0.89
	46.18. Adverse events (related to the dialysis machine)	0.89
	46.19. Adverse events (patient fall)	0.89
	46.20. Adverse events (loss of access during dialysis)	0.78
	46.21. Adverse events (non-functioning central venous catheter)	0.89
	46.22. Adverse events (inadequate access blood flow)	1.00
	46.23. Adverse events (inadequate central venous catheter implantation)	0.78
	46.24. Adverse events (bleeding from venous access)	0.78
	46.25. Adverse events (dialysis prescription error)	0.89
	46.26. Adverse events (omission of care)	0.78
47. Reason for entry (hypertensive nephrosclerosis; diabetic nephropathy; glomerulopathies; urological disease; chronic graft disease; cardiorenal; hepatorenal; patient in transit for parathyroidectomy surgery or for hospitalization for other reasons; systemic lupus erythema; other causes; exchange of therapy nephrotic syndrome; sepsis; polycystic disease or obstructive causes (myeloma).		1.00
48. Patient withdrawal (change of therapy)		0.89
	48.1 Patient withdrawal (renal function recovery)	0.89
	48.2 Patient withdrawal (clinic transfer)	0.89
	48.3 Patient withdrawal (return to the clinic of origin),	0,89
	48.4 Patient withdrawal (patient in transit)	078
	48.5 Patient withdrawal (kidney transplant)	0.89
	48.6 Patient withdrawal (abandonment of treatment)	0.89
49. Blood transfusion (red blood cells, platelets, plasma)		1.00
50. Use of ferric hydroxide sucrate		0.89
51. Use of EPO		0.89
52. Clinical complications (hypotension, hypertension, nausea/vomiting, cramps, hypoglycaemia/hyperglycaemia)		1.00
53. Monthly, semi-annual and annual blood collection		0.78

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Simone Soares da Silva, Email: simone.soaress1@gmail.com