Dialysis Facility Safety: Processes and Opportunities

Garrick, R.; Morey, R.

doi:10.1111/sdi.12395

Cited by 13 publications

(10 citation statements)

References 71 publications

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“…Because machine alarms cannot be relied on, direct observation remains important, involving vigilance on the part of nursing staff, and unit management, so that lines of sight are not obscured, patients are not dialysing alone and their vascular access sites are not covered. Because of the low prevalence of disconnection, complacency may develop: continuous education is therefore advocated to ensure awareness amongst healthcare staff, patients and their carers [193].…”

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Renal Association Clinical Practice Guideline on Haemodialysis

et al. 2019

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This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?”The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form.A few notes on the individual sections: This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines “enough” dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term “eKt/V” is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient.This section deals with “non-standard” dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week – this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here.This section deals with membranes (the type of “filter” used in the dialysis machine) and “HDF” (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it’s as good as but not better than regular dialysis.This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this.This section deals with dialysate, which is the fluid used to “pull” toxins out of the blood (it is sometimes called the “bath”). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasional...

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Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Renal Association Clinical Practice Guideline on Haemodialysis

et al. 2019

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“…In a more in depth review of dialysis facility safety Garrick and Morey highlight the importance of a non-punitive approach to safety where all stakeholders (patient, nurses, technicians, facility manager, and nephrologist) are engaged as a team to improve safety. The use of specific tools such as root-cause analysis, failure mode and effects analysis can be used to understand the “how” and “why” of errors (85). These tools provide a platform to promote improvement of care.…”

Section: Culture Of Safety Within Dialysis Unitsmentioning

confidence: 99%

Medical safety in the care of the person with end‐stage kidney disease

Duronville

Diamantidis

2018

Seminars in Dialysis

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Much is written about medical safety as it pertains to patients with chronic kidney disease, yet the transition to end-stage kidney disease and processes inherent to the receipt of dialysis present unique safety challenges in this population. Educational efforts in medical safety need to focus on the areas of greatest threat and where intervention can provide the greatest benefit. This study addresses such safety topics in the dialysis population and identifies potential strategies that may aid in harm reduction.

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“…Surveillance for infections (outcome measures), and monitoring adherence to recommended infection prevention practices (process measures) are important components of an infection prevention program [65]. To enable safety, accurate comparison and analyses of monthly rates within the same facility, or meaningful benchmarking with other units/centers, it is important that a standardized and validated surveillance protocol be used uniformly by all dialysis facilities [66] [67]. A centralized surveillance system for healthcare-associated infections like the CDC's national healthcare safety network (NHSN) which requires all participating facilities to strictly follow very specific surveillance criteria, can provide accurate and reliable data that can be used to identify problem areas as well as measure progress of prevention efforts.…”

Section: Tracking Infectionsmentioning

confidence: 99%

Hand Hygiene in Haemodialysis Units

Karkar¹

2016

OALib

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Healthcare-associated infections are a major risk to patient safety. Infection is the first cause of hospitalisation and the second most common cause of mortality among haemodialysis (HD) patients. HD patients, as well as the dialysis staff, are vulnerable to contracting healthcare-associated infections due to frequent and prolonged exposures to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions, and the immune compromised status of HD patients are major predisposing factors. HD patients are exposed to different types of infections which include bloodstream infections and localized infections of the vascular access, blood-borne infections with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus, and airborne infections. Sources of infections include contaminated water, equipment, environmental surfaces, and infected patients. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Contaminated hands of healthcare workers are among the most common modes of transmission of healthcare-associated infections. Hand hygiene is singled out as the most important infection prevention intervention. Hand hygiene compliance can be improved by continuous education and monitoring, providing a sufficient number of sinks with soap dispensers, paper towels, hand lotions and alcohol-based hand rub placed at each patient station, and regular feedback of surveillance results. Education and training and full awareness of infection control policies and procedures should be provided to all Healthcare workers and to be repeated regularly. The patient and/or caregiver should also be educated on hand hygiene and the care of new vascular access.

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Dialysis Facility Safety: Processes and Opportunities

Cited by 13 publications

References 71 publications

Renal Association Clinical Practice Guideline on Haemodialysis

Renal Association Clinical Practice Guideline on Haemodialysis

Medical safety in the care of the person with end‐stage kidney disease

Hand Hygiene in Haemodialysis Units

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