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Eight Questions for In-Patient Dialysis Safety Checks

02/20/2019

By Erin Bumpas, MBA, MHA, Hospital Services Administrator, DaVita Kidney Care

Current, best-demonstrated practices for in-patient dialysis now also include a time-out safety check protocol to prevent wrong-site, wrong-procedure and wrong-person surgeries—ultimately, reducing the risk of irreparable, life-threatening mistakes.

I’m sure we all agree, time-outs should be universally adopted for every dialysis and apheresis patient, every treatment, every time. Actually, this process – which includes details specific to dialysis – can also be generalized to other specialties.

To promote adherence to the safety check, while acknowledging the fast-paced health care environment, a safety check must be simple, memorable and easy to perform quickly. It can be as simple as an acronym or a theme covering questions that take two minutes to complete.

The following eight questions provide an example of what could be on a safety check list for a nurse or other care team member about to initiate a dialysis treatment with a patient.

  1. Is this the right patient (use two identifiers)? First and foremost, identify and process the patient as the right renal patient who has orders for dialysis.
  2. Has the patient given consent to treatment? Whenever possible, obtain patient consent for this life-saving procedure and confirm the patient understands the risks, benefits and alternatives.

Is this the right equipment? Confirm that all equipment details align with the patients’ needs. Stay current in the different modalities and components of dialysis—such as:

  • dialyzer size
  • dialysis delivery system/K-machine
  • type of acid and bicarbonate ordered
  • bloodlines
  • needle type

What is the patient’s hepatitis B status? Follow current guidance from the dialysis industry on how to dialyze those who are immune, susceptible or have an unknown status for hepatitis B. Ensure a copy of the hepatitis B result is in the patient record. Also, evaluate other contagious issues and ensure proper isolation status when necessary.

5. Are the orders complete?Ensure orders have been completed by a qualified practitioner—such as a nephrologist, internist or intensivist—and verified with the practitioner by a licensed dialysis nurse.Verify the correct dialysis treatment settings with the dialysis orders.

6. Is the access verified? Fully understand the patient’s fistula or graft maturity or central venous catheter care needs and the proper way to access.

7.Is the safety check being performed at the right time? Perform the time-out safety check immediately before accessing the vascular access. A new timeout should occur if the access is delayed.

8.Does the patient or family have any questions or concerns? Lastly, because health care comes with unknowns, risks and advantages, give the patient and family members the opportunity to ask questions and express concerns.

Of these eight questions, only the questions related to hepatitis B (#4) and access (#6) are unique to dialysis. The others can easily apply to just about any patient care intervention. The key point is to be diligent and deliberate with a repeatable process that ensures the personnel performing the task are:

  • stopping/pausing their routine
  • objectively reviewing what they are about to do 
  • using some form of a checklist so they don’t miss a step

 

Documenting Patient Safety Checks

Documented and signed safety checklists can help verify patient care and hold each member of the care team accountable to running a thorough time-out safety check with every patient. Documentation can also allow for a second pair of eyes to review the safety check, so one individual team member is not the sole patron of a medical mistake.  Overall, time-out safety checks involve a small time investment with large dividends that may lead to improved patient safety, better clinical results and, ultimately, enhanced patient quality of life. Time-out safety checks have been adopted worldwide, and continue to be an important tool for helping protect both patients and health care providers. Achieving patient safety should involve a checklist, appropriate implementation, ease of use and care team accountability. The bottom line: a safety checklist is an investment worth making, for the sake of placing patient safety first and honoring our medical oath.

 

Erin Bumpas, MBA, MHA, is the hospital services administrator for DaVita Kidney Care in Victoria, Texas and oversees six facilities. She was a recent 2017 National Summit guest speaker for fellow hospital services administrators and has overseen the rollout of the new DaVita “Time-Out” safety process.  DaVita Hospital Services has been accredited under the Ambulatory Health Care accreditation program since 2013.