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Silberzweig JI. Reducing Infections in Outpatient Hemodialysis: The Impact of Human Factors. Am J Kidney Dis 2024; 84:4-5. [PMID: 38613541 DOI: 10.1053/j.ajkd.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Jeffrey I Silberzweig
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York; The Rogosin Institute, New York, New York.
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2
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Zhang T, Mohsen M, Abbaticchio A, Battistella M. Patients' experiences of medication management while navigating ongoing care between outpatient services: A qualitative case study of patients on hemodialysis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100418. [PMID: 38374965 PMCID: PMC10875289 DOI: 10.1016/j.rcsop.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
Background Patients on hemodialysis have complex medical diagnoses and medication regimens, requiring access to numerous health services and consultation with various healthcare providers. While interprofessional collaboration can optimize care among hemodialysis patients, these patients commonly experience medication-related problems and frequent hospitalizations resulting from miscommunications and mismanagement of medications. Objectives This study aims to capture the lived experiences of patients on hemodialysis to reveal their medication management needs as they navigate ongoing care between various outpatient services. Methods A qualitative methodology was used to explore the perspectives of hemodialysis patients. One-on-one, in-person, semi-structured interviews were conducted at an outpatient hemodialysis clinic located inside an urban teaching hospital. English-speaking adults 18 years and older who have been followed at the clinic for at least three months were selected through random, convenience sampling. Interviews were recorded and transcribed verbatim. Patients were recruited and data were collected iteratively and continued until data saturation was reached. Data was analyzed through the lens of the Picker Principles of Patient Centered Care using a general inductive approach. Results A total of nine interviews were conducted. Two major themes, medication management and care navigation, were identified. Though patients had a wealth of knowledge about their medications, and they were motivated to self-manage their medications to enhance their well-being, they experienced barriers with medication management. Patients further expressed challenges with navigating care and spoke of the importance of having good rapport with healthcare providers who are attentive to their needs. Conclusions The results revealed a need for improved support for self-care and interprofessional collaboration to possibly reduce the burden of medications and care fragmentation experienced by patients and improve continuity of care for patients.
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Affiliation(s)
- Tracy Zhang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Mai Mohsen
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Angelina Abbaticchio
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Marisa Battistella
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
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Albreiki S, Alqaryuti A, Alameri T, Aljneibi A, Simsekler MCE, Anwar S, Lentine KL. A Systematic Literature Review of Safety Culture in Hemodialysis Settings. J Multidiscip Healthc 2023; 16:1011-1022. [PMID: 37069892 PMCID: PMC10105578 DOI: 10.2147/jmdh.s407409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
Background Safety culture is an important aspect of quality in healthcare settings. There are many risks that patients can encounter in hemodialysis settings one of which is the infection risks due to the regular need to access bloodstreams using catheters and needles. Implementation of prevention guidelines, protocols and strategies that reinforce safety culture excellence are essential to mitigate risks. The objective of this study was to identify and characterize the main strategies that enhance and improve patient safety culture in hemodialysis settings. Methods Medline (via PubMed) and Scopus were searched from 2010 to 2020 in English. Terms defining safety culture, patient safety were combined with the term hemodialysis during the search. The studies were chosen based on inclusion criteria. Results A total of 17 articles reporting on six countries were identified that met inclusion criteria following the PRISMA statement. From the 17 papers, practices that were successfully applied to improve safety culture in hemodialysis settings included (i) training of nurses on the technologies used in hemodialysis treatment, (ii) proactive risk identification tools to prevent infections (iii) root cause analysis in evaluating the errors, (iv) hemodialysis checklist to be used by the dialysis nurses to reduce the adverse events, and (v) effective communication and mutual trust between the employee and leadership to support no-blame environment, and improve the safety culture. Conclusion This systematic review provided significant insights on the strategies that healthcare safety managers and policy makers can implement to enhance safety culture in hemodialysis settings.
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Affiliation(s)
- Salma Albreiki
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Alaa Alqaryuti
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Tareq Alameri
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Amani Aljneibi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Correspondence: Mecit Can Emre Simsekler, Khalifa University of Science and Technology, Department of Industrial and Systems Engineering, P.O. Box 127788, Abu Dhabi, United Arab Emirates, Tel +9712 501 8410, Fax +971 2 447 2442, Email
| | - Siddiq Anwar
- Sheikh Shakhbout Medical City, Abu Dhabi, 10001, United Arab Emirates
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
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Haroon SWP, Lau TWL, Tan GL, Liu EHC, Hui SH, Lim SL, Santos D, Hodgson R, Taylor L, Tan JN, Davenport A. Risk assessment of failure during transitioning from in-centre to home haemodialysis. BMC Nephrol 2022; 23:406. [PMID: 36539703 PMCID: PMC9768953 DOI: 10.1186/s12882-022-03039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD. METHODS We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk. RESULTS Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable. CONCLUSIONS We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.
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Affiliation(s)
- Sabrina-Wong-Peixin Haroon
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - Titus-Wai-Leong Lau
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - Gan Liang Tan
- grid.508163.90000 0004 7665 4668Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Eugene-Hern Choon Liu
- grid.4280.e0000 0001 2180 6431Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soh Heng Hui
- grid.412106.00000 0004 0621 9599Renal Centre, National University Hospital, Singapore, Singapore
| | - Siao Luan Lim
- grid.412106.00000 0004 0621 9599Renal Centre, National University Hospital, Singapore, Singapore
| | - Diana Santos
- grid.412106.00000 0004 0621 9599Medical Affairs-Clinical Governance, National University Hospital Singapore, Singapore, Singapore
| | - Robyn Hodgson
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Lindsay Taylor
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Jia Neng Tan
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - FH HHD
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Andrew Davenport
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
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Abdolsattari S, Ghafourifard M, Parvan K. Person-centered climate from the perspective of hemodialysis patients and nurses working in hemodialysis units. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Person-centered care (PCC) is considered an important component of high-quality care in hemodialysis units. Hemodialysis patients and nurses may have different perceptions of person-centeredness in hemodialysis units. The present study aimed to assess the PCC from the perspective of hemodialysis patients and nurses working in the hemodialysis unit.
Methods
This cross-sectional study was performed on 200 patients and 71 nurses working in two hemodialysis units. Data were collected using a demographic questionnaire, person-centered climate questionnaire-patient version (PCQ-P), and person-centered climate questionnaire-staff version (PCQ-S). Data were analyzed by SPSS software (ver. 24) using ANOVA and independent t-tests.
Results
The mean score of person-centered climate from the patients' view was 81.49 ± 7.14 (Possible score: 17–102). Independent t-test showed that the mean total score of PCQ-P in patients undergoing hemodialysis in the Imam Reza Hospital (82.26 ± 7.09) was more than those undergoing hemodialysis in the Sina Hospital (78.60 ± 6.61) (P < 0.05). The mean score of the safety subscale showed a statistically significant difference between the two hemodialysis centers (P < 0.05). The mean total score of PCQ-S from the nurses' view was 66.86 ± 8.07 out of 84. The mean score of the everydayness subscale showed a statistically significant difference between nurses working in two hemodialysis units (P < 0.05).
Conclusion
Although the results showed an acceptable score in the person-centered climate questioner, it needs some improvements in the fields of safety and everydayness. The environment of the hemodialysis unit could limit or enhance the implementation of person-centered processes.
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Stavert BM, Monaro S, Tienstra L, Naganathan V, Aitken SJ. Protocol for a qualitative study exploring haemodialysis dependent patients' arteriovenous fistula experience, values and concerns in Sydney, Australia. BMJ Open 2022; 12:e058152. [PMID: 36691241 PMCID: PMC9171227 DOI: 10.1136/bmjopen-2021-058152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The experiences of patients from culturally and linguistically diverse backgrounds, with chronic mental illness, disabilities or who identify as sexual or religious minorities are under-represented in clinical research on arteriovenous fistula (AVF) for haemodialysis access. A greater understanding of the experiences, values and concerns of these diverse patient groups are needed to provide haemodialysis access care that addresses the needs of all haemodialysis-dependent patients. This study seeks to describe a broad range of patient experiences related to the creation, care and surveillance of AVFs, including interactions with healthcare teams. METHODS AND ANALYSIS This qualitative study will use semistructured interviews with individual patients purposefully selected to provide a diverse patient population. A deliberate strategy will be used to recruit a demographically broad range of participants. Thematic analysis of interview transcripts, using a constant comparative methodology, will generate themes that describe patient experiences, values and concerns. Findings from this study will give a nuanced insight into the experiences of patients on haemodialysis with respect to their AVF. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Sydney Local Health District Human Research Ethics Committee (REGIS identifier: 2021/ETH00362, CH reference number: CH62/6/2021-033). Results will be made available to the participants, local health district, funders and other researchers through various hospital and academic forums. Data will also be published in peer-reviewed journals and be part of a larger body of work looking into patient-reported outcome measures for patients with AVF.
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Affiliation(s)
- Bethany Miriam Stavert
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Susan Monaro
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Lisa Tienstra
- Renal Medicine Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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7
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Shqeirat MD, Hijazi BM, Almomani BA. Treatment related problems in Jordanian hemodialysis patients. Int J Clin Pharm 2021; 43:1352-1359. [PMID: 33748911 DOI: 10.1007/s11096-021-01259-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
Background Treatment related problems are any event or circumstance involving patient treatment that actually or potentially interferes with an optimum outcome for a patient. Hemodialysis patients have on average 5-6 comorbid conditions and require 8-12 medications each day making them vulnerable to treatment related problems. Objective This study aimed to investigate treatment related problems affecting Jordanian hemodialysis patients, as well as assessing the factors associated with them. Setting Three hemodialysis centers in Jordan. Method A cross sectional multi-centered study was conducted. Direct interviews and patient files were used to collect patient information. A validated data collection form was used. Main outcome measure The average number of treatment related problems per patient. Results 160 patients from three different Jordanian dialysis centers were included. The cohort was 53 ± 15.2 years old, been on dialysis for 5.9 ± 5.3 years, had 3.9 ± 1.8 comorbid conditions and took 10.2 ± 2.8 different medications. There were a total of 1018 treatment related problems, a treatment related problem occurred once every 1.47 drug exposures. Adverse events were the most commonly occurring treatment related problems (27%), followed by indication related errors and dosing errors (24% and 21%, respectively). The number of treatment related problems is positively associated with age, the number of comorbid conditions, the number of hospital admissions in the previous year and the number of medications taken by the patient. Conclusion In the Jordanian hemodialysis population, treatment related problems affect virtually all patients. Most patients suffered adverse drug events and/or had drug indication problems. The number of treatment related problems correlated positively with age and the number of medications taken by the patient. Those with more treatment related problems also had higher hospital admissions and longer admission periods. Serious measures should be made in order to reduce the number of treatment related problems affecting this vulnerable population.
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Affiliation(s)
- Mais D Shqeirat
- Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Bushra M Hijazi
- Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Basima A Almomani
- Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Rosa TS, Corrêa HL, Deus LA, Stone W, Reis AL, Gadelha AB, de Araújo TB, Silva Junior PR, Moraes MR, Silva JAB, Tzanno-Martins C, Simões HG, Prestes J, Neves RVP. Effects of dynamic and isometric resistance training protocols on metabolic profile in hemodialysis patients: a randomized controlled trial. Appl Physiol Nutr Metab 2021; 46:1029-1037. [PMID: 33651633 DOI: 10.1139/apnm-2020-0900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to compare the effect of dynamic (DRT) and isometric (IRT) resistance training on glycemic homeostasis, lipid profile, and nitric oxide (NO) in hemodialysis (HD) patients. Patients were randomly distributed into 3 groups: control (n = 65), DRT (n = 65), and IRT (n = 67). Patients assessed before and after the intervention period were tested for fasting blood glucose, glycated hemoglobin, oral glucose tolerance test, insulin resistance, lipid profile, leptin, insulin, adiponectin, C-reactive protein, and NO . Patients underwent to strength and body composition assessments. Subjects allocated in both DRT and IRT groups took part in a 24-week resistance training program, 3 times per week. Each training session was approximately 1 hour before dialysis and consisted of 3 sets of 8-12 repetitions at low intensity. Total workload was higher in the DRT as compared with the IRT. This heightened workload related to better glycemic homeostasis in HD patients as measured by regulation of insulin, adiponectin, and leptin, while improveing triglycerides, free-fat mass, and muscle strength. Additionally, NO levels were increased in the DRT group. NO was significantly correlated with glucose intolerance (r = -0.42, p = 0.0155) and workload (r = 0.46, p = 0.0022). The IRT group only improved strength (p < 0.05). Twenty-four weeks of DRT improved glycemic homeostasis, lipid profile, and NO in HD patients. Although IRT seems to play an important role in increasing strength, DRT might be a better choice to promote metabolic adjustments in HD patients. Clinical trial: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w. Novelty: DRT might be a better choice for metabolic improvements in patients with chronic kidney disease (CKD). Exercise-training might treat metabolic imbalance in CKD patients.
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Affiliation(s)
- Thiago Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Hugo Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Lysleine Alves Deus
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Whitley Stone
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, KY, USA
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - André Bonadias Gadelha
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil.,Seção de Educação Física, Colégio Militar de Brasília
| | | | | | - Milton Rocha Moraes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | | | | | | | - Jonato Prestes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
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Virtanen H, Tuominen R, Kiukainen S, Koskinen J, Koskenniemi J, Laulaja J, Numanovic V, Leino-Kilpi H. Experiences of safety among patients receiving home dialysis therapies. J Ren Care 2019; 45:223-231. [PMID: 31496117 DOI: 10.1111/jorc.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dialysis patients' experience of safety can be seen positively connected with their wellbeing and successful outcomes of their treatment and care. Therefore, it is necessary to identify the factors promoting and weakening the safety experiences and create a basis for empowering interventions. OBJECTIVES Analyse patients' experiences of safety with dialysis and the factors promoting and weakening their safety. METHODS A descriptive study design was used. This study analysed Finnish patients' (n = 70) experiences of safety with dialysis and the factors promoting and weakening patients' safety. Data were collected using a questionnaire including one structured question and two open questions. FINDINGS The patients experienced their care as safe. Thematic analysis provided three factors promoting patients' safety: certainty of patient's own competence in dialysis self-management, competence of personnel in dialysis treatment and care, continuity of ensuring patients' state of health, as well as three factors weakening safety: patients' uncertainty of living with chronic kidney disease, insufficient patient education and uncertain realisation of dialysis treatment and care. CONCLUSION This study provided new insight into understanding patients' experiences of safety with dialysis. We show that the factors connected with patients' safety were related to the successful realisation of self-management, support for the self-management, and delivery of dialysis treatment and care anticipating high-level outcomes. In light of this study, there are development needs in dialysis treatment and care as a whole in order to ensure patients' safety.
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Affiliation(s)
- Heli Virtanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Tuominen
- Pulmonary Diseases Outpatient Clinic, Turku University Hospital, Turku, Finland
| | | | - Jenni Koskinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | | | - Vanesa Numanovic
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku University Hospital, Turku, Finland
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Gómez López VE, Muñoz Macías C, Casas Cuestas R, Álvarez de Lara MA, Crespo Montero R. Análisis de las medidas correctoras para la disminución de los eventos adversos en una unidad de hemodiálisis hospitalaria. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Determinar los eventos adversos más prevalentes y los factores de riesgo asociados a su desarrollo en el paciente que se somete a hemodiálisis en el estado de Guerrero, México. Material y Método: Estudio observacional, longitudinal, retrospectivo en 157 pacientes en hemodiálisis afiliados al Instituto Mexicano del Seguro Social en Guerrero, atendidos en 5 unidades privadas y 2 públicas. Se recolectaron variables socio-demográficas, mediciones de laboratorio, evolución de la enfermedad, complicaciones propias de la enfermedad y del tratamiento dialítico. Resultados: Los eventos adversos se presentaron en el 73% de la población estudiada, la principal causa etiológica fue Diabetes mellitus tipo 2 (DM2) e hipertensión arterial. Los eventos adversos más frecuentes fueron: hipotensión (35,5%) infección de angioacceso (24%), cefalea (22,3%), crisis hipertensiva (14,5%), mareos (9,9%), escalofríos (9,9%), y trombosis de FAVI (9,9%). Los factores que se asociaron a su desarrollo fueron: pacientes mayores de 65 años, (OR=6,859 IC 95%; 1,55-30,35), ser obeso, (OR=1,70, IC 95%: 1,60-4,81), e hipoalbuminemia (OR=0,251, IC 95%: 0,160-0,593). Conclusión: Los pacientes mayores de 65 años, obesos, con hipertensión diastólica e hipoalbuminemia tienen mayor probabilidad de desarrollar eventos adversos durante el periodo de hemodiálisis.
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Kennedy C, McGrath‐Chong M, Arustei D, d'Gama C, Faratro R, Fung S, Magtoto E, Wong E, Chan CT. A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study. Hemodial Int 2019; 23:151-157. [DOI: 10.1111/hdi.12737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/12/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Kennedy
- Division of NephrologyUniversity Health Network Toronto Canada
| | | | - Daniela Arustei
- Division of NephrologyUniversity Health Network Toronto Canada
| | - Celine d'Gama
- Division of NephrologyUniversity Health Network Toronto Canada
| | - Rose Faratro
- Division of NephrologyUniversity Health Network Toronto Canada
| | - Stella Fung
- Division of NephrologyUniversity Health Network Toronto Canada
| | - Eduardo Magtoto
- Division of NephrologyUniversity Health Network Toronto Canada
| | - Elizabeth Wong
- Division of NephrologyUniversity Health Network Toronto Canada
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Aguiar LL, Guedes MVC, Galindo Neto NM, Melo GAA, Almeida PCD, Oliveira RM, Caetano JÁ. Validação de instrumento de avaliação da segurança de pacientes renais em hemodiálise. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Construir e validar um instrumento de avaliação da segurança de pacientes renais crônicos em hemodiálise. Métodos Estudo metodológico que abrangeu elaboração do instrumento e validação de conteúdo por 14 juízes; e avaliação da compreensão, por nove enfermeiros. A construção foi fundamentada na legislação sanitária sobre hemodiálise e padrões internacionais de segurança de pacientes. Para análise da concordância dos juízes, foi calculado o Coeficiente de Correlação Intraclasse, Índice de Validade de Conteúdo e teste binomial. Resultados Os itens do instrumento do tipo Likert foram distribuídos nas seis metas internacionais de segurança de pacientes, obtiveram Coeficiente de Correlação Intraclasse de 0,98. O instrumento final ficou com 57 itens com Índice de Validade de Conteúdo de 0,96 e teste binomial ≥0,86. Conclusão O instrumento foi considerado compreensível, relevante e condizente com os padrões de segurança, tendo demonstrado validade de conteúdo e compatibilidade para avaliar a segurança do paciente em ambientes de tratamento hemodialítico.
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Lessa SRDO, Bezerra JNDM, Barbosa SMC, Luz GODA, Borba AKDOT. PREVALÊNCIA E FATORES ASSOCIADOS PARA A OCORRÊNCIA DE EVENTOS ADVERSOS NO SERVIÇO DE HEMODIÁLISE. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003830017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a prevalência e os fatores associados para a ocorrência de eventos adversos no serviço de hemodiálise. Método: estudo descritivo longitudinal com abordagem quantitativa, cuja amostra foi composta de 51 pacientes atendidos na unidade de hemodiálise entre maio e julho de 2016. Os dados foram obtidos por meio do registro diário de eventos adversos em um checklist e submetidos análise e, para as variáveis categóricas, foi realizada a análise bivariada, por meio do teste Qui-Quadrado de independência de Pearson. Resultados: foram registrados 1110 eventos adversos com prevalência em 98,03% dos pacientes, sendo os mais frequentes: erro de medicação (45,2%) e fluxo sanguíneo inadequado (42,9%). Quanto ao grau de dano, a maioria dos eventos foi de grau leve (93,8%), seguido do moderado (5,9%). A ocorrência do evento adverso esteve associada ao sexo feminino, idade menor que 40 anos, ausência de comorbidades, tempo de tratamento menor que um ano e uso de cateter venoso central de longa permanência. Conclusão: a prevalência de eventos adversos foi considerada alta, com predominância do grau leve. O estudo reforça a necessidade de estratégias de gestão e assistência para implantação de medidas de controle da ocorrência dos eventos adversos em hemodiálise, resultando em benefícios econômicos e sociais para a instituição e sua clientela.
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Brown RS, Brickel K, Davis RB. Two-Year Observational Study of Bloodstream Infection Rates in Hemodialysis Facility Patients with and without Catheters. Clin J Am Soc Nephrol 2018; 13:1381-1388. [PMID: 30194227 PMCID: PMC6140562 DOI: 10.2215/cjn.13551217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Bloodstream infection rates of patients on hemodialysis with catheters are greater than with other vascular accesses and are an important quality measure. Our goal was to compare relative bloodstream infection rates of patients with and without catheters as a quality parameter among the facilities providing hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used CROWNWeb and National Healthcare Safety Network data from all 179 Medicare facilities providing adult outpatient hemodialysis in New England for >6 months throughout 2015-2016 (mean, 12,693 patients per month). There was a median of 60 (interquartile range, 43-93) patients per facility, with 17% having catheters. RESULTS Among the five batch-submitting dialysis organizations, the bloodstream infection rate in patients with a catheter in four organizations had adjusted risk ratios of 1.44 (95% confidence interval, 1.07 to 1.93) to 1.91 (95% confidence interval, 1.39 to 2.63) times relative to the reference dialysis provider group (P<0.001). The percentage of catheters did not explain the difference in bloodstream infection rates among dialysis provider organizations. The bloodstream infection rates in patients with a catheter were negatively correlated with the facility's proportion of this patient group. Facilities with <10%, 10%-14.9%, 15%-19.9%, and ≥20% catheter patients had bloodstream infection rates of 4.4, 2.2, 1.9, and 1.5 per 100 patient-months, respectively, in that patient group (adjusted P<0.001). This difference was not seen in patients without catheters. There was no effect of facility patient census or season of the year. CONCLUSIONS A study of the adult outpatient hemodialysis facilities in New England in 2015-2016 found that four dialysis provider groups had significantly higher bloodstream infection rates in patients with a catheter than the best-performing dialysis provider group. Hemodialysis facilities with lower proportions of patients with a catheter have significantly higher bloodstream infection rates in this patient group than facilities with >20% catheters, a finding that did not explain the difference among provider organizations.
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Affiliation(s)
| | | | - Roger B. Davis
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and
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Kliger AS. Targeting Zero Infections in Dialysis: New Devices, Yes, but also Guidelines, Checklists, and a Culture of Safety. J Am Soc Nephrol 2018; 29:1083-1084. [PMID: 29507046 DOI: 10.1681/asn.2018020132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alan S Kliger
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, Yale New Haven Health, New Haven, Connecticut
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Arenas Jiménez MD, Macía-Heras M. Seguridad en hemodiálisis: paradigma del trabajo en equipo. Nefrologia 2018; 38:1-3. [DOI: 10.1016/j.nefro.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022] Open
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Pássaro PG, D’Ávila R. Nursing educational intervention for the identification of Adverse Events in hemodialysis. Rev Bras Enferm 2018; 71:1507-1513. [DOI: 10.1590/0034-7167-2017-0843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/18/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To develop an educational program aimed at the qualification of the nursing technicians that makes possible the understanding of Adverse Events (AE), aiming to adapt the data records; to elaborate tools for the records of the AE in hemodialysis patients; and to assess the knowledge before and after the educational program. Method: An educational intervention was conducted through a classroom and online course on how to recognize and record AE in hemodialysis. The effectiveness of the program was assessed through the gain of knowledge measured through online record of the AE in fictitious problem cases before and after the course. Result: Sixteen nursing technicians participated in the study. In the initial test, the mean score was 3.7 ± 0.3 points and in the final assessment was 4.2 ± 0.3 points (p=0.0002). Conclusion: It was possible to verify that the educational intervention contributed to increase the knowledge of the participants and that the training of these can be achieved with classroom and online learning courses.
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19
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Arenas Jiménez MD, Ferre G, Álvarez-Ude F. Estrategias para aumentar la seguridad del paciente en hemodiálisis: Aplicación del sistema de análisis modal de fallos y efectos (sistema AMFE). Nefrologia 2017; 37:608-621. [DOI: 10.1016/j.nefro.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/31/2017] [Accepted: 04/05/2017] [Indexed: 11/28/2022] Open
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20
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Jose MD, Marshall MR, Read G, Lioufas N, Ling J, Snelling P, Polkinghorne KR. Fatal Dialysis Vascular Access Hemorrhage. Am J Kidney Dis 2017; 70:570-575. [DOI: 10.1053/j.ajkd.2017.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/28/2017] [Indexed: 11/11/2022]
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21
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Ferrandino R, Roof S, Ma Y, Chan L, Poojary P, Saha A, Chauhan K, Coca SG, Nadkarni GN, Teng MS. Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis. Otolaryngol Head Neck Surg 2017; 157:955-965. [PMID: 28949797 DOI: 10.1177/0194599817721154] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine rates of readmission after parathyroidectomy in patients with chronic kidney disease and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in patients with chronic kidney disease between January 2013 and November 2013. Patient-, admission-, and hospital-level characteristics were compared for patients with and without at least 1 unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the 30 days after discharge, but readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5 to 6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% confidence interval [CI], 1.55-7.05; P = .002) and 1.87 (95% CI, 1.10-3.19; P = .02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR, 2.53; 95% CI, 1.07-5.95; P = .03) were associated with higher risk of readmission. Conclusion Postparathyroidectomy readmission rates for patients with chronic kidney disease are nearly 5 times that of the general population. Careful consideration of postoperative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.
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Affiliation(s)
- Rocco Ferrandino
- 1 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott Roof
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yue Ma
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lili Chan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Priti Poojary
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Aparna Saha
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kinsuk Chauhan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Steven G Coca
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Girish N Nadkarni
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Marita S Teng
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Polikandrioti M, Koutelekos I, Gerogianni G, Stefanidou S, Kyriakopoulos V, Floraki E, Babatsikou F. Factors Associated with Hemodialysis Machine Dependency. Med Arch 2017; 71:122-127. [PMID: 28790544 PMCID: PMC5511538 DOI: 10.5455/medarh.2017.71.122-127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Hemodialysis is one of major stresses in patients’ daily lives since there is no other path for life maintenance but to accept the machine and its’ related rules. Purpose: of this study was to explore factors associated with dependency on dialysis machine as reported by the patients. Material and Methods: The sample of the study included 250 patients undergoing hemodialysis. For data collection a questionnaire specially designed for the needs of the research was used. More specifically, socio-demographic and clinical characteristics as well as several other self-reported variables were collected. Results: Of the 250 participants, 53.2% was men while 65.2% was aged over 60 years. The study showed that 44% of the patients reported that their life depended very much on hemodialysis machine. Statistically significant association was observed between dependency on dialysis machine as reported by the patients and gender (p=0.030), education (p=0.022), job (p=0.001) and place of residence (p=0.001). Additionally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and the degree of information about their problem (p=0.001) and whether patients reported adherence to treatment guidelines (p=0.001) or followed the proposed diet (p=0.001). Finally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and relations with nursing staff (p=0.001), whether patients had noticed change in body image (p=0.001), whether they faced difficulties in social (p=0.001) and family environment (p=0.030), whether they hid their problem (p=0.006), whether they needed help in daily activities (p=0.001) and whether their lifestyle had changed (p=0.001). Conclusions: Socio-demographic and clinical characteristics as well as hemodialysis patients’ beliefs are associated with machine dependency. This study contributed in outlining factors affecting dependency on dialysis machine, thus reinforcing multidisciplinary health care teams to develop interventions in order to address hemodialysis patients’ needs.
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Affiliation(s)
- Maria Polikandrioti
- Department of Nursing, Technological Educational Institute of Athens, Greece
| | - Ioannis Koutelekos
- Department of Nursing, Technological Educational Institute of Athens, Greece
| | - Georgia Gerogianni
- Department of Nursing, Technological Educational Institute of Athens, Greece
| | | | | | - Eirini Floraki
- Department of Nursing, Technological Educational Institute of Athens, Greece
| | - Fotoula Babatsikou
- Department of Nursing, Technological Educational Institute of Athens, Greece
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Abstract
Patients with chronic kidney disease (CKD) are at risk for complications both inherent to the disease and as a consequence of its treatment. The dangers that CKD patients face change across the spectrum of the disease. Providers who are well-versed in these safety threats are best poised to safeguard patients as their CKD progresses.
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Affiliation(s)
- Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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24
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Thomas A, Silver SA, Rathe A, Robinson P, Wald R, Bell CM, Harel Z. Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study. Clin Kidney J 2016; 9:335-42. [PMID: 27274816 PMCID: PMC4886914 DOI: 10.1093/ckj/sfw019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease are at high risk for medical errors given their comorbidities, polypharmacy and coordination of care with other hospital departments. We previously developed a hemodialysis safety checklist (Hemo Pause) to be jointly completed by nurses and patients. Our objective was to determine the feasibility of using this checklist during every hemodialysis session for 3 months. METHODS We conducted a single-center, prospective time series study. A convenience sample of 14 nurses and 22 prevalent in-center hemodialysis patients volunteered to participate. All participants were trained in the administration of the Hemo Pause checklist. The primary outcome was completion of the Hemo Pause checklist, which was assessed at weekly intervals. We also measured the acceptability of the Hemo Pause checklist using a local patient safety survey. RESULTS There were 799 hemodialysis treatments pre-intervention (13 January-5 April 2014) and 757 post-intervention (5 May-26 July 2014). The checklist was completed for 556 of the 757 (73%) treatments. Among the hemodialysis nurses, 93% (13/14) agreed that the checklist was easy to use and 79% (11/14) agreed it should be expanded to other patients. Among the hemodialysis patients, 73% (16/22) agreed that the checklist made them feel safer and should be expanded to other patients. CONCLUSIONS The Hemo Pause safety checklist was acceptable to both nurses and patients over 3 months. Our next step is to spread this checklist locally and conduct a mixed methods study to determine mechanisms by which its use may improve safety culture and reduce adverse events.
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Affiliation(s)
- Alison Thomas
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Samuel A. Silver
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrea Rathe
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Pamela Robinson
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ron Wald
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Chaim M. Bell
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ziv Harel
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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25
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Affiliation(s)
- Renee Garrick
- Division of Nephrology; Department of Medicine; Westchester Medical Center; New York Medical College; Valhalla New York
| | - Rishikesh Morey
- Division of Nephrology; Department of Medicine; Westchester Medical Center; New York Medical College; Valhalla New York
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26
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Lovink MH, Kars MC, de Man-van Ginkel JM, Schoonhoven L. Patients’ experiences of safety during haemodialysis treatment - a qualitative study. J Adv Nurs 2015; 71:2374-83. [DOI: 10.1111/jan.12690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marleen H. Lovink
- Radboud Institute for Health Sciences; IQ healthcare; Radboud university medical center; Nijmegen The Netherlands
- Dialysis Department; Radboud university medical center; Nijmegen The Netherlands
| | - Marijke C. Kars
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Janneke M. de Man-van Ginkel
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; The Netherlands
- Department of Rehabilitation, Nursing Science and Sport; University Medical Center Utrecht; The Netherlands
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27
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Bray BD, Metcalfe W. Improving patient safety in haemodialysis. Clin Kidney J 2015; 8:262-4. [PMID: 26034585 PMCID: PMC4440477 DOI: 10.1093/ckj/sfv033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 01/17/2023] Open
Abstract
Thomas Inman (1820-76) wrote 'Practice two things in your dealings with disease: either help or do not harm the patient', echoing writings from the Hippocratic school. The challenge of practicing safely with the avoidance of complications or harm is perhaps only heightened in the context of modern medical settings such as the haemodialysis unit where complex interventions and treatment are routine. The current issue of CKJ reports two studies aimed at improving the care of haemodialysis patients targeting early use of arteriovenous grafts as access for haemodialysis and the implementation of a dialysis checklist to ensure the prescribed dialysis treatment is delivered. The further challenge of ensuring that such evidence-based tools are used appropriately and consistently falls to all members of the clinical team.
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Affiliation(s)
- Benjamin D Bray
- Division of Health and Social Care Research, King's College London , London , UK
| | - Wendy Metcalfe
- Department of Renal Medicine, Royal Infirmary of Edinburgh , Edinburgh , UK
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28
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Patient safety culture and nurse-reported adverse events in outpatient hemodialysis units. Res Theory Nurs Pract 2015; 29:53-65. [PMID: 25799696 DOI: 10.1891/1541-6577.29.1.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Patient safety culture is an important quality indicator in health care facilities and has been associated with key patient outcomes in hospitals. The purpose of this analysis was to examine relationships between patient safety culture and nurse-reported adverse patient events in outpatient hemodialysis facilities. METHODS A cross-sectional correlational, mailed survey design was used. The analytic sample consisted of 422 registered nurses who worked in outpatient dialysis facilities in the United States. The Handoff and Transitions and the Overall Patient Safety Grade scales of the Agency for Healthcare Research and Quality's (AHRQ) Hospital Patient on Safety Survey were modified and used to measure patient safety culture in outpatient dialysis facilities. Nurse-reported adverse patient events was measured as a series of questions designed to capture the frequency with which nurses report that 13 adverse events occur in the outpatient dialysis facility setting. RESULTS Handoff and transitions safety during patient shift change in dialysis centers was perceived negatively by a majority of nurses. On the other hand, a majority of nurses rated the overall patient safety culture in their dialysis facility as good to excellent. All relationships between patient safety culture items and adverse patient events were in the expected direction. Negative ratings of handoffs and transitions safety were independently associated with increased odds of frequent occurrences of vascular access thrombosis and patient complaints. Negative ratings of overall patient safety culture in dialysis units were independently associated with increased odds of frequent occurrences of medication errors by nurses, patient hospitalization, vascular access infection, and patient complaints. CONCLUSION Findings from this analysis indicate that a positive patient safety culture is an important antecedent for optimal patient outcomes in ambulatory care settings.
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Abstract
Errors in dialysis care can cause harm and death. While dialysis machines are rarely a major cause of morbidity, human factors at the machine interface and suboptimal communication among caregivers are common sources of error. Major causes of potentially reversible adverse outcomes include medication errors, infections, hyperkalemia, access-related errors, and patient falls. Root cause analysis of adverse events and "near misses" can illuminate care processes and show system changes to improve safety. Human factors engineering and simulation exercises have strong potential to define common clinical team purpose, and improve processes of care. Patient observations and their participation in error reduction increase the effectiveness of patient safety efforts.
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Affiliation(s)
- Alan S Kliger
- Yale University School of Medicine, Yale New Haven Health System, New Haven, Connecticut
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30
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Silver SA, Thomas A, Rathe A, Robinson P, Wald R, Harel Z, Bell CM. Development of a hemodialysis safety checklist using a structured panel process. Can J Kidney Health Dis 2015; 2:5. [PMID: 25780628 PMCID: PMC4349476 DOI: 10.1186/s40697-015-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The World Health Organization created a Surgical Safety Checklist with a pause or "time out" to help reduce preventable adverse events and improve communication. A similar tool might improve patient safety and reduce treatment-associated morbidity in the hemodialysis unit. OBJECTIVE To develop a Hemodialysis Safety Checklist (Hemo Pause) for daily use by nurses and patients. DESIGN A modified Delphi consensus technique based on the RAND method was used to evaluate and revise the checklist. SETTING University-affiliated in-center hemodialysis unit. PARTICIPANTS A multidisciplinary team of physicians, nurses, and administrators developed the initial version of the Hemo Pause Checklist. The evaluation team consisted of 20 registered hemodialysis nurses. MEASUREMENTS The top 5 hemodialysis safety measures according to hemodialysis nurses. A 75% agreement threshold was required for consensus. METHODS The structured panel process was iterative, consisting of a literature review to identify safety parameters, individual rating of each parameter by the panel of hemodialysis nurses, an in-person consensus meeting wherein the panel refined the parameters, and a final anonymous survey that assessed panel consensus. RESULTS The literature review produced 31 patient safety parameters. Individual review by panelists reduced the list to 25 parameters, followed by further reduction to 19 at the in-person consensus meeting. The final round of scoring yielded the following top 5 safety measures: 1) confirmation of patient identity, 2) measurement of pre-dialysis weight, 3) recognition and transcription of new medical orders, 4) confirmation of dialysate composition based on prescription, and 5) measurement of pre-dialysis blood pressure. Revision using human factors principles incorporated the 19 patient safety parameters with greater than or equal to 75% consensus into a final checklist of 17-items. LIMITATIONS The literature review was not systematic. This was a single-center study, and the panel lacked patient and family representation. CONCLUSIONS A novel 17-item Hemodialysis Safety Checklist (Hemo Pause) for use by nurses and patients has been developed to standardize the hemodialysis procedure. Further quality improvement efforts are underway to explore the feasibility of using this checklist to reduce adverse events and strengthen the safety culture in the hemodialysis unit.
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Affiliation(s)
- Samuel A Silver
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Alison Thomas
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Andrea Rathe
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Pamela Robinson
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ron Wald
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- />Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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31
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Torchi TS, Araújo STCD, Moreira AGM, Koeppe GBO, Santos BTUD. Condições clínicas e comportamento de procura de cuidados de saúde pelo paciente renal crônico. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Identificar as condições clínicas e comportamento de procura de cuidados de saúde pelo paciente renal crônico no itinerário terapêutico para a hemodiálise.Métodos Estudo qualitativo, descritivo e exploratório a partir de entrevista com dez pacientes de uma clínica de terapia renal substitutiva em tratamento hemodialítico e análise resultante da utilização da técnica do Discurso do Sujeito Coletivo por meio do software qualiquantisofty.Resultados As condições clínicas no itinerário terapêutico evidenciaram sintomas de mal-estar e o perfil das doenças de base identificadas foram nefroesclerose hipertensiva, nefroesclerose diabética, causa indeterminada e nefroesclerose diabética associada com hipertensão arterial. Os comportamentos que prejudicaram o controle de saúde foram à demora no atendimento na rede de saúde, a não aceitação da doença e do tratamento.Conclusão Poucos tiveram acompanhamento precoce, sem manifestação de sintomas. Todavia, a maioria deles tiveram internação hospitalar de maneira repentina.
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32
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Maddux FW, Nissenson AR. The evolving role of the medical director of a dialysis facility. Clin J Am Soc Nephrol 2014; 10:326-30. [PMID: 25278550 DOI: 10.2215/cjn.04920514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility. This commentary provides context to the nature and expected competencies and behaviors of these medical director roles that remain central to the delivery of high-quality, safe, and efficient delivery of RRT, which has become much more intensive as the dialysis industry has matured.
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Abstract
OBJECTIVE The aim of this study was to assess the safety climate as perceived by nurses and physicians in the dialysis units in Saudi Arabia. METHODS This is a cross-sectional survey-based multicenter study using the Safety Climate Scale, which assesses the perception by staff of the prevailing climate of safety. We used 17 items in this survey. These could be further divided into 3 summative categories: (a) handling of errors and safety concerns (9 items), (b) leadership emphasis of safety (7 items), and (c) overall safety recommendation (1 item). The survey uses 5 Likert scale options (1, disagree strongly; 2, disagree slightly; 3, neutral; 4, agree slightly; and 5, agree strongly). RESULTS There were 509 respondents--a response rate of 76.6% and 53.3% among nurses and physicians, respectively. The internal consistency using Cronbach α was 0.899. The overall mean (SD) of satisfaction with safety climate was higher among the nurses than the physicians (4.13 [1.1] and 4.05 [1.7], respectively; P = 0.029). The overall agreement rate was 73.8%, with more nurses than physicians agreeing that safety climate prevails the dialysis center (75.4% versus 72.1%, respectively; P = 0.047).The respondents perceived a stronger commitment to safety from their clinical area leaders than from senior leaders in the organization (76.2% and 72.4%, respectively). In addition, the physicians gave lower scores to more questions than the nurses particularly in 3 areas, namely, "leadership is driving us to be a safety-centered institution" (71.5% versus 76.5%; P = 0.037), "I am encouraged by my colleagues to report any patient safety concerns I may have" (67.4% versus 84.7%; P = 0.03), and "I know proper channels to ask questions about safety" (69.6% versus 87.2%; P = 0.002).The scores by the physicians in all the 3 summative categories were again less than the scores by the nurses, but this did not reach a statistical significance. CONCLUSIONS The nurses had higher perceptions of a prevailing safety climate than the physicians. There was a perception of a stronger commitment to safety from their clinical area leaders than from senior leaders in the organization. Senior management needs to relay their commitments to safety more effectively especially to physicians and to open clear and easily accessible channels for communication for safety issues.
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Dietz I, Plog A, Jox RJ, Schulz C. “Please Describe from Your Point of View a Typical Case of an Error in Palliative Care”: Qualitative Data from an Exploratory Cross-Sectional Survey Study among Palliative Care Professionals. J Palliat Med 2014; 17:331-7. [DOI: 10.1089/jpm.2013.0356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Isabel Dietz
- Department of Palliative Medicine, Ludwig-Maximilian-University, Munich, Germany
- Department of Anaesthesiology, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Anke Plog
- Department of Anaesthesiology, Technical University of Munich, Munich, Germany
| | - Ralf J. Jox
- Institute for Ethics, History and Theory of Medicine, University of Munich, Munich, Germany
| | - Christian Schulz
- Interdisciplinary Center for Palliative Medicine, University of Düsseldorf, Düsseldorf, Germany
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Miller BW. The Umpire's Call: Safe at Home, but the Game Is Not Over. Am J Kidney Dis 2014; 63:178-9. [DOI: 10.1053/j.ajkd.2013.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 11/11/2022]
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Bray BD, Boyd J, Daly C, Doyle A, Donaldson K, Fox JG, Innes A, Khan I, Mackinnon B, Peel RK, Shilliday I, Simpson K, Stewart GA, Traynor JP, Metcalfe W. How safe is renal replacement therapy? A national study of mortality and adverse events contributing to the death of renal replacement therapy recipients. Nephrol Dial Transplant 2013; 29:681-7. [PMID: 24068777 DOI: 10.1093/ndt/gft197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients receiving treatment with renal replacement therapy (RRT) have high mortality, and ensuring patient safety in this population is difficult. We aimed to estimate the incidence and nature of medical adverse events contributing to the death of patients being treated with RRT. METHODS This population registry-based retrospective case review study included all patients being treated with RRT for established renal failure in Scotland and who died between 1 January 2008 and 30 June 2011. Deaths were reviewed by consultant nephrologists using a structured questionnaire to identify factors contributing to death occurring in both the inpatient and outpatient setting. Reviewers were able to use any information source deemed relevant, including paper and electronic clinical records, mortality and morbidity meetings and procurator fiscal (Scottish coroner) investigations. Deaths occurring in 2008 and 2009 where avoidable factors were identified that may have or did lead to death of a patient were subject to further review and root cause analysis, in order to identify recurrent themes. RESULTS Of 1551 deaths in the study period, 1357 were reviewed (87.5%). Cumulative RRT exposure in the cohort was 2.78 million person-days. RRT complications were the primary cause of death in 28 (2.1%). Health-care-associated infection had contributed to 9.6% of all deaths. In 3.5% of deaths, factors were identified which may have or did contribute to death. These were both organizational and human error related and were largely due to five main causes: management of hyperkalaemia, prescribing, out of hours care, infection and haemodialysis vascular access. CONCLUSIONS Adverse events contributing to death in RRT recipients mainly relate to the everyday management of common medical problems and not the technical aspects of RRT. Efforts to avoid harm in this population should address these ubiquitous causes of harm.
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Pippias M, Tomson CRV. Patient safety in chronic kidney disease: time for nephrologists to take action. Nephrol Dial Transplant 2013; 29:473-5. [PMID: 23975749 DOI: 10.1093/ndt/gft364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maria Pippias
- Specialist Registrar in Nephrology, Richard Bright Renal Unit, Southmead Hospital, Bristol BS10 5NB, UK
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Jacob D, Marrón B, Ehrlich J, Rutherford PA. Pharmacovigilance as a tool for safety and monitoring: a review of general issues and the specific challenges with end-stage renal failure patients. Drug Healthc Patient Saf 2013; 5:105-12. [PMID: 23637559 PMCID: PMC3636760 DOI: 10.2147/dhps.s43104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pharmacovigilance is instrumental in helping to ensure patient safety for both newly released drugs and those that are well established in the market. However, while pharmacovigilance procedures are strictly regulated in the clinical trial setting, post-marketing adverse event reporting is not well implemented or enforced. As such, the underreporting of adverse events, in relation to drugs that are on the market, is estimated to be in the region of 90%. The identification of drug safety issues in patients with complex diseases and extensive comorbidities is therefore particularly challenging. Dialysis patients - those with end-stage renal disease and often other comorbidities such as diabetes, hypertension, and cardiovascular disease - are a population with significant treatment challenges. Patients receive dialysis using complex medical devices (eg, a peritoneal dialysis home cycler) and also receive a range of pharmaceutical agents as part of dialysis itself (eg, peritoneal dialysis solutions). Many of the pharmaceutical agents used to treat these patients have been developed in populations without these complications and, therefore, an extensive knowledge of potential problems and contraindications in the dialysis population is lacking. It is important that the nephrology community understands the concept of pharmacovigilance - the pharmacologic science relating to the detection, assessment, understanding, and prevention of adverse effects, particularly long-term and short-term side effects, of medicines. Health care professionals (HCPs) and providers, pharmaceutical companies, global regulatory agencies, and the patients themselves all play unique and critical roles in this process. This review defines the science of pharmacovigilance and the process of adverse event reporting, highlights the new directions that pharmacovigilance has taken, and provides insight for HCPs managing dialysis patients into the important role that they play in helping to shape the understanding of a drug's safety profile in order to continually enhance patient safety.
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Affiliation(s)
- Dalia Jacob
- Baxter Healthcare Corporation, Deerfield, IL, USA
| | | | - Jay Ehrlich
- Baxter Healthcare Corporation, Deerfield, IL, USA
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Jacob D, Marrón B, Ehrlich J, Rutherford PA. Pharmacovigilance as a tool for safety and monitoring: a review of general issues and the specific challenges with end-stage renal failure patients. Drug Healthc Patient Saf 2013. [PMID: 23637559 DOI: 10.2147/dhps.s43104.p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Pharmacovigilance is instrumental in helping to ensure patient safety for both newly released drugs and those that are well established in the market. However, while pharmacovigilance procedures are strictly regulated in the clinical trial setting, post-marketing adverse event reporting is not well implemented or enforced. As such, the underreporting of adverse events, in relation to drugs that are on the market, is estimated to be in the region of 90%. The identification of drug safety issues in patients with complex diseases and extensive comorbidities is therefore particularly challenging. Dialysis patients - those with end-stage renal disease and often other comorbidities such as diabetes, hypertension, and cardiovascular disease - are a population with significant treatment challenges. Patients receive dialysis using complex medical devices (eg, a peritoneal dialysis home cycler) and also receive a range of pharmaceutical agents as part of dialysis itself (eg, peritoneal dialysis solutions). Many of the pharmaceutical agents used to treat these patients have been developed in populations without these complications and, therefore, an extensive knowledge of potential problems and contraindications in the dialysis population is lacking. It is important that the nephrology community understands the concept of pharmacovigilance - the pharmacologic science relating to the detection, assessment, understanding, and prevention of adverse effects, particularly long-term and short-term side effects, of medicines. Health care professionals (HCPs) and providers, pharmaceutical companies, global regulatory agencies, and the patients themselves all play unique and critical roles in this process. This review defines the science of pharmacovigilance and the process of adverse event reporting, highlights the new directions that pharmacovigilance has taken, and provides insight for HCPs managing dialysis patients into the important role that they play in helping to shape the understanding of a drug's safety profile in order to continually enhance patient safety.
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Affiliation(s)
- Dalia Jacob
- Baxter Healthcare Corporation, Deerfield, IL, USA
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Hübner NO, Fleßa S, Jakisch R, Assadian O, Kramer A. Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis - a perspective from structurally- and process-oriented hygiene. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc15. [PMID: 22558049 PMCID: PMC3334955 DOI: 10.3205/dgkh000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene.
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