P137 What are the Current Patient Safety Issues in Dialysis

Fielding C.A.1, Fluck R.J.1 and Rylance P.2
Derby Hospitals NHS Foundation Trust, 2Royal Wolverhampton NHS Trust
Problem:RA / BRS Patient Safety want to develop a proactive approach to patient safety.
Whilst patient safety approaches often involve reacting to individual patient safety incidents, the
ultimate goal is to prevent incidents before they cause harm. Identifyingcurrent patient safety
issuesand predicting incidentsis challenging. Patient safety can cover a potentially infinite
numbers of issues, with risks to patients changing with developing treatments and technology.
Purpose:One approach adopted to identify patient safety issues within dialysis, was to survey
the lead nurses opinions across the UK. As nursesare theprofessionals that perform dialysis
treatments on a day to day basis, it was felt their opinions and insights would be valuable.
Design:An electronic survey document was designed with the aim to gain the lead nurses
opinions on what they thought were current patient safety issues within dialysis. Open ended
questions were developed which provided little guidance, except to ask their opinions. The
survey was constructed so as not be leading or onerous to complete. Included within the survey
were both questions related to haemodialysis and peritoneal dialysis. The survey was sent to all
the current lead nursecontacts in the UK. Returns from the survey were examined, leading to
identification of a number of patient safety issues.
Findings: Returns were received from 15 renal units within the UK, with varying degrees of
detail. For haemodialysis, a total of 53 patient safety issues were mentioned, which covered 23
different types of patient safety issues. These fell into 4 categories: the extracorporeal circuit
(20.8%of incidents identified; 11/53); vascular access (20.8%; 11/53); nurse staffing (18.8%;
10/53) and an ‘other’ category for other issues (39.6%; 21/53).
Issues identified of note included:
Blood loss from vascular access – VND; ruptured AVF
9/15renal units
7/15renal units
Reduction of HD time due to transport
4/15renal units
VA infection
2/15renal units
Nurse Staffing issues – staffing levels; inexperienced staff
5/15renal units
Only 7 units (7/15) completed the sectionrelated to peritoneal dialysis. The patient safety issues
Peritonitis (including encapsulating sclerosing peritonitis)
7/7renal units
Risk of overfill of the peritoneal cavity in APD
2/7renal units
Lack of specialist support for PD patients out-of-hours
1/7renal units
Conclusion: The potential risks to patients undergoing dialysis continue to be numerous and
varied. Infection and blood loss from vascular access persists as an area of concern. Falls in
dialysis patients was the second highest risk identified and requires multi-professional working
to provide viable and practical solutions. Both these issueswill provide focus for RA / BRS
Patient Safety in the future. The extracorporeal circuit in haemodialysis continues to be a high
risk area that requires vigilance and skill to manage.This issuelinks to another area of concern the need for adequate, competent haemodialysis nurses. Whilst peritoneal dialysis had less
issues identified, there are still areas of concern that require consideration.
Relevance: The results of the survey provide focus for potential patient safety issues that could
be proactively considered by RA / BRS Patient Safety. These results have contributed to the
strategy for RA / BRS Patient Safety, along with other data. The spectrum of issues raised does
indicate that RA / BRS Patient Safety alone cannot address all these issues. Whilst it can
provide guidance and support to units and develop patient safety in renal care in the future, renal
units need an engaged approach to patient safety. Joint working between RA / BRS Patient
Safety and all renal units in the UK is essential to ensure patient safety is improved.
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