Implementation of a quality and safety checklist for haemodialysis sessions

Abstract

BackgroundPatient survival and quality of life depend on each haemodialysis session being performed without fault. Monthly assessments of dialysis dose adequacy often fall short of this. This study reports the results of a feasibility study for the achievement of improved safety and quality in a haemodialysis session with the implementation of a 15-point checklist.MethodsFifteen quality indicators were compiled and tested in a Portuguese dialysis clinic from 1 February 2012 to 30 June 2013. The checklist was completed by the nursing staff and comprised three parts: Pre-session Safety Checks; Session Initiation Checks and Post-session Quality Checks. The maximum score that could be reached per session was 15.ResultsOne hundred and twenty-eight patients were distributed over 2–3 shifts. Of the 16 nurses employed, 4 were full time. The final average score was between 14 and 15. No nurse-specific and no shift-specific significant differences were detected. Four issues were identified that had a major effect on the results as a whole: delays in connection time; incompletely delivered treatment time; non-achievement of final body weight and failure to reach a Kt/V of at least 1.4. Improvements were most consistent in the Monday–Wednesday–Friday morning shifts compared with other shifts, and were temporarily compromised by the opening of a new shift.ConclusionsThe implementation of checklists for haemodialysis is feasible in routine clinical practice, even in clinics where only part of the staff is employed full time. The application of such checklists enhances the overall quality and safety of the delivered treatment.

Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study

“…The results of our study are in keeping with the results of two other hemodialysis checklist feasibility studies [ 10 , 11 ]. The checklists by Marcelli et al [ 10 ] and Galland et al [ 11 ] were found to be feasible and acceptable for use among their study participants. The acceptance of our checklist by nursing staff and patients may be related to the common features it shares with the aforementioned checklists, with 70–80% of the items similar across all three checklists.…”

“…Another important difference is the format of the checklist. The Hemo Pause checklist was designed to be completed manually as the hemodialysis session progresses, whereas the checklist by Marcelli et al [ 10 ] was completed automatically from device monitors and electronic records rather than being physically checked by a person. This difference may be important, since it is the act of completing the checklist that affects behavior, not using the checklist as a means of data collection or assurance [ 22 , 23 ].…”

“…Checklists may represent a solution to improving the safety culture in the hemodialysis unit. Indeed, checklists have been piloted in two European hemodialysis units, which demonstrated an improvement in safety culture and quality of care [ 10 , 11 ]. Despite the improvements, the aforementioned checklists focused primarily on nurse–physician communication and the patient experience.…”

The Effect of Nursing Instructions on Nurses’ Knowledge, Practice and Suggestions Regarding Adverse Events in Hemodialysis

“…Tool II: Observational Checklist: Which containing Safety and Quality Checklist in Hemodialysis session: it is adapted from [1,14] to assess level of nurse's practice regarding prevention of adverse events at hemodialysis. It contains 39 items divided into three levels.…”

Improving patient safety in haemodialysis

“…The study by Marcelli et al [ 7 ] describes the use of a dialysis checklist in a dialysis facility in Portugal. The checklist included 15 items encompassing pre-session safety checks, session initiation checks and post-session quality checks.…”