title: Patient and facility safety in hemodialysis: opportunities and strategies to develop a culture of safety.
abstract: Patient safety is the foundation of high-quality health care. More than 350,000 patients receive dialysis in the United States, and the safety of their care is ultimately the responsibility of the facility medical director. The medical director must establish a culture of safety in the dialysis unit and lead the quality assessment and performance improvement process. Several lines of investigation, including surveys of patients and dialysis professionals, have helped to identify important areas of safety risk in dialysis facilities. Among these are lapses in communication, medication errors, patient falls, errors in machine and membrane preparation, failure to follow established policies, and lapses in infection control. The quality assessment and performance improvement process should include a dedicated safety team to focus on specifically identified areas of risk and to establish outcome goals guided by best practices and agreed-upon measures of success. A safety questionnaire can be given to patients and staff and the responses evaluated to improve understanding of the prevailing attitudes and concerns about safety. By sharing these results, openly acknowledging the challenges, and using a blame-free root cause process to identify action plans, the facility can begin to establish a culture of safety.
authors.affiliation: New York Medical College, Westchester Medical Center, Valhalla, 10595, USA. GarrickR@wcmc.com
authors.forename: Renee
authors.initials: R
authors.lastname: Garrick
authors.forename: Alan
authors.initials: A
authors.lastname: Kliger
authors.forename: Beth
authors.initials: B
authors.lastname: Stefanchik
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004869:Equipment Safety / Q000592:standards; D019983:Guideline Adherence; D006268:Health Facilities / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000592:standards; D019300:Medical Errors / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic; D016730:Program Development; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome