title: Development of a hemodialysis safety checklist using a structured panel process.
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.
  
  
  METHODS
  A modified Delphi consensus technique based on the RAND method was used to evaluate and revise the checklist.
  
  
  METHODS
  University-affiliated in-center hemodialysis unit.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Silver
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rathe
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Robinson
authors.affiliation: 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.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.affiliation: 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.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
keywords: Checklist; Delphi panel; Hemodialysis; Patient safety; Quality improvement