Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study.
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.
Division of Nephrology , St Michael's Hospital, University of Toronto , Toronto, ON , Canada.
Alison
A
Thomas
Division of Nephrology , St Michael's Hospital, University of Toronto , Toronto, ON , Canada.
Samuel A
SA
Silver
Division of Nephrology , St Michael's Hospital, University of Toronto , Toronto, ON , Canada.
Andrea
A
Rathe
Division of Nephrology , St Michael's Hospital, University of Toronto , Toronto, ON , Canada.
Pamela
P
Robinson
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.
Ron
R
Wald
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.
Chaim M
CM
Bell
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.
Ziv
Z
Harel
checklist; hemodialysis; patient safety; quality improvement