Improving Dialysis - Mid Atlantic Renal Coalition, ESRD Network 5

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Improving Care in the Dialysis Setting

Interactive Session
May 10, 2002
McLean, Virginia

Dr. Derrick Latos introduced the topic, followed by Dr. Barbara Fivush who presented an overview of safety science, national activities focused on patient safety, and activities specific to the renal community. Dr. Jack Moore facilitated an interactive session to gather the audience's viewpoint.

The blame-free environment and organizational culture necessary to impact on safety issues was emphasized. Top patient safety issues, identified by Network 5 providers, are listed below and illustrated in the attached graphs. The audience identified possible causes, which are also listed below, by discipline. The last segment includes possible solutions that were contributed by the audience.

Top Patient Safety Issues Identified by Network 5 Providers

	1. Access related events
	2. Excess blood loss
	3. Medication errors
	4. Violent patients
	5. Exposure to blood/body fluids

Possible Causes of Major Patient Safety Issues, by Discipline

Patients' Perspective

Unresponsive administrative system

Problems are hidden

Inadequate staff

Poorly paid staff

Overworked staff

Inadequate support

Social Workers' Perspective

Staff bringing human needs/problems to work

Unprofessional staff is tolerated

Lack of interdisciplinary communication

Expedient behavior

Patients that behave inappropriately have no resources available to them

Working environment is stressful

Staff overworked and underpaid

Physicians' Perspective

Safety is not the mission of central priority

Poor/inadequate supervision of existing procedures

Staff not following protocol

Lack of opportunity for professional training

Administrators' Perspective

Inadequate staff

Inability to secure adequate staff

Nursing/technicians/nephrologist shortages

Litigations

Bad reimbursement

Inadequate training/follow-up/supervision

Not manufacturing safe "mechanisms"

Regulatory agencies

Creating a culture where people feel comfortable coming forward is difficult

Not much leadership "buy-in"

Highly complex patients consume time

Nurses' Perspective

Unfocused staff

Nurses afraid to question

Staff not following what they know is right

Inadequate training of new staff

Problems with the types of patients coming to dialysis today

Staff shortages

Hurried environment-staff and patients want in and out of center quickly

Bottom line

Poor physical environment

MD's aren't listening to nurses

Not "nephrology" related impairments are not treated

Often no primary doctor

Physician unresponsiveness

Insurance/payment systems

Insufficient time for continuing education

Unfriendly technology

Environment not conducive to creative and analytical thinking

What Can We Do?

	1. Increase staff	11. Have patient be active part of team
	2. Provide better and longer training	12. Have highly disciplined team
	3. Pay people more	13. Have adequate supplies
	4. Create a respectful environment	14. Need better people in authority
	5. Have more flexible work schedule	15. Fewer patients
	6. Limit work hours	16. Listen to patient experience
	7. Create open lines of communication	17. Recognize people/professionals
	8. Commitment to patient education	18. Empower patients to speak out & be heard
	9. Be proactive	19. Pre-dialysis education in physicians office
	10.Start education of general public

Graph of Top Patient Safety Issues in Dialysis Clinics Identified by Network 5 Renal Community April 2002

Graph of Response Rate by Discipline & Contribution to Overall

Graph of Top 3 Patient Safety Issues in Dialysis by Discipline April 2002