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Promoting Patient Safety - Tips From Heartland Kidney Network Facilities

Promoting Patient Safety - Tips From Heartland Kidney Network Facilities

Medications

“Ensure that no other patients medications are on the dialysis machine while a patient is receiving his/her treatment.”- Brenda Herring, RN, Unit Supervisor, Renal Care Group- Newton, Kansas

“Utilize double check of standing order on patients chart for that particular treatment date prior to administering medications.”-Brenda Herring, RN, Unit Supervisor, Renal Care Group-Newton, Kansas

Patient Ambulation

“Clean and dry water spills and wet spots ASAP- so that no one slips and falls!”-Jennifer Coates, RN, BSN, Clinical Coordinator at Kansas Dialysis Services, Ottawa, Kansas & Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“Patients are encouraged to use the bathroom prior to dialysis and are offered the bedpan or taken off the treatment if they must use the bathroom during their treatment.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“Patients are observed in the lobby area before and after dialysis treatments.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

Equipment Maintenance and Safety

“When there are positive machine cultures and LAL’s despite repeated disinfection and bleaching the machine, change dialysate filter!”-Paul Roberson, Machine Maintenance Chief Technician at Chromalloy American Kidney Center, St. Louis, Missouri

“When a machine is moved from clinic to clinic, we routinely change the dialysate filter.”-Paul Roberson, Machine Maintenance Chief Technician at Chromalloy American Kidney Center, St. Louis, Missouri

“We use IV pumps instead of free hanging IV drips medications.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“In an effort to prevent access clotting, we use Transonic monitoring.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

Preventing Chemical Exposure

“ Two people sign off Renalin check sheet as a means of double checking. This has increased our awareness to really look at the machine and has reduced errors.”-Dona Koenigsman, RN, Supervisor at Renal Care Group, Hays, Kansas

Medical Records

“We started a monthly flow sheet audit to reduce the number of documentation and compliance errors.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri

“Ten percent of our flow sheets are audited monthly to assess documentation. This information is presented during our CQI meeting.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri

“We use a Nursing Care Plan Audit Assessment Tool.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri

“Two staff members identify each dialyzer before the dialysis treatment begins.”-Jennifer Coates, RN, BSN, Clinical Coordinator, Kansas Dialysis Services, Ottawa, Kansas

Facility Security

“A workplace violence committee has been formed and is working on developing a comprehensive plan for the clinics.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“We have monthly facility inspections to identify any potential risk to patients, staff, or visitors.” -Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“Video cameras view the doors and parking lot for safety.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“The units are secured, needing a swipe card or key to move about the buildings.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

Facility Policy & Procedure Compliance

“All staff review and sign off on any new or revised policies and procedures.” -Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“We use the same machines, equipment, and policies & procedures consistently throughout all the clinics. This helps with patient and staff safety when working in different clinics, and for quality control.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

Infection Control

Patients and staff are not allowed to eat and drink in the dialysis unit. This is not only for infection control, but also safety.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“When there are positive machine cultures and LAL’s despite repeated disinfection and bleaching the machine, try changing the dialysate filter!”-Paul Roberson, Machine Maintenance Chief Technician at Chromalloy American Kidney Center, St. Louis, Missouri

“Patient accesses must remain uncovered (able to be visualized) during the treatment.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“Patients are encouraged to use the bathroom prior to dialysis and are offered the bedpan or taken off the treatment if they must use the bathroom during their treatment.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

“Patients catheters are clamped, capped, and taped when leaving the unit.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites

Dialysis Prescription Compliance

“Staff members double check each others work, i.e. review the doctor’s orders and the patients dialysis machine each treatment.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites Dialysis.

Centers. need to have more than one staff member double check machine information re: bath, URR, heparin, and dialyzer.”-Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit, Kearney, Nebraska

“We started a monthly flow sheet audit to reduce the number of documentation and compliance errors.” -Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri

“Our Charge RN is responsible for double checking each patient against the orders in our unit.” -Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit, Kearney, Nebraska

“I have put together a Power Point Presentation as a teaching tool to prevent the number of lab errors, missed labs, and mis-drawn labs. Properly drawn labs are so important to obtaining dialysis adequacy goals.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri

“Ten percent of our flow sheets are audited monthly to assess documentation. This information is presented during our CQI meeting.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri.

Adequate Staffing in the Dialysis Facility

“I believe we need to utilize our registered nurses as “true” Charge Nurses to address patient needs and organize the workday.”-Sue Knaust, RN, Supervisor at Renal Care Group, Fort Scott, Kansas.

“Our Charge RN is responsible for double checking each patient against the orders in our unit.” -Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit, Kearney, Nebraska.

Staff Education

“Staff education is a priority, monies are allocated for staff to attend conferences not only locally but nationally.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“Staff members are actively involved in The American Nephrology Nurses Association (ANNA) and the National Association of Nephrology Technicians (NANT).”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“Staff members are required to complete skill competencies during orientation, at the time a new competency is developed, and annually.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“We offer a comprehensive staff orientation program.” -Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“Keep staff members informed. Educate them as much as possible. Knowledge is power!” -Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit, Kearney, Nebraska.

Patient Education

“ A patient education committee has been formed.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“We utilize bulletin boards in the patient lobby for education.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“We review emergency procedures quarterly with the patients.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“Review evacuation process with patients on a regularly scheduled basis.”-Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit Kearney, Nebraska.

“Our unit publishes a patient newsletter three times a year for education.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“Keep patients informed. Educate them as much as possible. Knowledge is power!”-Patrice Taylor, RN, Manager at Overland Trails Dialysis Unit, Kearney, Nebraska.

Root Cause Analysis

“Our Quality Assurance and Risk Management programs meet monthly.”-Elizabeth Wilson, RN, BSN, CNN, Director of Nursing at Dialysis Clinic, Inc., Omaha, Nebraska & Satellites.

“We use a great CQI (plan-do-check-act) flow Chart.”-Jean Audrain, RN, CNN, Patient Care Coordinator at Chromalloy American Kidney Center, St. Louis, Missouri.

“1. Determine the cause. 2. Take steps to prevent from happening again (re-train, review procedure, review patient schedule & staff assignments, etc.). 3. Re-educate staff. 4. Monitor results. 5. Re-evaluate staff.” -Shirley Windscheffel, RN, Manager of Hutchinson Dialysis, Hutchinson, Kansas.

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