Improving patient safety and avoiding incidents in renal units

Abstract

The Renal Association Patient Safety Project has identified that renal patients have been exposed to incidents and risks from failure of dialysis equipment or disposables, or from use error. Blood loss on haemodialysis, particularly from venous needle dislodgement, as well as haemolysis associated with haemodialysis, are risks for potential fatal outcomes. Solutions to these incidents and risks have been formulated and circulated, and guidelines for water treatment quality have been developed. Renal patients are susceptible to infection and also are at risk when admitted as acutely ill. Attention to the influence of ‘human factors’ on safety of renal patient care should be emphasised, especially in communication, handover and team-working. Incident reporting through hospital reporting systems within a ‘no blame’ culture is essential in order to learn from incidents. Incidents and risks related to medical devices should also be reported to the Medicines and Healthcare Products Regulatory Agency (MHRA). Sharing of incidents, risks, solutions and best practice can be rapidly achieved through the Renal Association Patient Safety Project and is being further developed in a multidisciplinary approach through collaboration with the British Renal Society and the Association of Renal Technologists.