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Home Haemodialysis: Improving Patient Safety

Home Haemodialysis: Improving Patient Safety. Judith Moore Pre Dialysis and Home Therapies Team Leader Belfast City Hospital. Facts. Facts. Population of 1.8 million Host of the recent 2013 World Police and Fire Games (WPFG). “The friendliest games ever” – WPFG Federation President.

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Home Haemodialysis: Improving Patient Safety

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  1. Home Haemodialysis: Improving Patient Safety Judith Moore Pre Dialysis and Home Therapies Team Leader Belfast City Hospital

  2. Facts

  3. Facts • Population of 1.8 million • Host of the recent 2013 World Police and Fire Games (WPFG). • “The friendliest games ever” – WPFG Federation President.

  4. Contents • Background • Home Haemodialysis (HHD) in Northern Ireland • Biomed Central Report 2012 • Identified Area of Change • Conclusion • Acknowledgements

  5. Background • Belfast City Hospital - 200 in-centre HD patients. • Sub-regional units - 500 in-centre HD patients.

  6. Home Haemodialysis (HHD) in Northern Ireland Established 10 years 77 patients trained Approx 45% transplanted Current total of 33 patients 69% monthly reviews by BCH HHD team 31% monthly reviews by sub-regional community dialysis teams

  7. Existing Patients

  8. Biomed Central Nephrology Report 2012 • “Exsanguination of a home haemodialysis patient as a result of misconnected blood-lines during the wash back procedure: a case report” (Allocock et al, BMC Nephrology 2012, 13:28). • Key points of the report relating to the HHD programme: • 30 years experience • 80 patients • MDT selection • Train 20-25 patients per year • Average approx 3-4 months training per patient • Monthly visits and support

  9. Biomed Central Nephrology Report 2012 • Key Points of the report relating to the patient: • 67 year old male • AVF • 20 weeks successful training • Contact with case manager on morning of death • Death occurred due to misconnected bloodlines • 2.3L of blood • Hypovolaemia

  10. Biomed Central Nephrology Report 2012 Pictures • The saline bag found attached to the deceased’s dialysis machine • The weight of the bag was 3.3Kg – implying the addition of 2.3L of the patient’s blood to the saline bag during the wash-back procedure

  11. Identified Area of Change • Competency based training for our HHD patients • Reports of misconnected bloodlines • Identified and rectified mistake • Change in wash-back procedure • Introduction of a Y-Connector

  12. Introduction of Y-Connector for all HHD Patients with an AVF

  13. Introduction of Y-Connector for all HHD Patients with an AVF • Patient connects the Y-Connector to the arterial fistula needle and ensures the BLUE clamp is closed on the connector prior to needle insertion • Patient inserts venous needle as usual

  14. Introduction of Y-Connector for all HHD Patients with an AVF • Patient connects the arterial bloodline to the RED clamp side of the Y-connector • Patient connects the venous bloodline to the venous needle • Patient commences dialysis in the usual way

  15. Use of the Y-Connector for Wash-Back Procedure • In preparation for the disconnection procedure, the patient removes the saline wash-back line from the dialysis machine

  16. Use of the Y-Connector for Wash-Back Procedure • The patient closes the clamp on the ARTERIAL fistula needle • The patient attaches the saline wash-back line to the redundant BLUE leg of the Y-connector

  17. Use of the Y-Connector for Wash-Back Procedure • The patient opens the roller clamp on the wash-back line and the BLUE clamp on the Y-Connector • Wash back commences

  18. Use of the Y-Connector for Wash-Back Procedure

  19. Use of the Y-Connector for Wash-Back Procedure • Patient closes the clamps on the bloodlines, venous fistula needle, Y-connector and the roller clamp on the saline wash-back line • Patient disconnects the Y-Connector from the arterial needle and the bloodline from the venous needle and attaches these to the circuit • Patient removes and discards the fistula needles in the sharps bin

  20. Evaluation of the Y-Connector • 74% re-trained • Safety information given to the patients • Patients quote that “it makes sense” and is “easily understood” • 22% are not using the Y-connector • Nursing documentation • No further misconnections have occurred

  21. Conclusion • The Biomed Central Nephrology Report has highlighted a potential risk for all patients on HHD who dialyse with an AVF • Misconnected bloodlines during the wash-back procedure can be fatal • The introduction of a Y-connector to be used during the wash-back procedure can be a viable solution to improve patient safety on HHDand minimise the risk of exsanguination

  22. Acknowledgements • HHD patients and their families • Colleagues and friends at the Belfast City Hospital • Baxter Healthcare • Amgen

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