Implementation of a quality and safety checklist for haemodialysis sessions

BACKGROUND Patient survival and quality of life depend on each haemodialysis session being performed without fault. Monthly assessments of dialysis dose adequacy often fall short of this. This study reports the results of a feasibility study for the achievement of improved safety and quality in a haemodialysis session with the implementation of a 15-point checklist. METHODS Fifteen quality indicators were compiled and tested in a Portuguese dialysis clinic from 1 February 2012 to 30 June 2013. The checklist was completed by the nursing staff and comprised three parts: Pre-session Safety Checks; Session Initiation Checks and Post-session Quality Checks. The maximum score that could be reached per session was 15. RESULTS One hundred and twenty-eight patients were distributed over 2-3 shifts. Of the 16 nurses employed, 4 were full time. The final average score was between 14 and 15. No nurse-specific and no shift-specific significant differences were detected. Four issues were identified that had a major effect on the results as a whole: delays in connection time; incompletely delivered treatment time; non-achievement of final body weight and failure to reach a Kt/V of at least 1.4. Improvements were most consistent in the Monday-Wednesday-Friday morning shifts compared with other shifts, and were temporarily compromised by the opening of a new shift. CONCLUSIONS The implementation of checklists for haemodialysis is feasible in routine clinical practice, even in clinics where only part of the staff is employed full time. The application of such checklists enhances the overall quality and safety of the delivered treatment.