Ramnath Balasubramanian1, Rachel Folwell1, Arran Wheatley1, Heidi Ramsey1, Carmen Barton1, Christopher J D Reid1, Manish D Sinha2,3. 1. Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK. 2. Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK. manish.sinha@gstt.nhs.uk. 3. Kings College London, London, UK. manish.sinha@gstt.nhs.uk.
Abstract
BACKGROUND: We developed a paediatric haemodialysis trigger tool (pHTT) for application per haemodialysis (HD) session in children receiving intermittent in-centre HD and systematically monitored adverse events. METHODS: Single-centre quality improvement study performed over two 8-week cycles. Data collected prospectively using a 'per-dialysis session' pHTT tool including 54 triggers across six domains, adapted from a recently described haemodialysis trigger tool (HTT) for adults. Each trigger was evaluated for level of harm following assessment by two authors. Following a period of training, HD nurses completed the HTT at the end of each dialysis session. RESULTS: There were 241 triggers over 182 dialysis sessions, with 139 triggers in 91 HD sessions for 15 children, age range 28-205 months, over an 8-week period (first cycle) and 102 triggers in 91 HD sessions for 13 children, age range 28-205 months, over a further 8-week period (second cycle). After interventions informed by the pHTT, the harm rate per session was significantly reduced from 1.03 (94/91) to 0.32 (29/91), P < 0.001. There was a significant difference between the distribution of triggers by harm category (P < 0.001) and between the proportion of triggers across the various domains of the pHTT (P = 0.004) between the two cycles. No triggers were evaluated as causing permanent harm. CONCLUSIONS: This pilot study demonstrates potential benefits of a bedside tool to monitor adverse events during haemodialysis in children. Thus, following interventions informed by the pHTT, the harm rate per session was significantly reduced. Under standard patient safety systems, the vast majority of triggers identified by the pHTT would remain unreported and perhaps lead to missed opportunities to improve patient safety. We propose the use of a paediatric HTT as part of standard care by centres providing HD to children in the future. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: We developed a paediatric haemodialysis trigger tool (pHTT) for application per haemodialysis (HD) session in children receiving intermittent in-centre HD and systematically monitored adverse events. METHODS: Single-centre quality improvement study performed over two 8-week cycles. Data collected prospectively using a 'per-dialysis session' pHTT tool including 54 triggers across six domains, adapted from a recently described haemodialysis trigger tool (HTT) for adults. Each trigger was evaluated for level of harm following assessment by two authors. Following a period of training, HD nurses completed the HTT at the end of each dialysis session. RESULTS: There were 241 triggers over 182 dialysis sessions, with 139 triggers in 91 HD sessions for 15 children, age range 28-205 months, over an 8-week period (first cycle) and 102 triggers in 91 HD sessions for 13 children, age range 28-205 months, over a further 8-week period (second cycle). After interventions informed by the pHTT, the harm rate per session was significantly reduced from 1.03 (94/91) to 0.32 (29/91), P < 0.001. There was a significant difference between the distribution of triggers by harm category (P < 0.001) and between the proportion of triggers across the various domains of the pHTT (P = 0.004) between the two cycles. No triggers were evaluated as causing permanent harm. CONCLUSIONS: This pilot study demonstrates potential benefits of a bedside tool to monitor adverse events during haemodialysis in children. Thus, following interventions informed by the pHTT, the harm rate per session was significantly reduced. Under standard patient safety systems, the vast majority of triggers identified by the pHTT would remain unreported and perhaps lead to missed opportunities to improve patient safety. We propose the use of a paediatric HTT as part of standard care by centres providing HD to children in the future. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Swati Agarwal; David Classen; Gitte Larsen; Nancy M Tofil; Leslie W Hayes; Janice E Sullivan; Stephanie A Storgion; Barbara J Coopes; Vicki Craig; Christine Jaderlund; Hema Bisarya; Layla Parast; Paul Sharek Journal: Pediatr Crit Care Med Date: 2010-09 Impact factor: 3.624
Authors: Anne G Matlow; G Ross Baker; Virginia Flintoft; Douglas Cochrane; Maitreya Coffey; Eyal Cohen; Catherine M G Cronin; Rita Damignani; Robert Dubé; Roger Galbraith; Dawn Hartfield; Leigh Anne Newhook; Cheri Nijssen-Jordan Journal: CMAJ Date: 2012-07-30 Impact factor: 8.262
Authors: Eric S Kirkendall; Elizabeth Kloppenborg; James Papp; Denise White; Carol Frese; Deborah Hacker; Pamela J Schoettker; Stephen Muething; Uma Kotagal Journal: Pediatrics Date: 2012-10-08 Impact factor: 7.124