By Mark Meier, MSW, LICSW

Safety is an important issue we face each day. We hear about safety concerns in our schools, airports and places where we do business. However, our own personal safety is not always the first thing we consider when entering a healthcare setting. Most of the time, we are focused on our health, considering questions to ask our doctor, or coping with our fears. What patients are now learning is that they need to be aware and take responsibility for their own safety when receiving medical care.

In 2001, the Institute of Medicine released a report, titled “Crossing the Quality Chasm.” This report details concerns about safety issues in hospitals and medical clinics, and specifically states; “Quality problems are everywhere, affecting many patients.” It is observations such as this that you as a dialysis patient need to be aware of each time you receive a dialysis treatment.

One of the realities of medical treatment, including dialysis, is that errors do occur. We have all heard the phrase “I’m only human” as a response to a mistake. The people who care for you in the dialysis clinic, whether a nurse, technician or your physician, are only human and, despite their advanced training, caring attitude and diligent efforts to provide safe care, can and do make errors. The real difference though is that errors made in our medical settings tend to have devastating outcomes.

An important aspect of ensuring your own safety is to educate yourself about the many aspects of your dialysis treatment. For example, you should understand the machine you receive your care from. Learn to recognize some of the common reasons your machine alarms. Have a clear picture in your mind of how your machine should be set up prior to receiving your treatments, and if something does not look right, stop and have one of the dialysis clinic staff explain what you are observing. You should also request to look at the policies and procedures your clinic follows to ensure your safety. For example, what is the policy for ensuring your dialysis machine is clear of the solution that is used to clean it? This solution, although an effective cleansing agent, can be very dangerous to you if introduced into your system.

In addition to understanding the dialysis machine, you should educate yourself about the elements related directly to your dialysis treatment. For example, what is the correct policy ensuring a sterile environment as the staff prepares to initiate or finish your treatment? How frequently during your treatment are the nurses or technicians required to monitor your blood pressure, heart rate, temperature or other vital signs related to your well-being during treatment? You should ask about your clinic’s plan to care for you if you experience a significant event on dialysis, such as a major change in blood pressure, vomiting, respiratory distress or change in your level of consciousness.

Another area of concern for you as a patient is your clinic’s water system. Your dialysis center uses a complex process to receive, filter and clean the water used to provide dialysis. Your clinic is required by federal regulation to perform routine checks on the water system throughout the day and it is reasonable for you to inquire about the procedure your clinic follows to make sure this happens.

As you gain a better understanding of the dialysis process, you will also want to maintain open and honest communication with those who provide your care. A key element of the “Patient Safety” movement is the notion that healthcare providers need an outlet to report major errors or “near misses” in care and in doing so will not be punished. On first reading this, many people mistake this statement to mean that healthcare providers will be “allowed” to get away with mistakes and not be held accountable. This is not the case, rather this statement makes the presumption that if an individual practitioner has a mechanism to safely report medical errors, the medical community can monitor the types of errors that are occurring, understand the system that may have caused the error, make adjustments to the process in which care is provided, and ultimately reduce the number of errors that occur.

Keeping this in mind, consider the manner in which you identify and report safety issues in your dialysis clinic. If your first words involve threats to get individuals fired or suspended, or that your intention is to hire an attorney and sue, it is the Patient Safety’s assumption that change will not occur. Rather, the individual making the mistake may deny or attempt to cover up the error, or worse, commit the error again. If these actions occur, this costs the clinic the opportunity to make changes to ensure the error does not happen again to you or any other patient.

As a dialysis patient, you should also be allowed the same level of understanding as you would be allowing the clinic. You should always feel free to report concerns to the clinic staff without fear of retribution or reprisal on the part of the nurses, technicians, doctors or other staff. Further, you should expect the clinic, upon being made aware of a valid safety concern, will take the necessary actions to promptly correct the problem.

Although the thought of having to educate yourself about your dialysis machine, clinic operating policies or care you should receive while dialyzing might seem to be an additional burden, it is anything but that. Becoming familiar with your needs will in all likelihood provide you with numerous benefits as you live with kidney disease. Your knowledge will help to improve your clinical outcomes, help keep you safe, allow you to help your fellow dialysis patients who are new or unfamiliar with the care you have come to understand, and should ultimately be viewed by your physician and the clinic staff as an indication of your commitment to your care, the care of other patient’s in the clinic, and to the safe and effective operation of the dialysis center.

Mark Meier, MSW, LICSW, is the consumer services coordinator at the Renal Network of the Upper Midwest, Inc., and serves on the AAKP National Board of Directors. He is also the recipient of the 2004 AAKP President’s Award.

This article originally appeared in the September 2005 issue of aakpRENALIFE, Vol. 21, No. 2.

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