RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / Name of the Candidate
And
Address / SHWETHA. G. BHAT
D/O GOPALKRISHNA BHAT,
NO. 46, “KRISHNA KRUPA”, NEAR GODWIN SCHOOL, DEE – ENCLAVE LAYOUT,
MARUTINAGAR, KODIGEHALLI MAIN ROAD,
BANGALORE – 560 092.
KARNATAKA.
2 / Name of the Institution / ACHARYA INSTITUTE OF HEALTH SCIENCES, COLLEGE OF HOSPITAL ADMINISTRATION.
3 / Course of study / MASTER IN HOSPITAL ADMINISTRATION.
4 / Date of admission to Course / 4th OCTOBER 2011
5 / Title of the Topic- “A STUDY ON THE PERSONNEL ADHERENCE TO PATIENT SAFETY PRACTICES IN A DIALYSIS UNIT OF A SELECTED HOSPITAL.”
6
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7 / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:-
Patient safety is a new health care discipline that emphasizes the reporting, analysis and prevention of medical errors that often leads to adverse health care events.1
Recognizing that health care error impacts one in every ten patients around the world, the WHO calls patient safety an endemic concern. When professionals make errors it can become costly in terms of both patient suffering and medical care. Patient safety hence is of great importance at a hospital.
When a person’s kidneys are so impaired by disease or injury that they are unable to function adequately then blood is cleansed artificially by a procedure called Dialysis.2
Ensuring patient safety in a dialysis unit is an on-going challenge for today’s health care providers. It requires clinical expertise, working knowledge of equipment and supplies, proper dispensing of medication etc. It is an intensive environment with a high potential for procedural errors and other human factor hazards. The process of providing dialysis treatment includes the use of medication, chemicals, machinery etc. Some common sources of errors that
can risk patient safety are 1). Medication errors 2). Blood administration errors. 3). Falls 4).Equipment’s malfunction 5). Medical Records errors 6). Infection control errors 7). Dialysis prescription errors 8.) Similar name errors etc. So it becomes obvious that dialysis unit has a potential of causing danger to the patient if proper measures are not taken regarding patient safety. Hence it is very important that patient safety be incorporated by the personnel in their work practices in the dialysis unit, to reduce such errors.
Hence this study intends to enable us to understand the basic concept of patient safety, why a dialysis unit should implement patient safety practices, what are the patient safety issues in the dialysis unit, what are the measures to be considered to provide safe patient care, what measures are being taken in the Dialysis unit, What improvements can be made, so that patients are safe and good quality patient care can be delivered.
6.2 REVIEW OF LITERATURE:-
An article by Hogan, Michelle states that the trouble spots are hand washing, medication errors, patient falls, needle insertion, pre-dialysis setup, not taking necessary investigations. The practical measure suggested for safety improvement is hand washing, patients assessed for risk factors of falling, review of medications of patients often, design a culture of safety in the dialysis unit, proper training of nurses3.
An article reported in Pennsylvania Patient Safety Advisory in 2010 states that from November 12, 2008 through October 31, 2009 Pennsylvania healthcare facilities submitted 526 event reports involving haemodialysis administration to the Pennsylvania Patient safety authority. Medication errors where reported most and others included failure to follow policy, needle disconnection, falls. This article also states the strategies to prevent the likelihood of errors and ensure patient safety4.
An article by Jonathan Himmelfarb, M.D states that though technical improvements have taken place in most aspects of haemodialysis procedure, that have greatly improved overall safety, still many gaps remain in the safety net around this complex procedure and the current approaches for improving safety in dialysis population are often sub optimal. Some common patient safety problems are medication errors, complications related to vascular access, patient falls etc.,so these problems can be addressed by following patient safety measures like medication reconciliation, targeted interventions for prevention of falls5.
An article by Jean L Holley, MD illustrated a patient identification error involving dialyzer reuse in a haemodialysis unit. This article states that most patient undergo haemodialysis three times a week and along with the dialysis treatment are given multiple medications like heparin, erythropoietin etc., and hence dialysis centre can be uniquely hazardous places for patients. The article also states the common errors in the dialysis unit like patient identification errors, medications administered during the treatment, risk of falls and hence reduction of errors becomes an essential aspect for the safety of the patients and is becoming the responsibility of the unit medical directors and manager6.
An article by Mark Meier, MCW LISW states that as a dialysis patient, the patient should be aware of the aspects of the dialysis treatment as it would ensure his safety and also will create an open and honest communication with those who provide the care. This would help the medical community monitor errors and rectify them thereby ensuring patient safety7.
An article Patient Safety in the Dialysis Facility states that keeping patients safe while in the dialysis unit is important concern for patients & providers. It lists out the sources of injuries like medication errors, blood administration errors, falls, equipment malfunction, chemical exposure, infection control errors, dialysis prescription errors. This article also provides the strategies that needs to be followed for safety of the patient. The article concludes that it is the responsibility of all health care providers to work together to promote a safe environment for patients in the dialysis care setting8.
An article Dialysis Safety states there are six safety points to consider they are clean hands, correct dialyzer and dialyzing solution, correct medications, following specific routines, prevention of fall, preventing needle dislodgement to ensure patient safety in a dialysis unit.9
6.3 OBJECTIVES OF THE STUDY:-
1.  To know the basic concepts of patient safety.
2.  To know what are the dialysis related patient safety issues.
3.  To observe the existing work practices of the personnel.
4.  To systematically assess if personnel are adhering to correct patient safety practices in the dialysis unit.
5.  To provide appropriate suggestions.
MATERIALS AND METHODS:-
7.1 SOURCE OF DATA:-
a.  PRIMARY DATA:-
Shall be collected by observing the work practices of the medical and technical staff in the dialysis unit, in handling dialysis cases.
b.  SECONDARY DATA:
Shall be collected from medical records, registers, documents, journals, articles, books, websites.
7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING
PROCEDURE, IF ANY) :-
i)  Inclusion Criteria:-
a)  A hospital having a dialysis unit.
b)  Medical & Technical staff in the dialysis unit.
ii) Exclusion Criteria:-
a)  Hospital not having a dialysis unit.
b)  Medical & Technical Staff not of the dialysis unit.
iii) Study Design:-
Descriptive study.
iv) Duration of the study:-
One Year.
v) Sampling Design:-
Purposive sampling design.
vi) Sample Size and Population:-
Sample size is 50 – cases of dialysis.
vii) Data Collection Method:-
Methodology:-
Data would be collected using an observational check list.
viii) Data analysis and interpretation (statistical test if any) :-
Data would be analysed & interpreted using appropriate statistical method and with the help of various literature experts in the field.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
Not applicable.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3.
Not applicable.
8 / LIST OF REFERENCES:-
1.  Patient safety – Wikipedia
http://en.wikipedia.org/wiki/Patient_Safety
2.  Tortora and Grabowski – Principles of Anatomy and Physiology, Wiley International 10th edition, p 978.
3.  Hogan, Michelle Dialysis Safety a challenge, but practical changes can help.
Nephrology Times,
September 2008 – Volume 1 – Issue 9 – p1, 11, 12.
http:// journals.lww.com/nephrologytimes/fulltext/2008/09000/…
4.  Pennsylvania Patient Safety Advisory.
Haemodialysis Administration: Strategies to Ensure Safe Patient Care.
Pa Patient Saf Advis 2010 sep ; 7 (3) ; 87-96
http://patientsafety authority.org/ADVISORIES/Advisorylibrary
5.  Jonathhan Himmelfarb, MD,
Optimizing Patient Safety During Haemodialysis,
JAMA (Journal of the American Medical Association) October 19, 2011, Vol 306, No.15.
http://jama.jamanetwork.com/content/306/15/1707.full
6.  Jean. L. Holley, MD-Dangerous Dialysis – Case Study.
U.S Department of Health and Human services.
AHRQ- Agency for Healthcare Research and Quality.
http://webmm.ahrq.gov/case.aspx?caseID=224
7.  Mark Meier, MSW, LICSW.
Ensuring Safety in Dialysis Unit,
American Association of Kidney Patients.
http://www.aakp.org/aakp-library/Safety-at-dialysis-unit/
8.  Patient Safety in the Dialysis facility: A Basic and Practical Approach,
Heartland Kidney Network: Quality Improvement Department. Fact Sheet.
http://www.heartlandkidney.org/quality/downloads/patient_saf.
9.  Dialysis Safety: Keeping Kidney Patients Safe,
Renal Physicians Association
www. Kidneypatientsafety.org
http://www.kidneypatientsafety.org/workarea/linkit.aspx?link
9 / SIGNATURE OF CANDIDATE:-
10 / REMARKS OF THE GUIDE:-
11 / NAME AND DESIGNATION OF :
11.1 GUIDE:- MR. A. RATHEESH
ASSISTANT PROFESSOR.
11.2 SIGNATURE:-
11.3 CO-GUIDE (IF ANY):- MRS. JAYASREE RADHAKRISHNAN
ASSOCIATE PROFESSOR.
ACHARYA INSTITUTE OF HEALTH SCIENCES.
COLLEGE OF HOSPITAL ADMINISTRATION.
11.4 SIGNATURE:-
11.5 HEAD OF DEPARTMENT: - Dr. (COL) S. C. MOHANTY
HOD & PRINCIPAL.
ACHARYA INSTITUTE OF HEALTH SCIENCES.
COLLEGE OF HOSPITAL ADMINISTRATION.
11.6 SIGNATURE:-
12 / 12.1 REMARKS OF THE PRINCIPAL:-
12.2 SIGNATURE:-