PubMed · 3649370
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J M Hexum. 1987. Monitoring standards instead of problems.. https://doi.org/10.1097/00001786-198705000-00004
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Recently, there has been a decline in chronic peritoneal dialysis (CPD) utilization in several countries. And, in these countries, the percent of patients with end-sage renal disease maintained on CPD is less than nephrologists think is appropriate. The reasons for these problems are uncertain, but it is likely that difficulties with the structural organization of CPD facilities play a contributory role. This paper discusses the structural requirements for a successful CPD program, focusing attention on the following domains: (1) adequate chronic kidney disease education, (2) provision and support of physician training in the principles and practice of CPD, (3) adequate size and organization of CPD centers, (4) development of appropriate support systems within the CPD facility, and (5) development of appropriate continuous quality improvement programs to monitor a variety of domains, including adequacy of dialysis, peritonitis rates, catheter infections and problems, psychosocial status of patients, etc.
Medical mistakes that harm patients have occurred in dialysis facilities, just as they have been reported to cause death in hospitals. A plan to recognize and prevent mistakes includes several elements. (1) Establish a culture of safety, where safe practices are a priority and reporting of adverse events and 'near misses' is encouraged in a non-punitive environment. (2) Redesign processes of care to minimize patient falls, medication errors, bleeding from vascular accesses, dialyzer reuse errors and other problems. (3) Perform root cause analyses of adverse events and 'near misses'. (4) Involve patients in safety efforts, including maintaining an accurate, up-to-date medication list. (5) Dialysis facilities should function as high-reliability organizations, focusing on the possibility of failures, expecting to make errors, training to recognize and recover from them and making system reforms following root cause analyses.
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