An integrative risk assessment approach to enhancing patient safety in Continuous Renal Replacement Therapy (CRRT)

IF 3.7 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
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Abstract

Continuous Renal Replacement Therapy (CRRT) serves as an intervention strategy for the management of acute kidney injury (AKI) in critically ill patients. However, owing to its complex nature and the potential for complications, the implementation of CRRT demands continuous monitoring to prevent patient safety risks. This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting, intending to propose preventive measures grounded in expert insights. To systematically categorize and visually depict the risks, their consequences, preventive measures, and recovery controls, our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety (SEIPS) model. In addition to considering patient-related factors that exhibit variability among critically ill individuals, our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters, bleeding risks arising from the necessity of anticoagulation for filter efficacy, vascular catheter-related bloodstream infections, variations in proficiency levels among healthcare professionals regarding CRRT modalities, especially in operating the CRRT machines, high nursing workload, frequent nursing turnover, occurrences of hypophosphatemia, variability in CRRT prescribing patterns, and issues related to communication among stakeholders. This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management. Furthermore, the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.

加强持续性肾脏替代疗法 (CRRT) 患者安全的综合风险评估方法
连续性肾脏替代疗法(CRRT)是治疗重症患者急性肾损伤(AKI)的一种干预策略。然而,由于其复杂性和潜在的并发症,CRRT 的实施需要持续监测,以预防患者安全风险。本研究旨在识别和验证真实临床环境中与 CRRT 相关的普遍风险,并根据专家的见解提出预防措施。为了对风险、其后果、预防措施和恢复控制进行系统分类和直观描述,我们的研究采用了 Bowtie 方法和患者安全系统工程倡议(SEIPS)模型。除了考虑危重病人之间存在差异的患者相关因素外,我们的主要研究结果表明,影响 CRRT 有效实施的最大风险是滤器凝血事件、为保证滤器疗效而必须进行抗凝治疗所导致的出血风险、血管导管相关血流感染、医护人员对 CRRT 模式的熟练程度存在差异(尤其是在操作 CRRT 机器方面)、护理工作量大、护理人员流动频繁、低磷血症的发生、CRRT 处方模式的变化以及利益相关者之间的沟通问题。这项研究揭示了与 CRRT 相关的主要风险,并为有效管理提供了切实可行的策略。此外,作为本研究一部分而开发的鲍特图(Bowtie diagram)是一种宝贵的工具,可直观地表示医疗保健系统,并有助于识别医疗保健环境中与系统相关的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
安全科学与韧性(英文)
安全科学与韧性(英文) Management Science and Operations Research, Safety, Risk, Reliability and Quality, Safety Research
CiteScore
8.70
自引率
0.00%
发文量
0
审稿时长
72 days
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