‘Walking billboards’ help patients understand information about dialysis and renal care

The following report is taken from a presentation by Pat Seddon, advanced practice nurse in the dialysis unit (11D), UPMC Presbyterian, during a recent meeting of the Total Quality and Patient Safety Council.
 
Because patient education is such a critical part of patient satisfaction and patient safety, it’s important to educate patients through innovative strategies that are attention-getting and inviting. To address this challenge, and to start conversations around topics involving dialysis and renal care, dialysis unit staff members began wearing scrub tops designed as walking billboards. Topics for shirts included:

  • phosphorus control and the importance of keeping phosphorus levels in range
  • fistulas as the preferred access due to low infection rates and best function
  • hyperkalemia and how to keep potassium levels in range
  • peritoneal dialysis as a treatment option

Ms. Seddon said this initiative had a great response from patients and families for these topics. Staff saw a 20 percent increase in patient- and family-initiated teaching moments when the shirts were worn, with the highest percentage of questions coming from patients who were relatively new to dialysis. These patients mostly asked questions that showed they were ready for education — and needed it. Almost one-third of the questions were related to vascular access, with another third being asked about peritoneal dialysis.
Questions didn’t just come from patients and families. Ms. Seddon explained that other clinical providers also asked dialysis staff questions when they saw the shirts, which she said was a “phenomenal” result.
 
To enhance patient safety and satisfaction further, a patient safety checklist was developed to reduce potential errors and miscommunications that happen during setup and initiation of hemodialysis. These missteps included improper patient identification, being unaware of patient allergies, and being unaware of patient code status. To eliminate these concerns, a checklist was developed that included items to be verified before a treatment was initiated. These items included:

  • patient identification
  • allergies
  • code status
  • isolation status
  • dialyzer
  • dialysate
  •  machine settings
  • current sanitization log
  • absence of residual disinfectant
  • presence of normal pH and conductivity
  • presence of a hand crank (enabling staff to power the machine by hand if necessary)

Compliance to the checklist is monitored through weekly unit rounds and documentation audits. Staff who do not comply with completing the checklist are counseled and reminded of the importance of using this patient safety tool. Ms. Seddon noted that since the checklist has been implemented, there have been zero errors in dialysis setup or initiation.