Validation of a safety assessment instrument for chronic renal patients on hemodialysis

Aguiar, Letícia Lima; Guedes, Maria Vilani Cavalcante; Galindo Neto, Nelson Miguel; Melo, Geórgia Alcântara Alencar; Almeida, Paulo César de; Oliveira, Roberta Meneses; Caetano, Joselany Áfio

doi:10.1590/1982-0194201800084

Brasil

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Original Article • Acta Paul Enferm 31 (6) • Nov-Dec 2018 • https://doi.org/10.1590/1982-0194201800084 linkcopy

Validation of a safety assessment instrument for chronic renal patients on hemodialysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To construct and validate a safety assessment instrument for chronic renal patients on hemodialysis.

Methods Methodological study that comprised the instrument’s construction and content validation by 14 experts, and evaluation of its understanding by nine nurses. Construction was based on the health legislation on hemodialysis and international patient safety standards. For analysis of the experts’ agreement, intraclass correlation coefficient, content validity index, and binomial test were calculated.

Results The items of the Likert-type scale were distributed into the six international patient safety goals, with 0.98 intraclass correlation coefficient. The final instrument had 57 items with a 0.96 content validity index, and binomial test ≥ 0.86.

Conclusion The assessment instrument was considered understandable, relevant, and compatible with safety standards, showing content validity and compatibility to assess patient safety in hemodialysis treatment environments.

Patient safety; Hemodialysis units, hospital; Nephrology nursing; Nursing assessment; Renal insufficiency, chronic

Dimensions	*ICC	**95% CI
1- Patient identification	0.85	0.71 – 0.94
2- Effective communication	0.80	0.62 – 0.92
3- Administration of potentially dangerous medications	0.91	0.83 – 0.96
4- Proper procedure and intervention site	0.94	0.90 – 0.98
5- Risk of infections	0.94	0.89 – 0.97
6- Risk of injuries due to falls	0.95	0.90 – 0.98

Items	n(%)*	p-value**
1. Legible identification of the dialyzer and lines with patient name, serology, and first date of use.	9(100.0)	1.00
2. Identification of the hemodialysis session control sheet with: name, individuals taxpayers’ register, date of birth, patient identification at the clinic, serologies, and HD session data.	9(100.0)	1.00
3. Supervision carried out by nurses together with nursing technicians before the beginning of each session, checking the correct identification of the hemodialysis control sheet, dialyzer, and lines. In addition to the undertaking of devices’ pre- and post-test before each session for system’s sterilization assurance.	9(100.0)	1.00
4. Identification of blood collection bottles with type of test, patient name, and other identification methods, such as individuals taxpayers’ register and date of birth.	9(100.0)	1.00
5. Use of labels for record of medication dilution with dose, date, dilution time, name of the professional responsible for dilution, and patient name.	9(100.0)	1.00
6. Storage in washable compartments of the hemodialysis system with legible identification, patient full name, date of birth, differentiation by shifts, and serologies.	8(89.0)	0.86
7. Checking of any medication before administration applying the nine certainty technique: right patient, right medication, right dose, right time, right route of administration, right documentation, right action, right way, and right response.	8(89.0)	0.86
8. Full record with legible letter of test results received and signature of the professional who received information.	9(100.0)	1.00
9. Record in the patient’s medical file with all information regarding clinical evolution and care provided. The same must contain the signing of each nursing professional and multidisciplinary team.	9(100.0)	1.00
10. Presence of a nursing station close to the hemodialysis room with easy access for professionals, which allows seeing all patients, with availability of the material required for hemodialysis.	8(89.0)	0.86
11. Availability of all measurement values of the internal volume of the dialyzer’s fibers (prime) obtained during its processing. They must be recorded, dated, separated by shifts, and signed by the person who undertook the process for eventual consultation from patients and health authority, and kept in the patient’s medical record.	9(100.0)	1.00
12. Availability of technical reports of analyses of the treatment and distribution system of water for hemodialysis, for technicians and health inspection, in accordance with the frequency required by the current legislation.	8(89.0)	0.86
13. Supervision of potentially dangerous medication administration carried out by nursing technicians and nurses (epinephrine, norepinephrine, propofol, dipyrone, propranolol, metoprolol, lidocaine, amiodarone, heparin, insulin, oral hypoglycemic agents, intravenous inotropic agents, neuromuscular blockers, intravenous moderate sedatives, acidic and basic solutions, injectable sterile water, injectable potassium phosphate, calcium gluconate, hypertonic glucose).	9(100.0)	1.00
14. Storage of potentially dangerous medications in exclusive and appropriate place.	9(100.0)	1.00
15. Visible and legible identification of the storage place for potentially dangerous medications.	9(100.0)	1.00
16. Use of devices that cause barriers in the occurrence of errors with the administration of potentially dangerous medications, such as bar codes.	8(89.0)	0.86
17. Publication of a list of all medications, especially of those potentially dangerous, used in the institution.	8(89.0)	0.86
18. Incorporation of security warning in computer systems of dispensation and prescription of potentially dangerous medications.	8(89.0)	0.86
19. Establishment and publication of maximum doses of potentially dangerous medications to be used in the unit.	9(100.0)	1.00
20. Standardization in the preparation and administration of potentially dangerous medications, thus preventing errors.	9(100.0)	1.00
21. Dispensation of potentially dangerous medications in containers for each patient and separated from other medications.	8(89.0)	0.86
22. Appropriate storage of acidic and basic solutions for hemodialysis out of direct sunlight, in good conditions of ventilation and environmental hygiene, according to manufacturer’s recommendations and expiration date control.	9(100.0)	1.00

Items	n(%)*	p-value**
23. Check of the correct puncture site and fremitus before puncturing the fistula.	9(100.0)	1.00
24. Check of the dressing’s look, ostium, and catheter flow before connecting patients to the hemodialysis device.	9(100.0)	1.00
25. Check of all tests (TAP^‡, TTPA^§, hemogram) required for the undertaking of the surgical procedure, carried out by nurses.	8(89.0)	0.86
26. Conducting of the time-out - All professionals of the team verbally confirm names and professions, patient identification, site or procedure to be carried out right before the beginning of the procedure.	9(100.0)	1.00
27. Antisepsis of the procedure’s correct site.	9(100.0)	1.00
28. Patient guiding regarding critical steps of the procedure, its estimated duration, and possible complications.	9(100.0)	1.00
29. Patient questioning, before the procedure, regarding the presence of allergies and use of anticoagulants.	9(100.0)	1.00
30. Check of the informed consent form signed by the patient or accompanier before the beginning of the procedure.	9(100.0)	1.00
31. Prophylactic antibiotic administration after procedure.	8(89.0)	0.86
32. Hand hygiene of the nursing team before and after each procedure.	9(100.0)	1.00
33. Change of gloves at each new procedure (such as dressings, device handling, and hemodialysis system) by the nursing team.	9(100.0)	1.00
34. Undertaking of dressings with aseptic technique by nurses.	9(100.0)	1.00
35. Disinfection and cleaning of the device and surfaces that come into contact with patients at each session.	9(100.0)	1.00
36. Allocation of nursing technicians, with anti-HBs^\|\|reagent, exclusive for the care of patients with positive serology for hepatitis B, C, and HIV^¶during the whole hemodialysis session, thus preventing cross-infection.	9(100.0)	1.00
37. Exclusiveness of a nursing technician for new patients admitted to the institution with unknown serology.	8(89.0)	0.86
38. Processing of dialyzers with exhaust air system, specific benches for the cleaning stage, with a deep tank made of resistant material and suitable for cleaning and disinfection, supplied with treated water for hemodialysis with individualized depletion. In addition to specific benches for each sterilization stage of the dialyzer, also made of resistant material and suitable for cleaning and disinfection.	8(89.0)	0.86
39. Restriction on circulation and access of people to the dialyzer processing room.	9(100.0)	1.00
40. Monitoring and record of residual levels of sanitizing products used in the sterilization of dialyzers, before connecting patients.	9(100.0)	1.00
41. Use of disposable insulators in devices to measure blood and venous pressure.	9(100.0)	1.00
42. Continuous checking of the bacteriological quality of the water for hemodialysis and whenever pyrogenic manifestations, bacteremia, or suspicion of septicemia occur in patients.	9(100.0)	1.00
43. Biannual cleaning record of the drinking water reservoir.	9(100.0)	1.00 Continue...
Continuation. 44. Monthly bacteriological control record of the drinking water reservoir.	9(100.0)	1.00
45. Monthly cleaning and disinfection of the reservoir and water supply system for hemodialysis, with record of the professional in charge.	9(100.0)	1.00
46. Packaging of the dialyzers processed in individual lidded containers with patient identification.	9(100.0)	1.00
47. Check of each patient’s clinical condition by nurses, associating with risk of falls at each hemodialysis session.	9(100.0)	1.00
48. Checking of the floor’s cleaning and drying at each hemodialysis session or whenever necessary.	9(100.0)	1.00
49. Checking of the lifting of bed rails, whenever patients are making use of them.	9(100.0)	1.00
50. Supervision and assurance of devices for patient locomotion with assistance from family members or employees.	9(100.0)	1.00
51. Availability of equipment for checking anthropometric measures, appropriate for wheelchair users and individuals with special needs.	9(100.0)	1.00
52. Guidance for patients on asking help whenever necessary to enter and exit the hemodialysis room.	9(100.0)	1.00
53. Assurance of locomotion assistance for patients with special needs to use the bathroom.	8(89.0)	0.86
54. Maintenance of the wheels of armchairs and beds, which must be locked whenever in use by patients.	9(100.0)	1.00
55. Adequacy of furniture close to patients. They must be appropriately placed enabling circulation of professionals during the hemodialysis session, as well as the presence of accompaniers when required, preventing the risk of falls.	8(89.0)	0.86
56. Patient monitoring during the first walks after the undertaking of procedures (infusion of blood derivatives, fistula confection, catheter puncture).	9(100.0)	1.00
57. Daily emphasis on the guidance for the use of the device to assist in walking.	9(100.0)	1.00

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Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
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[TFN1001] *ICC – Intraclass correlation coefficient; ** CI – Confidence interval