Dialysis Unit Accreditation: What I Learned

I had a fascinating time last week; I was the patient representative when my unit went through their Safety and Quality Accreditation audit.  Accreditation is a big deal for all health services in Australia – as it is for most countries.

Quality Accreditation has been around for many years, but has been completely revamped by the Feds, and just about every health service has had to be re-accredited this year.

There are ten safety and quality standards designed to “Improve the quality and level of care consumers can expect from health services”.  Each standard has Actions which the auditors use to measure how well the unit is complying with the standard.

As usual with these things, the staff at the unit had been preparing for the review for months.  They first had to get to know what was required, and develop strategies to make sure those things were part of day-to-day operations.  Then over the period before the audit, they had to gather evidence that the actions had taken place.

My role was based around Standard 2 – Partnering with Consumers.  There are 14 actions involved.  Most are to do with patient engagement and feedback.  They look for evidence of patient orientation and training, involvement in the governance of the unit, how we have a say the various aspect of improving the service, opportunities to be involved in staff training, feeding back on unit publications and incorporating suggestions, etc.

Most of these actions had been implemented, some supported by evidence like Orientation Manuals, and Comment, Complaint and Suggestion systems, feedback on issues.  Others, like patients training staff (eg how to remove needles without pain!), tend to be informal, but functional.

No one was surprised when the unit passed every standard with colors flying and zero recommendations for improvement.  It is an excellent unit.

A couple of interesting things came out of this process for me.

First, some units elect/appoint a patient representative, who speaks for, raises issues and occasionally attends meetings on their behalf.  While it has never been a problem for individuals to do these kinds of things at our unit, making it formal may ensure that even the most timid BigD-er has a say.  I know a couple of people in our unit who would be great, so I will suggest it to them and to Chris.

Second, I suspect there is a better way to orient and train new patients.  Currently most units have an orientation pack that is provided before or on the day they start dialysing.  But many people are still in shock when they get the materials.  They glance at it, and then put it aside, maybe to never pick it up again.  What they are usually looking is information about the things they are feeling right now, like whether how they feel is normal; when they will feel better; if they really are going to die because they read that on the internet.

I was discussing this with one of the auditors, and she suggested that a better way may be to prepare a self-paced Training Plan, with learning objectives and modules that can be completed as the patient becomes ready to learn them.

That sounded like a great idea, so I put together a couple of example modules for the first week or so:

Unit No.

Subject

Objective

Week 0: Before You Start

1

Getting started Complete registration, medical history, record medications, personal details, photo

2

Your Unit Understand the layout of the unit: location of chairs, controls for TV, nurse call etc, internet, locker,  toilets, meals, snacks and drinks, etc

3

What to expect Understand what will happen on the first day: prewash, weighing, needling, blood pressures, connecting, the run, disconnecting, weighing
Week 1: The Basics

4

How things work Meet staff and some patients, how to obtain passwords to unit and internet,  borrow loan iPad, ordering meals

5

How you will feel during the first couple of weeks Understand how your body is reacting to dialysis, the physical impact, how you may feel when you come off, get home, effect on sleep

6

Why dialysis is not the end of the world as you know it Place the limitations imposed by dialysis in context with the rest of each day; understand the myriad of life opportunities still available

7

How you will feel during the first couple of weeks Know how you may feel during and after the first few runs.  When to expect to feel better.  The effect of fluid on how you feel.

8

How you can expect to feel after your first month Understand how factors like weight, fluid, different foods, fitness and stress effect how you feel and how you dialyse
Month 1: Your Dialysis

9

What is dialysis Understand concepts behind dialysis, blood volume in the machine, identify blood lines and filter

And so on.

Most early modules could be run by other BigD-ers, with staff taking over for the more technical bits.  Now, that’s involvement.

This could be a fun and useful project – an unusual combo!  They say knowledge is the antidote of fear.  These modules could be used by BigD centres everywhere to ease those early BigD fears.

So, I’ll start to flesh out each module over the next few weeks (months?) and put the first set of modules together.  But I’ll need help.  If you have some ideas, either with subjects or content that you would like to have known in your early BigD days (or even now), please email me at greg.collette(at)gmail.com and I’ll add them to the Plan.  If you have the time and would like to be involved in writing a module, you would be very welcome.

Once we have something substantial, I will release it for free use under a Creative Commons licence.

There really is something to this Quality Accreditation stuff, huh!

One thought on “Dialysis Unit Accreditation: What I Learned

  1. Hey

    I am a portuguese 43 year old guy, living on pre dyalisis. I follow your blog for very long, and now came the time to speak a word.

    Since I am in pre dyalisis since forever, I am more than willing to help you out withe these modules.

    I know the exact fears I am experiencing, and you can get those fresh in first hand 🙂

    I have to say also, that I always admired your resilience.

    Hug, form the other side of the world,

    Pedro

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s