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Developing a trigger tool to monitor adverse events during haemodialysis in children: a pilot project
Ramnath Balasubramanian1, Rachel Folwell1, Arran Wheatley1
1Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK.
Insights
A new pediatric haemodialysis trigger tool (pHTT) significantly reduced adverse events in children undergoing dialysis. This bedside tool helps improve patient safety by systematically monitoring and reporting potential harms during haemodialysis sessions.
Area of Science:
- Pediatric Nephrology
- Patient Safety
- Quality Improvement in Healthcare
Background:
- Intermittent in-centre haemodialysis (HD) in children requires systematic monitoring for adverse events.
- Existing patient safety systems may not adequately capture all potential harms during pediatric HD sessions.
- A validated tool is needed to identify and address adverse events in pediatric haemodialysis.
Purpose of the Study:
- To develop and evaluate a pediatric haemodialysis trigger tool (pHTT) for use during intermittent in-centre HD sessions in children.
- To systematically monitor adverse events and assess the impact of interventions informed by the pHTT on patient safety.
- To determine the feasibility and effectiveness of a bedside tool in reducing harm rates during pediatric haemodialysis.
Main Methods:
- A single-centre quality improvement study was conducted over two 8-week cycles.
- A pediatric haemodialysis trigger tool (pHTT) with 54 triggers across six domains was developed and prospectively applied.
- Haemodialysis nurses completed the pHTT at the end of each dialysis session, with triggers evaluated for harm level.
Main Results:
- A total of 241 triggers were identified over 182 dialysis sessions involving 28 children.
- Following interventions based on pHTT data, the harm rate per session significantly decreased from 1.03 to 0.32 (P < 0.001).
- Significant differences were observed in trigger distribution by harm category and pHTT domains between the two study cycles; no permanent harm was reported.
Conclusions:
- The pilot study demonstrates the potential benefits of a bedside pHTT for monitoring adverse events in pediatric haemodialysis.
- Interventions informed by the pHTT led to a significant reduction in the harm rate per session.
- The study proposes the routine use of a pediatric haemodialysis trigger tool in centers providing HD to children to enhance patient safety.
Background:
We developed a paediatric haemodialysis trigger tool (pHTT) for application per haemodialysis (HD) session in children receiving intermittent in-centre HD and systematically monitored adverse events.
Methods:
Single-centre quality improvement study performed over two 8-week cycles. Data collected prospectively using a 'per-dialysis session' pHTT tool including 54 triggers across six domains, adapted from a recently described haemodialysis trigger tool (HTT) for adults. Each trigger was evaluated for level of harm following assessment by two authors. Following a period of training, HD nurses completed the HTT at the end of each dialysis session.
Results:
There were 241 triggers over 182 dialysis sessions, with 139 triggers in 91 HD sessions for 15 children, age range 28-205 months, over an 8-week period (first cycle) and 102 triggers in 91 HD sessions for 13 children, age range 28-205 months, over a further 8-week period (second cycle). After interventions informed by the pHTT, the harm rate per session was significantly reduced from 1.03 (94/91) to 0.32 (29/91), P < 0.001. There was a significant difference between the distribution of triggers by harm category (P < 0.001) and between the proportion of triggers across the various domains of the pHTT (P = 0.004) between the two cycles. No triggers were evaluated as causing permanent harm.
Conclusions:
This pilot study demonstrates potential benefits of a bedside tool to monitor adverse events during haemodialysis in children. Thus, following interventions informed by the pHTT, the harm rate per session was significantly reduced. Under standard patient safety systems, the vast majority of triggers identified by the pHTT would remain unreported and perhaps lead to missed opportunities to improve patient safety. We propose the use of a paediatric HTT as part of standard care by centres providing HD to children in the future. A higher resolution version of the Graphical abstract is available as Supplementary information.
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