FRESENIUS that presented a safety concern who drew

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Fresenius Dialysis Center: Safety and Patient-Centered

Gina France










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            To me
safety means protecting yourself, co-workers, and patients from physical or
mental harm and patient centered care means providing care to patients that is
matched to that individuals needs and their responses. During my observation at
Fresenius Dialysis Center I was able to see how they implement safety measures
and how their care is patient centered.

is defined by Quality and Safety Education for Nurses (QSEN) as “minimize risk
of harm to patients and providers through both system effectiveness and
individual performance” (Anonymous, 2018). I observed at Fresenius the whole
team working to implement safety measures. The first thing I noticed was that
the patients were all in an open room except one who was in their own room that
had a stop sign on the door. When I asked the nurse that I was following she
explained to me that they use that as an isolation room for patients with
blood-borne infections, this patient had hepatitis B (B. Joslim, personal
communication, January 24, 2018). Every member wears a mask, gloves, and gown
while assessing patient’s fistulas if there was a problem with blood return
from the dialysis machine. The patients were also given a mask at this time as
well. One thing I noticed that I thought was a great idea for the number of
patients that were receiving treatment was that all the health care members
assumed responsibility for the patients. If one patients alarm was going off
the closest personnel would check it, fix the problem or find someone who

they do have several safety practices in place, I noticed a few things that I
thought could be improved. Although I found it to be a good plan, I also think
that every nurse intervening with every patient could be a safety concern. If
one health care member implemented some course of action and hadn’t notified
the other members, another individual may come along FRESENIUS DIALYSIS
CENTER                                                            3                                                                         and repeat what
another had just done. For example, I noticed that one would call out that this
patient needed Zofran, another called back I’ve got it and administered the
medication but I did not see them document it right after. Had this patient
told another individual that they were nauseated they may have received double
the dose. If they would document immediately I think this could prevent a
medication error. There was also one individual that I noticed that presented a
safety concern who drew up a medication, left the needle uncapped and walked
across the room with it open. It seems to be a pretty busy place with people
rushing back and forth and I feel that this could’ve lead to an accidental
needle stick. This be could resolved by simply slipping the cap back on the
needle (not with you hand but by scooping it) or by drawing the medication up
at the patients side. One more thing that I think could be improved is the
isolation room. There was no signs identifying it as an isolation room other
that the stop sign on the door. I understand that most of the workers there
likely know what that room is for but a newer employee may forget. Having
something on the door stating that the room is only to be used for patients on isolation
could prevent this.

QSEN defines patient-centered care as “recognize the patient
or designee as the source of control and full partner in providing
compassionate and coordinated care based on respect for patient’s preferences,
values, and needs” (Anonymous,
2018). There were a few times during the day that I observed
patient-centered care. Every patient there receives a set rate of mL/hour that
their blood is to run through the dialysis machine. This rate was adjusted throughout
their time there depending on if the patient developed cramping or if the blood
was having trouble being pulled from or returned through the fistula. Patient
preferences would be addressed by asking if the patients who blood pressure was
low if they would like some fluids to drink or if they felt

FRESENIUS DIALYSIS CENTER                                                            4                                                                        okay. Another way I observed patient preferences being met
was with a patient whose fistula was blocked, they had already given her one
cath flow but gave her the option to have a second one, the patient refused so
they respected her wishes, did not do one, and called her transport. She was
advised that she would likely need another fistula and agreed to this so the
staff arranged the appointment for her.

            In my
opinion safety and patient-centered care go hand in hand. If a patient decided
to leave a facility against medical advice, you would not administer anything
that needs monitoring that could cause them harm if they were to have an
adverse effect. You also would discontinue the interventions already in place,
such as an IV access. I will address safety concerns after I graduate by being
vigilant to any updates that could decrease safety hazards to the facility I
work in and keeping up to date on new research on the topic. I will promote patient-centered
care by listening to my patient, providing them with appropriate education, and
advocating for them.








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Reference List

Anonymous. (2018). QSEN Competencies. Retrieved from