FRESENIUS DIALYSIS CENTER 1 Fresenius Dialysis Center: Safety and Patient-CenteredCareGina France FRESENIUS DIALYSIS CENTER 2 To mesafety means protecting yourself, co-workers, and patients from physical ormental harm and patient centered care means providing care to patients that ismatched to that individuals needs and their responses. During my observation atFresenius Dialysis Center I was able to see how they implement safety measuresand how their care is patient centered. Safetyis defined by Quality and Safety Education for Nurses (QSEN) as “minimize riskof harm to patients and providers through both system effectiveness andindividual performance” (Anonymous, 2018). I observed at Fresenius the wholeteam working to implement safety measures. The first thing I noticed was thatthe patients were all in an open room except one who was in their own room thathad a stop sign on the door.
When I asked the nurse that I was following sheexplained to me that they use that as an isolation room for patients withblood-borne infections, this patient had hepatitis B (B. Joslim, personalcommunication, January 24, 2018). Every member wears a mask, gloves, and gownwhile assessing patient’s fistulas if there was a problem with blood returnfrom the dialysis machine. The patients were also given a mask at this time aswell.
One thing I noticed that I thought was a great idea for the number ofpatients that were receiving treatment was that all the health care membersassumed responsibility for the patients. If one patients alarm was going offthe closest personnel would check it, fix the problem or find someone whocould. Thoughthey do have several safety practices in place, I noticed a few things that Ithought could be improved. Although I found it to be a good plan, I also thinkthat every nurse intervening with every patient could be a safety concern.
Ifone health care member implemented some course of action and hadn’t notifiedthe other members, another individual may come along FRESENIUS DIALYSISCENTER 3 and repeat whatanother had just done. For example, I noticed that one would call out that thispatient needed Zofran, another called back I’ve got it and administered themedication but I did not see them document it right after. Had this patienttold another individual that they were nauseated they may have received doublethe dose. If they would document immediately I think this could prevent amedication error. There was also one individual that I noticed that presented asafety concern who drew up a medication, left the needle uncapped and walkedacross the room with it open. It seems to be a pretty busy place with peoplerushing back and forth and I feel that this could’ve lead to an accidentalneedle stick. This be could resolved by simply slipping the cap back on theneedle (not with you hand but by scooping it) or by drawing the medication upat the patients side.
One more thing that I think could be improved is theisolation room. There was no signs identifying it as an isolation room otherthat the stop sign on the door. I understand that most of the workers therelikely know what that room is for but a newer employee may forget. Havingsomething on the door stating that the room is only to be used for patients on isolationcould prevent this. QSEN defines patient-centered care as “recognize the patientor designee as the source of control and full partner in providingcompassionate 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 observedpatient-centered care. Every patient there receives a set rate of mL/hour thattheir blood is to run through the dialysis machine. This rate was adjusted throughouttheir time there depending on if the patient developed cramping or if the bloodwas having trouble being pulled from or returned through the fistula.
Patientpreferences would be addressed by asking if the patients who blood pressure waslow if they would like some fluids to drink or if they felt FRESENIUS DIALYSIS CENTER 4 okay. Another way I observed patient preferences being metwas with a patient whose fistula was blocked, they had already given her onecath flow but gave her the option to have a second one, the patient refused sothey respected her wishes, did not do one, and called her transport. She wasadvised that she would likely need another fistula and agreed to this so thestaff arranged the appointment for her. In myopinion safety and patient-centered care go hand in hand.
If a patient decidedto leave a facility against medical advice, you would not administer anythingthat needs monitoring that could cause them harm if they were to have anadverse effect. You also would discontinue the interventions already in place,such as an IV access. I will address safety concerns after I graduate by beingvigilant to any updates that could decrease safety hazards to the facility Iwork in and keeping up to date on new research on the topic. I will promote patient-centeredcare by listening to my patient, providing them with appropriate education, andadvocating for them. FRESENIUS DIALYSIS CENTER 5Reference ListAnonymous.
(2018). QSEN Competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#patient-centered_care