Division of Nephrology, QEII Health Science Center, Dalhousie University, Halifax, NS, Canada.
Division of Nephrology, QEII Health Science Center, Dalhousie University, Halifax, NS, Canada.
Adv Chronic Kidney Dis. 2021 Mar;28(2):170-177. doi: 10.1053/j.ackd.2021.02.007.
Patient safety is of the utmost importance in home hemodialysis (HHD). Recognizing that there are risks related to vascular access (both infectious and noninfectious events), dialysis water quality, and procedural-related adverse events (including arteriovenous fistula needle dislodgement or air embolism), there is a need for systematic identification and management. Although adverse events are relatively infrequent in HHD, the potential consequences of these events may include significant morbidity, HHD treatment failure, or death. Therefore, having a systematic framework to review each event, audit and retrain patient technique, disclose and discuss events with patients, home unit staff and device companies (if relevant) and determine preventative measures to avoid future adverse events, is crucial. In this review, we will describe the literature around the types and relative frequency of serious adverse events in the HHD setting and we will outline a quality assurance framework for capturing, managing, and avoiding serious adverse events. Finally, we will describe some of the novel existing approaches to preventing or addressing serious adverse events and critical knowledge gaps that should be evaluated in future study.
患者安全在家血液透析（HHD）中至关重要。认识到血管通路（包括感染和非感染事件）、透析用水质量和与程序相关的不良事件（包括动静脉瘘针移位或空气栓塞）存在相关风险，需要进行系统的识别和管理。尽管 HHD 中的不良事件相对较少，但这些事件的潜在后果可能包括严重的发病率、HHD 治疗失败或死亡。因此，有一个系统的框架来审查每个事件，审核和重新培训患者技术，向患者、家庭单位工作人员和设备公司（如果相关）披露和讨论事件，并确定预防措施以避免未来的不良事件，这是至关重要的。在本次综述中，我们将描述 HHD 环境中严重不良事件的类型和相对频率的文献，并概述一个用于捕获、管理和避免严重不良事件的质量保证框架。最后，我们将描述一些预防或处理严重不良事件的新方法，以及未来研究中应评估的关键知识空白。
