Análisis de las medidas correctoras para la disminución de los eventos adversos en una unidad de hemodiálisis hospitalaria / Analysis of corrective measures for reducing adverse events in a hospital dialysis unit

Los pacientes en hemodiálisis son una población susceptible de padecer eventos adversos por fallos en el proceso asistencial. Objetivo: Evaluar la eficacia de las medidas correctoras en un plan de seguridad del paciente en hemodiálisis para disminuir los eventos adversos. Material y Método: Estudio descriptivo y retrospectivo del registro de hemodiálisis de una unidad hospitalaria. Como método de evaluación se utilizó la metodología propia de nuestro centro (MIDEA) basado en el método Global Trigger Tools. Se revisaron todas las sesiones de hemodiálisis de marzo, mayo y julio de 2016: 2.080 sesiones; y los mismos meses en 2017: 1953 sesiones. Después del análisis de 2016, se implantaron las siguientes medidas correctoras: revisión del procedimiento de anticoagulación del circuito extracorpóreo, actualización del manejo de los accesos vasculares y actualización del procedimiento ante hipotensiones. Resultados: En el año 2016, se revisaron las gráficas de 208 pacientes. Se detectaron 255 eventos adversos (11,8% de las sesiones), siendo los más frecuentes: 85 hipotensiones, 74 coagulaciones del circuito sanguíneo, 31 problemas del acceso vascular y 65 otros eventos adversos. En el año 2017, se revisaron las gráficas de 258 pacientes. Se detectaron 155 eventos adversos (7,9% de las sesiones), siendo los más frecuentes: 60 hipotensiones, 36 coagulaciones del circuito, 30 problemas del acceso vascular y 29 otros eventos adversos. Conclusiones: Los eventos adversos disminuyeron un 39,2% en 2017, y aunque siguen siendo las hipotensiones, coagulaciones del circuito sanguíneo y los problemas derivados del acceso vascular los más frecuentes, pensamos que las medidas correctoras están siendo eficaces

Patients on hemodialysis (HD) are a population susceptible to suffering adverse events (AD) due to failures in the healthcare process. Objective: To evaluate the efficacy of corrective measures in a HD patient safety plan to reduce AD. Material and Method: Descriptive and retrospective study of the HD records of a hospital unit. As an evaluation method, we used the methodology of our center (MIDEA) based on the Global Trigger Tools method. All the HD sessions of March, May and July 2016 were reviewed: 2,080 sessions; and the same months in 2017: 1953 sessions. After the 2016 analysis, the following corrective measures were implemented: revision of the anticoagulation procedure of the extracorporeal circuit, updating of the vascular access management and updating of the procedure before hypotension. Results: In 2016, the clinical records of 208 patients were reviewed. 255 EA were detected (11.8% of the sessions). The most frequent AEs were: 85 hypotension, 74 blood circuit coagulations, 31 vascular access problems and 65 other AD. In 2017, the clinical records of 258 patients were reviewed. 155 AE were detected (in 7.9% of the sessions). The most frequent AEs were: 60 hypotension, 36 circuit coagulations, 30 vascular access problems and 29 other AE. Conclusions: Adverse events decreased by 39.2% in 2017, and although hypotension, blood circuit coagulation and vascular access problems are the most frequent, we consider that corrective measures are being effective

Post-dilution high convective transport improves microinflammation and endothelial dysfunction independently of the technique.

BACKGROUND/AIMS: We examined the effects of different online hemodiafiltration techniques on microinflammation and endothelial damage/repair. METHODS: The study was designed as a prospective crossover study. Flow cytometry was used to measure CD14(+)CD16(+) monocytes, apoptotic endothelial microparticles (EMPs), and endothelial progenitor cells (EPCs). RESULTS: Patients treated with high-flux hemodialysis showed a marked chronic inflammatory state (HF-HD 11 ± 2) versus healthy subjects (HS 3.9 ± 2.3; p < 0.05). High convective transport, independent of the technique used, improves microinflammatory parameters (OL-HDF 7.3 ± 2.1 or MID 6.5 ± 3.4; p < 0.05) and the endothelial damage/repair balance compared to HF-HD (EPCs HF-HD 0.3 ± 0.2), with no differences found between the two modalities (EPCs OL-HDF 0.6 ± 0.1, MID 0.6 ± 0.2; p < 0.05). CONCLUSION: An increase in convective transport improves the microinflammatory state and the endothelial damage/repair of these patients independently of the technique used.