RISK MANAGEMENT
Possible risk patients & situations
Step 1 – Factors affecting how well secured the needles are
These risk factors will make it more likely that a VND incident will occur, either due to a higher risk of tugging on the lines connected to the needles, or to a higher risk of the taping of the needles not being able to hold the needles in place.
- Patients prone to erratic or restless behaviour, e.g. intradialytic hypotension, cramping.
- Patients with a history of VND.
- Patients with oozing around venous needle.
- Patients who have a high degree of sweating.
Step 2 – Factors affecting the ability of staff/carers/other patients to monitor patients
These risk factors will make it less likely that in the event of a VND event, healthcare professionals, carers or other patients will observe the incident and either take suitable remedial action or raise the alarm for somebody else to act.
- Poor lighting in the room.
- Patients covering the access during dialysis.
- Dialysing in isolation rooms.
- Self care or minimal care units.
- Inadequate staffing levels.
Step 3 – Factors affecting the ability of patients to monitor themselves
These risk factors will make it less likely that the patient who has suffered a VND event will notice that it has occurred and either take suitable remedial action or raise the alarm for somebody else to act.
- Tendency to sleep during dialysis.
- Mental or cognitive impairment, e.g. dementia.
- Temperature/fever.
- Reduced sensitivity.
Step 4 – Factors affecting the ability of the dialysis machine to monitor patients
These risk factors will make it less likely that in the event of a VND event, the dialysis machine will raise the alarm so that somebody can take suitable remedial action.
- Inappropriate setting of venous pressure alarms.
- Frequent false alarms causing alarm fatigue.