A Checklist for Dialysis

August 15th, 2012 12:53 pm ET - .

Staff volunteers demonstrate the use of scrub-the-hub protocol checklist

Guest Author – Gemma Downham, MPH
Infection Prevention Epidemiologist,
AtlantiCare Regional Medical Center
We have all heard about the heroic feat of

Captain “Sully” Sullenberger when he performed
an emergency landing of a passenger jet on the Hudson River in 2009. It was amazing that no
lives were lost during that potentially disastrous situation. Checklists, which have been used for decades in the airline industry, were said to have helped Captain Sully and his co-pilot run through tasks to attempt to restart the engines—and when all else failed, perform an emergency landing.

Dr. Atul Gawande, professor of surgery at Harvard Medical School and bestselling author, has advocated in his book, The Checklist Manifesto, for the use of checklists in medicine to improve patient outcomes in surgery, prevent infections, etc., by reducing the potential for human error. So, when one of the nurses in our dialysis unit asked for a checklist for putting catheterized patients on and off the dialysis machines, I was both delighted (and overwhelmed.) Where to start?

Luckily, the CDC Dialysis BSI Prevention Collaborative had just devised a new scrub-the-hub protocol and published it on the website in checklist format. We held an in-service with “Dialysis Dan” (our simulation dummy with a catheter), and staff volunteers demonstrated use of the scrub-the-hub protocol checklist. We went through each step so that everyone knew the proper order for disinfection of the catheter limbs and hubs, and how to prevent contamination of the catheter ends after disinfection. Staff feedback indicated that the checklist was useful as dialysis turnover can feel very rushed, and it’s not easy to remember all of the steps. Further, we have recently welcomed new staff members to our unit, and the checklist has proven helpful for orienting them on the proper steps for aseptic catheter connection and disconnection. We even keep laminated copies of the protocol checklist on the dialysis station clipboards to which staff can refer.
In our next blog, Dr. Priti Patel will discuss how these checklists and tools are protecting dialysis patients. In the meantime, tell us what novel strategies you are using to protect your patients? How have checklists or other tools assisted you in providing better patient care?