How safe is renal replacement therapy? A national study of mortality and adverse events contributing to the death of renal replacement therapy recipients
| Autor: | Jennifer Boyd, Conal Daly, Bruce Mackinnon, Andrew Innes, Robert K. Peel, Jamie P. Traynor, Benjamin Bray, Graham A. Stewart, Wendy Metcalfe, Ilona Shilliday, Ken Donaldson, Izhar U. H. Khan, Jonathan G. Fox, Keith Simpson, Arthur Doyle |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Population urologic and male genital diseases Patient safety Renal Dialysis Risk Factors medicine Humans Renal replacement therapy Intensive care medicine Adverse effect education Aged Retrospective Studies Cause of death Aged 80 and over Transplantation education.field_of_study business.industry Incidence Middle Aged Renal Replacement Therapy Survival Rate Nephrology Cohort Kidney Failure Chronic Female Hemodialysis business |
| Zdroj: | Nephrology Dialysis Transplantation. 29:681-687 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gft197 |
| Popis: | Background Patients receiving treatment with renal replacement therapy (RRT) have high mortality, and ensuring patient safety in this population is difficult. We aimed to estimate the incidence and nature of medical adverse events contributing to the death of patients being treated with RRT. Methods This population registry-based retrospective case review study included all patients being treated with RRT for established renal failure in Scotland and who died between 1 January 2008 and 30 June 2011. Deaths were reviewed by consultant nephrologists using a structured questionnaire to identify factors contributing to death occurring in both the inpatient and outpatient setting. Reviewers were able to use any information source deemed relevant, including paper and electronic clinical records, mortality and morbidity meetings and procurator fiscal (Scottish coroner) investigations. Deaths occurring in 2008 and 2009 where avoidable factors were identified that may have or did lead to death of a patient were subject to further review and root cause analysis, in order to identify recurrent themes. Results Of 1551 deaths in the study period, 1357 were reviewed (87.5%). Cumulative RRT exposure in the cohort was 2.78 million person-days. RRT complications were the primary cause of death in 28 (2.1%). Health-care-associated infection had contributed to 9.6% of all deaths. In 3.5% of deaths, factors were identified which may have or did contribute to death. These were both organizational and human error related and were largely due to five main causes: management of hyperkalaemia, prescribing, out of hours care, infection and haemodialysis vascular access. Conclusions Adverse events contributing to death in RRT recipients mainly relate to the everyday management of common medical problems and not the technical aspects of RRT. Efforts to avoid harm in this population should address these ubiquitous causes of harm. |
| Databáze: | OpenAIRE |
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