ESPN 50th Annual Meeting

ESPN 2017


 
Developing a trigger tool to monitor adverse events during haemodialysis in children: a pilot project
RACHEL FOLWELL 1 ARRAN WHEATLEY 1 CARMEN BARTON 1 CHRISTOPHER JD REID 1 MANISH D SINHA 1

1- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, EVELINA LONDON CHILDREN’S HOSPITAL, UK
 
Introduction:

Haemodialysis trigger tools (HTT) have been proposed to enable regular monitoring of adverse events in adults during haemodialysis. There is currently no specific HTT available for children. We describe results of a pilot project to monitor adverse events during haemodialysis following development of a paediatric HTT. 

Material and methods:

Prospective data collection was performed using a broadly applicable ‘per-dialysis session’ tool including 53 triggers across 6 domains. Each trigger was additionally evaluated for level of physical harm; allocation to harm categories was subsequently reviewed jointly by two authors to minimise subjectivity. Trained haemodialysis nurses completed the HTT at the end of designated dialysis sessions in <5 minutes. 

Results:

The HTT was completed for 91 haemodialysis sessions of 17 children over an eight-week period, in which 139 triggers were identified. The 5 most frequent triggers included: failure to have nursing safety huddle during session (n=23), need for additional fluid removal (n=19), need for tissue plasminogen activator infusion (n=13), need for line reversal and problems with dialysis machine failure (n=8 each) and delayed reporting of abnormal laboratory results (n=7). 63 percent of triggers were categorised to have a potential to cause temporary harm and required intervention and others categorised to have no potential for harm. For an individual patient, the need for additional fluid removal was the most frequently cited trigger for potential harm. There were no triggers categorised to have potential to cause permanent harm. 

Conclusions:

This pilot study provides evidence of the risks inherent to paediatric haemodialysis provision and the value of regular monitoring of adverse events using a paediatric HTT. Further cycles of modifications to the HTT with re-testing and continuing team education are ongoing. We would propose the use of paediatric HTT to be included as part of standard care by centres providing haemodialysis to children in the future.