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Rasio Perawat HD 3

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40 views17 pages

Rasio Perawat HD 3

Uploaded by

AstangSupriyadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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How does the nurse-patient ratio

influence the quality and safety of


renal care?
Anki Davidson
EDTNA/ERCA Marketing Director
on behalf of
Jitka Pancirova
EDTNA/ERCA Executive Director
Staffing of dialysis clinics

• Staffing of dialysis clinics has changed considerably


over the past two decades
• A wide variation was found in perceived best
practice staffing ratios, particularly for patient-to-
nurse

Identifying Best Practices in Dialysis Care: Results of Cognitive Interviews and a National Survey of Dialysis Providers

Amar A. Desai,*† Roger Bolus,‡§ Allen Nissenson,‡ Sally Bolus,§ Matthew D. Solomon,§‖ Osman Khawar,‡ Matthew Gitlin,¶ Jennifer
Talley,§** and Brennan M. R. Spiegel‡§**

Clin J Am Soc Nephrol. Jul 2008; 3(4): 1066–1076.


HD/HDF treatment reimbursement rate cuts

• Various European countries experienced


HD/HDF treatment reimbursement rates cuts
• As a consequence, some dialysis centres increased
nurse-patient ratio
• Is this the best solution?
Nurse – patient ratio

• The recommended nurse- patient ratio for chronic


haemodialysis is 1:4, some dialysis centres
increased it up to 1:6 or 1:8
• Do we believe that quality of care is always the
same?
What can happen if nurse is responsible for
too many patients?
• Quality of care might be compromised as nurse is
just a human being with two hands and two eyes
• Patients may feel unsecure
• Nurses can experience “burnout syndrome“ and
leave the healthcare sector
What can concretely happen in renal care?
Just one example…
• Venous needle dislodgement (VND) happens when
the venous fistula needle becomes dislocated out of
the vascular access, resulting in blood loss.
• This can lead to a rapidly declining blood volume in
the patient and may cause morbidity and mortality if
not discovered quickly.
What can concretely happen in renal care?
Just one example…
• At typical hemodialysis blood flow rates of 300 to
400 ml/minute, it can take only minutes for the
patient to lose over 40% of blood volume
• There is statistical evidence that the risk of venous
needle dislodgements (VND) is higher if unit has a
higher nurse-patient ratio.
Risk for a serious VND incident

• The risk for a serious venous needle dislodgement


(VND) incident depends on both:
− the likelihood of the needle becoming dislodged and
− the likelihood that the action necessary to stop
blood loss will not be taken in time to prevent
serious harm e.g. nurse is responsible
for too many patients
Risk assessment

• In order to further educate


nurses and prevent VND
incidents, the EDTNA/ERCA
performed the assessment
of the overall risk for a
serious VND incident and
identified the possible risk
factors that contribute to the
overall risk of VND
Groups of risk factors related to:

− The staff failing to observe that a VND had


occurred or was likely to occur (e.g. due to
tension on the lines, loose tape)
− The patient not realising that a VND occurred or not raising
the alarm (e.g. due to dementia, lack of awareness)
− The patient behaviour that could dislodge a needle
(e.g. uncontrolled movement, tampering with the tapes)
− Security of the taping of the needle and line (e.g. difficult
needle angle, excessive perspiration)
Why is it important to take general actions,
not just in renal care?
• The RN4CAST study conducted by the National
Institute of Nursing Research (NINR) confirmed that
hospitals in Europe, where nursing staff care for
fewer patients and have a higher proportion of
bachelor’s degree-trained nurses, had significantly
fewer surgical patients die while hospitalized.
Why is it important to take actions?

• The RN4CAST study estimated that an increase


in hospital nurses’ workloads by one patient
increases the likelihood of in hospital death by 7
percent.
• Also, a better educated and trained nurse workforce
was associated with fewer deaths. For every 10
percent increase in nurses with bachelor’s degrees,
there was an associated 7% drop in the likelihood of
deaths.
Can we rely on these data?

• A consortium of scientists from the University of


Pennsylvania School of Nursing, Philadelphia and from
the Catholic University of Leuven in Belgium, reviewed
hospital discharge data of nearly 500,000 patients from
nine European countries who underwent common
surgeries.
• They also surveyed over 26,500 nurses practicing in
study hospitals to measure nurse staffing and
education.
Way forward

• Scientific associations and organizations to define a


“best practice” nurse-patient ratio for chronic HD
• Government and healthcare organizations to define
minimum HD/HDF treatment reimbursement rates
for all European countries as differences are
enormous starting from 85 Euro per HD
treatment………
Way forward

• Contradictory,some countries have HD treatment


reimbursement rate 250 Euro
• Are renal patients different according to where
they live?
• Are we going forward?
Thank you for your attention !

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