Time-Out Safety Check for In-Patient Dialysis Patients: 8 Questions for Clinicians

The health care industry continues to advance technology and work toward improving patient care. As care becomes more complex, health care workers are experiencing greater challenges ensuring patient safety and ultimately abiding by the “First, do no harm” principle. To address this concern, in 2003 the Joint Commission established time-out safety checks, which serve as a universal protocol to prevent wrong-site, wrong-procedure and wrong-person surgeries—ultimately, reducing the risk of irreparable, life-threatening mistakes. Current, best-demonstrated practices for in-patient dialysis now also include a time-out safety check for every dialysis and apheresis patient, every treatment, every time. This practice should  be universally adopted for all patients receiving dialysis.

Adherence to this safety process may directly reflect the simplicity of the safety check. Therefore, to promote adherence, while acknowledging the fast-paced health care environment, a safety check must be simple, memorable and easy to perform quickly. It can be as simple as an acronym or a theme covering questions that take two minutes to run through.

The following eight questions provide an example of what could be on a safety check list for a nurse or other care team member about to initiate a dialysis treatment with a patient.

1. Is this the right patient (use two identifiers)? First and foremost, identify and process the patient as the right renal patient who has orders for dialysis.
2. Has the patient given consent to treatment? Whenever possible, obtain patient consent for this life-saving procedure and confirm the patient understands risks, advantages and processes.
3. Is this the right equipment? Confirm that all equipment details align with the patients’ needs. Stay current in the different modalities and components of dialysis—such as dialyzer size, the dialysis delivery system/K-machine, type of acid and bicarbonate ordered, bloodlines and needle type.
4. What is the patient’s hepatitis B status? Follow current guidance from the dialysis industry on how to dialyze those who are immune, susceptible or have an unkown status for hepatitis B. Also, evaluate other contagious issues and ensure proper isolation status when necessary.
5. Are the orders complete? Ensure orders have been completed by a qualified practitioner—such as a nephrologist, internist or intensivist—and verified with the practitioner by a licensed diaysis nurse.
6. Is the access verified? Fully understand the patient’s fistula or graft maturity or central venous catheter care needs and the proper way to access.
7. Is the safety check being performed at the right time? Perform the time-out safety check immediately before accessing the vascular access. A new timeout should occur if the access is delayed.
8. Does the patient or family have any questions or concerns? Lastly, because health care comes with unknowns, risks and advantages, give the patient and family members the opportunity to ask questions and express concerns.

Documenting patient safety checks

Documentation is a key element in every health care environment. Documented and signed safety checklists can help verify patient care and hold each member of the care team accountable to running a thorough time-out safety check with every patient. Documentation can also allow for a second pair of eyes to review the safety check, so one individual team member is not the sole patron of a medical miracle gone wrong.

Overall, time-out safety checks involve a small time investment with large dividends that may help lead to improved patient safety, better clinical results and, ultimately, enhanced patient quality of life. Time-out safety checks have been adopted world-wide, and continue to be an important tool for helping protect both patients and health care providers. Achieving patient safety should involve a checklist, appropriate implementation, ease of use and care team accountability. The bottom line: a safety checklist is an investment worth making, for the sake of placing safety first and honoring our medical oath.