How training with mannequins is enhancing dialysis safety

All patients depend on their doctors and nurses to keep them infection-free during treatment, but few experience the risks faced by kidney patients who receive regular dialysis.

Dialysis Wright Robin Smaller
Dialysis Wright Robin Smaller

“Three times a week these people come in trusting us to access their bloodstream,” says Roberta (Robin) Wright, MSN, RN, a nurse educator at St. Elizabeth's Medical Center in Brighton (which is a member of Steward Health Care). “That’s why infection control is so important in dialysis. You can’t get any more personal than that.”

The Centers for Disease Control and Prevention (CDC) estimates that one in 10 dialysis patients in the United States — or about 37,000 people — acquire bloodstream infections annually from the life-sustaining treatment.

Adhering strictly to the CDC’s prevention guidelines could cut that number in half, the agency says. But the recommendations are complex and subject to periodic revision. Even good hospitals and dialysis centers sometimes struggle to follow all the protocols. 

'The training is fabulous'

Medical educators are always looking for better ways to teach dialysis safety, and Wright and her colleagues have developed a method that is earning praise from educators and students — using lifelike mannequins to simulate actual dialysis care.

With no patient, the staff feels comfortable asking questions they might not have asked in a real-life setting. And if they do something wrong, we can make them do it 20 times until they get it right.

Roberta (Robin) Wright, MSN, RN

In the St. Elizabeth’s Medical Center training, Wright mixes the usual lectures and handouts with hands-on practice to impart key safety skills by using real dialysis equipment and simulated body parts in place of live patients (see photos).

The combination is a hit. With the help of federal and Massachusetts Department of Public Health authorities, Wright has now developed a training program that is being offered to all dialysis nurses and technicians in the Commonwealth. And Wright was recently named one of the core advisors to the CDC’s new Making Dialysis Safer for Patients Coalition, which was launched last month.

“The training is fabulous,” says Debra Reyad, RN, clinical manager of the Norwood Dialysis Center in Norwood, one of the early “graduates” of the program. “The first part of the day you hear from the experts. But then in the afternoon, Robin has the mannequins and dialysis equipment, and you break into groups to learn by actually practicing — like sticking the needle into the dummy arm.”

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Trainees like Reyad say the simulations are especially helpful for teaching subtle techniques — like how to clean a dialysis machine between patients.

“Most people know they’re supposed to clean from the top down,” Reyad says. “But they often start by washing the front of machine from top to bottom. If you do that, you may pick up a drop of blood underneath the bottom, where you can’t see it, and transfer that to the back and sides. So you should either wash all around the top first, or just change disinfectant wipes for each side.”

The training has also proved valuable for those who have to supervise dialysis services delivered by others. “We have an experienced outside agency that provides our dialysis,” says Linda Riley, MEd, RN, CIC, manager of infection prevention at Cooley Dickinson Hospital in Northampton, Mass. “But the Joint Commission holds us ultimately responsible for supervising their care. So this training helps us meet that expectation.”

Dialysis Teamaction Final
Dialysis Teamaction Final
Robin Wright, MSN, RN and Janice Flanagan, RN attend to a simulated dialysis patient at St. Elizabeth's Medical Center.

A ‘no-blame’ environment

The idea of using simulations grew out of Wright’s 18 years as a staff nurse at St. Elizabeth’s Medical Center before she joined the education department in 2008. “We needed a way to get the attention of the frontline staff,” she said. “So I felt it might help to use the hospital simulation lab to mimic a dialysis setting, with the dialysis machine, a simulated arm, chest catheter, and so forth.”

The clinical content was drawn from CDC and APIC (Association for Professionals in Infection Control and Epidemiology) guidelines. But it is the realistic setting — and, importantly, the absence of patients, Wright believes — that makes the training so effective. “With no patient, the staff feels comfortable asking questions they might not have asked in a real-life setting,” says Wright. “And if they do something wrong, we can make them do it 20 times until they get it right.”

Jaya Bhargava, PhD, CPHQ, operations director for the IPRO ESRD, which has a federal contract to promote dialysis safety throughout the region, invited Wright and her team to run a training session at a meeting with 44 dialysis centers in Hamden, Conn. “The attendees loved it, because her simulation set up a no-blame environment that was both visual and tactile,” Bhargava says.

One attendee was Eileen McHale, RN, BSN, Healthcare Associated Infection Coordinator for the Massachusetts Department of Public Health (DPH). McHale says she felt the simulations were an innovative way to teach best practices. So with support from the CDC, DPH began offering the training to nurses and technicians across the state.

“Now we are like a traveling road show in the back of my truck,” says Wright. “We’ve set up everywhere from a medical office suite to a state hospital gymnasium to a state-of-the-art simulation lab. You can do this anywhere, which is exciting. And even before the evaluations come in, you can tell it was a good conference if you have to dim the lights to get people to leave at the end of the day.”

Dialysis Team
Dialysis Team
From left, Robin Wright, MSN, RN; Janice Flanagan, RN; and Kumba Quinama, RN of St. Elizabeth's Medical Center, with one of the mannequins used in simulation training for dialysis safety.

Initially the students were mostly nurse leaders who could take the lessons back to their staffs. But starting this fall, the training was expanded to dialysis technicians.

“Dialysis patients are at high risk of infection as a result of immunosuppression, the presence of other illnesses and the need for repeated, prolonged vascular access,” says McHale. “So training like this, done in partnership with dialysis subject matter experts, helps us meet a critical need for people on dialysis.” 

For more: Making Dialysis Safer For Patients Coalition

All images credit: Professional Event Images Inc.


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