A comparative risk assessment of dialysis care processes in the home and hospital care contexts

Dialysis processes within the home care context is associated with risk factors which are not very prominent in the hospital context. This includes risk factors such as unanticipated device malfunction, or erroneous operation of the equipment, which exposes the patient to injury while undergoing dialysis. Importantly, the mentioned risk factors are further attributed to technical aspects such as sub-optimal equipment maintenance or following improper clinical procedures when administering care to the patient. Hence, it is important to follow a methodological approach to identify and assess hazards embedded within the dialysis treatment process, and on this basis, formulate effective strategies to mitigate their negative consequences on patient safety. This paper presents a comparative risk assessment for in-hospital versus in-home dialysis care. For the two cases, the risk assessment considers expertise of care givers involved in administering dialysis. The findings show that performing risk assessment for hospital environment, is more structured owing to expertise of clinicians and care givers responsible for administering dialysis. However, assessing risks for the home-care environment is more challenging owing to absence of domain knowledge, hence a survey approach to structure the risk assessment process is necessary. Moreover, risks in the home care context is influenced by logistical aspects, and lack of domain knowledge for maintaining dialysis equipment. Overall, insights from the comparative studies yields important learning points expected to improve dialysis care as more healthcare providers transfer care to the home environment.