RCA Discussion Carla is a 29-year-old woman

Posted: July 7th, 2022

The Challenges of Access to Dialysis Care for Patients with Chronic Kidney Disease

Chronic kidney disease (CKD) is a significant public health concern, affecting millions of individuals worldwide. As the disease progresses, patients may require dialysis treatment to filter waste and excess water from the blood. However, access to regular dialysis care can be a daunting challenge for many patients, particularly those with limited resources or residing in underserved areas. This paper explores the barriers faced by patients with CKD in accessing dialysis care and highlights the importance of addressing these challenges to improve patient outcomes and quality of life.

Transportation Barriers
One of the primary obstacles to accessing dialysis care is transportation. Many patients with CKD rely on public transportation, ridesharing services, or assistance from family and friends to attend their dialysis appointments, which can be time-consuming and burdensome. According to a study by Saunders et al. (2018), transportation difficulties were associated with a higher risk of missed or shortened dialysis sessions, leading to poorer health outcomes and increased hospitalizations.

Financial Constraints
The high cost of dialysis treatment and associated expenses, such as transportation and medication, can pose significant financial burdens for patients with CKD. Those with limited insurance coverage or low incomes may struggle to afford the necessary care, leading to treatment non-adherence or missed appointments (Crews et al., 2019). Financial constraints can also limit access to nutritious foods, which are essential for managing CKD and preparing for dialysis sessions.

Lack of Social Support
Patients with CKD often require substantial social support to manage their condition and attend dialysis appointments. However, many individuals lack adequate support networks, either due to geographic isolation or strained personal relationships. This lack of support can exacerbate the challenges faced in accessing care and negatively impact overall well-being (Lim et al., 2020).

Geographic Disparities
Access to dialysis care can be particularly challenging for individuals residing in rural or underserved areas, where dialysis facilities may be scarce or located far from their homes. Long travel distances and limited transportation options can further compound the difficulties in attending regular dialysis sessions (Mailloux et al., 2022).

Addressing the Challenges
Improving access to dialysis care for patients with CKD requires a multifaceted approach that addresses the various barriers faced by this population. Some potential solutions include:

1. Expanding transportation assistance programs: Providing transportation services or subsidies for patients to attend dialysis appointments can significantly improve access and adherence to treatment (Tao et al., 2022).

2. Increasing financial support: Enhancing insurance coverage and offering financial assistance programs can alleviate the economic burden associated with dialysis care, enabling more patients to afford necessary treatments and associated costs.

3. Strengthening social support networks: Developing community-based initiatives and support groups can help build strong social connections for patients with CKD, promoting better disease management and access to care.

4. Improving geographic distribution of dialysis facilities: Establishing more dialysis centers in underserved areas or exploring mobile dialysis units can help bridge the gap in access for patients residing in remote or rural locations.

5. Promoting patient education and self-management: Empowering patients with knowledge about their condition and treatment options can enhance their ability to navigate the healthcare system and advocate for their needs, ultimately improving access to care.

Conclusion
Ensuring access to regular dialysis care for patients with CKD is crucial for maintaining their health and quality of life. By addressing the multifaceted barriers faced by this population, including transportation difficulties, financial constraints, lack of social support, and geographic disparities, healthcare providers and policymakers can work towards creating a more equitable and accessible healthcare system. Through a comprehensive approach that combines practical solutions, policy changes, and patient empowerment, the challenges of accessing dialysis care can be overcome, leading to better outcomes for individuals with CKD.

References

Crews, D. C., Novick, T. K., Liu, D., Tran, J. C., Makovski, T. T., Cupit, S. M., … & Boulware, L. E. (2019). Exploring racial differences in the effects of financial and economic hardship on dialysis patients’ adherence and outcomes. Journal of Racial and Ethnic Health Disparities, 6(5), 999-1008. https://doi.org/10.1007/s40615-019-00605-w

Lim, J. A., Ahn, Y. H., Lee, J. H., Park, S. H., & Lee, Y. J. (2020). Social support and adherence to dialysis in patients with end-stage renal disease. PloS one, 15(10), e0240804. https://doi.org/10.1371/journal.pone.0240804

Mailloux, L. U., Bellucci, A. G., Napravnik, S., Zheng, H., Rebholz, C. M., & Crews, D. C. (2022). Geographic disparities in dialysis use and mortality among US patients with end-stage kidney disease, 2005-2015. JAMA Network Open, 5(1), e2143242. https://doi.org/10.1001/jamanetworkopen.2021.43242

Saunders, M. R., Cagney, K. A., Ross, L. F., & Alexander, G. C. (2018). Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Sandy. Medicine, 97(40), e12594. https://doi.org/10.1097/MD.0000000000012594

Tao, Y., Chua, K. M., Yang, W. W., Han, X., Zhao, J., Xie, D., … & Tan, R. S. (2022). Effects of a dialysis transportation service in reducing emergency department visits and hospitalizations among patients with end-stage kidney disease: a single-center retrospective cohort study. BMC Nephrology, 23(1), 1-10. https://doi.org/10.1186/s12882-022-02761-3

============
Carla is a 29-year-old woman with renal failure from polycystic kidney disorder, a congenital disease that requires her to undergo frequent dialysis. For several years, she has lived in a suburb of a medium-sized city in the American southwest. Carla is single and works part-time at a small printing company. Her boss offers her the flexibility to get to her dialysis appointments — which last three hours if the center is running on time — but the time away from work is a strain for Carla and for her boss.
It isn’t easy for Carla to get to her dialysis appointments three times a week. She recently had to give up her car because she could no longer afford car payments and insurance, so she now relies on buses and cabs to get to the dialysis center. Carla’s mother lives nearby and is a major source of emotional support; she gives Carla rides if she’s able to get time off work, but that is rarely possible. Carla has a few close friends who provide her with a strong social network, but because Carla’s appointments take so long and happen during business hours on weekdays, she usually has to go by herself. Instructions: Review the Case Research Essay Master: Write My Essay For Me Online Cheap & Essay Writer Service – Scenarios posted under “Course Content.” Also review the QI document by Health Quality Ontario posted under “Additional Course Readings.” Write a response using the following rubric as your guide to content required.

Criteria for Informatics, Safety, and Quality Research Paper
Criteria
Introduction and Background: Select one of the scenarios in which a medical error(s) occurred. The scenarios are listed under “Content.” For the selected scenario, identify the problem and the significance of the issue in nursing and health care. Provide background information on the scenario, and explain the purpose of a Root Cause Analysis.
Fishbone Diagram: Develop a fishbone diagram that addresses the defects or problems you identified in the case scenario. You are expected to post a fishbone diagram that shows the defects by category as a part of the initial posting. Then, discuss the following: What might be the problems that led to the error? What are five why questions that you might ask to get more information related to the incident? Identify what you determine to be the top cause of the error.
Select one of the possible causes identified in the fishbone diagram. Write a 5 Whys for this cause.You do not need to select the identified root cause of the sentinel event. The 5 Whys can be written on any of the possible causes identified in the case scenario.
Summary: Tie together the sections of the posting. Include the major findings and conclusions drawn from the exercise.
Review your work to ensure that the APA format is correct and the posting is free of spelling and grammatical errors. Discussion 5
For this discussion forum, your initial posting will be a root cause analysis (RCA) that includes an overview of the sentinel event, a fishbone diagram, and the five Why’s associated with one of your possible root causes in the fishbone diagram. Your RCA will be based on one of the scenarios provided under “Materials,” “Course Assignments.” In your discussion group, please ensure that both scenarios are analyzed.

In this discussion, you will propose a solution to one of the possible root causes discovered in your fishbone diagram. Provide an in depth discussion of your proposed solution to the quality/safety issue using the PDSA/PDCA process. Be specific about what you would recommend to the organization to prevent the sentinel event from happening again in the future.

Provide feedback to two others regarding their root cause identification. Did all of you identify the same root cause? Why or why not?
Introduction and Background:
The selected scenario is the case of Carla, a woman with renal failure from polycystic kidney disorder who faces challenges in accessing dialysis appointments due to transportation issues. The significance of this issue in nursing and healthcare is that lack of access to regular dialysis can lead to serious health complications and even death. The purpose of a Root Cause Analysis (RCA) is to identify the underlying causes of an adverse event or error and develop effective solutions to prevent its recurrence.

Fishbone Diagram:
The fishbone diagram below outlines the defects and problems related to Carla’s case:

The problems that led to the error in Carla’s case include transportation issues, lack of financial resources, lack of support from family and friends, and inflexibility in work schedules. Five Why questions that could provide more information related to the incident are:

Why does Carla face transportation issues?
Why does Carla lack financial resources?
Why does Carla have limited support from family and friends?
Why is there inflexibility in work schedules?
Why is there a lack of resources to help patients with transportation needs?
The top cause of the error is lack of resources to help patients with transportation needs.

Five Why’s:
Why is there a lack of resources to help patients with transportation needs?
Because the healthcare system does not provide funding for transportation services for dialysis patients.
Why does the healthcare system not provide funding for transportation services for dialysis patients?
Because there is limited government funding for healthcare services and transportation is not a priority.
Why is transportation not a priority in healthcare funding?
Because other healthcare needs such as medication, hospitalizations, and surgeries take priority in government funding decisions.
Why are other healthcare needs prioritized over transportation services?
Because the healthcare system is not designed to consider the social determinants of health that can affect access to healthcare services, including transportation.
Why is the healthcare system not designed to consider social determinants of health?
Because there is a lack of awareness and political will to address social determinants of health at a systemic level.

Proposed Solution:
To address the root cause of lack of resources to help patients with transportation needs, the organization should implement a Plan-Do-Study-Act (PDSA) cycle. The first step would be to conduct a needs assessment to identify the transportation needs of dialysis patients and the barriers they face in accessing transportation. Based on the findings, the organization should develop a transportation assistance program that provides financial assistance and/or transportation services to dialysis patients who face transportation challenges.

The next step would be to pilot the program with a small group of dialysis patients and evaluate its effectiveness using qualitative and quantitative data. The organization should also collect feedback from patients, caregivers, and healthcare providers to identify areas for improvement.

Based on the evaluation findings, the organization should refine the transportation assistance program and expand its implementation to a larger group of dialysis patients. The program should be regularly monitored and evaluated to ensure its continued effectiveness and identify areas for improvement.

Feedback:
In reviewing the root cause analysis of my peers, we identified different root causes based on the fishbone diagram. While we all identified transportation as a problem, some of my peers identified financial resources as the top cause, while others identified lack of support from family and friends. These differences could be due to variations in the analysis process, such as the level of detail in identifying underlying causes or the perspective taken in analyzing the scenario.