Safety culture in hemodialysis services: a scoping review protocol

Marília Alves Hoffmann1, Tatiana Aparecida Rodrigues3, Cissa Azevedo2, Fabrícia

Moreira Amorim Amaral3, Samanta Luíza da Silva Oliveira1, Helen Cristiny

Teodoro Couto Ribeiro3, Luciana Regina Ferreira da Mata1

from the perspective of the multidisciplinary team in hemodialysis services. Method: a

scoping literature review developed according to the methodology proposed by the Joanna

Briggs Institute manual, in the following information sources: LILACS, BDENF, IBECS and

ColecionaSUS (via the Virtual Health Library), MEDLINE via PubMed, COCHRANE, CINAHL,

SCOPUS, Web of Science, EMBASE, CAPES theses and dissertations database and

institutional repositories. Studies that answer the research question and are available in

full will be considered eligible. There will be no language restrictions. Selection of the

studies will take place independently by two reviewers and the differences will be discussed

with a third reviewer. Data synthesis and extraction will be performed through a

spreadsheet built in the Microsoft Office Excel Online program. The final synthesized results

INTRODUCTION

Chronic Kidney Disease (CKD) can be characterized as the gradual loss of the nephron

function, which results in impaired renal filtration capacity and homeostasis1). In cases

where CKD evolves to the terminal stage, there is a need to initiate dialysis treatment or

to perform a kidney transplant. It is estimated that more than 2.5 million people currently

receive renal replacement therapy(2). Despite the existence of therapeutic resources,

mortality due to CKD is still a concern. Between 1990 and 2017, there was a 41.5%

increase in the overall mortality rate caused by CKD in different age groups(3).

Among these therapies, hemodialysis stands out as the most prevalent modality, being

physiological changes caused by renal failure make patients undergoing dialysis therapy

more susceptible to clinical complications resulting from adverse health events(6).

Therefore, the importance of safe hemodialysis services is noted, in which the occurrence

of avoidable adverse events is reduced and quality of care may be assured to the patients.

For this, measures should be adopted to promote patient safety, such as those proposed

in the 2021-2030 global action plan for patient safety(7).

The safety culture can be defined as a set of group and individual values, attitudes and

competences that determine a pattern of behavior and commitment to institutional safety.

Thus, achieving a safety culture also involves the safety climate, which encompasses the

professionals' perception of the environment and the relationships developed in the work

patient safety culture in the health services result in the possibility of offering effective

care, with less risk of health-related infection and other preventable complications.

A preliminary survey of studies on the patient safety culture from the perspective of

professionals working in hemodialysis services was carried out in the following databases:

LILACS, BDENF, IBECS and ColecionaSUS (via the Virtual Health Library), COCHRANE,

CINAHL, EMBASE, SCOPUS, Web of Science, and MEDLINE via PubMed. Completion of this

research took place on February 9th, 2021 and the results evidenced that there was no

scoping or systematic review in progress or completed on the topic of interest.

Therefore, the need to conduct a scoping review is justified, with the objective of mapping

the available evidence on the assessment of the patient safety culture from the perspective

To formulate the guiding question of this study, the PCC strategy will be used, in which the

letter “P” represents the population; “C” the concept; and “C” the context. Thus, the

guiding question of this study will be: “What studies are available in the national and

international literature that assess the patient safety culture from the perspective of the

multidisciplinary team in hemodialysis services?”.

Inclusion criteria

Participants

The scope of this review will include studies with professionals from the multidisciplinary

team who work in the care of patients with renal failure undergoing dialysis treatment.

Assistance workers of all technical levels and undergraduate courses will be considered, as

well as service managers.

Concept

This review will consider studies that assess the patient safety culture, as well as those

that show the perceptions about the values, environment and relationships developed in

The context of this review will consist of hemodialysis services without distinction as to

their administrative nature (public or private services), size (large, medium and small) and

type of service (hospital or outpatient). The eligible studies will not be limited to any

geographic location.

Types of evidence sources

Studies available in full will be considered, which answer the research question and without

restriction as to the methodological design. There will be no language restrictions. Articles

published in journals and non-conventional publications, such as course completion papers,

theses and dissertations, will be considered, since the methodological evaluation of the

by the Joanna Briggs Institute Manual(9). The findings of this review will be reported

through the PRISMA extension for scoping reviews(10). The research protocol was registered

on the Open Science Framework platform (https://osf.io/7ug86).

Search strategy

findings, the strategy was defined by the reviewers with the help of a librarian (Figure 1).

Information sources

Search Strategy

Figure 1 - Search strategy. Belo Horizonte, MG, Brazil, 2021

In the first place, the databases of the Virtual Health Library and MEDLINE were searched

and the following descriptors were defined: renal dialysis, dialysis, hospital hemodialysis

units, patient safety, organizational culture and safety management. This preliminary

strategy.

From this definition, the second stage was initiated, in which the search strategies were

structured for the information sources used in the review: LILACS, BDENF, IBECS and

ColecionaSUS (via the Virtual Health Library), MEDLINE via PubMed, COCHRANE, CINAHL,

SCOPUS, Web of Science and EMBASE.

The reference list of all the studies selected for critical review will be analyzed as a strategy

for including additional studies.

The gray literature will be considered based on the search in the CAPES theses and

dissertations database, in addition to institutional repositories (Institutional Repository of

the Federal University of Ceará, Common Repository of the Lisbon Nursing School,

Selection of studies

All the literature identified will be transferred to the EndNote Web manager (Clarivate

Analytics, PA, USA) and duplicates will be removed. The references will then be uploaded

reference screening phase is initiated, in which two independent reviewers will read the

titles and abstracts, comparing them as to the inclusion and exclusion criteria. Any and all

disagreements in the screening will be resolved by a third reviewer.

The next stage is reading in full all the studies selected and assess the inclusion criteria

already established. Studies that do not meet the inclusion criteria will be disregarded with

due justification. The results of this process will be presented through the PRISMA-ScR

Figure 2 – Data extraction instrument. Belo Horizonte, MG, Brazil, 2021

Two reviewers will independently map and tabulate the data. Disagreements will be

resolved through discussion with a third reviewer in order to eliminate misunderstandings.

safety culture. A narrative summary will accompany the tabulated and mapped results in

order to describe how the results relate to the objective and research question of the

review.

REFERENCES