The vein preservation experiences of people with chronic kidney disease and criteria for medical alerts to prevent harm
A significant challenge that patients with chronic kidney disease face is avoiding medical treatments that could damage the veins needed for an arteriovenous fistula for haemodialysis. Patient safety is described as a wicked problem in healthcare. To improve patient safety, designers must identify the patients' journeys, their interactions with healthcare providers, and the socio-technical systems that surround them. This research aimed to understand and describe the experiences of patients with chronic kidney disease, their whānau, their healthcare providers, and the systems and strategies currently in use. It also aimed to create the design criteria for a medical alert to protect patients' veins. Previously, the design requirements for a medical alert that best suits patients with CKD in Aotearoa New Zealand were not known.
Under a pragmatist research paradigm, qualitative semi-structured interviews, observations, and participatory design workshops were used to understand people's experiences with vein preservation. A participatory methodology was chosen to emphasise collaboration and inclusivity. It included a significant proportion of Tangata Whenua to ensure that any design innovations suit people who experience health inequalities in Aotearoa New Zealand. The findings were analysed using reflexive thematic analysis.
The research indicates there is a lack of awareness and acknowledgment among healthcare providers regarding the importance of protecting veins for dialysis fistulas. While patients recognise the need to protect their veins, power imbalances between patients and healthcare providers can negatively affect patients and their ability to prevent harm. The visibility and effectiveness of medical alerts for vein preservation in the New Zealand medical warning system and phlebotomy systems are inadequate, resulting in healthcare providers' unawareness, alert fatigue, and potential long-term damage to patients' veins. Medical warning alert wristbands create patient identification and staff workload concerns.
Service blueprints, patient storyboards, and systems diagrams were also created as part of this research to depict the patient's journey with CKD, their interactions with healthcare providers and healthcare systems, and where medical harm most often occurs. A set of design criteria was developed to serve as a foundation for formulating and evaluating a medical alert to improve patient safety and change healthcare providers' behaviours to protect patients' veins for dialysis fistulas. These design criteria can potentially increase healthcare providers' awareness and acknowledgment of the potential long-term harm to patients' veins, foster shared knowledge of vein preservation, and significantly reduce the need for patients to advocate for themselves to prevent medical harm and ultimately contribute to a more positive experience for renal patients, their whānau, and their healthcare providers. This research also highlights the importance of understanding people's experiences and real-world problems in Aotearoa New Zealand to inform the design of medical alert systems.
