Abstract
This study evaluates and improves the patient education and care process before and after arteriovenous fistula surgery in hemodialysis patients. Inadequate implementation of this process may lead to multiple clinical risks. Currently, Southern X Hospital lacks a standardized patient education protocol, resulting in duplicated, omitted, or inconsistent content. These deficiencies negatively affect patients' comprehension and adherence, potentially leading to resource waste and reduced dialysis quality. To address these issues, this study applies Failure Mode and Effects Analysis (FMEA) to systematically identify potential failure modes within the education and care continuum. The CRITIC (Criteria Importance Through Intercriteria Correlation) method is used to generate objective weights for severity, occurrence, detectability, and expected cost, while Grey Relational Analysis (GRA) ranks overall risks based on weighted scores to overcome the subjectivity and ranking limitations of traditional FMEA scoring. Based on literature review, process mapping, and expert surveys, the study identifies 24 failure modes across six stages: preoperative preparation, postoperative care, vascular access maturation, vascular access training, daily maintenance, and management of access complications. The five highest-ranked risks include failure to rotate puncture sites, inadequate monitoring of pseudoaneurysm development, failure to perform vascular access reconstruction as prescribed, improper hemostasis technique after needle removal, and inadequate wound care. Accordingly, five improvement strategies were developed to reduce risks associated with these critical failures. This study provides a scientific, structured risk-evaluation framework for patient education processes, supporting dialysis units in establishing standardized procedures, revising care guidelines, and implementing quality improvement initiatives to enhance patient self-management and dialysis-related quality of life.
Notes
Reference list attached as separate document file.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Teaching and Learning Strategies, Academic-Clinical Partnership, Continuing Education, Hemodialysis, Arterial Catheterization
Recommended Citation
Hsiao, Nai-Hua, "FMEA-Based Risk Assessment and Improvements for Vascular Access Education in Hemodialysis" (2026). International Nursing Research Congress (INRC). 160.
https://www.sigmarepository.org/inrc/2026/presentations_2026/160
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-18
FMEA-Based Risk Assessment and Improvements for Vascular Access Education in Hemodialysis
Toronto, Ontario, Canada
This study evaluates and improves the patient education and care process before and after arteriovenous fistula surgery in hemodialysis patients. Inadequate implementation of this process may lead to multiple clinical risks. Currently, Southern X Hospital lacks a standardized patient education protocol, resulting in duplicated, omitted, or inconsistent content. These deficiencies negatively affect patients' comprehension and adherence, potentially leading to resource waste and reduced dialysis quality. To address these issues, this study applies Failure Mode and Effects Analysis (FMEA) to systematically identify potential failure modes within the education and care continuum. The CRITIC (Criteria Importance Through Intercriteria Correlation) method is used to generate objective weights for severity, occurrence, detectability, and expected cost, while Grey Relational Analysis (GRA) ranks overall risks based on weighted scores to overcome the subjectivity and ranking limitations of traditional FMEA scoring. Based on literature review, process mapping, and expert surveys, the study identifies 24 failure modes across six stages: preoperative preparation, postoperative care, vascular access maturation, vascular access training, daily maintenance, and management of access complications. The five highest-ranked risks include failure to rotate puncture sites, inadequate monitoring of pseudoaneurysm development, failure to perform vascular access reconstruction as prescribed, improper hemostasis technique after needle removal, and inadequate wound care. Accordingly, five improvement strategies were developed to reduce risks associated with these critical failures. This study provides a scientific, structured risk-evaluation framework for patient education processes, supporting dialysis units in establishing standardized procedures, revising care guidelines, and implementing quality improvement initiatives to enhance patient self-management and dialysis-related quality of life.
Description
This study used FMEA with CRITIC and GRA to evaluate risks in the vascular access education process for hemodialysis patients. Twenty-four failure modes were identified, with the highest risks related to puncture-site rotation, pseudoaneurysm monitoring, hemostasis, wound care, and access reconstruction. Five improvement strategies were developed to standardize education and strengthen patient self-management.