Medical mistakes that harm patients have occurred in dialysis facilities, just as they have been reported to cause death in hospitals. A plan to recognize and prevent mistakes includes several elements. (1) Establish a culture of safety, where safe practices are a priority and reporting of adverse events and ‘near misses’ is encouraged in a non-punitive environment. (2) Redesign processes of care to minimize patient falls, medication errors, bleeding from vascular accesses, dialyzer reuse errors and other problems. (3) Perform root cause analyses of adverse events and ‘near misses’. (4) Involve patients in safety efforts, including maintaining an accurate, up-to-date medication list. (5) Dialysis facilities should function as high-reliability organizations, focusing on the possibility of failures, expecting to make errors, training to recognize and recover from them and making system reforms following root cause analyses.