Home Hemodialysis

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

During the transitioning process to the new hemodialysis unit, Ms. Conlon anticipated the challenges acquired by learning to set up and use new water equipment in an acute situation. In response to this, Ms. Conlon created and implemented a reverse osmosis flow sheet to assist her colleagues with the quick set-up of the portable RO in the ICU care setting. This tool resulted in a smoother transition for her colleagues, improvement in the delivery of care to the acute dialysis patient, and a decrease in the possibility of staffing overtime.

I am a Nurse Manager in the hemodialysis unit. The unit has eleven stations with a patient population of 40. The age range of veterans that receive care in this unit is 40 – 92. Most of the hemodialysis patients have difficulty managing their chronic illness and usually receive treatment three times a week for five hours of each visit. Most of them have

There were no significant differences between either of these labs or the blood volume processed before or after Ateplase push or dwell administration (Vercaigne, Zacharias, & Bernstein, 2012). Push administration injects a small amount of Ateplase into circulation, while the dwell method doesn’t. Often time patient catheters are dwelled with Ateplase in between treatments, as the dwell method requires at least two hours (Vercaigne, Zacharias, & Bernstein, 2012). Hemodialysis units operate on a stringent schedule per shift that decreases flexibility of time. As a result of this the push method is most widely ordered. Within this author’s clinic, once the push method is unsuccessful after two attempts the dwell method is then implemented. In conclusion, the push method was found to have the best immediate and long term results within this study. The authors identified that the sample size was inadequate, which ultimately decreased the validity of this finding (Vercaigne, Zacharias, &

The usual way was to log onto a computer (if not in use); look for the patient and quickly skim the patient’s history, resulting in wasted time. The result was a flow sheet that was easily accessible, located in front of the patient's bedside chart. The flow sheet included pertinent information from the patient’s last two hemodialysis treatments. We received positive feedback from the staff, and the flow sheet was adopted in the unit. After one year, the project was reviewed and continued to receive positive

CPOE training program should be as meticulously customized as the CPOE system itself. Initial training must be complete, comprehensive, and specific to your institution. It should include the hospital’s exact order sets, feature actual screen shots, and be developed around the facility’s workflow, essentially imitating a day in the life of the clinician. Persuading busy hospital and community physicians to attend classroom difficult. Online training — accessible to all users at all times from any location with Internet access — solves this problem. Web-based CPOE training can be made adequately comprehensive that some users can do without the classroom experience altogether. The typical workday of an intern in the ED differs substantially from a cardiology resident in the catheterization lab, and CPOE training must be individualized to reflect such differences. Separate Web-based training can be developed for large audience segments, (e.g., emergency department vs. in-patient or adult vs. pediatric) but to accommodate specific individualization, guided practice exercises in a facilitated classroom are required. This generally involves users completing the e-learning in an interactive classroom. Lesson plans include introductory announcements and preliminary teaching, followed by the user/student’s completing recommended e-Learning sections. Guided practice exercises to fine-tune the training are completed in the classroom, but the facilitator is present mainly for questions and guidance. Certification While some hospitals avoid testing physicians for CPOE proficiency, evaluation is desirable to certify competence and confirm the completion of training. Progress checks can be embedded in the Web-based training and administered randomly during classroom instruction. As the CPOE system is brought online, significance shifts from training to support

The financial impact of ESRD can be devastating. Anyone undergoing dialysis must cope with financial stressors and other factors that impacts their lives. Dialysis patients often experience daily disruptions due to resulting nausea, fatigue, and time to recover following their treatments. They often perceive

In October 2015 the number of Veterans being fee-based to outside healthcare facilities was rising. In order to decrease the fee-based costs and return our Veterans back to the Veterans Administration (VA) a peritoneal dialysis program needed to be created. The Nephrologist and Nurse Manager (NM) worked diligently to make sure the components of the program could be managed within the organization. A big obstacle found was getting buy-in from the nurses. Change has always been stressful for staff and this was going to be a big undertaking. When approaching the nurses the NM discussed how the program would benefit the patients and open up doors for other Veterans receiving hemodialysis. All Veteran care would now be at one facility which would

In observation, (Fahnestock, McComb, & Deshmukh, 2013) stated "Information technologies are transforming the way healthcare is delivered. Innovations such as computer-based patient records, hospital information systems, computer-based decision support tools, community health information networks and new ways of distributing health information.” (p.3.2). In the sector of delivering healthcare using technology, has made it easier for healthcare professionals to access medical records, digitization of prescriptions and view test results. With the use of high-performance devices being used in the hospital, helps to make the jobs of healthcare professionals a little easier. As well as relieve anxiety from anxious patients that may be awaiting lab results to come back. Therefore, IT devices and services has been and continues to be a tremendous help and game changer for the healthcare system. However, there is still a lot of work to be done to help shape and reform the healthcare

BACKGROUND: Innovations within the healthcare industry related to scientific and technical advancements often lead to changes in healthcare delivery. To cope with these changes, it is necessary to prepare and train healthcare workers to improve employees ' knowledge and the quality of care. Limited clinical experience with the mechanical ventilation approach, like high frequency oscillatory ventilation (HFOV), makes its implementation difficult in the real critical care world. The authors investigated the effectiveness of technology-enhanced simulation with debriefing in improving participants’ confidence level, cognitive knowledge and psychomotor skills in using SensorMedics 3100B high frequency oscillatory ventilation (HFOV) in adult patients. METHODS: This is a quasi-experimental research design with pre and post-tests. The educational strategy involved technology-enhanced simulation training with debriefing. The population included critical care respiratory therapists, residents, fellows and attending physicians at Rush University Medical Center. RESULT: Twenty six participants were included for data analysis; 12 respiratory therapists and 14 critical care physicians. There were almost an equal number of females (53.8%) and males (46.2%). The improvement was statistically significant in cognitive knowledge test score with p value < .05; t (25) = 3.91. The mean for post-psychomotor skills test score was 3.15 (SD = .88) and the mean for pre-test total score was 2.35 (SD=

For years nurses have gained experience in the medical field through clinical rounds at hospitals and doctors offices. Learning has always taken place first through textbooks and then through personal experience during required clinical time. These methods have proven effective but include limitations to the amount of exposure a student can gain before entering the workforce. A new way of learning is on the rise with the use of High Fidelity Simulations (HFS) or the Sim Man. HFS is a computerized life size manikin that simulates real human responses to treatment. This new technology allows students to practice rare procedures or treat common diagnoses.

In Kidney failure cases urea, creatine, uric acids and electrolytes move from the blood to the dialysate with the net effect of lowering their concentration in the blood. RBC s WBC s and plasma proteins are too large to diffuse through the pores of the membrane. Hemodialysis patient are exposed to 120 to 130 L of water during each dialysis treatment. Small molecular weight substances can pass from the dialysate in to patient’s blood. So the purity of water used for dialysis is monitored and controlled.

The research article discussed using isothermal dialysis to control the intradialytic hypotension (IDH) and patient comfort during hemodialysis. IDH has been responsible for early termination of dialysis treatment, which has resulted in patients receiving inadequate treatment, metabolic waste buildup and an increase in fluid volume overload causing further complications (Jianjun, Baird, Van Brackle, & Aduddell, 2014). This study focus on thermal control of dialysate and patient comfort in an acute care dialysis unit. The study consisted of 68 dialysis patients, but only 59 were able to complete the study. They were divided into two categories; 28 receiving isothermal HD and 31 in the standard HD. Their ages ranged from 31-90, with 38 males and 21 females. The study set out to answer three questions; how does isothermal HD affect IDH in patient receiving HD at a community acute care hospital; what is the relation between isothermal HD and patient comfort; does a patient who received isothermal complains of elevated discomfort. The results showed that Isothermal HD helped to decrease hypotension and side effects Jianjun et al. (2014). Kolcaba’s comfort theory also showed that patients were in a better state of well-being, as they denied having any level of discomfort that were not managed by the nursing interventions.

Literature reviews provide nurses with “critically appraised and scientifically proven evidence for delivering safe quality care” (Majid, Foo, Luyt, Zhang, Theng, Chang & Mokhtar, 2011, p. 229). Use of the evidenced-based information found in the literature review provided the writer with information to change clinical practice. It was evident that a foot check program was needed in the writer’s hemodialysis unit to prevent foot complications because of the high incidence of diabetes and peripheral vascular disease. There were many literature reviews read in preparation for planning a foot check program. According to Jones, Crawley, Phillips & Riley (2013) all hemodialysis patients must be considered at high risk for foot ulceration. It was

Kidney failure is a public health problem, which has dramatic effects on patients' health. In some