Schedule Policy For Dialysis Patients

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

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

    The modern day emergency room is a department that is constantly busy. In the hustle of caring for patients, there are some details of the patient’s care that can be overlooked in a standard phone report to the accepting nurse. With this in mind, a change is needed so that there is an optimum patient outcome for each and every one of the people that walk through the doors of the emergency room and get admitted.

A few service models are generally accepted as an outpatient dialysis service line. Healthcare organizations have to decide which mode of dialysis they deem most effective in serving their patients: 1) Outsourcing their dialysis service line to a specialized service provider such as Fresenius or Davita, 2) instituting a home dialysis service 3) Implementing a hospital stand alone outpatient dialysis center 4) Free standing dialysis clinic. In addition, organizations need to establish protocols on the two-dialysis treatments, hemodialysis or peritoneal dialysis, and reach a consensus which to provide.

Once you arrive at the emergency room, you experience more waiting depending on your current condition. Some of these waits depend on: length of stay, time waiting for assessment, condition, waiting for inpatient bed, and lack of resources. Finally, when you’re ready to leave the emergency department waits can occur, like waiting for an inpatient bed or a ride home (CIHI, 2012). All of these reasons impact the growing wait times, with older adults becoming more frequent in emergency departments and the increasing population of older adults these wait times are going to continue to grow causing more harm than good, if older adults are unable to receive the appropriate care in a timely matter (Cooke, Oliver, & Burns, 2012).

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

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

Often, veteran’s may present as a walk-in with various complaints such as swelling of the extremities, medication renewals, blood pressure issues, or dialysis access problems. As the renal nurse, I am able to triage and document my assessment, including vital signs, and then communicate it to the nephrologist for further recommendations. Medication compliance is a big issue seen in the renal clinic. For example, all veterans are asked to bring in all medication bottles to their visit. As a kidney disease patient, there are always a fluctuation in the patient’s lab values, which may result in change in their medications. One concern that is found for example, a veteran was told by the nephrologist to increase his blood pressure medication from 25 mgs to 50 mgs. That veteran then is to follow up in the renal nurse clinic 4 weeks later for blood pressure monitoring, and bring in all medication bottles to that visit. Upon returning to renal nurse clinic appointment, it is noted that the veteran’s blood pressures are still elevated and the medication request to increase to 50 mg, had not been

“I have been as a registered nurse for 20 years. My full time job is in UT South western dialysis center as a registered nurse. Most of my patients have chronic and severe diseases. They need more attention and observation. I have another job in family clinic as a nurse practitioner. The majority patients in medical clinic are healthy and stable patients.” (C.L. September 10, 2016)

My community assessment project focused on adults with chronic renal disease who are receiving peritoneal dialysis under the care of the Davita Dialysis Clinic located in Dothan, Alabama. This modality of artificial kidney replacement minimizes the disruption of the user’s daily life by allowing them to remove waste products from their bodies on daily basis during their ordinary sleeping hours. According the Centers for Disease Control and Prevention, it was estimated that as many as 10% of adults or more than 20 million people in the United States may be suffering from chronic kidney disease and in 2011 alone, 113,136 of these individuals began treatment for their end stage renal disease ("National chronic kidney disease fact sheet,

Congress mandated QIP, as part of the dialysis bundle reform, which will result in payment decrease to providers who do not meet certain quality metrics. These quality measurements could avert the possibilities of harmful incentive effects (Gupta, C., Chertow, Linthicum, Van Nuys, Belozeroff, Quarles, & Lakdawalla, 2014). The CMS is working to develop a comprehensive quality monitoring initiatives to avoid problems associated with incentives to stint on care. This type of approach could be a significant tool for avoiding and solving the issues of incentives versus quality care (United States Government Accountability Office, 2011). This SE MI clinic is currently struggling to meet Dialysis Quality Indicators (DQI) doing poorly in bone demineralization and access managements, and could mean potential reductions on their bundled payments. The company would have to be more efficient in other budget measures including labor productivity and trimming of supply cost. Cost-containment measures such as staffing shortages can significantly affect quality care (Thomas-Hawkins, Denno, Currier, & Wick,

The other will allow the blood that is returning to back into the body. Treatments will last anywhere from 2 ½ to 4 ½ hours. Your blood pressure will be check regularly. Your machine will be adjusted to ensure that correct amounts are being removed from your body. You are allowed to relax, read, watch television, do work, or even sleep. The other type of dialysis is called peritoneal dialysis. This requires more work from the patient. The patient must maintain a clean surface on the abdomen in order to help prevent infection. The patient will again weigh themselves to determine the amount of fluid. Then the patient will wear a mask while cleaning the catheter site. Fluid allowed to stay in the peritoneal cavity is drained back into a plastic bag. The patient will then remove the bag and connect a new one. Once the fluid is in the body, the new bag will be rolled up and placed on the patient’s underwear until time for the next treatment. This type of dialysis is more work, more intense, and is required much more. It is done four to five times a day at about 30 minutes each time. There is alternative machine to this called a cycler. It is used every night. Five to six bags are used and the machine will automatically change fluid while the patient is sleeping. Dialysis can make things easier on the patient however it depends on how much help your kidneys need as to which treatment you will need.

An extraction from the DoH Admitted Patient Care data set of individuals with a diagnosis or procedure code for dialysis or transplantation (excluding acute dialysis) between 2000 and 2014 identified 1899 individuals of which 1241 were also present in ANZDATA. The additional patients are likely to comprise of individuals: a) receiving care for less than 90 days and therefore not registered in ANZDATA, b) visiting from interstate (“holiday patients”), and c) never registered in ANZDATA for other, unknown reasons. A possible total of 2045 individuals met the criteria for receiving renal

This week in Telemetry I mainly got to observe a patient on the first day and talk to a telemetry nurse the second day. On the first day I was assigned to a nurse named Missy. She was not very busy at the time so I got to observe a man on dialysis. The dialysis nurse's name was Chris, and he told me all about what dialysis is. Dialysis is a machine used when someone's kidney is not working. Since your kidney is what cleans your blood, that is one of the things that the machine has to do for you. The nurse also told me that the machine removes fluids and can add electrolytes. He said that a patient is on average on dialysis for anywhere from two to four and a half hours. The fistula is where the machine attaches to your body and is where a vein and an artery are sewn together. Chris was explaining to me what the fistula feels like, he said that is feels like a pulse, but much stronger. It is not that the rhythm is any different, the pulse just feels stronger. The patient told me to grab a glove and feel his fistula but the nurse told me I don’t really need to because I would have to put a gown and gloves on just to feel the pulse.

The physician may adjust the hemodialysis intensity and frequency based on the test results. These labs are crucial and must be checked monthly while being on dialysis.