outpatient renal dialysis guidelines and protocol

[susan]

As a nurse, I think the only area I didn't work was dialysis. I have no idea why.

Now, because of family illness, I'm curious about the patient routine, ie: vital signs, weight, any testing and what happens when dialysis is complete? I imagine there would be more vital sgns; more tests also? Who is responsible for the patients? Are they assigned? Generally, how many patients does each RN work with? I once worked in a disgusting ICU with no ventilation and routinely had 4 patients.
That didn't last long.

Thank you for your time. smpat@bellsouth.net

[Beth Witten MSW ACSW]

There are federal regulations that govern dialysis clinics that include such things as personnel qualifications and functions, appropriate water treatment, environment, quality improvement, patient's rights, etc. These are not as specific as to say how often a patient's vital signs must be checked. However, there is public reporting of 3 key indicators for dialysis -- adequacy, anemia management, and survival -- and clinics don't want to end up on the worse than expected list.

Typically in a dialysis clinic, a patient is assessed prior to dialysis. The assessment is done by a nurse or technician. it includes weight, temperature, BP, pulse, listen to chest, check for edema, etc. A patient's access site is prepared and dialysis is initiated by a nurse or by a technician under the supervision of a nurse. Patients are monitored periodically through the treatment -- sometimes machines automatically check and record blood pressures while other times staff do this manually. After dialysis the patient is reassessed for all the things mentioned previously. If they are not stable, they are advised to stay at the clinic until they are and sometimes are kept in their dialysis chair where nurses can watch them more closely than in the waiting room. By the way, patients can learn to do dialysis at home, they can drive themselves in most cases, and they can even work if they have encouragement to do so.

Different clinics assign patients differently. Some have primary nursing while others don't. Nurse-to-patient ratios depend on what the dialysis provider believes is safe for the patient acuity at the clinic. There are no federal regulations that mandate specific staffing ratios; however, some states have established ratios. The National Kidney Foundation submitted a comment for newly proposed regulations for dialysis clinics in which it recommended 1 staff per 4 patients and a technician to nurse ratio of 7:3 with an optimal ratio being 6:4. You can read the NKF recommendations at:
www.kidney.org/general/pubpol/pdf/WarnockLetter.pdf