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Date ArticleType
2/29/2016 Regulatory
Lowdown with Lori: Dialysis

Quality of Care as it relates to Dialysis continues to be a concern and rightfully so. Federal Tag 309 was in the top 10 tags cited in 2015 related to Pain Management, Hospice and Dialysis.

For residents who require dialysis, the nursing home provider must have an arrangement with the entity providing the dialysis. The arrangement is to address how the residents care is to be managed and coordinated. As with any good relationship, communication is vital and must be established between the resident, nursing facility and the dialysis provider, and it must be timely and consistent and a true interdisciplinary approach.

To provide non-fragmented care and ensure excellent outcomes, review your current system for communicating with the dialysis center(s) with your QAPI committee. Implement a Communication Notebook that would travel with the resident back and forth from the dialysis provider The communication notebook is to be imitated by the facility, however both the facility and dialysis provider would exchange information each and every time the resident has dialysis. Click here to see an example of a Dialysis Communication Form.

Within your facility, Social Services is to contact and coordinate care planning with the dialysis provider, resident and interested parties, to ensure attendance of the interdisciplinary team is established. Conference calls may be utilized when the dialysis center representative(s) cannot be onsite. Consider how laboratory tests will be obtained, results shared and who will be responsible to ensure all parties receive timely information and tests are not duplicated, causing unnecessary inconvenience and/or cost. Consider residents’ nutritional needs, and ensure communication, as well as establishing who will obtain the resident weight, as duplication is unnecessary for the resident.

Other responsibilities of the facility include:
• Medications – if medications are scheduled during the dialysis appointments, they are missed and considered a medication error. Reschedule medications for compliance with physician orders, and at a time resulting in a positive clinical outcome for the resident.
• Training and documented competency of licensed and non-licensed staff related to all aspects of dialysis care upon hire and annually thereafter. Consider the access site the resident’s life-line because it is!
• Anticipate the resident needs – prepare a care package to include a blanket, a cushion (especially if a resident is at risk or has current skin concerns), a snack, simple activity.

Good vascular access is necessary for residents with End Stage Kidney disease. Reviewing your facility policy and procedures is the best place to start. Here are some other clinical tips to assist you in keeping your resident safe:
• No B/P measurements, venipuncture's, injections on the affected side
• No restricted clothing or jewelry over or to the arm with vascular access.
• Good hand hygiene before touching vascular assess site.
• Check for patency every 8 hours
• Palpate the vascular access to feel for thrill or vibrations to ensure atrial/venous patency
• Auscultate with a stethoscope to detect a bruit/swishing sound
• Assess for infection to the accesses site (warmth, redness, swelling, drainage, tenderness)
• Look for bulging or a Popeye arm
• Assess circulation (pulses distal to the vascular site, capillary refill to fingers, numbness and/or tingling and temperature of the skin).
• Document assessment findings and notify the attending physician immediately of any abnormal findings. 

Click here for information on how to know the difference between an AV Fistula and AV graft.
In conclusion, communication between nursing facilities and dialysis centers is essential for excellent clinical outcomes, resident satisfaction and safety. Strive for the Triple Aim - better care, better health and reduced cost.