Dialysis Unit Communication: Real Time or Real Problem
Dialysis Unit Communication: At present, there are more than 6500 dialysis centers in the United States that provide life-saving care for patients with end-stage renal disease (ESRD) requiring renal replacement therapy. This often thrice-weekly form of treatment has become commonplace in virtually every major city and suburb in the US. Dialysis care is almost universally provided by Nephrologists (physicians specializing in the diagnosis and treatment of kidney diseases) in close collaboration with a team of health care providers that includes specially trained dialysis nurses technicians, social workers, and dieticians. Dialysis care is now considered sufficiently routine that the Nephrologists need not be present during each treatment.
Potential Consequences of Dialysis: As with any procedure, hemodialysis carrels a small but significant risk of complication including infection, low blood pressure, and bleeding. The risk of choric blood loss is real, even under ideal conditions; however, blood loss may also be acute, especially in patients with plastic dialysis catheters that are susceptible to accidental disconnection during or after the dialysis procedure.
Standard of Care: Recent evidence suggests that hemodialysis units widely vary in standardizing communication when untoward vents occur in the absence of the Nephrologist. While some units report any unit ward event, others elect not to inform the Nephrologist, potentially causing these events to be unaddressed, thereby increasing the risk of recurrence, complications and even death. Partly as a result of this variability in practice, it is necessary for the physician to review the “event threshold” that mandates communication between the Dialysis Unit and Nephrologist in order to prevent or minimize or the risk of dialysis-related complications that jeopardize the patients’ well being. It is also clear that the absence of documentation that communication has, in fact, occurred increases liability in cases of these unfortunate complications.
- Di Benedetto A, Pelliccia F, Moretti M, d’Orsi W, Starace F, Scatizzi L, et al. What causes an improved safety climate among the staff of a dialysis unit? Report of an evaluation in a large network. J Nephrol.
- Spiegel B, Bolus R, Desai AA, Zagar P, Parker T, Moran J, et al. Dialysis practices that distinguish facilities with below- versus above-expected mortality. Clin J Am Soc Nephrol.5(11):2024-33.
- Harwood L, Ridley J, Lawrence-Murphy JA, White S, Spence-Laschinger HK, Bevan J, et al. Nurses’ perceptions of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment–Part II. CANNT J. 2007;17(2):35-43.