All for One, and One for All!! Ha!

[Mr. B]

Dear nurse,

I am an inchoate administrator. Please tell me, specifically what you would change? I am VERY interested because my home health company is developing a center. We are independent and strive to be patient-centered. Let me ask a specific question: what staffing levels would you suggest? We are opening a 20 chair center, assuming full capacity, how would you staff it? Give me your dreams. How would you change the physical environment to make patients more comfortable?

[bioya]

treat your patients as human beings. Involve them in their plan of care, just don't talk about it, do it!!  Hire people who are not already burnt out on dialysis. try to find people that have worked for the great Duh-Vita and FMC. The reason is that many of the chain employees as mentioned above, are burnt out by promises and pompus a$$es. Have a bright unit, keep it clean. Talk to your patients like they know what your talking about because guess what... they do know what your talking about. When you get a non-compliant patient, work with them, just don't threaten them, teach them.
Let the patients families have a say in the unit and how it is run. They are the ones that sit in the waiting room for 3 to 5 hours a day, three days a week. Allow them to have some input into a coffee machine, a snack machine, etc, etc. Don't have a stupid wall of fame to impress surveyors, they see right through that. Instead make the patient a part of the team and they will take care of the surveyor for you.
Just be human... don't be like the corp. chain dialysis units.

[kitkatz]

Put trash cans that the patients can reach by the chair.

Keep the place reasonably warm. It  shell to sit in a colder than col building for four hours at a stretch. Have more than one person able to adjust the temperature.

[tmrwalters]

I have been reading some of the responses and I need to say something.  My comment is about FA's. This is not a generalization, this is just my own experience.  Our unit was only 8 chairs with an average census of 18-21 patients.  We were a M-W-F clinic. There were two LPN's working as techs and an RN. The RN passed meds, doctor calls, and adjusted med doses.  I was one of the LPN's.  I was also responsible  for inventory and the other LPN did the labs. We also did monthly progress notes on the patients, all patient education, foot checks, monitoring labs, assessments, dressing changes, town crier, access champion, water checks, and etc... We arrived at 3 am and usually worked til the last patient was off the machine.  Then we stayed to disinfect the machines....usually til about 5 o 6 pm.  Our FA was hired about a month after the big "D" took over our clinic.  Rumors were that she would rather file her nails then do patient care or, for that matter, work at all.  Our FA would arrive anywhere from 9 am til 1 pm. That is if she arrived at all.  There were weeks when we saw her at the most 18 hours.  She spent her days talking on the phone with other FA's about what gown they were gonna wear to the national convention or what snack they were gonna bring to the next FA meeting.  Her cell phone was constantly ringing from her husband or kids.  The one thing she did do was round with the doctors.  She would be giving reports to doctors about the patients that she didn't even know what had been going on with them.  Of course the doctors would believe her as she was the FA.  the doctors would then give orders but the FA wouldn't put them in the computer for maybe two days or at times it was two weeks or more...sometimes not at all.  Reports to the ROD did no good because they were drinking buddies at the conventions.  Several other incidents happened involving the FA and poor decisions involving criitcal  patient safety issues. These isues were reported to the ROD by the LPN's and the results were both LPN's lost there jobs and the FA was transferred to a clinic closer to her home.  Calls to the Compliance Hotline, Risk Management, Ohio Board of Nursing, and the Ohio Board of Health did no good.  This FA is still working for the big "D" and two very devoted LPN's are no longer in dialysis.  I even e-mailed K.T. himself and was informed the decision stands. 
  LIke I said, I don't feel all FA's are lazy and unsafe, but I think the big "D" needs to monitor their actions or lack of actions more closely.

[formerteammate]

Way to go!  K.T. is so full of himself.  I don't know why they say they are all "teammates".  There is no team to it, especially if you don't fall for the hoopla.  This company doesn't care about the patients or employees.  Do you realize that the Lufkin, TX unit has been temporarily closed down due to a spike in deaths?  They won't say how many, but I left there 2 yrs ago and I recognized 9 names in the obits just from when I was there and that was just in the month of April.  I hope they get their pants sued off!!

[okarol]

Hi formerteammate - please introduce yourself here http://ihatedialysis.com/forum/index.php?board=14.0 Thanks!
The Lufkin story is in our News Articles section http://ihatedialysis.com/forum/index.php?topic=8233.0



okarol/admin

[Bill Peckham]

The simplest, cheapest (basically no cost) first step would be to make each unit's Dialysis Facility Report public. The best disinfectant is sunlight - releasing the DFRs would shine sunlight on the dialysis operations of each individual unit.

Here is a sample  http://www.sph.umich.edu/kecc/usr/samplereport.pdf  . Every facility gets one every year. Time to post each one on the internet.

Three and a half years later and the Dialysis Facility Reports are on line.


http://www.propublica.org/article/dialysis-data-once-confidential-shines-light-on-clinic-disparities


Thank you Pro Publica.