Need help improving 1st time HD treatments for pts

[Ladyjrn]

I was reading some of the comments I found on the site about people's 1st HD treatments and some were really horror stories!  Wow, I had no idea what some of you go through since I work in an outpatient clinic and usually see you after you've already been through several treatments in the hospital.  What I'd like to ask, is if any of you would be so kind as to give me an idea as to what if anything you can remember of your 1st impression of your 1st clinic experience.  My clinic is growing by leaps and bounds, getting new patients almost every other week and I want their experience to be as pleasant as possible.  If we can make it anymore comforting and less intimidating than what it already appears, than I'd like any suggestions from outside sources.  Thanks in advance for any advice.  Janet

[okarol]

I think it might be helpful to invite patients to visit the center and, if they want, view a patient being put on and taken off, if the patient in center doesn't mind. I think the scariest thing is not knowing what to expect.
I would also like to see the employees of centers get some sensitivity training. They aren't just sticking a patient. Beginning dialysis is a huge change in the patient's life. They are changing how they live. It can be overwhelming, scary and depressing. Tech's, nurses, social workers, nutritionists, doctors and even the receptionist need to learn how to be supportive and respectful and professional. Eating and drinking when the patient can't, ignoring requests, belittling symptoms and a basic disregard for the individual needs of each patient should not be tolerated.
That's my 

[G-Ma]

Okarol..that was 100 bucks....yes. 

[Orange County Ca]

  Yep to what they said.  It was exactly what I was thinking.

Its actually quite simple in theory but difficult in practice.  Knowledge knowledge knowledge and treating people the way you want to be treated.  One person, you, can make a difference.  Get the head of the unit thinking that way because all organizations think and act like the boss does.

[Ladyjrn]

Thanks you guys for your quick responses.  Being the daughter of a previous dialysis patient it's easier for me to be a little more sympathic to the cause.  I do try to get my staff to be sensitive as well and most of the time they're pretty good, but I know there is nothing like living in your shoes.  Again, thank you.

[Wallyz]

One of he issues was that I had to sign a bunch of "Informed consent" form for treatment.  The idea that I am being told that I will die if I don't have this treatment, and then I have to sign IC forms without being educated is ridiculous.  I was angry and scared, and I created a "problem" for the staff that first day.  Having an educator there a couple hours before so that most of those quesitons can be gone over in greater detail would have been helpful.

[Orange County Ca]

You did the right thing Wallyz by not going ahead with anything you didn't understand or objected to.

Bug anything more than a tooth pulling calls for the "YOU MAY DIE" form as I call it.  And if they give you gas for that I imagine the form will appear even then.

Nobody is going to touch you without you signing that form first.

[Ang]

try  getting  pre  dialysis  patients  through  your  doors  before  there  time  comes  around,see  what  goes  on,maybe  talk  to  some  of  the  patients,  those  who  have  been  around  for  a  couple  of  years.

get  those  who  are  pre dialysis, to  research  dialysis  etc  etc,so  when  there  time  comes  along,  they  have  some  idea  on  what  to  expect.
my  motto  is  "information  is  power"

before  i  started  dialysis,  i  used  to  go  to  the  neph  and   he'd  say  see  you  in  3   months,  when  i  walked  in  to  start  dialysis,  it  was  like  shit  i  should  of  looked  into  this,  i  know  nothing.

[jbeany]

Yeah, that was bad the first day - in the middle of being scared out of your wits, they want you to sign a ton of forms that you are too out of it to really read.

[RichardMEL]

Good question. I think it might be difficult for you being at an outpatient clinic in that you get sent patients after they've started and been made somewhat stable at a hospital unit. I really like Karol's suiggestions though - they're  pretty spot on.

[devon]

I think one good policy for new patients especially is "answer their questions!" 
I asked all sorts of questions in the first few sessions (questions I was prepared to ask by virtue of my reading in IHD) and usually the tech or nurse would answer with a good explanation.  However, sometimes the tech would answer with a less than informative reply.  For example, the alarm went off and I asked what caused it.  The reply, "You".  That was hardly informative and went into the realm of rude. 

Also, it would be handy if all the staff wear nametags.  Many where I am do not wear name tags.  It's a struggle to learn all the names.  The first time I went into painful cramps, I couldn't get anyone's attention.  I didn't know their names!  Usually in a restaurant, the server begins with a name introduction.  That should be the case with dialysis, too!

Thanks for bringing up this topic!

-Devon

[okarol]

YES! Name tags and introductions would be great! One time I told the charge nurse "The tech with the long straight hair is NEVER to put Jenna on again (twice she ignored our request to adjust the fluid removal.) I didn't know her name.

[willieandwinnie]

I think it might be helpful to invite patients to visit the center and, if they want, view a patient being put on and taken off, if the patient in center doesn't mind. I think the scariest thing is not knowing what to expect.
I would also like to see the employees of centers get some sensitivity training. They aren't just sticking a patient. Beginning dialysis is a huge change in the patient's life. They are changing how they live. It can be overwhelming, scary and depressing. Tech's, nurses, social workers, nutritionists, doctors and even the receptionist need to learn how to be supportive and respectful and professional. Eating and drinking when the patient can't, ignoring requests, belittling symptoms and a basic disregard for the individual needs of each patient should not be tolerated.

Involve the patient in their treatment. Don't act like everything is a big secret. Tell them what you are doing and why you are doing it, what you are giving them and what it is for. And everything that okarol brought up is right on the money. 





Edited: Fixed quote tag error - okarol/admin

[BigSky]

YES! Name tags and introductions would be great! One time I told the charge nurse "The tech with the long straight hair is NEVER to put Jenna on again (twice she ignored our request to adjust the fluid removal.) I didn't know her name.

They really should wear name tags.  Helps to identify if they actually work there or someone is just posing as a nurse.

Many states, do not know if all of them require it,  its a requirement under the SBON regulations that all caregivers must wear a name tag. 

[cherpep]

I agree with willieandwinnie - involve the patient with the treatment.  I had no idea what was going on - even something as simple as to why 2 needles were needed.  What is the machine doing?  What does the technician need to monitor?  What should I be aware of - when is it necessary to alert a technician? 

I know a lot of clinics do not allow the patient to have company.  i think for the first week, it should be allowed.  The family also has so many questions and concerns, and it would have helped me to have my husband with me those first few sessions.  I was so frightened and confused, but I was just one of many patients in an assembly line.  It was a horrible experience.

When I was diagnosed, it was all very sudden for me - the diet, the dialysis - the entire new life.  I had so many questions.  The people at the clinic kept saying that a nutritionist would be by to discuss my diet with me.  Do you know it was over a month before I saw the nutritionist?  That was entirely too long.   The diet was the most confusing for me, but by the time I saw her, I had consulted the internet enough to get my own answers - very difficult and very confusing.  The nutritionist should make an effort to see new patients - preferably within the first week.  sometimes that may not be possible - but a month is entirely toooooo long!

[kitkatz]

Be sure to tell new patients:

About all of the modalities of dialysis. Sometimes they think there is only one way to do it.
Choices about which centers they want to be at int heir areas.  Sometime sinsurance will let you change centers to be better placed.
Have family be with the patient for the rounds of dialysis.  Allow family to bring comfortable things in for the patient.
Tell patients what they can bring in to the center. Food? Drink? Ice?
Give new patients a list of things they should bring with them.
Give the new patients their first set of headphones for the TV free.
Tell patients if you have special things like a DVD player to play movies on.
Give them alist of internet resources or help groups int he area in which they live.
Have a phone number of a dialysis patient willing to listen to them handy.
Introduce them to other patients in the area in which they sit.

[RichardMEL]

I agree with involving the patient in their treatment - specially if they are receptive to taking some kind of personal control/responsibility for theirs (some aren't/don't care/don't want to know - and some, like most of us, do).

The thing is I would limit it a bit initially. There's *SO MUCH* to take in.. expecting someone to get on top of the concepts like UF rates, machine alarms, watching the BP (and whatever else) could be a bit much specially if they're trying to cope with the reality of being needled, feeling sick/tired, needing treatment and so on.. you don't want to overload someone and have them feel like EVERYTHING is reliant on them.

I would probably try and take a middle ground - explain what is going on while it is going on and mention things along the way like "Well, when the machine makes this noise and flashes like it is, that's an alarm for attention.. now it doesn't mean anything bad is happening, but it's something you or the technician need to take note of. In this case it's been caused by a high arterial pressure, and we'll fix it this way. You don't really need to worry about it unless you want to...." - certainly if the patient seems keen to know more and asks - for example "So what ways can I stop this from happening?" or "What's the best way for me to sit?" or so on it would be then useful to go further.. depending on your specific clinc rules (some clinics allow patients more leeway than others in terms of monitoring their own machines, doing setups, etc... mine for example are happy for me to go over the settings and point out/query any I think are off or make adjustments and handle minor resets of alarms).

Don't patronise patients or treat them like they're idiots or children (unless they act that way!) - I like to be treated as intelligent enough to understand what is going on and to be an active part of what is going on (it's my body!!!)... Now some patients don't want to be involved and just sort of sit there and endure it, or even worse don't want to be there or know and have a bit of passive resistance to the whole thing - not much you can do about that - but definitely being treated with some kind of respect(unless you show otherwise) I think is important.