Texas Nurse Rethinks Kidney Care

Texas Nurse Rethinks Kidney Care

By Wendy Bonifazi
Monday November 17, 2008

The car accident that laid Cindy Barclay, RN, flat on her back for a year also laid the groundwork for an innovative nursing service that takes renal dialysis out of hospitals and outpatient centers and into Texas patients' homes. Her latest innovation is educating patients through what she calls a "medical novel."

Barclay, then a clinical nurse manager at M.D. Anderson's acute dialysis unit, was called in one night to stabilize a critical transplant patient. She remembers stopping at a traffic light en route home, then regaining consciousness hours later with a broken back, two daughters to support and no other local family.

"The medical profession actually does stick together, and you're recognized and appreciated if you do your best," says Barclay. Physicians she'd worked with stayed in touch, and one told her about a Department of Health program to start medical businesses.

"Since outpatient facilities wouldn't take patients with trachs, cancer and other special needs, they stayed in hospitals, adding to devastation and despair as well as costs," she says. "At the time, Texas permitted technicians to provide home dialysis, but they weren't equipped to take these patients either."

Barclay founded Quality Dialysis One, with offices in Dallas and Houston, to meet the needs of clinically complex patients as well as those with cancer, other critical conditions and debilitated elders. It allows patients from Austin to Dallas to stay home with family and friends, and is less expensive than hospitalization and ambulance trips.

"After we initiated home dialysis with nurses, several companies followed suit. Texas now requires nurses for home dialysis, although some states still permit technicians," she says. "Nurses can push drugs and keep patients going if they code. Our nurses stay there throughout the three to five hour dialysis treatment, and afterwards until patients are hemodynamically stable."

Each patient has their own dialysis machine, carbon tanks and reverse osmosis tanks, covered by Medicare and other insurance for durable medical equipment. It remains unless they decide to terminate treatment, have a transplant or die. Patients can receive treatment wherever they live, including assisted living and skilled nursing facilities.

"Since it's one to one care, they have plenty of time for patient education about their disease, dialysis and possible transplant," she says. And unlike clinic training for those doing self peritoneal dialysis, nurse teach patients in their home environment, where they know what's available and where it is. "Everyone isn't teachable, but many are competent to do peritoneal dialysis on their own at home if we invest enough time in education."

Barclay invested two years in her 200-page book, "That Damn Dialysis." "There's a real education deficit among patients, including the newly diagnosed and transplant patients I saw in the hospital," she says. "They needed something at their own level, in layman's terms, to understand the kidney disease, failure and treatment. Transplant is not a cure-after an average of five years, they need another. The disease process is very serious, and I wanted to add fun."

She added the entertainment to education by writing in the "first-person" of the fun-loving fifty-something Cledus B. Washington, Jr., who pulls no punches whether he's talking about his gym routine, love life, or the fears and frustrations of his disease.

"It's a project of love for community education, not profit," she says. "All Quality Dialysis One patients receive a free copy, and I drill them on it. Otherwise it's sold online, but if someone can't afford it, we'll send it."

She wanted the book to be representative and all-inclusive, so designed Cledus and his friends to represent the epidemic of kidney disease among African Americans and Latinos. Thanks to Cledus' curiosity, we learn the home countries of a virtual United Nations of nurses from Jamaica, Canada, the Philippines, a black man from Holland and other countries, including dialysis nurses she met in Germany and Switzerland. Other characters are composites of people she knows, including Drs. Killjoy, Quickslaver, and one Cledus nicknames "Eye-Candy."

When patients ask if the people are real, "I leave the mystery to them," says Barclay, including whether or not she's Cledus' love interest, dialysis nurse Cynthia Jones. Their story will continue in the sequel she's writing for publication in mid-2009. That's when she's opening additional offices in outside Texas. "I want to show different states how to do this," she says. "It's important to share wisdom and knowledge."

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