There is a post comment section, so let them know what you think. Renal Business Today (RBT) Roundtable: Dialysis Patient Comforthttp://www.renalbusiness.com/articles/patient-comfort-roundtable.html
Copyright 2009 by Virgo Publishing.
Posted on: 03/23/2009
IN DIALYSIS, AS WELL AS ALL OF HEALTHCARE, THERE IS ONE INESCAPABLE TRUTH: THE PATIENT NEEDS TO COME FIRST. This especially rings true with chronic treatments, such as dialysis, where patients are treated on a regular basis. This means clinics and providers need to be more attune to the changing needs of dialysis patients in order to make the otherwise grueling dialysis treatment more bearable. To learn more Renal Business Today asked the following renal community leaders their thoughts on dialysis patient comfort:
Roberta Wager, RN, MSN, president of the American Association of Kidney Patients
Doug Keeslar, president of Champion Manufacturing
Sandie Guerra Dean, Corporate Social Worker with Fresenius Medical Care North AmericaWhat is your definition of ideal dialysis patient comfort?
Wager: This can be defined in many ways. However, from a patient’s perspective the definition of ideal patient comfort is a non-eventful dialysis treatment. Uneventful meaning no pain, no cramps, no low blood pressure. The access stuck correctly with no infiltrations nor clotting; therefore, the patient does not have to be sent to an access center to be de-clotted and then returned to the clinic to be dialyzed. Also, there were no mechanical problems causing treatment to be extended longer than the prescribed time.
Keeslar: Since our early beginning in innovating and development of medical treatment recliners in 1992, Champion has aggressively pursued the “ideal dialysis patient comfort.” It did not take us long to realize the impossibility of reaching perfect comfort for every patient. But we knew we could implement significant improvements.
While many companies are tempted to simplify the definition of comfort to “a more cushioned seat,” or a “softer feel,” what they are actually doing is missing the opportunity to create effective solutions, promoting yesterday’s babble, and masking their lack of interest in improving healthcare service.
The concept of “comfort” alone is too subjective. What is comfortable to one patient may not be comfortable to the next. What is comfortable to the caregiver may not be comfortable to the patient, etc. In addition, most individuals do not want to be a patient of any type, so their concept of comfort totally changes based on their current, frustrating circumstances.
Trying to attain “comfort” in the broad sense is like chasing a moving target. Champion designers needed to find the one idea that gave the most patients the highest degree of comfort. Our experience has taught us that the answer is patient empowerment. And empowerment leads to comfort.
As a dialysis patient, it is easy to start feeling invisible, as though your illness becomes your identity. We know that each patient sitting in a Champion recliner is a person with opinions, preferences, and ideas of their own. And no two patients are alike.
For instance, a clinic may treat a petite female patient who is always cold during dialysis, and who prefers to watch a movie during her treatment time so it is not such drudgery. So why not allow her to control her environment through the chair’s integrated heat system and a chair-mounted bracket that holds a dedicated flat-screen TV?
A different patient may be a very tall gentleman who experiences lower back discomfort and who likes to return emails during his treatment. So he controls his environment through an integrated massage feature to help him relax his back muscles during treatment and an over-lap tray to offer him extra work surface for his laptop.
Finally, the same clinic may treat a larger patient who has little muscle tone and is not ambulatory. Staff can swing open the arm of the chair to make transfer from a stretcher or wheelchair easier for, and more respectful of, the patient. This patient may find reclining the chair and sitting it back up manually too difficult; so his recliner may be equipped with a power recline system allowing him to control his position easily without becoming frustrated while he waits for staff assistance.
Champion learned a long time ago that this is not a “one-size-fits-all” proposition. Offering a wide range of optional features and “patient-controlled” accessories makes all the difference in a patient’s perception of their own comfort.
Guerra Dean: Ideal dialysis patient comfort means creating an environment where patients feel safe and confident in the care being received, know the staff will listen and respond to their comments, concerns or questions, and where staff and patients work together to find suitable solutions to meet the individual needs of each patient. Patients should feel confident in the caregiver’s level of understanding of the kidney disease process and the available treatment options. It is also important to consider that physical factors contribute to patient comfort, such as room temperature and treatment chairs.
On a day-to-day level, it’s a process of being attentive and responsive to each individual patient and his or her needs.
How can clinics and patients work better as a team to improve comfort?
Keeslar: Certain aspects of the delivery of dialysis care are not negotiable and cannot be compromised. They are established as best practice for care and must be adhered to completely. Even the most demanding patient must understand this.
However, once those primary goals for delivery of care are accomplished, the time for patient and clinic dialogue on comfort improvements is possible and should be initiated. This discussion is a “two-way” street of communication. Both the patient and clinic have needs, concerns and reasons for improved comfort. These should be discussed. The process of listening and hearing adds tremendous value to the process; comforting the relationship on the issue is a positive step.
Since the majority of dialysis treatment time is spent in a medical recliner, much of the discussion may be about recliner comfort. The dialogue should center on improved patient empowerment, improved relaxation, and greater chair control. Avoid generalizing the concept of comfort. As mentioned earlier—one size does not fit every patient. With the patient having greater control over their warmth (integrated heat system), ability to relax (massage), ease of chair motion (power recline), recliner access (swing away side arms) and many other possible chair functions, it may lead to improved clinical treatment value.
Staff should also feel comfortable approaching their business partners to review alternatives to solving their comfort issues. There are many effective options available to solve common concerns. We deal with thousands of clinics and gather a wealth of feedback. Clinic staff can tap into the experience of their vendors. We can also work through the clinic’s concerns about cost and benefits. There are many cost-effective ways a clinic can make a patient more comfortable. Sometimes small changes generate big results.
Finally, we would encourage the team in the clinic to consider all of the benefits of patient empowerment. While it certainly brings comfort to the patient, the benefits do not end there. A more comfortable patient is less demanding and this will free up the clinical team for higher-order tasks than carrying pillows or blankets. There are significant and measurable operational efficiencies built in to a clinic full of comfortable patients.
Guerra Dean: UltraCare is the mission of all Fresenius Medical Care facilities, representing our commitment to delivering excellent care to patients through innovative programs, the latest technology, continuous quality improvement and a focus on superior customer service. Through UltraCare, Fresenius strives to improve the quality of life of every patient, every treatment. UltraCare is delivered by highly trained staff, and is demonstrated through dedication, leadership and compassion by every team member, every day.
A team approach to care encourages facility staff and patients to work together as a team to improve comfort through respect, open communication and collaboration. There needs to be willingness on all sides to identify and work toward a common goal, and ensure the clinic is a comfortable environment for both patients and staff.
UltraCare focuses on delivering patient-centered care and offers various treatment options to patients to suit their individual lifestyles; an availability of options for treatment can help improve a patient’s comfort and quality of life. Fresenius Medical Care offers traditional in-center daytime hemodialysis, nighttime hemodialysis in some facilities, and various home therapies. Our Treatment Options Program (TOPs) provides education for patients, as well as their families, about chronic kidney disease and available treatments, so that they can be comfortable in making decisions with their care team about the treatment that will affect the way they live.
Wager: It is vital the dialysis staff communicate with patients. Staff should make sure patients are aware of any problems that could delay their treatment, such as a water system breakdown. Such a problem would delay the patient’s time to be connected to the dialysis machine for treatment. Other key issues patients complain about are:
a. Temperature in the treatment area. If the temperature is too cold, patients will be uncomfortable for the 3-4 hours they are at the center. If the center is too hot, patients’ blood pressure could drop, causing patients to become nauseated which can lead to vomiting.
b. Patients enjoy having a television near their chair. It allows them to stay occupied and keeps their minds off their dialysis treatment while they are at the dialysis unit.
c. Provide patients with medication when they communicate they have a headache or are ill.
d. Educate patients about the importance of keeping their fluid intake under control before their dialysis session. Remind patients that keeping fluid intake under control before a dialysis session will help alleviate some of the complications they suffer while on dialysis.
e. Helping patients alleviate the possibility of cramping, low blood pressure, etc., by using the SVS program when patients’ goals of fluid withdraw are too high.
What products and/or services should clinics and patients look into to help comfort?
Wager: All patients want a comfortable chair. Patients spend three to four hours, three-times a week in a chair, receiving dialysis treatment. They want to be comfortable. Patients understand the chairs must be made of a material that can be swiped down/cleaned in between patients. However, the length and width of the chair can add to its comfort. Since dialysis clinics are usually cold, the chair could have the ability to be heated.
Patients would like to see the dialysis center staff members working together, helping one another to care for patients. Patients believe if staff members worked together patient care can be more efficient.
Keeslar: Because patient needs vary in so many ways, there is no single answer in the pursuit of comfort. The dialysis provider wants to be able to select from a wide variety of cost effective options that will help meet the needs of as many patients as possible.
Select vendors and business partners that share the provider’s dedication to patient comfort and satisfaction, as evidenced in product development, responsiveness and willingness to work with clinic staff and patients, where appropriate, for solutions. Improving patient comfort is an effort as broad as our most ambitious product development project, and as focused as fielding a phone call for help in meeting the unique needs of a single patient.
Your best weapon on the comfort front is a commitment to patient empowerment; an open, respectful dialogue between staff and patients; and a key group of vendors who are willing explore options, innovations and solutions with you and your patients.
Guerra Dean: Fresenius provides continuous training to staff, and education to patients to empower everyone to work collaboratively to identify solutions without conflict, and strives to create an atmosphere for patients that promotes patient education, as well as teaching and training, and provides them with information on any issues or concerns they might have, thus contributing to their level of comfort.
Fresenius provides access to entertaining media that can help make treatment time more enjoyable and comfortable for patients. A number of Fresenius Medical Care facilities offer patients access to DirectTouch, a modern touch-screen media system at each treatment station for patient use during their treatments. It features individual headsets, cable or satellite TV, Web browser, educational information and surveys. Having personalized control of access to state-of-the-art technology can allow patients to improve their overall sense of well-being, and can increase the level of safety they feel about the care they are receiving.
Fresenius Medical Care facilities feature the latest in innovative dialysis information systems, including CHAIRSIDE online charting system, with touch-screen monitors at dialysis stations for clinical staff to accurately enter and securely track critical patient information. CHAIRSIDE removes paperwork, which allows more time to focus on the patient and his or her comfort, and the work engine technology at the side of every treatment station provides staff with a prompted list of actions to ensure they efficiently deliver the individualized, patient-centered care plan described.
Fresenius clinics also use a proprietary Adequacy Monitoring Program, a caregiver “traffic light” alert system enabled by On Line Clearance monitoring, to continuously show the effectiveness and progress of every dialysis treatment, which allows staff and patients an ability to see the effectiveness of their treatment by the color of the lights.
All these things contribute to a patient’s sense of well-being and overall peace of mind and level of comfort. RBT