Centers with REUSE

[aharris2]

If you don't like it, OPT OUT, it is your right!

It is more than money saving. I understand they are reimbursed the same without regard to whether or not a new dialyzer is used.

We used to reuse because that's the direction the clinics lead you in when you first start dialysis and there was no one at the time of any potential problems. Human error and sloppiness are the problems with reuse.

We opted out of reuse when I saw his tech hang his dialyzer down into the hazardous medical waste bin with the top port resting on the top of the bin and the bottom port down in the bin exposed to whoever else's contamination was down in that bin. In principle reuse may be okay, but the people involved make it too risky.

[HILINE]

my unit reuses, the dializers  are marked.. they are placed in a plastic bag after use. 2 tech;s verify the dializers before each use. I have been on dialysis for 5 years without a problem

[lmunchkin]

Heck, I don't know if when husband was in-center they used reuse or not!  Thank the Lord for NxStage!  We control all of his treatments!

lmunchkin     

[dialysisadvocate]

[It has been my experience, here in california, that many of the units that have reuse, have also been cited during their inspection. Some of the common cited deficiencies I have noted have been staff not checking per the facility policy/procedure for ensuring the correct dialyzer goes to the right patient, and disinfecting. These surveys, specifically Davita, who uses reuse can be viewed at www.qualitysafepatientcare.com  You can, and it is your right to ask for the staff to use a new dialyzer each time. Upon admission the facility should be providing you with documents addressing such, with pros and cons, explanations, etc of reuse
Roberta Mikles BA RN
Dialysis Patient Safety Advocate

[The Noob]

dh uses davita. the first day i brought him he was pretty weak and sick and out of it. he could barely walk and i got him in wheelchair in lobby. we had no orientation for in-center prior. nurse comes out and i am telling her he is about to pass out (he really was and did) yet she holds out a stack of papers for him to sign, one being about re-use. papers were not explained to him, just that he needed to sign. i said i didn't believe he was in right mind to do so. she ignored me and had him sign them anyway. he couldn't hardly hold pen.
later we had him cancel re-use and he is pretty sure they are using disposables now. have to inquire next time.

[HILINE]

are reuse dializer's larger and more efficent than none reuse?

[dialysisadvocate]

You can file a complaint with you state.. the facility had  him sign a paper/document of which he was unaware what was written on the paper..Davita is suppose to EXPLAIN in full the pros and cons of reuse... end of story. I have heard from patients that they do not do this, and, in fact, to recall several units in California were cited for such. Shame on those nurses and technicians who would allow that to happen to your husband.. But, considering what my father went through, nothing surprises me. Report them.. of course, CMS has never taken any kind of action e.g. consequences when there is noncompliance. Even if a patient dies as the result of a preventable error the facility does not get fined.

Interesting that Medicare/CmS does not reimburse hospitals for certain events, but they continue to pay dialysis providers even in spite of the facilities NOT adhering to the regulations. Maybe I am off here.. but, if CMS agrees to pay the facility e.g.  reimburse them if they comply with regulations...well, HELLO.. what happened here? Facilities continue to get paid. The new QIP is also not addressing the day to day care... HELLO CMS.. take a good look at these surveys,, SHAME ON YOU for not attempting to get legislators to change the rules and have some real consequences for providers that place patients in potential or actual harm's way

opinions of Roberta Mikles BA RN
Dialysis patient Safety Advocate
www.qualitysafepatientcare.com

[noahvale]

^

[rsudock]

When I first started D I was with Fresienus and they did not reuse...I never had any real problems except sometimes at the end of treatment I would be really sick....anyway when I went to CDC they started using reuse and I was extremely itchy. The clinic kept brushing it off saying, "Oh it is your phospherous." But every month my labs came back in normal range...finally I told the doc I wanted nonreuse and would change clinics if I was forced to continue to use reuse dialyzers.....wouldn't ya know when I switched the itchy stopped!  I say no to reuse!!

xo,
R

[lmunchkin]

My thing is, Why would anyone want to Reuse anything that requires sterile and/or sanitary conditions especially with D.  It is very disturbing to hear that this has been a common practice within clinics and not to mention, covering their "asses" by having the patient sign off on their first day in center! I had no idea of this happening and can promise, that I will find out if clinic used reuse on J.

  I say no to reuse!!

xo,
R

Absolutely,  No to Reuse!

lmunchkin   

[dialysisadvocate]

The bottom line is that patients need to be fully educated when they are asked to sign papers, etc. I have found, from my expeience in California, especially, that Davita facilities are cited,more than they should be, for not providing such information. I also receive calls from patients, in Davita units, who state they are unaware of such reuse pros/cons, etc. WHAT IS of greater concern is that facility policies and procedures are not followed in many units, e.g. checking that the correct dialyzer is given to the right patient. This is evident in some surveys. I remember a spokesperson,a while back, during an interview with a reporter (about a situation in a unit) making a statement that they were going to increase their policy from two staff check to three staff checking.  Ridiculous.. As a retired nurse, my suggestion to Davita would be to ensure that staff know the consequences for their actions and that they are responsible for conducting correct practices and if not there are consequences, which in my opinion are not strong enough. The lack of unit supervision is obvious inthese facilities.

above opinions of Roberta Mikles BA RN Dialysis Patient safety Advocate
www.qualitysafepatientcare.com

[Lindia]

We also got the song and dance about dialyzer reuse when my hubby started dialysis in May.  We signed the paper to OK reuse of his dialyzer.  The longer we are at his unit, the more we see issues with a small percentage of the staff.  I see no reason to take ANY chance of human error.

How do we OPT OUT now ?     Do we need to put a statement in writing?    If you have "opted out",  how did you do it   ? ? ?

[noahvale]

^

[dialysisadvocate]

As a Dialysis Patient Safety Advocate, I fully support noahvale's statement. It is your right, etc. Often, when starting dialysis, this is not fully explained to patients.  It is my opinion, from the surveys I have reviewed in Califonria (specifically Davita), that there are significant problems with staff not following the facility policy/procedure for reuse. This, also in my opinion, is from a lack of adequate education/trianing and unit level oversight. It is also my opinion that staff do not understand the consequences of giving the wrong dialyzer to the wrong patient
Roberta Mikles RN
www.qualitysafepatientcare.com

[Lindia]

Thanks so much NoahVale and dialysisadvocate --  We will begin trying to rescind the form we signed.  My hubbys schedule is Tuesday, Thursday and Saturday, and it can be hard to catch the social worker or facility administrator on those days.   But at least, now we know how to begin.

[Cordelia]

Omg, here in Canada, where I'm from in Ontario, They do not reuse. In fact, I don't think centers reuse them in Canada period.  I wouldn't want mine reused.

[dialysisadvocate]

All anyone has to do is to tell your dialysis technician, who is putting you on diaysis, that you don't want reuse. They should be providing this information to their charge nurse and/or unit adminstrator. It is your right to refuse to have reuse. They should be able to provide you, at your request, with a single use dialzyer. If not, then, something is wrong.

I am not stating all units that do reuse have problems. However, my opinion, as I have stated, after reading dialysis surveys, from California, and other states over past years, that there are too many staff who do not comply wtih the facility policies and procedures. One staff not complying when it comes to reuse if one too many....

You can ask for a copy of your facility's inspection (survey) report. I am guessing that most unit will give you some excuse as to why they can't provide such, or refer you to the state for a copy. This is why I started posting California surveys to my website www.qualitysafepatientcare.com  All you have to do is call the state and request a copy of the facility's survey. It is shameful that CMS posts to their 'dialysis facility compare' data but will NOT post the surveys. Nursing homes MUSt post in public view their surveys, why not dialysis units.

Indeed reading the surveys can be frightening but it can also be very educational. If the survey, for instance if cited in infection control,, e.g. staff not washing their hands prior to putting on gloves, or not checking the reuse dialzyer (name and patient) then you are aware what staff should be doing.

Above opinions of Roberta Mikles RN BA
Dialysis Patient Safety Advocate
www.qualitysafepatientcare.com

[lmunchkin]

I want to thank you Roberta & Noah for bringing this to patients attention.  Iam not the one with this disease and I shudder to think that this could have been done with my husband.  Yes maybe his clinic at that time followed proper protocol, but I highly doubt that ALL of those techs did. This is another example of why we chose to do home hemo with NxStage!

lmunchkin    

[Bill Peckham]

are reuse dializer's larger and more efficent than none reuse?

That's a good question to ask. Back when I was incenter the choice was between an F-80 with reuse and an Alwal (sp? it's been a while) for non reuse. The F80 was the superior artificial kidney.

The Aksys PHD reused its F80 and its blood circuit. It used a sterile hot water disinfect. This was a huge advantage because with reuse the blood circuit was made of silicone instead of PVC. I would much rather dialyze on a reused Aksys blood circuit than the disposable NxStage circuit.

[MooseMom]

I would much rather dialyze on a reused Aksys blood circuit than the disposable NxStage circuit.

I know nothing about the whole issue of reuse, so could you explain this statement?  I would have thought that a one-use, disposable circuit would have been better, but then again, I don't even know what a "blood circuit" actually is! 

[Bill Peckham]

I would much rather dialyze on a reused Aksys blood circuit than the disposable NxStage circuit.

I know nothing about the whole issue of reuse, so could you explain this statement?  I would have thought that a one-use, disposable circuit would have been better, but then again, I don't even know what a "blood circuit" actually is!

With reuse you can use better quality materials. The Aksys used a blood tubing made out of silicone instead of the standard plastic blood tubing set that are single use disposable.

With the Aksys - which was for home use only - you left the blood tubing in place between treatments and the machine did a hot water disinfect cycle. The disinfect process would leave the protein coat that forms on the blood tubing in place - this I believe made the Aksys the most bio compatible dialysis I have have ever had ... there is a lot of plastic involved with each NxStage treatment.

[MooseMom]

So, what made you move to NxStage?  Was it the portability of the system one?  Did you weigh out the pros and cons and came up with NxStage?  Do you feel different than how you felt with the other Aksys thingy? ('Scuse my fancy medical jargon.)

[Bill Peckham]

So, what made you move to NxStage?  Was it the portability of the system one?  Did you weigh out the pros and cons and came up with NxStage?  Do you feel different than how you felt with the other Aksys thingy? ('Scuse my fancy medical jargon.)

They ripped the Aksys from my home when the company folded in January 2007.

I trained to use the NxStage in August 2006 so for those few months I could use the Aksys at home and the NxStage for travel - the best of both worlds.

[MooseMom]

So, what made you move to NxStage?  Was it the portability of the system one?  Did you weigh out the pros and cons and came up with NxStage?  Do you feel different than how you felt with the other Aksys thingy? ('Scuse my fancy medical jargon.)

They ripped the Aksys from my home when the company folded in January 2007.

I certainly didn't expect THAT answer!!!

[Bill Peckham]

So, what made you move to NxStage?  Was it the portability of the system one?  Did you weigh out the pros and cons and came up with NxStage?  Do you feel different than how you felt with the other Aksys thingy? ('Scuse my fancy medical jargon.)

They ripped the Aksys from my home when the company folded in January 2007.

I certainly didn't expect THAT answer!!!

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