Clinic Discontinues Treatment time slot

[PrimeTimer]

If it were me or my husband, we'd be writing a letter and giving copies to his neph, the FA, nurse and dialysis provider (Fresenius). We'd be very specific about why we chose the clinic, whether it was because of his neph, the location or the hours, etc) and then express our concerns and/or disappointments about them changing the schedule. We really do have to be our own advocates otherwise they will do whatever the &%# they want. My husband now goes in-center but back when he was doing home-hemo, I once had to write a letter about the delivery method they were using for supplies. Putting things into writing seemed to have gotten their attention and the problem was remedied. 

[Michael Murphy]

Call  CMS for unless you are being shifted because you are always late they will at least listen  and may make the clinic accomadate she your needs

[AshtonsMuse]

Hi your husband is being badly treated.  First by law the ADA, your husbands employer needs to make reasonable accommodations for his schedule.  Second, if your husbands treatment is moved because of a holiday that's fine canceling it is a CMS violation.  Every year for Thanksgiving, Christmas, and New Year my clinic is closed but the treatment is not canceled, schedules are changed instead M.W, F. I might be switched to M, W, Sat.  This way every one gets their treatments and the Staff gets there holiday.  CMS is the Center for Medicare and Medicaid Services and would take your complaint about canceled treatments and harassment over starting times.  Good Luck

After reading your advice, and others, I plan to file a complaint in writing.  They outright just cancelled his treatment.  And after I complained to the social worker, I haven't heard any more about them making him move his days.  I'm still going to file a written complain over the straight up harassment and over the tech sticking him with 102.5 degree fever.  We're still waiting to hear about our ADA application with his HR dept.

[AshtonsMuse]

..............hemo is draining the life out of him too.  He's lost 45lbs and barely eats as it is.  He does have some residual kidney function, and I don't know if that would help him with the amount of time he has to do pd.  Thanks everyone for sharing your experiences with us.

Setting the correct 'dry weight' is critical to doing well on Hemo.  Going too 'Dry' leaces the patient sick,, overly week, cramped, and remains like that until the circulating system reconstitutes until the blood viscosity becomes more fluid and able to circulate much easier.

At least that is my theory.  My clinic had initially set my weight far too low.  I wasn't P'ing.  I still have residual kidney function and I Believe this is what helps keep my labs so well balanced within mid-range.

We argued but the Clinic agreed and raised my weight a total of THREE Kilo's, one or one-half at a time, until I felt so much better, NO cramping after treatments.  I am not knocked out and sleeping 5 to 8 hours immediately after treatments.  I do have some very slilght swelling in my ankle but NOT every day so I Believe my weight is very near perfect.
Blood pressures alone are not the best indicator of how much water weight to take off, although pressure drops ARE a pretty good indication when too much has been taken off.

I your Husband has chronic high pressures such as I do then the clinic cannot use pressure as an indicator unless they take off too much.  Leg swelling and how he 'feels' may be better indicators.

Talk to his Dr about this immediately.

Excessive take-offs can 'stun' the kidneys and heart, causing the kidneys to lose the residual function, causing heart attacks to those person susceptible.  Setting a far better dry weight is critical to him feeling much better.

This isn't going to be resolved over night.  This is going to take some time to figure out.

Thank for you sharing your insight into the dry weight.  They routinely take off way too much leaving him weak and as you described, even to the point where he's nauseous and vomiting between treatments.  I'm sure they have him set too low.  High blood pressure is the reason behind his kidney failure we were told.  Interesting about the excessive take-off being a cause of losing residual function, as when he was hospitalized, his GFR went from a 4 to a 14, every day or so he gained a point.  I have yet to get to talk to the dr about it, but his dialysis treatments in the hospital were different.  I just wish I knew how.  I know I can't get my hopes up, but seeing him feel better, and knowing his GFR went up that much makes me wonder a lot.  And it makes me very suspicious of the clinic, because when he started, his GFR was above 10, tho I can't quite recall the exact number.  Of course, not that he's getting off dialysis, I just want his quality of life at home to be better than its been.

[PrimeTimer]

Hi your husband is being badly treated.  First by law the ADA, your husbands employer needs to make reasonable accommodations for his schedule.  Second, if your husbands treatment is moved because of a holiday that's fine canceling it is a CMS violation.  Every year for Thanksgiving, Christmas, and New Year my clinic is closed but the treatment is not canceled, schedules are changed instead M.W, F. I might be switched to M, W, Sat.  This way every one gets their treatments and the Staff gets there holiday.  CMS is the Center for Medicare and Medicaid Services and would take your complaint about canceled treatments and harassment over starting times.  Good Luck

After reading your advice, and others, I plan to file a complaint in writing.  They outright just cancelled his treatment.  And after I complained to the social worker, I haven't heard any more about them making him move his days.  I'm still going to file a written complain over the straight up harassment and over the tech sticking him with 102.5 degree fever.  We're still waiting to hear about our ADA application with his HR dept.

Good for you! Stick to your guns! Hope you get the results you both are needing. It doesn't have to be a nasty-gram but be firm and to the point. You won't regret it. 

[Michael Murphy]

Dry weight is not a science and my first 6 months on dialysis were not good.  It took my visit to the doctor with a horrible BP of 75 over 45 that's when my dry weight was adjusted up by 5 kilos.







sp mod Cas

[AshtonsMuse]

Hi your husband is being badly treated.  First by law the ADA, your husbands employer needs to make reasonable accommodations for his schedule.  Second, if your husbands treatment is moved because of a holiday that's fine canceling it is a CMS violation.  Every year for Thanksgiving, Christmas, and New Year my clinic is closed but the treatment is not canceled, schedules are changed instead M.W, F. I might be switched to M, W, Sat.  This way every one gets their treatments and the Staff gets there holiday.  CMS is the Center for Medicare and Medicaid Services and would take your complaint about canceled treatments and harassment over starting times.  Good Luck

After reading your advice, and others, I plan to file a complaint in writing.  They outright just cancelled his treatment.  And after I complained to the social worker, I haven't heard any more about them making him move his days.  I'm still going to file a written complain over the straight up harassment and over the tech sticking him with 102.5 degree fever.  We're still waiting to hear about our ADA application with his HR dept.

Good for you! Stick to your guns! Hope you get the results you both are needing. It doesn't have to be a nasty-gram but be firm and to the point. You won't regret it. 

Thanks!
Agreed, I just want to have my concerns in writing, direct and to the point, but no need to be nasty. 

[AshtonsMuse]

Call  CMS for unless you are being shifted because you are always late they will at least listen  and may make the clinic accomadate she your needs

Thanks for the advice, I didn't know I could call them.  He's very timely, and hasn't missed any sessions unless he's been in the hospital, and then received dialysis there. 

[AshtonsMuse]

Dry weight is not a science and my first 6 months on dialysis were not good.  It took my visit to the doctor with a horrible BP of 75 over 45 that's when my dry weight was adjusted up by 5 kilos.







sp mod Cas

Wow, that's low.  My husband had an 80/49 last week and he was not well.  He's usually too high tho, and that's always a concern. 

[Michael Murphy]

It was low enough the doctor almost panicked they put my butt on a gurney and ran me over to the urgent care center, I go to a medical group that is huge and have their own emergency clinic.

[AshtonsMuse]

It was low enough the doctor almost panicked they put my butt on a gurney and ran me over to the urgent care center, I go to a medical group that is huge and have their own emergency clinic.

That's nice, that everything is close together.  Here they turn to the Emergency Room for everything, and our town is kinda spread out, nothing close together.  Urgent care tells us they can't do anything for him.  His blood pressure is all over the place.  Usually nice and low, 120s/70s.  But when it shoots up, its 230s/110s now.  That makes me nervous.  It's like the highs are higher and the lows are lower.

[GA_DAWG]

Got a call yesterday morning as I was getting ready to leave. "Miss so and so who shares your chair decided to show up late this morning, so your time will be two hours late." Gee thanks. Rule should be you have a designated start time AND a designated off time. If you are late, you lose part of your run time or come on a different shift where there is an opening.

[Michael Murphy]

The clinic I go too has started tell late patients that they will be shifted. To TTS and a later shift.  It is a mater of fairness, in over 4 years I have never been late.   
Although one time the RO water system was down and we. Started a hour and a half late the moron who follows me came in while I was still hooked up and began to abuse me for being late.  Back in the early 70's I worked on a AT&T loading dock and I used to make truck drivers blush.  I called the moron every name in the book.  He complained but was told he had no business coming on the floor and harassing me.

[Simon Dog]

Got a call yesterday morning as I was getting ready to leave. "Miss so and so who shares your chair decided to show up late this morning,

If the clinic staffer actually mentioned so & so's name it was a HIPPA violation.

[SKS]

I think calling Guest Services at DaVita may give some results.  When we were in Florida (where Dialysis Techs are barely trained) and the Fac. Admin was totally inefficient we talked to them several times.  I told them of the infractions and emphasized they would not get a true picture if they simply interacted with the FA.  They needed to send someone in to observe.  The FA is no longer there but since we are snow birds I can't say what has changed at that location.  We are back in Ohio where our specific center is relatively well run and personable.  A simple thing like having packets made up for each patient instead of in FL someone running from chair to chair (24 of them in center) laying down 2 syringes, then next trip gauze, next trip mask, next trip etc etc - total lack of organization and time management. 

[GA_DAWG]

Probably so Simon, but at our clinic we have the same seat each time and you pretty much know who you share a seat with because you see them.

[Simon Dog]

someone running from chair to chair (24 of them in center) laying down 2 syringes, then next trip gauze, next trip mask, next trip etc etc - total lack of organization and time management.

The "Chinese Fire Drill" approach to supply deployment.   Distributing in the manner you suggest may be more time efficient than preparing packets, and a tech making a trip for each packet.

[Riki]

someone running from chair to chair (24 of them in center) laying down 2 syringes, then next trip gauze, next trip mask, next trip etc etc - total lack of organization and time management.

The "Chinese Fire Drill" approach to supply deployment.   Distributing in the manner you suggest may be more time efficient than preparing packets, and a tech making a trip for each packet.

My unit fills a plastic tote bin, one for each patient, with all the supplies needed to set up the machine and put the patient on and off.. it's specific for each patient, like what kind of dialyzer they use, or whether they have a fistula or central line.. they also do up packs with things like needles, saline syringes, gauze, for the on packs.. then for the off packs, they have bandaids and gauze.. the packs are wrapped in the paper that they put under your arm, and the ones for fistulas have a tourniquet tied around it.. if they need anything extra, or anything that's not in the packs, it's in the drawers under the counters at each station.. in those there are bandaids, gauze, saline syringes, betadine and chlorahexadine swabs, bottles of betadine, gelfoam, steristrips and other kinds of dressings, like mepore, mesalt, and tegaderm..

I'm on the evening shift, so I see them setting up for the next day.. after they've cleaned the machine, and I'm usually still holding, they clean off the table, and set the tote and chart for the next patient on the table.. we don't sit in the same chair each time, so this is how they choose who is going to sit where..

the totes and packs are done up ahead of time, usually by volunteers.  They have list on the wall saying what goes in each pack, and I think they have another list for the totes

[AshtonsMuse]

The clinic usually has all the supplies in a bag for each chair at the beginning of the session.  But what's up with gauze and tape approach to everything? Right now, my husband has a chest/tunnel cath and the hospital puts these nice slim semi-waterproof bandages over it, meanwhile Davita only uses gause and tape, and when my husband asked if he could bring his own, they said they weren't allowed to use his - only gauze and tape. 

[Simon Dog]

The clear bandage to which you refer is a Tegaderm, and costs somewhere around $.50 to $1.00, which is an answer to your question.

Fresenius will use Tegaderm but only with an order from your MD.  I don't know what the DaVita policy is.  When I though the tape was irritating my skin, I had no problem getting an order for Tegaderm back when I was on a cath.   I suggest asking your doc if Tegaderm is an option and, if the clinic does not supply it, if (s)he can write an order for the staff to use patient supplied materials.

When I was in for a hip transplant, the dialysis RN got squirrelly when I took my own needles out of my laptop bag (I prefer the scab picker on the JMS needles to the ones on the Medisense the hospital used).   The RN said "our policy does not allow you to use your own supplies".  I said "fine" and continued to canulate.   The issue was never raised in subsequent treatments.

The clinic usually has all the supplies in a bag for each chair at the beginning of the session.  But what's up with gauze and tape approach to everything? Right now, my husband has a chest/tunnel cath and the hospital puts these nice slim semi-waterproof bandages over it, meanwhile Davita only uses gause and tape, and when my husband asked if he could bring his own, they said they weren't allowed to use his - only gauze and tape.

[Riki]

When traveling, I always take my own supplies with me.  I always take bandaid and gelfoam, because I know that a lot don't use them, just gauze and tape, and I have such a strong fistula, that I'd be bleeding forever with it.  I know that the gelfoam isn't cheap either, to a point where I'm not sure that a lot of places use it.  The last time I was in New York, I had gelfoam with me, and I had to show them how to use it.  They'd never seen it before.  They did have the same bandaids I did (sure seals) but they were reserved for people with insurance.

[SKS]

I've been able to order Tegaderm on EBAY at a much better price than pharmacy charges.  Since he's allergic and will end up with blisters from most other dressings we keep some on hand.  VA will prescribe and supply if you  need them due to reaction to other dressings and we then carry them with us.  Neither of the centers we've been  to (DaVita's) questioned us bringing our own.  We simply said - Here is a Tegaderm the tape causes blisters.

[LoneHighway]

Y'all are scaring the hell out of me.

[Michael Murphy]

I use SureSeals which are bandaids with gel foam attached instead of gauge.  I get them on Amazon last price I got was 17.50 for a hundred.  That's 17.5 cents a piece.  But they get me out quicker so I buy my own.

[iolaire]

I use SureSeals which are bandaids with gel foam attached instead of gauge.  I get them on Amazon last price I got was 17.50 for a hundred.  That's 17.5 cents a piece.  But they get me out quicker so I by my own.

Some of the centers I listed traveling used those and I liked them.  I don't bleed a lot and could almost use a bandaid but since i'm so used to a ton of gauze at home its scary to use less, but every time the used those bandaids with gel foam it felt like enough and I didn't need to switch to a bandaid prior to going sightseeing.