Introduction What is dialysis and a brief history. What laws govern dialysis treatments. How to ensure high quality care for patients. How to behave in a professional way. How to become certified.
We don t do Dialysis just to clean the blood We do Dialysis to help patients live as fully as they can.
As a technician, you can have a chance each day to help patients feel their best and this can lead to a rewarding career.
Overview of Dialysis When Kidneys fail, patients need dialysis or a kidney transplant. Renal failure is irreversible. The nephrons (kidney cells) do not regenerate. Dialysis filters wastes and excess water out of the blood. Medications, Diet and fluid limitations are also ordered.
Types of Dialysis HEMODIALYSIS (HD) A vascular access is needed: Aretriovenous Fistula (avf), Areriovenous Graft (avg) or a Central vein catheter (cvc). Through one line the Blood flows out of the patient to a dialyzer (artificial kidney). The blood is cleaned is cleaned in the filter and then goes back into the patient through the other line. A fluid called dialysate is also needed to help carry the extra fluid and waste down the drain. The dialysis machine sets the rate of the blood flow, has safety alarms, mixes and delivers dialysate.
HEMODIALYSIS Types of Hemodialysis: 1. Standard in center Hemodialysis. 3/week about 4hrs 2. Nocturnal in center Hemodialysis. 3/week about 8 hrs 3. Standard home hemodialysis. 3/week or every other day about 4-6 hrs 4. Short daily home hemodialysis. 5 or 6/week about 2.5 4 hrs 5. Nocturnal home hemodialysis. 3 7 nights about 8 hrs
PERITONEAL DIALYSIS (PD) Peritoneal dialysis is a home treatment. Peritoneum tiny blood vessels. Filter to clean the blood. Access is through a catheter placed through the wall of the abdomen. The abdomen gets full of sterile dialysate. Excess fluid and waste flow out of the tiny vessels into the dialysate. After the dialysate dwells for a few hours it is drained out and new dialysate is then placed again. Exchange.
Peritoneal Dialysis After the dialysate dwells for a few hours it is drained out and new dialysate is then placed again. Exchange. Happens 7/week. Can be manual or using a cycler.
Payment for Dialysis and Transplant Before 1973, hospitals had Life and Death committees that chose which patients would receive dialysis. How were they chosen? Age. How mature and educated they were. Whether they could pay for their care. How much they might give back to society if they lived. High costs treatments. Insurance company called dialysis experimental and did not pay for it.
1972 Congress was convinced! 1073 Law 92-603 Medicare End Stage Disease Program. Medicare to patients who have worked enough to qualify for Social Security. Medicare pays 80% of dialysis or transplant. Private health insurances, Medicaid, State programs or the patients pays the rest. End stage renal disease (ESRD) is the only disease with its own Medicare program. Conditions for coverage rules by Medicare. * Dialysis is still very costly today.
Patients that do not have Medicare when they start dialysis have to wait for three full months before they qualify for it. If the patient starts in a home program Medicare starts paying from day 1. Patient with private insurance stay with their insurance as primary for 30 months, Medicare is secondary. After 30 months Medicare becomes primary. Medicare has a fixed rate for dialysis treatments with different tiers that can increase dialysis center revenue.
Quality in Dialysis ESRD Networks: 18 networks nationwide. Promote rehabilitation. Collect and report data about dialysis. Do quallity improvement projects. Handle patient grievances. Help clinics deal with conflicts. Provide resources to staff and patients. Dialysis clinics are required by law to work with the networks.
Guidelines for Dialysis Care Improve outcomes. Renal Physicians Association (RPA) National Kidney Foundation (NKF) Dialysis Outcomes and Practice Patterns study (DOPPS)
ESRD Quality Initiative Dialysis Facility Compare Fistula Firts Breakthrough Initiative ESRD Conditions for Coverage CAHPS In-center Hemodialysis Survey ESRD Clinical Performance Measures Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) Quality Incentive Program (QIP)
Quality Standards for Dialysis State surveyors inspections. (Condition for coverage). Dialysis standards: The Joint commission (TJC) The Association for advancement of Medical Instrumentation (AAMI) The food and drug Administration (FDA) The united states data system (USRDS)
Continuos Quality Improvement in Dialysis (CQI) Clinical anemia, access doses Technical water treatment, dialyzer reuse Organizational staff schedules, patient safety
Dialysis Technician Professionalism More direct contact with patients than other staff members. You should: Know the field and the job. (Expert). High quality work. High ethics. Good work morale and motivation. Respect patients and colleagues. Discuss page 10 from module 1.
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