POLICIES

A Community Based Facility Accepting Patients From Dialysis Centres

Across The Greater Toronto Area

 

POLICIES

 

GENERAL INFORMATION FOR PATIENTS AT

THE SELF CARE DIALYSIS UNITS

 

CLINICAL COORDINATOR - SUSSEX CENTRE SELF CARE DIALYSIS UNITS: Lydia Davis

 

CLINICAL COORDINATOR - SHEPPARD CENTRE SELF CARE DIALYSIS UNITS: Lee-Anne Hyer

 

 

DEFINITION OF LEVELS OF CARE:

 

• S.C. (Self Care)

Patient carries out total treatment without help. This includes cannulation.

 

• A.S.C. (Assisted Self Care)

Patient carries out the skills of dialysis without help, but needs assistance with some aspect of the treatment, such as cannulation.

 

• T. (Teaching)

Patient is actively being taught the skills needed to carry out the dialysis treatment

 

 

ENVIRONMENT:

 

The unit is smoke free. A colour TV, phone and a shared DVD are available at each dialysis station. Earphones must be worn, and initially, will be provided for each patient's use. Thereafter, if they are lost or broken, it is the patient's responsibility to provide them.

 

Nourishment and meals are not provided at the self-care unit. Patients are welcome to bring food with them. Coffee and tea are available. A refrigerator, coffee maker, toaster, and microwave are available. The staff will gladly heat up meals, if the patient is on dialysis. It is expected that everyone should clean up after himself or herself.

 

The patient and/or partner are responsible for the setting up, and tidying up their station. All staff and patients will practice "Body Substance Precautions"(B.S.P.)

 

Patient's visitors are welcome, but at times may be restricted at the discretion of the staff. An adult, other than the patient, must accompany children.

 

  

 

DIALYSIS FOR VISITORS:

 

Arrangements may be made for patients from Canada only visiting Toronto to have dialysis at the Self Care Units.  Advance notice of 30 days is requested. Patients must meet our admission criteria.

 

  

MEDICAL CARE:

 

1. Patients are selected to perform their own dialysis based on willingness to learn and meeting specific medical standards. As no physicians are on site, these standards are to be strictly adhered to, to ensure quality patient care and patient satisfaction in this out of hospital setting.

 

2. Transfer to the self-care unit is for dialysis treatment only. The hospital currently responsible for the patient will continue to provide physician coverage, backup dialysis, social work, and dietary support.

 

3. Patients will have a clinic assessment every two months, unless otherwise ordered by the physician. A nurse from the self-care unit will attend these clinics. The assessment will include a physical examination, blood work review, new prescriptions and pharmacy refills. It is mandatory that all patients attend their scheduled clinic appointments.

 

4. All services i.e. dietary, social work, psychiatric, physiotherapy, and pharmacy support will continue to be provided by the home hospital.

 

5. The only drugs supplied by the self care unit are drugs that are used for or on dialysis .The following drugs may be prescribed and given into the lines during dialysis: Heparin, erythropoietin, cathflo, antibiotics, Venofer and Calcijex. Emergency oral medications such as Tylenol, Gravol, sugar tablets, chewable A.S.A., and Benadryl are stocked on site.

 

6. If a blood transfusion is required, the cross match and transfusion will be done at the home hospital.

 

7. The self care unit will work in conjunction with the hospital transplant coordinator to facilitate the patient's transplant needs.

 

8. If on any occasion, a patient is deemed incapable, or medically unstable to carry out his treatment in a safe and competent manner, they will be referred back to the home hospital for dialysis. Return to the self-care unit will be at the discretion of the physician, and the unit nurses.

 

9. A physician's order is required, if a patient is going to omit a treatment for any reason. 

 

10. If an urgent medical problem occurs at home, patients must contact their Nephrologist, or present themselves at the Emergency Department of the closest or home hospital.

 

11. If an emergency occurs at the self care unit, 911 will be called, and the home hospital and physician will be notified.

 

12. If the patient has been dialyzed in hospital, a letter of transfer, and pertinent medical information is required prior to transfer back to self care.

 

 

NURSING CARE:

 

1. A comprehensive self care package has been developed, and will be given to the patient and/or partner during training.

 

2. The teaching program will be individualized to the patient's and/or partner's needs, abilities, and learning styles.

 

3. All dialysis procedures will be taught, including cannulation.

 

4. A primary nurse will be assigned, and will be responsible for development of the teaching program, documentation, and communication of this information.

 

5. Together, the nurse and patient will decide, when specific tasks may be carried out, without direct supervision.

 

6. The primary nurse will monitor the progress of the patient, and communicate with the home hospital, as needed.

 

7. The primary nurse will also carry out periodic reviews of procedures to assess, and assist each patient to maintain or improve their level of competence. These reviews will be done yearly, and documented.

 

8.  All patients must be assessed by a nurse before the patient can proceed with dialysis.

 

9. On a monthly basis, a nurse will review with each patient, the monthly blood results.

 

 

 

SCHEDULE CHANGES:

 

To change the time or day of a patient’s spot permanently, the patient informs the Clinical Coordinator, and his/her name and request will be dated and placed on a list. When a spot becomes available, the first person on the list will be given the opportunity to change.

 

For a temporary change in shift, or time for a specific date(s), the patient informs the Clinical Coordinator, and this will be noted in the request book. It is the patient's responsibility to check, and see if the schedule has been changed.

 

 

TECHNICAL:

 

There will be renal technologists on site to maintain and repair the water treatment system, dialysis related equipment, and other equipment.

 

Upon the request of the nurses, the technologists may teach the technical aspects of dialysis.

 

 

 

PATIENT'S RESPONSIBILITIES:

 

1. Patients are expected to be an active participant in the learning process.

 

2. If feeling unwell, this should be reported to the nurses at the self-care unit, and if necessary, to the Nephrologist.

 

3. If after hours and medical care is required, the patient should report to the closest emergency department, or to the home hospital.

 

4. If unable to dialyze at the self-care unit, due to illness, please inform the unit as soon as possible, via telephone.

 

5. Before returning to the self-care unit ensure medical information has been sent. It would be a good idea to bring a photocopy of your discharge letter to your first dialysis.

 

6. Patients shall arrive on time for their scheduled appointments. 48 hours notice is necessary for any requested change in your schedule, however, one week notice would be appreciated.

 

7. Patients are to make the self-care unit aware of any hospital admissions or changes of medications by other doctors.