6% "take off" rule - page 2

I work in a for-profit dialysis as an advanced practice RN. I am NOT employed by the unit, rather the MD's that staff it. I must preface this with the fact that I have only been in this position since July. I am very concerned... Read More

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    Delana - How do your doctors bill? I (along with three other NPs) do the Medicare-required three visits per month and then the MD does his one visit. Medicare requires these visits and that they be when pt is on HD.

    Don't all nephrologists have APRN's who do this? We are in an 11 MD practice and have 9 units that three of us cover. I have approx 200 pts in two units that I "round" on and care for.

    We are pretty accessible for the nurses too.

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  2. 0
    I've been away from the clinic for a while and will start in an inpatient/acute hospital unit next week. I'm pretty sure that our local clinics are still only covered by the nephrologists themselves (5 of them) - each is the medical director of one clinic. They do their own visits, and yes, round about once a week.

    For some reason, they just haven't (yet?) hired any ARNPs. Too bad, as a nurse I much prefer dealing with a nurse practitioner rather than the often grumpy on-call nephrologist

    One can always hope for the future, though.

    Last edit by DeLana_RN on Nov 20, '06
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    Our unit rule is 1kg per hour maximum and isolated UF (eg. 1000ml in 30 min) if they are really overloaded! 6% sounds about right though.
    rogue_maverick likes this.
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    Thanks Farkinott - nice to know that is what is done internationally too.
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    Quote from Farkinott
    Our unit rule is 1kg per hour maximum and isolated UF (eg. 1000ml in 30 min) if they are really overloaded! 6% sounds about right though.
    May I revive this old thread. I'm making a little search as I've come across a this "body weight percentage" as I was reviewing our protocols.

    Same goes here. We follow a maximum UF rate of 1L per hour, and when sequential UF is necessary it would be for 1L for 30 mins.

    However based on recent articles (with links found on another thread) we are considering shifting to the 13mL/Kg/hr guidleline.
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    +1 on the 13mL/kg/hour rule.

    We have noticed a significant drop in intradialytic mortality rate when started following it.

    Only 2 instances of a code in the past year in our chronic unit. Well it may be too premature too say, but having only 2 in a year as compared to what used to be an average of 5 is a good thing.
    rogue_maverick and traumaRUs like this.
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    In my unit we had guidelines, no more than 1L per hour, but this was not always followed. Those of us that knew the patients knew what they could handle taking off. Sometimes much less than the 1L per hour, occasionally a little bit more. Sequential allowed us to take more off. We also had people come in for extra treatments. If symptomatic we would decrease the goal. Our issue was the chronic noncompliance and a lot of patients who did not follow fluid guidelines at all and then knew they could come in for extra treatments whenever they felt like it. And guess who stays late to do it? Me. It was maddening to have patients come in with 2liter of Dr Pepper and drink the whole thing during treatment. The patient was diabetic and came in for extra treatments every week. I was not allowed to enforce the no drinking or eating policy in my facility because it decreased our customer service scores. So there the patients sit eating their KFC value meal and drinking more fluid than we could take off......and guess whose fault it is that they cant get to their dry weight, ours of course.

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