Dialysis Center as Case Management for all ailments

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    Hi, I've been working in at 24 chair Fresenius dialysis center for a couple of months now. One of the things that puzzles me is all of the stuff that we do that seems to have nothing to do with dialysis. I'm not sure why we do it. We are supposed to make most of if not all of their appointments with all of their doctors. They need their toenails cut, we call the podiatrist. I am supposed to dx their rashes? Oversee their constipation issues? What does this have to do with dialysis? Why doesn't it go through their family doctor? This is outpatient, not inpatient. Is this typical for outpatient dialysis? Just curious. Thanks.
    Joe V likes this.
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  3. 4 Comments so far...

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    This sounds familiar to me. The reasoning I was given was that the nurses should do this because patients fail to follow through with making appointments and we want to provide quality or ultracare. It makes sense for the dialysis company to "case manage" the patients non dialysis medical problems to try to avoid patient hospitalization rates. Patients who are ill or hospitalized, dont come in for their dialysis treatments and this will effect their profit margin. The nurses perform foot checks monthly, and when a patient gets a foot check elsewhere, we have to track it and provide documentation from that provider. Otherwise, the quality status reports will show foot checks that were not performed.

    When I think about it, patients are not just kidneys, and every system in their body will contribute to their overall health. A patient with an infection, will eperience low blood pressures, fever, and feel terribly during a dialysis treatment. I certainly understand the need for case management and treating the whole patient. I just wish they would staff for all the xtras they expect the nurses to do.
    nursetaminator likes this.
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    however with the bundle I think some of this will end.
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    I used to joke that the next thing we would be doing would be brushing their teeth for them.


    A lot of what we're seeing are the results of State regulations. You want CMS $$? Prove that you're doing x,y and z, with x,y, and z to be determined by the State.

    Not all of it is "bad", and does provide better patient outcomes for a patient population that isn't exactly known for self-care (like taking their rx's to the pharmacy, or making and keeping appropriate MD appt.s) in the first place.

    The multidisciplinary care plans are a bugger. They are now essentially MDS care-plans you find in nursing homes, and yes, it is designed to manage the entire patient.

    Problem is, is that in NH's there are designated MDS/Care Plan Coordinators that do nothing all day but track and ensure they are completed.

    Conversely in dialysis, the dialysis RN's are doing these. Unfortunately along with the trend of decreased RN staffing levels this adds even more burden to manage treatments. Da Vita and FMS have done away with post-tx patient assessments by the RN as there is simply no time. I find this appalling.
    jlynn2303 likes this.
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    Do all dialysis centers do this? I get that patients aren't just kidneys, I am just trying to figure out why it is the dialysis center and not, say, the primary care provider that manages it.The money part makes sense. But they don't staff for it.

    Yesterday this guy waited half an hour for us to call his doctor for him and ask a question. He was perfectly capable of calling the doctor and asking the question himself.

    I guess they see the dialysis staff more often and so we are the default! I spent twenty minutes yesterday with a guy whose foot occasionally itches. Not diabetic, no redness, no heat, no swelling. no dry skin. I asked him if he had thought of putting lotion on it. He also had a pimple on his head. He did say he was going to the doctor and would tell him. I wish I had twenty minutes. Or a woman who had felt sick to her stomach since the night before. Why didn't she take pepto bismol the night before? She said she was sick because of the laxative she took the night before. It does that to her. Ok, so what am I supposed to do about it? I don't have antinausea medicine to give her.

    Overall, I like it so far. My frustrations are primarily standard nursing frustrations - waaay too much paperwork, short staffed (although not nearly as short staffed as other places I have been, that's for sure.)

    You aren't kidding about the care plans. I am doing my first one now. My charge nurse informs me that they take a lot of time and no one really looks at them, but the government requires them - to be filled out by hand. We're not talking the computerized stuff, orders, etc what I am actually doing. I am sure I will see plenty more!


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