Level of Care

[dig'n_dialysis]

Hey Everyone,

I'm new to the website, but old to dialysis. Briefly, been working in dialysis for 11 years now in the same unit. A "sattelite" unit in Canada. Sattelite unit being a smaller branch, in our local hospital, of a larger centre about an hour away. Our town is approx. 13,000 people also servicing 4 nearby Aboriginal communities. With the overwhelming prevalence of renal failure secondary to diabetes in the Aboriginal population, the majority of our clientele are Aboriginal. First off, I think this forum for discussion is GREAT! It's realy nice to hear from people with a commen thread, so to speak. Our unit is 9 stations with only 7 opened at this time. Not d/t a lack of patients needing dialysis, but a lack of funding to open the last 2 stations. For those of you unfamiliar, the Canadian system is entirly government funded, and therefore, we constantly hear "There's no money". Our "parent" facility is way over crowded but can't send our own patients from our own community back to dialyze with us, because our funding is provided by our Regional Health Authority (RHA). (If you aren't confused yet, It's a trickle bown branch of the Provincial Government, the "parent" unit is overseen by the Federal Government). I hope I'm not boring you all, but our system, as you can see, comes with it's own set of frustrations!Free healthcare is great, except it's not really free becaused we are taxed to death to have it and we don't have alot of control over it's use! But I digress. My actual question for all of you is: Does anyone have a system in place to assess a units staffing needs based on the individual Level of Care of their patients? That is, a Level 1pt. being a more independent- walk into the unit and do their own weights,bp,temp,etc. and a Level 4 pt. - mechanical lift, totally dependent, non-responsive, lots of missing limbs and dressing changes. We are in the process of revamping our staffing guidelines to put all units at par with each other, so that no one unit is staffed better than the other. The only other dialysis unit in our RHA has the same # of patients but are a Level 1 type while ours are a mix of Level1 -4 and the majority are 4. The staffing is presently based solely on # of pts. Presently, we don't level pts. according to level of care, therefore I'm looking for somewhere that does for some brilliant guidence! Hope I haven't rambled too much, but I am frustrated!!

[gwenith, BSN, RN]

Ahh! So Canada operates on TINM as well!!! That stands for

"There IS no money!"

or put another way

"There is NO money!"

oe even

"There is no MONEY!!!"

As you can see we in Australia are familiar with it too. We have several "patient nurse dependency" programs and systems but probably thoe one in widest use here in QLD is "Trendcare".

Developed locally I do not know whether it would help but here is the website.

http://www.trendcare.com.au/

[Hellllllo Nurse, BSN, RN]

The U.S. system operates on plenty of money- just as long as none of it goes for pt care, supplies, or nursing staff. It goes into the pockets of corporate execs and share-holders.

[jnette, ASN, EMT-I]

Interesting post, Dig'n...

As far as I know, we don't do any type of "level of care" here at all. Our staff is not ratioed by level of care.. merely the #of patients. That's an interesting concept, however. And I also doubt that the upper mgt. would even give it one moment's consideration.

We have quite a few who have great difficulty tranferring from wheelchair to dialysis chair, and several who come in on stretchers by ambulance, and also some with recent amputaions, etc. But this has never been taken into consideration as far as staffing. Something I might bring up... just to see the reaction.

We do NOT do dressing changes (on amputees) however.. these are performed by the pt's. home health nurse. We don't even carry supplies for ANYTHING except dialysis related procedures.

Hope you get some feedback, and WELCOME TO THE BB !!!