Renal Unit

Daliadreamer · Mar 16, 2011

I currently work on a hem/onc and renal floor. When a patient goes for HD, the dialysis RN calls and lets us know that they are preparing the machines for the particular patient and asks if the patient can be ready at such and such a time. They even ask if there have been any changes in the patient's condition since the last HD day. Then, if there are no complications during HD, we get a small report from the RN, usually just how much fluid was taken off of them. If there were any issues during HD those are reported as well.

It seems odd to me that you don't even know when the patients are leaving your unit? I could see that being a major issue. They should also be giving you report. Ultimately you, or the other RN's on your unit, are responsible for that patient before during and after HD, and should know what is going on.

merlee · Mar 16, 2011

It should require a brief report, but each facility has its own policies.

How tolerated, whether any prn meds were used, last BP, total weight loss, and how the site is.

ckh23, BSN, RN · Mar 16, 2011

There should be a brief report. I would definitely want to know how much they took off, how the patient tolerated it, if they were able to have HD for the required time, and current vitals.

Sun0408, ASN, RN · Mar 16, 2011

I just left a renal floor. We had a schedule each day of when the pts are going. We do not give BP meds or ABX prior to HD. We also gave the hemo RN a brief report, last vitals, finger stick, labs to draw if they are first run, abx that need to run the last hour of hemo, etc.. We always got a report post hemo. That report included finger stick, last vitals, how much fluid was removed, prn pain meds given, if the MD rounded while the pt was with them,etc.. We also have a flow sheet that states their vitals every hour,etc while they are in hemo..

I would talk to your NM and come up with a hand off.

annister · Mar 16, 2011

We have a lot of HDY and PDY patients. We don't get much more of a warning than "we're on our way down the hall" when they take pts. to ADU. We recently started using an SBAR sheet and the ADU nurse fills it out and faxes it to us when HDY is complete. Problem is, these sheets get selectively filled out and depending on who does it, half may be left blank. Also, it seems that they fax the SBAR and transport the pt. simultaneously (and sometimes just dump them in the room without warning.

I hate our current system, but I would be very worried about a situation with NO post HDY communication. I have seen, more than once, pts. return from dialysis in much poorer condition than they left in. It's so hard on many pts. bodies, and some people are just "worn out" after treatment, but communication between nurses helps me figure out if a pt. is just "worn out", or something is seriously wrong.

I honestly think it should require a bedside handoff. I hope this helps.

Midwest4me · Mar 16, 2011

You are responsible for the patient while he/she is under your care on your floor. The Hd(hemodialysis) nurse is responsible for the pt while on Hd. I only worked chronic Hd for 5 years so not the acute hospital setting but I would think that Hd nurse should be giving you a report following the pt's tx! Better team communication needs to be in effect. I'd contact your supervisor and the Hd's nurse supervisor and see what can be done to accomplish that.

Been there,done that, ASN, RN · Mar 19, 2011

Thank you all, new situation, I realize there are MANY flaws in their system. Most seem basic to me.

Especially communication. My hemo patients and I appreciate your insight.:heartbeat