Bonus criteria

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Specializes in Dialysis.

Any Davitians out there, what do you think of the bonus system, as far as having your goals set for you and then having to meet the required numbers to get it?

I love bonuses! Don't get me wrong. I think it's great that they compensate everyone in the company for hard work. But what about when the goals are out of your control? What about, let's say phosphorus levels? I don't go home with my patients, I don't know what they're doing at home, (although I can tell when it's not good!) How can you base my clinic's bonus on something as out of my control as clinic-wide phosphorus? Then the clinic down the street has a goal of "teammate retention", or "OT hours". Dang, I think there is a big difference in those 2 categories! We can, as a clinic, definitely control the OT hours(there are none right now), and just make sure no one quits! Chronically high phosphorus levels from from the chronically noncompliant, that's another story.

Our goal this half was catheter reduction to __%. We were, at one point, dealing with 22 CVCs b/t all of our shifts. 22! We had an influx of new patients around March. Now, glad to say, we are down to 9. Some transfers, a death, or change in modalities, but mostly we worked our butts off to get rid of the CVCs and get the AVF/AVGs going in these ppl. I can't wait for the payoff. (the check should be over a grand!)

So, what are your goals in your clinic? Do the other companies do this as well?

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Specializes in med-surg, dialysis.

I like the bonuses as well, but as you said, you can only do so much about phosphorus. Educate, encourage, & educate some more. In the end, though, it comes down to the patient. As for teammate retention, there are some people who come through dialysis that need to quit so the clinic can hire someone else. If someone does leave, if they can stay on a prn status, then it won't show up as a TM loss.

The CVC's are a real challenge. We have some patients that just do not have much to work with for fistulas, but they get these little fistulas that either take forever to mature or never do at all. And Davita has a goal for decreased AVG's and a higher percentage of AVF's. You can't control what the surgeon decides to do. I really love those messages about "are you working with your surgeons to help increase AVF rates ?" I'm sure the surgeon would love for us to call him/her & tell them what we think is the best option for the patient (or really the clinic).

By the way, do you have any patients with the new HEro access? We have one that has been sent for a consultation about one, but I haven't actually seen one yet>

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Specializes in Dialysis.

No, i haven't even heard of this; what is it?

Yes, our surgeons would LOVE to get our opinions before placing accesses. NOT. Although sometimes I wish they would take some outside input before revising. We DO know what goes on with these accesses.

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Specializes in med-surg, dialysis.

The HEro access is supposed to be part catheter and part graft and is used for patients with catheter accesses d/t all other sites for AVG/AVFs being exhausted. It goes in the arm, but that is all I know about it right now. There is some info on Davita's website. There is only one surgeon in our region that does them, he is at UNC-Chapel Hill Hospital. The transplant clinic is handling the referrals right now. I will see if I can find some info for you.

I also just love it when we send a patient for a fistulogram because of poor flows, excessive post-tx bleeding, etc. and they say the access is patent and no problems found. Then the patient gets mad because they think we sent them for nothing. And of course, the problems continue until you have to send them again before the problem is actually found. It makes us look bad like we don't know what we're talking about.

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Specializes in Dialysis (acute & chronic).
No, i haven't even heard of this; what is it?

Yes, our surgeons would LOVE to get our opinions before placing accesses. NOT. Although sometimes I wish they would take some outside input before revising. We DO know what goes on with these accesses.

Your surgeons need to be educated "by the nephrologist" regarding Fistula First!

All of my patients must have a consult for a permanent access within 1 week of being admitted to the clinic. Our unit and vascular surgeons have a good relationship and they all know that a fistula is to be placed.

Out of 100+ patients, I currently have 9 catheters and only 3 of them, that is their only access. The others have maturing fistulas. the other 3 patients "refuse" to have a permanent access placed. One is well over 90 years old and I can't really blame them and the other 2 we are "still educating"!!!

As far as bonuses - some of those are "out of your control". How about having each month a different "education" month. Such as phosphorus month! Get everyone involved on educating about phosphorus control - we have posters, games, and the dietitian is involved.

Good Luck!

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Specializes in med-surg, dialysis.

We do phosphorus education every month. Usually it is pretty effective, but the last 2 months our PO4s have really been terrible. We show the patients their lab results, talk, talk, talk about binders, diet, types of binders, etc. Then when we do redraws, some of them come back even worse than they were the first time. Our dietician works with them, the SW helps with assistance for meds if they qualify, PCTs and nurses educate, and for some unidentifiable reason, the PO4s are not improving. Any ideas?

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I set the goals for my clinic. We always make the goals, but I always get input from the team to get their ideas. I take my "Snapshot" out to the floor each month so we all know what is going on. They all know what it is and how to read every page. As far as the phos. goes, we have contests for the patients. We get donated goodies, and the best labs get to draw for prizes. We do a lab Auction. The lab values get a point value, and they earn fake money and can buy things at the auction. This works pretty well for us. As far as the AVF's go, start with the Neph. Any time we get a new patient, we always ask if they have a fistula in place. If they don't, we then say, "if you've been seeing the patient, why not". Now the Doc's are so used to the questions, we have almost trained them all to have it in place before they walk in the door.

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Specializes in dialysis (mostly) some L&D, Rehab/LTC.

Try working for drs. that don't give a damn!

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