I sent a patient to the dialysis unit in a w/c. He sits in the chair and gets dialysis. Four hours later I get him. "He's sitting in feces". Me: Let's clean him up then. Dialysis Nurse: "We don't clean them up in here, there are other patients getting dialysis, it's a sterile procedure.". Me: "So if he pooped 4 hours ago, he is to sit in it for four hours?". Dialysis Nurse: (with attitude) "You don't understand".
I'm willing to admit I don't understand.
What's the scoop? Dialysis patients who are incontinent don't get cleaned up????
For those units who are fortunate enough to have adequate staffing, that is wonderful. Most, however simply are waaaaaaaaaaaay understaffed. And the families knew that and respected that. :)
I am talking an inpatient unit, with ratios of 1:2 during dialysis. Obviously the patients are sick with other issues not related to dialysis so the ratios need to be low. It's not a staffing problem, and it's not a supply problem. They can have all the hospital supplies they desire as they are connected to the renal med-surg unit. It's not a privacy problem, as their are curtains.
I'm glad I got some validation, but I'm still having a hard time with a nurse knowing a patient was sitting in feces for four hours. Sorry, I know it's because I'm not a dialysis nurse and as was rudely told me, I don't understand. I understand better but can't grasp it. I totally understand the outpatient thing though.
Thanks guys for helping clear my head. I knew I came to the right place. Woot!
Yes I know it sounds bad, but it's the less of two evils - cleaning up one patient at the peril of the other patients who need vigilant attention.
We truly do not have the staff to deal with situations like this. If someone steps off the floor to clean up the patient, another patient might have another problem (uncontrolled bleeding, dialysis machine stopped with no one to trouble shoot and getting it going again, patient crashing, etc., etc.)
What we try to do if this happens is call someone to bring the patient some clean clothes (family member, nursing home), take them off treatment long enough to get changed, then put them back on. If the patient is one who usually has this problem we ask the facility to put them in a Depends.
But in all honesty, the one thing we dread hearing a patient say is "I gotta go to the bathroom." I just CRINGE when I hear it. It's not so bad if they are ambulatory, but if they need assistance it can turn into a clown car in a very short time. Sometimes their tubing clots and we have to change it out and start all over again. Another time a patient accidentally pulled out her needles while she was in the bathroom and the entire floor and most of the walls were covered with blood - a major mess to have to deal with especially when it's getting close to turn-around time, not to mention infection control issues, volume loss for the patient, etc.
I know it sounds cruel to let them sit in soiled clothes, but the consequences of leaving other patients unattended are far worse.
Yes I know it sounds bad, but it's the less of two evils - cleaning up one patient at the peril of the other patients who need vigilant attention.
We truly do not have the staff to deal with situations like this. If someone steps off the floor to clean up the patient, another patient might have another problem (uncontrolled bleeding, dialysis machine stopped with no one to trouble shoot and getting it going again, patient crashing, etc., etc.)
What we try to do if this happens is call someone to bring the patient some clean clothes (family member, nursing home), take them off treatment long enough to get changed, then put them back on. If the patient is one who usually has this problem we ask the facility to put them in a Depends.
But in all honesty, the one thing we dread hearing a patient say is "I gotta go to the bathroom." I just CRINGE when I hear it. It's not so bad if they are ambulatory, but if they need assistance it can turn into a clown car in a very short time. Sometimes their tubing clots and we have to change it out and start all over again. Another time a patient accidentally pulled out her needles while she was in the bathroom and the entire floor and most of the walls were covered with blood - a major mess to have to deal with especially when it's getting close to turn-around time, not to mention infection control issues, volume loss for the patient, etc.
I know it sounds cruel to let them sit in soiled clothes, but the consequences of leaving other patients unattended are far worse.
At a Davita unit I worked at it was against policy to take a patient off to go to the bathroom. Many times the urge to go is related to the fight or flight response to hypotension. That's all we need is for a patient to sit bolt upright saying I have to go to the bathroom, take them off quickly, adding 300 cc of NS to an already overloaded patient and then have them fall in the bathroom.
We had to offer them the bedpan. And that's no more pleasant for the patient sitting next to them either.
I believe the OP was referring to an inpatient unit and as I suggested earlier she should tell the dialysis nurse "If you need me to take care of my patient please call me and I will come right over". That is why there was probally only one nurse for two patients. And yes a patient could go bad whilst she was holding sites but usually we can use clamps for the site..When I was staff we had to go to the inpatient area and give two tylenol or do our finger sticks etc. Luckily, we could get blood from the lines and didn't have to poke the patient though.
HD patients are immunocomprimised and changing depends, wound care etc is an infection control issue.
Communication is the key here. Work with the dialysis nurse but also realize where she is coming from.
Thanks for asking Tweety. I agree that patients shouldn't be in this condition but a nurse has to set priorities and follow protocols.
I understand the risks with leaving your patients. I understand infection control issues. I am not at all critizing the RNs that work in hemo.
I send Pts to hemo all the time. I've never had them come back sitting in excrement. Must be my facility (hospital). But you would think that there is something that could be done. Afterall, this is a basic bodily function. One would think that the facilities would take this into consideration when staffing. What about bedside commodes? Then they wouldn't have to walk to the BR. If I were a patient and they said, "I'm sorry you are going to have to wait until the end of your session, and that's in 3 hrs":eek:, I would not be able to "hold it". How mortifying for the patients. :imbar You would think that being such a basic need and a common issue with the patient population that uses these services it would be considered in policy, staffing and unit design.
I understand the risks with leaving your patients. I understand infection control issues. I am not at all critizing the RNs that work in hemo.
I send Pts to hemo all the time. I've never had them come back sitting in excrement. Must be my facility (hospital). But you would think that there is something that could be done. Afterall, this is a basic bodily function. One would think that the facilities would take this into consideration when staffing. What about bedside commodes? Then they wouldn't have to walk to the BR. If I were a patient and they said, "I'm sorry you are going to have to wait until the end of your session, and that's in 3 hrs":eek:, I would not be able to "hold it". How mortifying for the patients. :imbar You would think that being such a basic need and a common issue with the patient population that uses these services it would be considered in policy, staffing and unit design.
~Jen
ESRD is the only chronic illness totally funded by Medicare. There isn't much left over.
Where would we store a bedside commode. We have no housekeeping. We use outside contractors to clean the unit. We don't have rooms. We don't have curtains. And just standing and pivoting could cause a patient to pass out and fall. With only one nurse available that is dangerous for both patients.
The thing to do is to let the dialysis nurse know how to reach the primary nurse and tell her you will come by immediately to take care of the situation.
Many of these patients are Bilateral AKA's . In the unit I work in now one gentleman has no legs what so ever. I can't get him on a bedside comode alone or with help probably.
Many patients come to dialysis on stretchers. Some haven't stood for years. If this patient had come to dialysis in a w/c I would have transferred him into a bed. If I were his primary nurse I would have insisted he be transferred into a bed and that way he could have been cleaned up quite easily. Most of the time patients do not sit bolt upright through 4 hours of a HD treatment. They are either in a bed or in a lounge chair. If he was sick enough to be in the hospital, in this day and age, he should never have be required to sit in w/c for 4 hours.
Tweety, now that you understand the dyanmics of the situation I know you will fix it for the next time.
ESRD is the only chronic illness totally funded by Medicare. There isn't much left over.
Where would we store a bedside commode. We have no housekeeping. We use outside contractors to clean the unit. We don't have rooms. We don't have curtains. And just standing and pivoting could cause a patient to pass out and fall. With only one nurse available that is dangerous for both patients.
The thing to do is to let the dialysis nurse know how to reach the primary nurse and tell her you will come by immediately to take care of the situation.
Many of these patients are Bilateral AKA's . In the unit I work in now one gentleman has no legs what so ever. I can't get him on a bedside comode alone or with help probably.
Many patients come to dialysis on stretchers. Some haven't stood for years. If this patient had come to dialysis in a w/c I would have transferred him into a bed. If I were his primary nurse I would have insisted he be transferred into a bed and that way he could have been cleaned up quite easily. Most of the time patients do not sit bolt upright through 4 hours of a HD treatment. They are either in a bed or in a lounge chair. If he was sick enough to be in the hospital, in this day and age, he should never have be required to sit in w/c for 4 hours.
That's why I said things like this should be considered in the policy, staffing and design of the hemo places. I understand that it's not possible the way things are now and even if things were diferent not for all Pt's. I guess that it was just wishful thinking, like wishing that we all had everything and all the people we need to do everything the way it should be done. If I ony had a magic wand. . .
I work in a hospital based dialysis unit. There is not a day that goes by that I don't clean up stool. I can appreciate how difficult it is for patients to be changed when they are sitting in a recliner, but our patients are usually in beds (making clean up much easier).
I have to ask, as no one has said anything about it yet;
Would it not be possible to have a couple of NA available to provide the basic comforts to HD patients? I strikes me as a bit odd that units that will pay big bucks to decorate a clinic wouldn't spend a dime on the feeding, cleaning and comfort of these people who are knitted to a machine for 4-6 hours. Just strikes me as inhumaine.
Who gets them a glass of juice if they ask? Or are they NPO for the duration? Who cleans up the juice if it gets spilled?
It is just a bit hard to understand that their basic needs are not being met while they are on dialysis.
Tweety, I understand your aggravation at this situation.
I hope that those of you who do work HD can provide a bit of insight here.
. If I were his primary nurse I would have insisted he be transferred into a bed and that way he could have been cleaned up quite easily. Most of the time patients do not sit bolt upright through 4 hours of a HD treatment. They are either in a bed or in a lounge chair. If he was sick enough to be in the hospital, in this day and age, he should never have be required to sit in w/c for 4 hours.
Tweety, now that you understand the dyanmics of the situation I know you will fix it for the next time.
I am talking about an in-patient unit. There were two RNs there when I picked up the patient, with two patients there.
I never send a bed-ridden patient to dialysis in a wheelchair.
The nurse did indeed know how to get ahold of me as he called to have the med sheets faxed to him. I didn't know the patient was incontinent of bowel, he had only been there two days and hadn't pooped yet. Perhaps if he was in the bed the HD nurse might have called. Also, why couldn't he let me clean the patient up while I was getting him the chair. The cross-contimination doesn't fly with me here. The HD was over, all he had to do was steady the patient while I did the cleaning.
I'm starting to wonder if the HD guy just didn't tell the man to "hold it, or just go in the bed".
While I'm understanding the dynamics a bit better, I'm still having trouble. Guess it's the floor nurse in me. I have let go of my harsh judgement and understand better.
I have to ask, as no one has said anything about it yet;
Would it not be possible to have a couple of NA available to provide the basic comforts to HD patients?
Tweety, I understand your aggravation at this situation.
I hope that those of you who do work HD can provide a bit of insight here.
Staffing and patient comfort isn't a priority in some facilities in the USA. Sad but true. Dialysis is a guaranteed right of Americans, but doesn't mean it's funded well.
.thumb.gif.fc0b5b00a77a1cf676541776e02de0f9.gif){kind=avatar}
Tweety, BSN, RN
36,337 Posts
I am talking an inpatient unit, with ratios of 1:2 during dialysis. Obviously the patients are sick with other issues not related to dialysis so the ratios need to be low. It's not a staffing problem, and it's not a supply problem. They can have all the hospital supplies they desire as they are connected to the renal med-surg unit. It's not a privacy problem, as their are curtains.
I'm glad I got some validation, but I'm still having a hard time with a nurse knowing a patient was sitting in feces for four hours. Sorry, I know it's because I'm not a dialysis nurse and as was rudely told me, I don't understand. I understand better but can't grasp it. I totally understand the outpatient thing though.
Thanks guys for helping clear my head. I knew I came to the right place. Woot!