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????
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).
Hindsight is 20/20. I don't care if they are a walk-talkie, from now on they are going in a bed. The aggravation of myself and the embarrassment of this person is not worth it the time and muscle power saved. :)
Tell me about. I'm experience a staffing cut back where I work, at the same time they are telling us to provide customer service "Disney style". But that's another topic.
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
Most CHRONIC units barely have enough room for staff to care for pts. There is no way a bedside commode would fit. Also, blood lines are not long enough for a pt to move much at all. A pt would still have to have their blood returned, and extra saline added to an already over-loaded pt, and miss that amount of treatment time. Trying to have a pt transfer to a bedside commode would create a high risk of dislodge of needles and significant blood loss.
Dialysis is an invasive procedure, in which approx 15% of a pt's total blood volume is outside of the body, being moved very fast. Exsanguination can occur in approx 3 mins. VS are frequently unstable during tx.
Pt's who are able to go to the bathroom can have their blood returned, be taken off of tx, and go to the bathroom up to 2 times per tx, per policy in most chronic units. After that, they must be taken off of their machine, and tx discontinued. Of course, by the time some pts' VS are stable enough to them to be able to amb to the bathroom, it can be too late.
Most pts are able to do just fine without bathroom breaks. W/ bedridden or Hoyer lift pts, unfortunately, bathroom breaks are not feasable. Fortunately, it's very infrequently, in my experience, that a pt has had to sit in excrement.
Just as when you are performing CPR, you may hear ribs break. You can't stop CPR to address the ribs.
In many situations, this comparison can be applied to HDTX and bathroom issues.
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.
We are taking fluid OFF not putting in on. Many units have a policy ( a very lax one at that) of not eating during HD treatments.
Reasons not to eat on HD:
# 1. A patient can drop their b/p VERY quickly on HD. They don't even know it's happening. IF they have something in their mouths they can easily aspirate it. I go around and take all the gum I see early on in the treatment. I've had to fish out gum before It's not a fun process
#2. As Hello nurse has said the patient has a fair amount of blood out side of their system. Many are diabetics. The human body is smart when there is blood volume depletion the blood is routed to the most vital organ, the brain, and away from the stomach. Thus the digestive system is not at it's peak of performance resulting in vomiting at times even without food in the gut. Bicarb helped that some by buffering the blood
# 3 HepB and C are real concerns in an HD unit. As we all know it really is easier for someone to get Hep B than it is to get AIDS. There are blood spatters you don't even see. Eating in a dialysis unit is NASTY.. The staff are not allowed to chew gum or fiddle with their contact lens in the unit. And those are common sense issues and adhered to quite well. We have to protect our patients as much as we protect ourselves.
Dialysis isn't like your local hospital. Where there is one place to go and that's it. Dialysis is a very competitive business with very tight financial margins..If a patient doesn't like it there they can go to a competitor. Are we to cater to one patient over 20-30 others? You'd probably "hack up a hair ball" if you knew what you and I are paying for dialysis every week. The population increases by about 9-10% every year.
Again there is just so much money in the pot.
As for insight please read all the posts.
I agree this wasn't handled well in the acute inpatient HD unit. I've given my opinions on how to remedy it in the future. Tweety doesn't sound like a whimp to me.. It will be handled better the next time.
Just a question for ya'll. Does X-ray or MRI clean a poopy patient when they bring them back to you.. Does RT clean a poopy patient after they give an albuterol treatment.
I send Pts to hemo all the time. I've never had them come back sitting in excrement. Must be my facility (hospital). ~Jen
I agree with Ms.Jen. In 15 years, I've never heard of such a thing, leaving patients soiled because it's against policy for the dialysis nurses to do it. If anything, if the patient couldn't be moved during the actual dialysis, they would at least clean the patient up prior to returning them to me. The floor is short-staffed too. And I can't imagine being called to another unit by another nurse to do something that theoretically they are supposed to be able to do. I would have had the same (initial) reaction as Tweety.
I agree with Ms.Jen. In 15 years, I've never heard of such a thing, leaving patients soiled because it's against policy for the dialysis nurses to do it. If anything, if the patient couldn't be moved during the actual dialysis, they would at least clean the patient up prior to returning them to me. The floor is short-staffed too. And I can't imagine being called to another unit by another nurse to do something that theoretically they are supposed to be able to do. I would have had the same (initial) reaction as Tweety.
How many years of HD experience do you HAVE???????????
Oh wait a minute. The guy has a broken hip from me standing him up to clean him but he has a clean butt.. For surgery.
How many years of HD experience do you HAVE???????????
Oh wait a minute. The guy has a broken hip from me standing him up to clean him but he has a clean butt.. For surgery.
As stated before, I have 15 years of nursing experience with 12 of them being med-surg and I'm sure you know where they admit HD patients? I also worked one year on a dedicated renal failure floor. I'm not sure why you would ask that as it's not really germane to the discussion.
As for the guy with the broken hip, I'm not really following you there. Would you be unable to clean someone up with dropping them and breaking their hip?
Finally, why the defensive tone? I haven't criticized anyone, I merely stated what my experience has been and I am quite surprised to read about others' experiences with this. Why should that upset you?
Hellllllo Nurse and 1940 are right on the money here. As far as Hospital Floor HD, that's a whole 'nuther matter... I'm sure this could have been handled differently, at least helping cleaning the patient up before returning to his own floor.
But in an outpatient CHRONIC unit this doesn't work. The other patients are all sitting within inches of each other.. they're sick enough from pressure drops on the machine.. add to that cleaning up feces right next to them and you'd not only be cleaning up feces, but THEIR VOMIT as well.
We do our best to keep them from getting sick on the machine as it is. There are only so many staff to go around, when you have one cleaning up poop, and the others tending to those now getting sick on the machine from the poopy patient incident, and others having a crisis on the machine for whatever reason... it's more than we have staff to safely tend to.
And again, you do NOT want to be cleaning poop where there is so much expoxure to patients' blood... the one involved, and that of all the other patients as well. Big no-no. (again, in this case I am referring to outpatient clinics).
As Hellllo stated, this happens VERY rarely to begin with.. we DO take the patients off the machine to allow them to use the restroom. But SHOULD an incident like this occur, we either temporarily d/c tx. until they can use the restroom and clean up (usually with assistance of a family member, and if not available, yes, we at our unit HAVE cleaned up our patients in the restroom.. but NOT out on the floor with the other patients!)... if the patient is bedridden (stretcher) and cannot be moved to the restroom, we must let it go until tx. is over. We do NOT clean the patient out on the floor, ever. We have deordorizer spray to help with odor, etc., but we are not to clean a patient out on the floor.
As for the eating/drinking on the floor, same reasons given by 1940.. totally against policy at our unit. Would you want to eat your sandwich with all that exposure to everyone else's blood and germs? We do give sips of water when neccessary, but no "pic-nics" allowed.
Yes... extra help would certainly be ideal in these units.. but our NA's are our techs, and they are busy doing everything the nurse is but for meds and initial assessments, and have their own patient load... usually four a piece.
And because medicare is so overloaded now with dialysis costs, they are reimbursing lass all the time... so adequate staffing is a MAJOR issue anymore. And also one of the main reasons so many are leaving dialysis... the chaos and stress involved is unbearable anymore, and IMO getting downright unsafe for these poor patients.
I work acute HD. I have never let a pt sit 4 hours in poop but I have waited 2-3 hours for the pt's primary nurse to respond to a call for help. If I am able I will clean the pt myself, but if I have another unstable pt...well, sorry, that's my priority. Most hosp HD units are contracted out, we are not responsible for the primary care of the pt. There are those cross-contamination issues but as I said, I will do my best. I have had many floor nurses respond to my call "why can't you do that, you are a nurse"... well yes I'm a nurse but sorry, I don't have a glucometer, narcotic supply etc & I am taking care of your pt for 4-5 hours. I used to do floor nursing, I understand how crazy it is which is why I do my best not to call them. However, many floor nurses think dialysis nurses just sit on the butts. Let me clear that up....I have an occassional slow day maybe in ICU 1/1 with a stable pt. Most of my days are in a 4 bed unit with myself & another nurse, both of us very experienced dialysis nurses & I don't get to sit or sometimes eat for 12-18(or more) hours. Our phone is constantly ringing nurses, drs, pts, asking when is the tx going to be done, we don't have a secretary or ward clerk. Machines alarming, BPs dropping, calling the lab 10 times to pick up that stat test, calling the pharmacist AGAIN to read the order as it was written so I can scan this darn EPO, giving 2-3 units of bld to a pt so the floor nurse doesn't spend her entire shift giving it...oh yeah that's after I draw the T&C, finally get the lab to pick it up, beg the bld bank to get it ready asap & leave my fellow nurse with 4 pts to go pick it up! Meanwhile, pts are puking, pooping, bleeding & screaming @ me to call their nurse for the 5th time to bring their pain med....to which I respond "I'm sure she'll be here as soon as she can, she is very busy & another phone call will just slow her down.We can't just walk out of the room to get away we have to listen to your pt constantly (you know the ones I'm talking about) That is just scratching the surface.
Sorry, I didn't intend this to be a rant but once I got started I couldn't stop. Maybe b/c I was at the hosp last nite til 1AM b/c nobody bothered to worry that this pt had not had dialysis in 4 days until 5PM on a Sat eve.
Tweety and the others that supported him: Kudos for advocating for your patient.
While I do not condone cleaning up a patient in the treatment area of a chronic unit, I do believe that the patient can be taken to the br, or an empty exam room to be cleaned up. In a chronic unit, what happens to the patient that is going home, in an ambulette or family members car? Against policy? Well, policies are written and can be changed.
Staffing issues? who covers for breaks? If staff can be off the floor for breaks they can be off the floor to clean up a patient. In Tweety's scenario there was no reason ...he offered to do the clean up! The nurse who refused needs an attitude adjustment.
Yes, Medicare funds ESRD...not totally, but 80% of it. Everyone knows what the reimbursement is. If the management cannot run a profitable unit within those restraints, they need to decide if they should provide dialysis services at all. I'm sorry but this is a pet peeve of mine. It is bad enough for these patients that they have to depend on us 3 times a week to stay alive. We should not allow them to be humiliated on top of that.
Those units that have "policy against" or "medical director won't allow" well, question if that were his/her family member sitting in the dialysis recliner, would the policy be changed or ignored?
Again, this is my pet peeve....many years in dialysis, several units and I HAVE had policies changed.
Hate it, Diva, but I'm standing firm and will have to disagree with you on this one... no cleanups on the unit floor. BR, yes.. not on the floor. For all the reasons given above, and then some.
Safety before dignity. There are too many safety and health hazards involved here.
Morning-glory
258 Posts
Well, that sucks!