Drive Through Dialysis: A Study in Resource Utilization

Hellllllo Nurse, BSN, RN

In illustrating my skill in utilizing the resources available to patients, and to me as a nurse, the events of a particular day come to mind.

In April of this year, I was working as a traveling hemodialysis charge nurse in a large, metropolitan area. The circumstances of the day necessitated that I utilize nearly every resource available to me.

It was a typical, hectic day on the unit. The part of the workday referred to as "turnaround" in the chronic dialysis setting was nearing. "Turnaround" occurs when treatments for one group of scheduled patients are being completed, while treatments for a subsequent group are initiated.

One of the patients was a pleasant lady who suffered from dementia. She had been recently discharged from an acute care facility where she had been treated for pneumonia. She became febrile and was not tolerating treatment well. I phoned her husband and told him I wanted to transfer her back to the hospital. He agreed and informed me that he wanted to drive her himself. He stated he would arrive directly. I arranged for the patient's transfer. In the meantime, I continued my pre- and post-treatment patient assessments, assisting the technicians, charting, as so on. A physician arrived at the unit and asked me to round with him.

Suddenly, there was a very loud crash from across the hall. I stepped off the floor to see what had happened. I saw that the patient's husband, who had arrived to transport his wife to the hospital, had inadvertently driven his car through the glass and steel wall of the exam room. The entire wall was shattered, and the exam room was full of debris. The underside of the car was impaled on some steel beams. The man was revving his engine, trying to free his car from the building. I asked him to put the car in park, and turn off the ignition, which he did.

I then saw that I had been joined by every team member on the unit; they had come to see what had happened. I instructed the technicians to return to the floor and continue caring for the patients. I asked them to be very low-key in communicating with the patients and each other concerning what had just happened, in order to avoid upsetting the patients. The technicians returned to the floor and resumed their duties. The physician assessed the patient's spouse and determined that he was not injured. I asked the physician if he would remain on the floor a while longer. Prior to his arrival, I had been the only licensed person in the facility. The physician agreed to stay for a few more minutes.

This particular unit is a free-standing, sixteen-bed, independent clinic. It is located in a shopping center and is not associated with a hospital or any other medical facility. The unit manager was out of town, and the unit secretary had called in sick. The only staff at the facility consisted of four technicians, two trainees, and me. Ancillary services were available on an on-call basis.

The driver exited the car, entered the front lobby and sat down. He appeared quite shaken. I assessed the damage to the building. I did not see any exposed electrical wires or water pipes. The cinderblock walls attached to either side of the glass and steel sections were intact. I assessed that there was no immediate danger of fire, electrical hazard, or flooding. I returned to the treatment area and informed the patients and technicians that there was no immediate danger, but that I would summon the fire department to inspect the building. I informed the patients and technicians that I would be occupied addressing the situation and instructed the technicians to call upon me, as needed.

The patient's spouse and I agreed to have his wife transported to the hospital via ambulance. He contacted his son to drive him to the hospital.

I then called 911 and requested three EMS services: I asked that the fire department come and inspect the building, and determine if we needed to evacuate. I arranged for an ambulance to transport the ill patient to the hospital, and for the police department to come and initiate an accident investigation. I requested that all three EMS services be dispatched Code-2 (no emergency lights, no sirens). I did this to avoid causing the patients further distress and to minimize additional disruptions to unit functioning.

The fire department arrived almost immediately. They inspected the building and declared that is was safe to occupy. I informed the patients and staff of this and reassured them that the building was safe. Right after the fire department left, I saw that several patient family members who had been in the lobby had gone outside, and had taken it upon themselves to start cleaning up the broken glass and other debris. I told them they had to stop immediately. I let them know that I appreciated their desire to help, but for reasons of their safety, I could not allow it. They all complied and returned to the lobby. The police arrived and completed the accident investigation. They assisted the driver in making arrangements to have his car removed from the building.

The two newly-hired technicians present that day had not been assigned any patient care duties. Their only responsibility was to shadow their preceptor. I asked them to start cleaning up the smaller, more manageable pieces of debris. Per my request, their preceptor provided them with protective goggles, gloves, lab coats, shoe covers, brooms, and dustpans, as well as a large, puncture resistant garbage can.

At this time, I paged the on-call biomedical technician to see what could be done to address the damage to the building. Additionally, I paged the social worker and requested that he come to the unit to provide emotional support and reassurance to the patients and families.

I went to check on the patient's spouse who had been involved in the accident. He was tearful and seemed very distraught. He verbalized that he felt very embarrassed. I encouraged him to express his feelings and provided emotional support.

One of the technicians had an excellent rapport with this man and his wife. Coincidentally, this technician had recently been involved in a similar auto accident, in which he had inadvertently driven through his sister's garage door. I asked him if he would mind sharing this with the distraught man, in order to console him. The technician agreed and spoke to the man. After a few minutes, I observed that the man was no longer fearful. He and the technician were laughing together. Soon after, the man's son arrived and drove him to the hospital to be with his wife.

The social worker arrived and spoke with the patients and their family members. None of them appeared to be particularly distraught. The biomedical technician arrived and contacted the property manager, from whom the building was leased. Together, they cleared the remaining debris and bolted large sheets of plywood and wood beams to the building, securing it.

Throughout all of these undertakings, the technicians and I continued to care for our patients, and ensure their safety.

After the crisis had passed, the atmosphere of the unit was jovial. The staff and I joked with the patients, telling them that we now offered a new service: drive-through dialysis.

At the end of the day, after all the patients had left, I expressed to my co-workers how pleased and proud I was with how well we had all worked together. Every team member had contributed towards managing the situation successfully and minimizing the potential negative impact. It had been a challenging day; but together, we had risen to the challenge.

Drive Through Dialysis: A Study in Resource Utilization

About Hellllllo Nurse, BSN, RN

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