Feeding patients

81Bubbles, BSN, RN · Aug 29, 2009

Did you guys know that DSI now actually does completely follow the no food or drink policy that DPH has outlined for Dialysis clinics. They actually had a patient who coded r/t eating on the machine. The pateint didn't make it. It was really sad, it did however make some patients actually understand that the no food thing isn't just some form of us trying to micromanage them. I'm on the acutes side more than in the clicinc these days and I do not allow any food in the room or visitiors during trreatment. It's written in our policy that way and I follow it to the letter. If a pateints wants to eat they can either wait or sign an AMA, and finish treatment then eat. I do however try to contact the pateints floor ahead of time to let them know when I should be there to try and schedule their food around it. Also if I show up in the morning and a pateint has their breakfast try and is eating I won't put them on. I'll either see if any other patienst I have for the day are not eating and they can get Treatment first or I'll wait and I bill the hospital for the wait time.

kristinking · Sep 18, 2009

It makes me feel sad when I read so many entries regarding having to feed or hand out meals to our patients. Remember they are why we are here in the first place - to care for them.

In our unit and many units that I am aware of the patients can eat- yes they can eat what ever they like as long as they are not a crasher on the machine!! If they tend to crash then it is explained to them why they are not to eat and they accept that. The other patients do not have to go with out because of it. Our patients get supplied with sandwiches or a cooked meal and they enjoy it. Some of my patients are from very low income backgrounds and this meal 3 times a week is the best they get.

kristinking · Sep 18, 2009

Keep it cool 35 to 36

Trauma Columnist · Sep 20, 2009

You COOK for your patients? Wow - I work in a very large (32 chair, 170 pts) unit which is in the poorest zip code in the USA.

Cooking/eating on hemodialysis is not ony a safety issue, but an infection control issue and just plain gross in my opinion. At this unit, it is impossible to care for pts because the techs have become waiters/waitresses. They pts want the tech to run things like condiments, candy, drinks across the room to their friends.

That's not what the techs are there for: they are there to ensure safety of the pt. This is outpt dialysis: you wouldn't bring your meal to a doctor's office would you?

81Bubbles, BSN, RN · Sep 23, 2009

I'm with TraumasRUS. Why do people asume it's sad because we think we are too good? That is not the issue at all it's a huge safety issue. Just because some one is not a regular crasher doesn't mean that today isn't going to be the day that their pressure drops so quickly and so low that they die? Or that today is not the day that they are going to aspirate and die?

It is sad if these patient never get a good meal but this is not Walmart or The Soup Kitchen.

It's Dialysis Our Job is to run Dialysis treatment and keep them alive so they can go about the rest of their lives as normally as possible.

Some of the people here commenting are not looking at this the right way what so ever. You need to look at what is best for the patienst over all well being and quite simply that is the safest most effective Dialysis treatment you can give them. So no Techs should never be off the floor pertaining to someone wants something from the vending machine they should be on the floor monitoring the patients. No one should be passing food or treats between patients hooked up to machines. That spreads infection.

Why do you think that anything that enters a station needs to be disnfected or is trash. Dialysis patients have weakened immune systems and they are at high risk for deadly infection.

You're priority is to keep them safe. Any if the dialysis way of life is to much for them you need to help the patient explore other options PD, withdrawl of HD, or get them talking to the SW so they can resolve it. Compromising safety and care is not the answer ever!

NDXUFan · Sep 25, 2009

Believe it or not, I agree with many of the posts. I believe that clients in the dialysis station need to be treated as adults, not children. Patients, if they need to have a snack because of low blood sugar, need to bring a reasonable snack to the center, not a refrig. In addition, patients need to bring their binders when they want a snack. The Registered Nurse and the dialysis staff are not part of a hotel staff. If you want to have a snack, be respectful of your fellow clients and Nursing staff, the dialysis clinic is not your personal home or pig-pen. The Nursing staff is not your personal punching bag. If you want to act like a jerk, you need to be in another place, not this clinic. The dialysis clinic is not your personal refrig. How would you feel if someone on the Nursing staff treated you as you are treating them? You do not have to take abuse, but, you need to show respect towards the staff.

I think if the U.S. went to a more Nocturnal dialysis based system, we would be able to have a much happier environment for patients and staff. Patients would be able to drink and eat, a much more liberalized eating plan. In fact, as stated by Dr. John Agar, Professor of Nephrology, Director of the Barwon Clinics, if we use dialysis at least forty-eight hours per week, for the most part, we can eat and drink as we please. One of the issues I have with my fellow dialysis clients is that they do not understand, the more dialysis you have, the better you will feel and live, and enjoy a more liberal diet. Sometimes, with some dialysis clients, it is like bashing your head against the wall. Some of these guys are so stupid, it boggles the mind.

Many times, when you work with individuals with physical disabilities, they tend to be very verbally abusive. I dealt with someone like that for three years. In the third year, they were told in a very profane way, the facts of life. The problem is that many of the parents feel so guilty for what has happened to their children, they do not discipline them. The person that I worked with was so used to everyone waiting on him, hand and foot, he never stopped to think how his attitude and verbal abuse were hurting other people.

Quite honestly, the only thing I wanted from the staff was my treatments. As stated by my R.N. sister, "Most of the people on dialysis have been thru so much, they just want to live life in peace." What I meant by consumer or client focused, has to do more with some of the practices in home dialysis. For example, it used to be that dialysis clients received their Epogen in the mail. Now, according to our brilliant government, we must drive to the clinic to pick up our Epogen. Are these not the very same people who complain about pollution from cars, as I have to drive 30 minutes to the clinic to pick up my Epogen or Heparin? In addition, I fail to comprehend why I must drive thirty minutes to pick up my supplies when there is a Davita clinic right down the street? I am able to drive because my health is close to that of a normal person. Yet, policies like this, are an incredible burden to people who have very serious health issues on top of kidney disease. If the $27 million CEO of DaVita wants more private pay patients, then he and his company are going to have to become more focused on the dialysis patient and not his own convenience.

Sadly, I have seen many patients and staff with very bad attitudes. A dialysis clinic is not Wal-Mart or a hotel and nor should they try to be that business model.

Patient safety is the #1 priority. Yet, patients need to treat the staff with kindness and respect and vice versa. Some staff members need to lose the drill instructor mentality. If you would like to know what it is like for the client, go to You Tube and watch the first ten minutes of "Full Metal Jacket." No, the clinics do not use foul language, but this covers the attitude of some of the staff and patients who are abusive to the staff. I have to warn you, tons of foul language.

Nurses have been some of the best people in my life. They have taken great care of me, the vast majority of the time. Sadly, there are bad people in every profession, even police officers. Bad police officers need to face the firing squad. I wish I could hug each and everyone of you, Nurses are so special to me. :)