Handovers - Dialysis

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I am doing a management project for school that requires me to make a change that I can evaluate. I am currently on the dialysis outpatient unit. As I asked staff what is an issue they stated "Communication". One of the issues is that when the staff is gone of a few days they have difficulties following up on all the care. I have given advise for written report to be charted in a "Ledger" (something that can not be tore out). A notebook that will contain only important abnormals for the day. Another issue is that not all labs and x-rays are being followed up on. Please if anyone has any advise please share. The staff was against verbal reports or recordings.

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Specializes in jack of all trades.

We had a Ledger as you suggested and wrote out daily any abnormalities, changes or specifics related to any pt that was out of just the routine daily "conveyor belt" tradition lol. Problem usually is having time to do it as most chronic dialysis units are on such a tight schedule to get patients in, on and out for the next turn over to go on. Staffing is usually the biggest issue you find primarily retention of experienced RN staff. I finally left working dialysis (was a DON/FA) not long ago for these very reasons. Guess after so many years in critical care I just couldnt get that tunnel vision to just run them through like cattle without looking at the whole picture.

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Specializes in ER, Renal Dialysis.

We used to have a round table discussion everyday when all the pts are settled and all the nurses discuss about their pt of the shift. Anything out of the ordinary was discussed. The charge nurse of the day is usually noted of the change.

And based on experience, dialysis (at least chronic) is not so much of a handover type of nursing. You and me have seen or nursed the pt so many times and we can anticipate or expect what their problems may be at the time of the future.

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Specializes in Nephrology, Cardiology, ER, ICU.

Does your nephrology practice utilize APNs or PAs? I'm an APN in a large neph practice and we have three of us full time that round on chronic HD pts. This is our job - to sort things out, f/u on labs, order referrals, meds, etc..

I'm also going to move this to the dialyis/renal forum for better traffic for you.

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