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.