Robbilin

Right now our required response time is within 45 minutes when on call. What is the response time in your facilities? I am trying to hire new nurses, but everyone lives an hour away, limiting my choices. I want to change the policy but need some ideas as to what is typical in other places. Thanks.

Do you use antibiotic in single dose packets? I am trying to do this cost effectively, but still best for the patient. I know the KDOQI recommendations are not to use an occlusive dressing, which is why we are switching to paper tape also. Thanks

Our current policy for drsg changes is to change them weekly, cleanse with betadine and then H2O2, apply a Bio-patch, and then a Tegaderm dressing. We will possibly be changing to using just a dry guaze and a piece of tape and doing that at each HD tx. What advice, cautions do you have? What are you all doing for your drsg changes? Thanks in advance.

How did your error occur? Someone apparently unloaded one carton of the 0 Ca++ baths and mixed them with the 2.5 C baths accidently. Then when they got the stations ready, grabbed the wrong baths without reading the label, assuming they were stocked correctly. And since almost all the patients get the same bath, the nurse hooking up that patient didn't look at the bath strength. So like 3 people "assumed" everything was correct. Not a good day. We generally take a red marker and label the jugs anytime we add packets, but never taped the packet to the jugs. I like that idea. Plus we never do any witnessing of any of that, that might be another good idea. Anyone on our unit mixes - RN, LPN, Tech.

We had an incident where the wrong Ca++ bath was put on some of the patients machines - 0 instead of 2.5. The patients all were very symptomatic before we figured out the problem. My question is, do any of you keep 0 Ca+ or 0 K+ baths on your unit and add the powder packets of Ca or K? Or do you consider that a dangerous practice and only keep certain strengths on hand? Most of our patients are 2K, 2.5 Ca but we have a couple that differ and we add the packets. Someone told me that should never be done, because it is an accident waiting to happen, which finally did happen on our unit (first time ever) I don't want to over-react, but patient safety is of utmost importance. Any advice?? Thanks

We are a hospital based center in Wisconsin. Our patients don't get discharged first if they are inpatient, to come down to our unit. It is charged under their inpatient hospital number. Our normal outpatient chronics have one number, but if they get admitted they get a new number, then those tx go under the new number. There is one charge for inpatient hemodialysis if the tx is down in the unit, whether they come down in a bed or a wheelchair, or a different charge if we have to take our RO unit to the bedside. Transients, etc, obviously have their own number that everything gets charge to. Hope this helps! R

I also work at a hospital based facility. We run the unstable acutes in their ICU rooms, but we do any stable ones in our regular unit. I don't understand the billing nightmare; though I am not a medicare billing guru! We have one acute charge and one chronic inpatient charge that would be billed accordingly.

I work in a hospital based hemo unit and am on call 10 shifts per month. We only have 3 nurses who take call. We are open M-W-F from 6 am til 6 pm, so are on call all the hours in between. We get called in maybe 25 % of the time, but it goes much higher and lower, you never know. We get paid $1.75 per hour while carrying the pager, and paid 1 1/2x/hr if called in, plus 1/2 hour driving time.

Thanks for all these ideas and suggestions. We are kind of dependent on the clamps too. As far as the bleach soaking, does anyone know how long they have to sit in it? (For the state to be happy!) Robbilin

Tell me, what do you all think of using clamps on graft and fistula needle sites? What is your technique - like use one clamp and hold the other needle site, no clamps ever, use them all the times?? And if you do use clamps, what is your policy for cleaning them? We do use them, and they all get wiped down and then thrown all together in a basket. They are labeled for each patient, but the cleanliness is only as good as the person who wiped them down. I only know what our facility does and would like to hear what other places do. Thanks!

And where I work, they came into town and offered the experienced nurses big bucks to come over to their facility. They were actually intending to shut down our facility! They are all about money, not about patients.

We often times will use the 2mg of Activase and put it in whatever port is either clotted off or very sluggish, leave it in until the next treatment, then withdraw it. If the port is completely clotted, we will put it in and then wait 20-30 minutes, then attempt aspiration. If it doesn't work still, we wait another 30 minutes, etc. Hope this helps!