acutedialysis

If you want a set schedule and guaranteed 40 hours per week, do not do acutes. Acute schedules are variable, but for the person who love it (like me), it is the flexability of acutes that makes it all worth it. My staff almost alwys have the ability to get 40 hours and often get overtime. We have shift diff for all shifts/weekends. Acutes is a lifestyle for sure, you either love it or hate it.

We no longer have our acute room, but when we did, it was 2 patients: 1 staff. Bedsides are always 1:1. I expect my staff to be able to do upto 3 runs per day (all 1:1) but they very often end up with 1-2 runs per day. Somehow, it balances out to 40 hours/week.

Yes, they clock out for a 30 minute break, but they cannot leave the building unless someone else is the the building (which rarely happens). Since the unit is kinda off the beaten path (way in the country), there really would be no where to go in a half hour. So we just veg in the break room, watch TV or what ever. I can be lonely though.

We have a small unit (8 chairs) that is run the same way, 1 RN +1 PCT. Both have to be in the building at all times, but they are given breaks. The state has been there to audit twice in 3 years (initial and renewal) and has never said a word about it.

Tony 55! I agree, I work for a physician owned independant and LOVE it! They are still out there, just far and in between. I will never work for a big chain again.

Found it faster than I thought. From the CMS ESRD Program Interpretive Guideline V116 "Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before taken to a common clean area or used on another patient. Nondisposable items that cannot be cleaned and disenfected (e.g. adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. Unused medications (including multiple dose vials conatining diluents) or supplies (syringes, alcohol swabs, etc.) taken to a patient's station should be used only for that patient and should not be returned to a common clean area or used on other patiens." Since there is no way to disenfect the bath, our interperation was that the jugs must be disposed of for each patient.

In our clinics we cannot mix the left over bath due to infection control. Once a supply has been utilized on one patient it cannot be utilized on another. So we dump the left over jugs. We centrally pump in 2K, so our only mixing is for maybe 10% of the patients. I will look through the guidelines to see if there is an exact line on this.

We use the showers quite often. The water supply is the same as what is provided to the sinks. A word of caution is the temperature. When using the shower, the dialysis staff must make sure that they RO system is being fed cold water not luke warm or hot.

i am attaching a link that we used for our techs. the ceu's only work for rn's in the state of fl, but kim at the nncc stated that they would be ok for technicians. i should add that the techs reported to me that the fl ceu's are very good, but not exceptionally easy. medscape also has plenty of ceu's, but they come in .5 intervals, so they take awhile. the last one is the new cdc infection control ce. the link for that is also listed. good luck! http://www.cdc.gov/dialysis/provider/ce/infection-prevent-outpatient-hemo.html http://fmqai.com/esrdcontinuingeducation.aspx

We utilize Chloraprep, antibiotic cream and island dressings. Our infection rate is very low. In one of our acute hospitals we use the biopatch with great success, but it stays on for a week. I'm not sure if more mobile patient (versus a hospitalized patient) would get a tegraderm to last a week. Maybe look at your access care policy. How often do you change gloves? If your infection rate is high, something is wrong.

My guess (and it's only a guess) is that they use "aucte" to mean hospital and "renal" for patients that have some form of renal imparment. That means that you will see all stages of renal failure, some on dialysis, some not. Good luck, but ask lots of questions in the interview :)

If you have an RN, do you have a year's experience in nursing? With the new CMS guidlines mandating charge RN's have at least 1 year nursing experience, this could be part of the problem. Many smaller units only have 1 RN on site, so they have to be more picky. Since you asked about how people started: I started in a hospital that had in-house outpatient dialysis. I was part of the float (technician) pool and was asked to float to dialysis, which I did. I finished my nursing degree and stayed in dialysis. 3 years later I moved into acutes and never looked back :) (I'm at 19 years of dialysis now, and run the acute program.) There are other areas of nursing that you might be able to get into dialysis. We have a state run psych center that offers in house dialysis, as does the local prison. Not my cup of tea, but I have heard many dialysis nurses tell me it is very interesting. Also some rehab centers have their own in-house acute teams. You could also look into one of the groups that offers nursing home dialysis. In my area it is Affilated Dialysis and I believe they service 20-25 nursing homes. Good luck!

Maybe try asking the patient? Otherwise I would call the hospital and ask them. They will most likely deny using the catheter, but at least you can documnet the information and the conservation. That way, if , God forbid, the catheter ends up infected, you have some documentation on your end. We also use the TEGO connectors and love them. (With Swab caps on the end of them).

We advertise in local papers and online when necessary. We have several dialysis tech schools in the area so we rarely have the need to do any ads (unless we want previous experience.) I will say, even though these techs have no clinical experience, the class does a great job with theory and they do very well on their certification tests.

Does anyone have any experience with the new BARD catheter that combines a PICC line and a temporary dialysis catheter? It seems great in theory, but the rep says it can't be used while dialysis is running? If that is true, then what's the point? Also, who takes the CLASBI hit if it gets infected? Any feedback is appreciated :redbeathe