Toileting during Dialysis

[Lynx25]

I am currently at a LTC facility, where several of our patients go out 3 times a week for outpatient dialysis.

Currently, the facilty we send them to does NOT toilet our patients while they are there. They refuse to assist someone from wheelchair to toilet, and incontient patients get their treatment cut off EARLY, and the transport company is called to take them back to us.

Is that typical?

Is that reasonable?

It's a four hour treatment, is it unreasonable that someone would have to pee?

[Double-Helix, BSN, RN]

Hmm, well, by calling us ignorant people for not doing research, I just find it ignorant that you can't take a person to the BATHROOM! Maybe you can help me understand why a nurse would not be able to take someone to the bathroom. If you are an RN, your job is to educate people. Try dong that before you criticize us for not knowing. It's people like you that scare all the new ones away. Geez.

Many people on this thread have provided reasons why it is not always possible to toilet patients while on dialysis.

But there is no need to call anyone ignorant, for any reason. None of us are deliberately providing poor care on purpose. There are flaws in the system- staffing, policies, patient rations, lack of supplies, etc. There's no reason to resort to name calling or insults. Please, let's all be professional.

[NotFlo]

Again, dialysis equals doctor's office equals there is no staff to take pts to the bathroom.

This is not a hospital, not LTC, it is outpt where pts are expected to be self-sufficient.

Dialysis is not about keeping folks alive as long as possible, its about quality of life.

If these pts are not cognizant, it is necessary to have a family conference about continuing dialysis. And...no this should not take any length of time. This is the nephrologist or mid-levels responsibility!

I totally agree with this. I'm a SNF nurse but I can easily see the other side. Outpatient dialysis facilities are simply not set up to handle ADLs. They are outpatient offices. If we send Mr. Smith who is incontinent for a consult with his ortho we can't expect that someone there will feed him, check his blood sugar, give him insulin, and somehow hoyer him onto and off a toilet or change his brief. It's just not what they're set up for.

At my facility we try our best to get a family member to accompany anyone who might need assistance while at dialysis. There is a certain criteria for sending a CNA with someone to an appointment and I don't think we've ever had anyone on dialysis who met that criteria. Most people we toilet/change right before they leave and as soon as they get back. We try to time those laxatives and stool softeners for the off days in an attempt to reduce the need to have a BM at dialysis. There have been a couple people who actually had a straight cath 3 x week prior to dialysis order.

I'm not sure what the policy is at every dialysis center but at the Davita we work with most frequently they will allow the patient to have a small, non-messy snack if the pt can eat it themselves. There have been a couple people that take a "Nephro" supplement drink and a few that take a simple bagged lunch (sandwich, fruit) who had issues with their blood sugar dropping.

I know there is a lot of resentment both ways but I have found when I talk to the dialysis nurses and try to understand where they are coming from they are willing to work with me to get issues resolved.

[MJB2010]

Hmm, well, by calling us ignorant people for not doing research, I just find it ignorant that you can't take a person to the BATHROOM! Maybe you can help me understand why a nurse would not be able to take someone to the bathroom. If you are an RN, your job is to educate people. Try dong that before you criticize us for not knowing. It's people like you that scare all the new ones away. Geez.

Have you not read the answers posted?

[missladyrn]

That is neglect, bordering on abuse. Good excuses for a dialysis clinic. Too bad that doesn't fly in LTC. I am surprised patients can't be assisted to the bathroom and helped. What do you tell them if they say they need to go? "No, I can't take you, sorry?" Hmmm. Nice.

Neglect would be leaving all the other patients unattended and in an unsafe situation to take one person to the restroom. Don't even get me started on all the neglectful things I could write up on what I see in the patients who come from LTC. The bottom line is this, we cannot take patients to the restroom. We have no one to assist them, nothing to clean them with, and nothing to change them into. They do not get left to sit in it they get sent back to their facility. The families and LTC are fully aware that they are supposed to send an attendant with the patient in order for them to be accepted into our outpatient clinic. It is neglectful for them to not follow through with their agreement. please toilet and feed the patients before sending them to dialysis. Otherwise they suffer by having their treatment cut.

[SE_BSN_RN, BSN]

Have you not read the answers posted?

Yes, I have. I was replying to another post. I got it now. I don't work in dialysis, and I probably never will. LTC was enough for me. I get it. I don't, and I don't think others, appreciate being called ignorant. That was my original reasoning behind this reply. I was not the original poster calling others ignorant.

[SE_BSN_RN, BSN]

Neglect would be leaving all the other patients unattended and in an unsafe situation to take one person to the restroom. Don't even get me started on all the neglectful things I could write up on what I see in the patients who come from LTC. The bottom line is this, we cannot take patients to the restroom. We have no one to assist them, nothing to clean them with, and nothing to change them into. They do not get left to sit in it they get sent back to their facility. The families and LTC are fully aware that they are supposed to send an attendant with the patient in order for them to be accepted into our outpatient clinic. It is neglectful for them to not follow through with their agreement. please toilet and feed the patients before sending them to dialysis. Otherwise they suffer by having their treatment cut.

I know what you mean about LTC, I spent many years there. Our dialysis procedures were a little different, as we didn't send an attendant with them.

[traumaRUs, MSN, APRN]

We are seeing more NH getting into outpt dialysis too - this solves the problem of LTC pts having to be toileted at a dialysis clinic.

[just keep swimming]

Dialysis is not about keeping folks alive as long as possible, its about quality of life.

If these pts are not cognizant, it is necessary to have a family conference about continuing dialysis. And...no this should not take any length of time. This is the nephrologist or mid-levels responsibility!

While I agree with you about this, it does not always happen this way. There are many things that are the nephrologist or mid-levels responsibility that are initiated by nurses or social workers because the others do not do it. I am not suggesting that you do not; and when I am an NP, I will make sure that I initiate care conferences when necessary. Unfortunately, this has not been my experience so far.

What I was saying takes time is getting all involved parties together and then getting them to actually make a decision. I make it a point to be a part of these meetings for all of my patients and there is always so much fighting within the family that we are never able to come to an agreement immediately. There have been times when we have had to take it to the ethics commitee at the hospital and that does take time.

But back to the issue at hand...Trauma is right. Even though I do make it a point to toilet patients and make sure they are cleaned up, this is not our responsibility and we are not equipped to do it. I have a very senior staff who is able to manage time very well and they work as a team. I know this is not so in other units and that it would be impossible to take care of patients in this way at those clinics.

People forget that we are an outpatient clinc because we see our patients so regularly and oftentimes go above and beyond for them. We have to draw the line somewhere. My advice to LTC nurses is to establish an open line of communication with your patients dialysis nurses and coordinate their care. This goes for toileting as well as meds, meals, post HD problems, etc. You would be amazed how far a little communication can go.

[BrandonLPN, LPN]

I'm a LTC nurse, and I don't blame the dialysis staff for not toileting the patients. They have neither the staff nor the supplies. Of course, expecting us to send a CNA is equally absurd.

[missladyrn]

I'm a LTC nurse, and I don't blame the dialysis staff for not toileting the patients. They have neither the staff nor the supplies. Of course, expecting us to send a CNA is equally absurd.

I agree, however, the ltc agrees to these terms as does the family when trying to get a spot in our clinic. I have yet to see one follow through with it. But it is part of he agreement. We do however have 2 patients who are capable of toileting themselves that bring their private care nurse with them to treatment at least once a week. They just play cards with the patient and such.

[Kooky Korky, BSN, RN]

I am upset by reading what it is like at so many dialysis centers. I am upset to read nurses bickering back and forth and blaming each other for ignorance and lack of awareness.

I hope those who work in LTC and dialysis will begin to develop better communication in order to help the patients.

Remind me, though, to never go on dialysis unless I can do it myself at home. Even then...

[serenidad2004]

I am upset by reading what it is like at so many dialysis centers. I am upset to read nurses bickering back and forth and blaming each other for ignorance and lack of awareness.

I hope those who work in LTC and dialysis will begin to develop better communication in order to help the patients.

Remind me, though, to never go on dialysis unless I can do it myself at home. Even then...

We do toilet our pts if they need to go and i have done incontinent care more times than i can count.... ive even changed a foley cath in dialysis....

That being said we do try to discourage use of the bathroom while they are dialyzing