Waiting until patient has vacated station by before disinfecting and setup for next patient

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I'm a PCT at a dialysis clinic, and there had been a policy for a couple of years now that the patient has to completely vacate the station before disinfecting and setting up for the next patient.

Basically, I always do it, and everything else that we have to do between patients: Cleaning the lines and chase box behind the dialysis machine, wiping down the back wall, counter, and television, etc. It's a lot. Basically, you get the idea from the policies that disinfection is supposed to be a thorough, meticulous process.

I know not everyone does all of this, but that isn't something that should concern me. My problem is that I'm again not able to put patients on on-time and I get a reputation from the patients for being slow.

All of this, I guess, is old news. I've been doing this for going on five years now. The old manager adjusted the schedule so that I can get patients on on-time, but the new one tells me there isn't a budget for that. I've had to reduce my hours due to the pandemic, so it doesn't affect me as much. But they praise me saying that I do everything right and even wanted me to be preceptor.

My only question is... Are all the clinics like this? I'm not talking about that some pcts and nurses don't do what they are supposed to, but that this even becomes institutionalized by management because it helps them make budget. It seems that whenever we get techs or nurses from the float pool or other clinics, they immediately start doing things the old way before the policies were updated.

So my sense has never been that I am doing things the normal way, but that I stick out conspicuously, not just in my clinic, but in the majority of clinics. I have gotten my share of passive aggression from techs and nurses for doing that I'm clearly supposed to do, and am not even allowed not to do.

It just shouldn't be like this.

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Specializes in Dialysis.

Our area clinics had to extend our times between patients because of the reason you gave. You can't properly disinfect the station in 5 minutes, although some pcts with have you think they can. State knows this! You are doing the right thing. When your clinic manager has their butt in the sling, they will figure this out. A minimum of 45minutes-1:00 is necessary to schedule in (this includes things like holding the patient, excess bleeding, hoyer to w/c or stretcher, etc). I'd say that this is coming down the pike from a higher up, to your manager who probably is too afraid to rock the boat to explain.

Which company are you with? Fresenius will not allow closer scheduling times with their ScheduleWise program, and it gives warnings if it is attempted.

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DaVita. I have heard from people in management something like an hour between patients at each station, but I never really understood what exactly they are talking about. It seems they mean I can take a patient off, run around and take the other patients off, then be able to have the next patient on in an hour? What if you are running five patient pods?

Thanks for your insights.

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Specializes in Dialysis.

The start and finish times should be staggered to 15-30 min in between each chair; 1 pod in my clinic has 5 chairs, the others 4. You should be able to wipe down, go to next patient coming off and do their treatment termination. While they are holding, the previous station should be air dried and ready to set up. Set up machine and prime. Go back to patient that is holding and finish up. 1st machine should be ready to put into test, do so at that time. Weigh out patient 2, clean station and finish data input; move to patient 3, and so forth. It should take no more than 10 minutes or so to clean a station, unless there is blood everywhere, 5 minutes or less is too little time. I hope this helps

ETA: a good manager/scheduler looks at ending times of treatments as well as beginning times to assure that everything fits. It's not easy, but once you get to that schedule, it's easy to maintain

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I'm actually going to write that down and maybe share it with others. The whole idea of air drying makes sense, and is generally recommended for infection control, yet it isn't in our P&P to my knowledge. But it makes sense to break that time up. Also a lot of patients make it hard to multitask. Either they can't hold on their own, the clamp slips off the site, etc etc, or I'm getting called back because they want taped up after two minutes...but this can be worked out.

I'm going to try it. Thank you for spelling it out.

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I'm actually going to write that down and maybe share it with others. The whole idea of air drying makes sense, and is generally recommended for infection control, yet it isn't in our P&P to my knowledge. But it makes sense to break that time up. Also a lot of patients make it hard to multitask. Either they can't hold on their own, the clamp slips off the site, etc etc, or I'm getting called back because they want taped up after two minutes...but this can be worked out.

I'm going to try it. Thank you for spelling it out.

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Okay... I'm running into the same problems. So I broke it down on a spreadsheet even. If I give myself a minimum amount of time of 5min to take a patient off, 5min to wipe down a station, and 5min to setup a station, I'm getting that it takes 75min between the take-off of your first first-shift patient and being ready for your first second-shift patient for a five patient pods.

How the heck does your region do this in under an hour? And I'm pretty much assuming ideal circumstances: not responding to alarms, charting patients during turnover, bleeders, helping patient transfer, post-tx blood pressure measurements taking forever, etc.

Basically, I'm trying to figure out if it is that my performance doesn't meet expectations, or if the expectations aren't meeting reality. It could be me then at least I know what I need to work on. But if it isn't me, then I'm in a bad situation.

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Specializes in Dialysis.

They just do. We have bad days: bleeders, alarms, etc. I find myself helping on the floor some days. Most of my techs have 10+ years experience and can move like the wind

I do help out during changeover to make it a little smoother. Vitals, takeoffs, wipe down a station, even set up. It's all about being a team from management on down

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My guess is that they just don't. They are just really good at letting you think that they do. I follow policy more than anyone at our clinic. But I can't blame them...I run behind a lot.

Nonetheless, I could just be too slow for this job. I'm 38. I'm not getting any faster. There are other things I could probably do.

Thanks for your insights.

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Specializes in Dialysis.

As I'm helping them in changeover, I'm directly observing. So, they may get away with shortcuts occasionally, it's not often. Age isn't a factor. I'm 57 and can run a pod, keep up nicely, if needed. It's not easy though, that's for sure

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Fair enough. It was arrogant for me to make assumptions. I apologise.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's hard. Really hard to get it all done in the time allotted. Don't go being hard on yourself. I am older, too, and can keep up with the techs most days, but some days things just go awry. It's like riding a wave. The tidal wave comes at you and you feel you're going to drown and then it subsides; try to stay afloat until things get better. Use the slower times to stay caught up. Procrastination is death in this specialty. Hang in there.

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