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|Year : 2020 | Volume
| Issue : 7 | Page : 6-8
Personnel for hemodialysis unit
|Date of Web Publication||15-Jul-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Personnel for hemodialysis unit. Indian J Nephrol 2020;30, Suppl S1:6-8
| Introduction|| |
HD is recognized as being a highly specialized component of patient care. Ensuring that this care is delivered optimally requires a high level of expertise, training, and updating. The following guideline deals with the qualifications, responsibilities, training evaluation, rights, duties, and privileges of staff members working in dialysis units. It also suggests parameters for self and unit evaluation and internal audits.
- We recommend that the HD facility should have sufficient specialist and support staff
- We recommend that workforce handling and patient scheduling be done vis a vis available workforce competencies
- We recommend that dialysis unit should have the following categories of regular staff:
- Dialysis doctors (nephrologist can also be a dialysis doctor)
- Dialysis technicians/nurses
- Dialysis attendants/sanitation personnel.
We suggest access to the following:
- Medical social worker
We recommend the following qualifications, job descriptions, and appraisal/updating schedules for different categories of staff working in HD unit.
| Nephrologist|| |
DM/DNB in Nephrology.
- Responsible for overall functioning of the unit
- Assess all patients and frame dialysis prescriptions, evaluate comorbid illnesses, advice concomitant therapies, and make/approve specific recommendations
- Perform regular review of all patient charts
- Carry out periodic review of water quality and infection control measures
- Periodically evaluate the performance of dialysis doctors, technicians, and nurses
- Provide 24 × 7 h consultation cover
- Be responsible for enforcement of patient care and safety rules and regulations
- Act as liaison between the hospital management, statutory bodies, dialysis staff, and patients
- Protect patient rights
- Supervise in-house teaching program
- Be in charge of periodic performance audit.
She/he should sit with the team and discuss all issues of concern. The unit should maintain a record of performance parameters, including but not limited to, proportion of patients with arteriovenous (AV) fistula (AVF); treatment compliance rates; infection rates categorized by site, organism, and sensitivity; nutritional status; rehabilitation status; comorbidity management; clinically important events; dropouts; and outcomes.
We recommend that the nephrologist should regularly participate in national/zonal chapter meetings of Indian Society of Nephrology (ISN) and other recognized continuing medical education (CME) programs at least once a year.
| Dialysis Doctors|| |
- M.B.B.S. with a valid registration
- One-year house job
- Certified in advanced cardiac life support (ACLS)
- Experience in central line placement
- Experience in critical care management
- To be trained under the care of a nephrologist for a period of 6 months or more
- To report to a nephrologist in the same institute or in case of a standalone unit to a covering/visiting nephrologist from the nearest facility.
- To be involved in day-to-day patient management
- Before starting dialysis: Assess hemodynamic status, indication of dialysis, vascular access, and any comorbid illness
- During dialysis: Overall direct monitoring including dialysis prescription, care of vascular access, adequacy of flow, complications, and maintain liaison with and follow instruction of the nephrologist
- At the time of closure: Check access site, hemodynamic status, any complication, and give specific instruction if needed
- For inpatients: Assess the patient at least once in the ward after dialysis
- Accompany the patient to the ward, if critically ill
- Handle/supervise/guide supporting staff in cardiopulmonary resuscitation.
- Have working knowledge of the dialysis machine, water treatment plant, ventilator, defibrillator, and other equipment in the unit
- Act as the team leader during the day-to-day functioning of the unit
- Ensure implementation of all guidelines
- Look after the safety and security of the supporting staff
- Take regular teaching sessions for the dialysis staff.
We recommend that the dialysis doctor should participate in recognized CME programs of ISN or Indian Society of Hemodialysis at least once in 2 years.
| Dialysis Technicians|| |
One year or longer certificate course in dialysis technology (after high school) certified by a government authority or have sufficient verifiable hands-on experience.
- Performing all aspects of the dialysis procedure as per prescription
- Conducting discharge assessment
- Following instructions of the dialysis doctors
- Conveying to the dialysis doctor any new event/change in patient status and recommending changes in the treatment based on the current needs of the patient
- Facilitating communication between the patient and patient's family on one side and the treating team on the other
- Keeping an inventory of items in the unit
- Providing oversight and direction to the trainee technicians/nurses
- Participating in continuous quality improvement activities
- Entry and maintenance of records of all patients and produce them for medical auditing
- Maintenance of machines and the water treatment plant in accordance with the ISN guidelines and the unit protocol
- Surface cleaning of machines as part of disinfection procedures.
- Implementing the disinfection policies.
We recommend that technicians should attend update sessions meant for dialysis technicians at least once a year.
| Dialysis Nurses|| |
We recommend that the appointment of a head nurse could be left to each individual center depending on the number of nurses and technicians and the need for having duty rosters and allotment of individual tasks.
Auxiliary nurse midwife should have +6-month experience in a dialysis unit. He/she should be registered with the local nursing council.
Job description, auditing, and updating
As for dialysis technicians.
Nurses are privileged to carry out certain nursing responsibilities such as giving IV/subcutaneous medications and conducting a nursing assessment in addition to the above.
| Attendants/sweepers|| |
We recommend at least one attendant for every ten dialysis beds.
| Dietician|| |
Dietician should be involved in the development of nutritional care plan, documentation, ongoing nutrition assessment and remedial steps, patient education, and research and participate in medical review audit.
| Medical Social Worker|| |
Should be involved in psychosocial evaluation, case work counseling of patients and families, and group work; evaluate and facilitate rehabilitation and team care planning and collaboration; facilitate community agency referral, and improve communication with the treating team.
The companion piece to credentialing is “privileging,” which is the process of authorizing a licensed or certified health-care practitioner's specific scope of patient care services. Privileging is performed in conjunction with an evaluation of an individual's clinical qualifications and/or performance.
- We recommend that the organization have a well-defined organizational chart, which should be prominently displayed
- We recommend that personnel records shall be maintained for all employees
- We recommend that the number of personnel be sufficient to ensure patient care and safety
- We recommend a patient:technician/nurse ratio of 3:1
- We recommend that a formal system of staff evaluation and monitoring be established with annual performance evaluation
- We recommend that the organization have a well-documented disciplinary procedure and grievance-handling mechanism
- We recommend that the organization should address the health needs of the employees
- We recommend that all staff should be screened for transmissible infections including blood-borne viruses
- We recommend that the staff must receive all recommended vaccinations.
Personnel records should contain:
- Application for employment and a record of any disciplinary action taken
- Wage and salary information, time records, authorization, and record of leave.
- Verification of the respective employment requirements for the staff position held, including annual verification of basic skills, and annual evaluation of personnel performance. This evaluation shall be in writing. There shall be documentation to verify that the employee has reviewed the evaluation and has had an opportunity to comment on it
- Documentation of training and development activities for the staff
- Documentation of health and vaccination records for all employees, including volunteers.