Indian Journal of Nephrology Home 

CHAPTER 2
[Download PDF]
Year : 2020  |  Volume : 30  |  Issue : 7  |  Page : 6--8

Personnel for hemodialysis unit

 

Correspondence Address:

How to cite this article:
. Personnel for hemodialysis unit.Indian J Nephrol 2020;30:6-8

How to cite this URL:
. Personnel for hemodialysis unit. Indian J Nephrol [serial online] 2020 [cited 2020 Aug 14 ];30:6-8
Available from: http://www.indianjnephrol.org/text.asp?2020/30/7/6/289771

Full Text



 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 staffWe recommend that workforce handling and patient scheduling be done vis a vis available workforce competenciesWe recommend that dialysis unit should have the following categories of regular staff:

NephrologistDialysis doctors (nephrologist can also be a dialysis doctor)Dialysis technicians/nursesDialysis attendants/sanitation personnel.

We suggest access to the following:

Medical social workerDietician.

We recommend the following qualifications, job descriptions, and appraisal/updating schedules for different categories of staff working in HD unit.

 Nephrologist



Training

DM/DNB in Nephrology.

Job description

Responsible for overall functioning of the unitAssess all patients and frame dialysis prescriptions, evaluate comorbid illnesses, advice concomitant therapies, and make/approve specific recommendationsPerform regular review of all patient chartsCarry out periodic review of water quality and infection control measuresPeriodically evaluate the performance of dialysis doctors, technicians, and nursesProvide 24 × 7 h consultation coverBe responsible for enforcement of patient care and safety rules and regulationsAct as liaison between the hospital management, statutory bodies, dialysis staff, and patientsProtect patient rightsSupervise in-house teaching programBe 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



Training

M.B.B.S. with a valid registrationOne-year house jobCertified in advanced cardiac life support (ACLS)Experience in central line placementExperience in critical care managementTo be trained under the care of a nephrologist for a period of 6 months or moreTo report to a nephrologist in the same institute or in case of a standalone unit to a covering/visiting nephrologist from the nearest facility.

Job description

To be involved in day-to-day patient managementBefore starting dialysis: Assess hemodynamic status, indication of dialysis, vascular access, and any comorbid illnessDuring dialysis: Overall direct monitoring including dialysis prescription, care of vascular access, adequacy of flow, complications, and maintain liaison with and follow instruction of the nephrologistAt the time of closure: Check access site, hemodynamic status, any complication, and give specific instruction if neededFor inpatients: Assess the patient at least once in the ward after dialysisAccompany the patient to the ward, if critically illHandle/supervise/guide supporting staff in cardiopulmonary resuscitation.Have working knowledge of the dialysis machine, water treatment plant, ventilator, defibrillator, and other equipment in the unitAct as the team leader during the day-to-day functioning of the unitEnsure implementation of all guidelinesLook after the safety and security of the supporting staffTake 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



Training

One year or longer certificate course in dialysis technology (after high school) certified by a government authority or have sufficient verifiable hands-on experience.

Job description

Performing all aspects of the dialysis procedure as per prescriptionConducting discharge assessmentFollowing instructions of the dialysis doctorsConveying to the dialysis doctor any new event/change in patient status and recommending changes in the treatment based on the current needs of the patientFacilitating communication between the patient and patient's family on one side and the treating team on the otherKeeping an inventory of items in the unitProviding oversight and direction to the trainee technicians/nursesParticipating in continuous quality improvement activitiesEntry and maintenance of records of all patients and produce them for medical auditingMaintenance of machines and the water treatment plant in accordance with the ISN guidelines and the unit protocolSurface 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.

Training

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.

[INLINE:1]

[INLINE:2]

 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 displayedWe recommend that personnel records shall be maintained for all employeesWe recommend that the number of personnel be sufficient to ensure patient care and safetyWe recommend a patient:technician/nurse ratio of 3:1We recommend that a formal system of staff evaluation and monitoring be established with annual performance evaluationWe recommend that the organization have a well-documented disciplinary procedure and grievance-handling mechanismWe recommend that the organization should address the health needs of the employeesWe recommend that all staff should be screened for transmissible infections including blood-borne virusesWe recommend that the staff must receive all recommended vaccinations.

Personnel records should contain:

Application for employment and a record of any disciplinary action takenWage and salary information, time records, authorization, and record of leave.

Job responsibilities:

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 itDocumentation of training and development activities for the staffDocumentation of health and vaccination records for all employees, including volunteers.