March is National Kidney Month! An estimated 37 million people in the US have chronic kidney disease and 600,00 of them rely on dialysis to stay alive. The number of nursing home residents that receive hemodialysis is on the rise. Whether your facility performs in-house dialysis or sends residents to a dialysis center, it is important to periodically review your processes to ensure that you are providing optimal care while maintaining regulatory compliance.

Schedule some time to evaluate the current state of your facility. Audit medical records of residents that receive dialysis. Begin by checking the provider’s orders to confirm that they are being followed accurately. Verify that the resident is on the correct dialysis schedule and prescription. Review the care plan, making sure that it is up to date and that it contains interventions and goals that reflect the treatment plan. Confirm that it is developed and revised in collaboration with the dialysis facility, and it reflects the most current treatment plan. Consult with IDT members if updates are needed. 

Audit the documentation of vital signs to evaluate that they are being monitored as ordered. Verify that the blood pressure is being taken on the correct extremity. Confirm that the target weight is identified and that weights are being done as ordered.  Check that medications and meals are being administered before and after treatment as ordered. Review that nutritional and fluid needs are being followed, including any restrictions. Evaluate the assessment and care of the access site, including that dressing changes are performed as ordered.

Do you residents go to a dialysis center for treatment? Check that the dialysis facility and transportation arrangements are documented. Make sure a contract is in place for each dialysis facility and for the transportation company. Verify that handoff communication occurs with the dialysis center before and after treatment. 

After completing your facility’s evaluation, take some time to action plan based on your findings. Celebrate your successes and identify areas for improvement. Develop a performance improvement plan and set goals for your facility. Taking a proactive approach will help you provide safe care to your residents and will prepare you for regulatory surveys.