Dialysis treatment

• Discuss and/or provide educational material that describes kidney failure, dialysis treatment, lab values, renal diet, what to expect, etc
• Provide staff contact information and a brief description of the roles of key staff
• Notify if there are adverse events during treatment, such as bleeding, low blood pressure, hospitalization, behavior changes, cognitive functioning, etc.
• Assist patient with a change of clothing if soiling has occurred during treatment

• Provide education for all NH staff on kidney disease, its treatment, and needs of kidney patients
• Provide contact information and a brief description of the roles of key staff
• Provide information about the patient’s  activities,  atypical behaviors, personal needs  when not at dialysis facility  
• Notify if there are adverse events before or after treatment, such as diarrhea, incontinence, cramping, pain, behavior changes, etc.
• Provide change of clothing if soiling may occur.   

Dialysis Schedule

• Identify the best time for treatment (work with NH schedule in terms of meals, being up and dressed, etc.)

• Notify in case of an emergency (weather, power, water, etc) and provide backup facility information
• Notify if dialysis time changes

• Notify all departments of patient’s dialysis schedule to coordinate other activities
• Coordinate with NH dietary staff if a meal needs to be at a different time or if a snack needs to be given to the patient to accommodate dialysis schedule
• Notify ahead of time if patient is unable to attend a treatment due to illness, hospitalization, or if will be late.  

Transportation

• Notify when patient should arrive for treatment and  when treatment will be completed

• Arrange transportation for resident to/from dialysis facility and make changes as needed

Renal diet

• Collaborate regarding appropriate renal diet, fluid intake, snacks
• Request patient’s meal plan periodically

• Collaborate with renal dietitian regarding appropriate meal plan, fluid intake, and snacks

Medication /lab values

• Provide copy of patient’s meds and lab values and provide any changes in meds
• Collaborate on ways to improve poor lab values (discuss fluid intake, appropriate food, staying full treatment, etc)

• Provide list of patient’s medications and notify if meds change
• Collaborate on ways to improve poor lab values (discuss fluid intake, appropriate food, staying full treatment, etc)

Patient Behavior:
Coping with treatment

• Collaborate with nursing home staff (nurse, social worker, activity director) regarding how patient is coping with treatment, if patient is restless and would benefit from activities to do during dialysis, if patient needs assistance at the NH to cope with kidney disease, etc. 

• Collaborate with dialysis facility staff (nursing, social worker) informing them if resident is reluctant to come to treatment, is angry about dialysis, depressed, receiving mental health treatment, etc . to coordinate a plan of action.

Patient Behavior:
Yelling, threatening staff, loud, etc

• Notify NH of any changes in patient’s behavior during treatment
• Collaborate with NH (social services/nursing) to identify possible  root causes of behavior
• Collaborate on techniques to work with patient consistently at both facilities for the same type of behaviors  (anger, frustrations, feeling powerless, etc)

• Notify dialysis facility if resident has challenging behaviors at NH
• Collaborate to identify possible root causes of behavior
• Collaborate with dialysis facility staff (nurse and social worker) to work with resident on challenging behaviors in a consistent manner  (anger management, frustration tolerance, how to be in control of self, etc)

Cognitive Impairment

• Obtain information regarding cognitive status of patient
• Collaborate with NH activity director to offer activities which may calm/distract patient during treatment 
• Discuss if arrangements need to be made for a sitter during treatment which could include a patient’s family member or volunteer

• Collaborate with dialysis staff (social worker/nurse/technician) to provide or suggest activities which may calm/distract patient during treatment 
• Provide assistance for a family member or a volunteer to sit with the patient during treatment if needed
• Provide in-service or educational material on cognitive impairment , Alzheimer’s Disease, etc.

Patient Assessment

• Share assessments and updates
• Share and involve NH staff regarding assessments for unstable status and plan of action as it relates to patient’s quality of life and dialysis treatment.

• Share assessments and updates
• Notify if  patient is hospitalized, has deterioration in health status, significant changes in psychosocial status, poor nutritional status, etc.

Patient Care Plan

• Request and share relevant information of care plans

• Request and share relevant information of care plans

Discharge planning /
End-of Life

• Discuss palliative care and end of life issues when there are concerns about continuing treatment
• Discuss dialysis as part of hospice
• Notify and collaborate if patient becomes at risk for discharge

• Share palliative care issues and end of life issues discussed with patient and family
• Notify if patient chooses to terminate dialysis and/or when resident dies
• Collaborate on finding solutions for at risk for discharge behaviors