Dialysis: Chronic/Acute
Dialysis at Shands at the University of Florida consists of separate inpatient and outpatient units for pediatric and adult patients. The nursing staff collaborates with other team members to care for patients receiving renal replacement therapy or who are being treated for acute renal failure.
The Inpatient Adult Unit (acute dialysis) is a six-station special care unit, and the pediatric dialysis unit is a five-station unit. Both the Inpatient Adult Unit and the Pediatric Unit provide care to patients who require hemodialysis, peritoneal dialysis and continuous renal replacement therapies (CRRT).
The Adult Chronic Unit has 24 stations for hemodialysis and hometraining.
Patient Population
The Renal Services/Dialysis program exists to provide quality care to residents of Gainesville and the surrounding areas. Profesional working in Renal Services strive to achieve a new standard of excellence in caring for the patient populations requiring renal replacement therapy. The staff is committed to patient advocacy and innovative patient care through encouraging family participation in care and soliciting patient and family feedback. The patient population for these areas are patients who have been diagnosed with end stage renal disease (ESRD) or acute renal failure and who require renal replacement therapy.
The staff in Renal Services assess, diagnose, and treat the care needs of the patients in the unit. Clinical functions include hemodialysis, homehemo dialysis, peritoneal dialysis, CRRT, administration of blood products, intravenous medication administration, recirculation studies and kinetic modeling.
Health Care Team
The medical director of Renal Services is board-certified in nephrology and internal medicine. Renal Services’ faculty, adult and pediatric nephrologist, physician’s assistant and nephrology fellows provide 10 hours of coverage per day for the outpatient facility and 24 hours of coverage per day for the inpatient units.
Nurse management for the unit includes a nurse manager and clinical coordinator, who are registered nurses. The unit staff include registered nurses; hemodialysis technicians; a purchasing, business and quality control technician; clerical support (a receptionist); and a data entry specialist dialysis tech. Registered nurses in Renal Services meet the basic requirements for the registered nurse staff and function in accordance with a unit-based job description as described in the hospital plan for nursing care. Other members of the multidisciplinary care team include a physician’s assistant, a vascular access outcome coordinator, a social worker and a dietician.
Collaboration on the units among nurses is fostered by the mentoring of staff, participation in multidisciplinary care rounds and commitment to a team approach to care. Patient assignments are made by the charge nurse (chronic unit) or designee based on patient care needs and competency levels of the practitioner. All registered nurses are required to complete clinical skill measurements required for orientation as well as maintain annual clinical skill measurements. Nursing staff are provided training experiences to attain and maintain competence in their role as defined by the job description for the specific role and departmental education plan.
Staffing Plan
Nursing care in Renal Services is based on a team nursing delivery model. In the Adult Chronic Unit, a charge nurse is assigned to each eight- to 10-hour shift and is responsible for the overall operation of the outpatient unit. Three registered nurses are assigned to 10-hour shifts with 48 patients (24 patients per shift). A hometraining registered nurse supports the hometraining area and acute/pediatric/chronic units as needed. Five to six hemodialysis technicians and a purchasing, business, and quality control technician are also assigned to the area.
The acute/pediatric unit is staffed by a charge nurse and three registered nurses for the day shift, two hemodialysis technicians per day shift, a registered nurse for the evening shift, and a registered nurse for the night shift.
Minimum staffing is based upon patient census, acuity mix and availability of assisting nursing staff. Clerical support coverage is provided 10 hours per day, Monday to Saturday, as well as support for ancillary service requisitions.
The nurse manager, clinical coordinator or charge nurse (chronic unit) will make decisions concerning the overall adjustment of staff, either increasing or decreasing according to census and acuity.