The aroma of the clinic was not one that was familiar to me. It was odd, and was the first thing I noticed upon entering the treatment floor to tour the clinic after my interview. The patients were consistent throughout the clinic; eyes closed, bodies covered with thick blankets. I proceeded into the reuse and water room where I was immediately intimidated by the components. The clinic manager was kind in reassuring me that eventually all of what I was seeing would be understood in time and I’d master each task as time progressed. Despite my fears and uncertainty, I accepted the offer to begin my career as a Hemodialysis Patient Care Technician. Several years later, I transitioned into a regulatory role and worked for the Department of Health as a Federal and State Licensing Surveyor.
Understanding the rules and regulations that govern the many types of healthcare facilities throughout the state intrigued me. The Centers for Disease Control and Prevention (CDC) defines infection control as “infrastructure and routine practices for occupational infection prevention and control services” (2019). Adherence to infection control practices can reduce patient hospitalizations in outpatient settings. We as healthcare providers have a responsibility to abide by exceptional infection control practices. Dialysis policies and procedures are in place to protect the health and safety of patients. Continuous education and training related to infection control is key to decreasing the risk of infection to our dialysis patients.
In addition to state rules, dialysis clinics must also adhere to the Centers for Medicare and Medicaid (CMS) regulations. Most of the population of dialysis patients have Medicare as their primary payer for dialysis services. For this reason, CMS has many regulations that dialysis clinics use as a support to comply with Federal regulations. Our clinics are surveyed every two to three years by CMS to ensure that they are in compliance with the basic requirements for continued certification, or Conditions for Coverage (CfCs). The CfCs vary depending on the provider type such as Hospice, End-Stage Renal Disease, Ambulatory Surgery Center, Rural Health Clinics and many more.
Dialysis providers have strict guidelines that must be practiced in order to ensure that patient safety is paramount in the patient’s daily care. Every patient must keep their access site uncovered during treatment. This may be uncomfortable for some patients because they are usually cold and like to be completely covered. Access sites must be visible so that the dialysis care team can see that the needles and lines are not dislodged, which can cause serious complications. Safety checks are also a guideline mandated by CMS under the CfCs. Every thirty minutes, staff must visually check and document the patient’s status during treatment. Some of these checks include ensuring that the access site is visible and intact, what the patient is doing (resting, reading, watching tv), bloodlines are secure and also reviewing the patient’s blood pressure and heart rate. Dialysis treatment documentation should tell the story of what happened during the treatment and how the patient responded to treatment. Documentation should never be left to interpretation.
Over the years, dialysis has changed and will continue to change as research evolves and new treatment options become available to patients. We as healthcare providers endeavor to move with the times, continuing to excel and advance in our respective disciplines. We have a responsibility to be in compliance with our local, federal and state organizations. Our patients deserve the very best patient care delivered in excellence and compassion, never compromising quality and value-based care. Our commitment to our dialysis patients can ultimately help provide a meaningful lifestyle that extends beyond the walls of the dialysis clinic. When our patients feel better, they show up as better people for their families and loved ones. Let us never compromise our integrity and work ethic for company metrics. Value-based, quality patient care should always be our motivation to continue in the wonderful work that we do for our patients every day.
Fresenius Medical Care North America