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Friday, May 25, 2012


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Roberta Mikles BA RN

Peter, thanks for posting this most informative information - The following are my opinions -
To start, I believe that each patient, who wants to return to work, or start work, should have such opportunity - As I have stated, many times, when a patient is injured at work, they are able to be rehabilitated and the same should apply to those who must stop work due to dialysis and related issues -- Many patients can not return to work, or can not even start to work, for a variety of reasons, therefore, my opinion is that is we focus on employment rates to measure dialysis outcomes, we are placing the entire population in jeopardy of unintended negative outcomes - I fully agree with your comment on this -- I, too, applaud those for their efforts who are focused on this aspect -- but, CAUTION --- we have major problems existent now in the dialysis world -- even if some believe that surveys/inspection reports are useless, they still show very serious problems in units -- if we get 'back to the basics' perhaps we would see patients feeling better, improved outcomes, less complications etc. Are providers reinventing the wheel with all that is happening at the CMS level? As I have stated, over and over --Each patient is an individual, unique unto themself, therefore, requiring an individualized treatment -- Patients need to be included in their care and part of the team - not on paper, but in reality -- Patients need to be fully educated as to that which staff will be implementing in order to remind staff if they (pt) observe an incorrect practice being implemented -- (APIC discusses this when it comes to infection prevention in their "Guidelines for Hemodialysis Infection prevention")_

Would focusing on employment rates leave others behind? Would focusing on employment rates encourage providers to ONLY look at this aspect? The dangers far outweigh the positive results -- again, stating that we must take the entire population into account -- BEFORE ANYONE CAN RETURN TO WORK, THERE MUST BE AN IMPROVEMENT IN DELIVERY OF CARE TO THE POINT THAT PATIENTS DO NOT EXPERIENCE NEGATIVE OUTCOMES/CONSEQUENCES FROM TREATMENTS e.g. removal of too much fluid in too short a period of time, etc ..(how many patients have had complications - from minor to serious - due to short treatment times, etc. ---how many patients could have benefited from an extra treatment that week, but they were not ordered such --?)

Considering this is a profit-making world of delivery of dialysis care --- we need to walk very carefully in this respect --- My fear is that, again, if the 'employment rate' is the measure that is used, this will allow providers to leave behind the most vulnerable of dialysis patients - having been in many units, as we all have, I have witnessed the most vulnerable receiving different care than those who are able to speak up and openly communicate, or try, with staff... I have observed staff turning off an alarm and not checking a patient, who is asleep, or elderly, or unable to communicate for some reason, while on the other hand, observed staff turning off an alarm and checking a patient who is awake and alert and communicative with staff... This happens in many units and is the reality, .. With all the known information about the delivery of care in many units in the U.S. I have to wonder where people/advocates are coming from -- why doesn't anyone realize that many units are not adhering to their own policies/procedures or regulations/Conditions? Why have we not seen improvement in care e.g. decreased infection rates, over the last few years, considering providers have been aware that infection is the number two killer of their patients? Why haven't we seen increased levels of supervision in units to ensure correct practices are implemented? Why are there minimal standards for dialysis units? Why are there NO real effective consequences for providers (e.g. there are for nursing homes and hospitals) when negative outcomes occur?

Inspection reports for California can be read at www.qualitysafepatientcare.com

My advice ----Walk slowly with this because the unintended consequences of having 'employment rates' as the leading factor/aspect, might prove dangerous for the more vulnerable dialysis patient, who can not return to work, or start to work.....

opinions of Roberta Mikles BA RN www.qualitysafepatientcare.com
Dialysis Patient Safety Advocate

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