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Friday, January 07, 2011

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MooseMom

Could you name five things that the dialysis industry could do right now that would have them gain your trust?

Peter Laird, MD

Trust is something that is earned. I will leave it to the dialysis industry themselves to define such an outcome if that is something that they desire.

MooseMom

Come on, help me out here. There are so many issues, so many obstacles, so many players that a newcomer like me needs to find a starting point. I know that trust is something that is earned, but we can't wait around for the dialysis industry to start singing kumbayah. So, if this was an ideal world and the dialysis industry was eager to gain your trust, what are five things they could do to achieve that goal?

Peter Laird, MD

Dear MooseMom, not to skirt the issues, but limiting the changes needed to only 5 would artificial limit the discussion, there are unfortunately more than 5 uniquely American Dialysis practices that in my opinion are contributing to poor outcomes for the sake of monetary gain just as Dr. Scribner stated many times over.

To sum them all up, I woud have to address your question with a simple retort, when the dialysis industry will provide their patients the same treatment parameters and modaliites that they themselves would choose if faced with ESRD, we will have arrived.

roberta mikles

Oh Peter, you hit a spot in our lives here, in my home.. When my father and I brought forth concerns to the medical director of his unit e.g. infection control, or lack of.... etc. we were told, especially me -- that I did not trust staff and that we were looking for fault with implying lawsuit..............We were told 'you need to trust staff (and, physician)..but what many did not understand,, is that trust is earned and if staff are not implementing correct practices then one can not trust... Earning trust... interesting concept..If a patient and/or family member is educated to what should be and they observe such not being done... well, how can you trust. There were many staff who did the right thing... and, even six years later, those who were not doing the right thing continue..
What was disappointing was to hear, over and over, about the unit not having infections and rates being so great... then to learn that in 2008 the facility was double that of state and national averages/percentages for access-related infections. Well, I was not surprised considering what I observed e.g. preparation for cannulation. I observed staff touch the outside of a contaminated treatment cart, opening a drawer, then taking the 2x2s for cannulation procedure, without washing their hands. Indeed, these gauze pads are not sterile but clean...but to touch a grossly contaminated object then those nasty germs are on the gauze that is touching the access site.... that was just one of many observations. I could go on and on, but to learn of the double rate, I knew we were doing the right thing in reminding staff (some, not all). But it does make a patient anxious and does not do anything to support a good relationship with staff because for the most part staff resent being reminded.. and, between the years of 2006 and 2008 35-50% of deaths were contributable to infection. So, I guess again, when we reminded staff, some every treatment, we were not too far off base. Thank God my father was educated and able to remind staff, otherwise, I know he would have acquired an infection. Interesting, one simple aspect was that no one disinfected chairs per the facility policy... interesting... but as I read the survey, latest one, they were cited. I never, in six years, ever saw anyone disinfect according to policy - which I learned as I read the survey. Ironic that the facility had their recertification survey the same day my father died (at home). The facility was inspected in the end of 2006 and then half way through 2010 .. Three and a half years.. or a bit less. This is infrequent, but the prior survey, as I read it, I was shocked to see over four deaths in center within short time span. Interesting that all deaths, maybe five, were all reviewed by the medical director and found to not be the result of preventable error. Well, ... interesting that after that survey, one staff came to me with questions e.g. what would happen if someone made a mistake, etc.At that time, I had not read the survey, as it was in process. But, again, there are good and bad in all facilities and those that care and those that don't. I am not stating that these deaths were result of preventable errors, just stating what I know and my opinions. Surveys have a voice of their own. There is NOT any reason why a patient should have to be concerned about reminding staff to implement a correct practice be it infection control, or machine settings. And, often, medical directors have no clue what goes on when they are not there, in addition to the dysfunctional cohesiveness that exists in many units....
opinions by Roberta Mikles RN
www.qualitysafepatientcare.com

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