What are the key concepts related to “Reasonable and Prudent” Care? (3)
- Standard of Care is care which a reasonable and a prudent nephrology nurse would give under the same or similar circumstances
- Actions a reasonable and prudent nephrology nurse would do as well as actions the nurse would avoid doing
- Skills and knowledge expected for a nephrology nurse is key to the specialty of nephrology nursing
Who established the Standards of Care for Nephrology Nursing and for what purpose?
- American Nephrology Nurses Association (ANNA) established the standards of care and scope of practice for Nephrology nursing
What are the 3 considerations when delegating nursing care activities?
- Must be within the nurse’s scope of practice
- Must be delegable by State Board of Nursing
- Personnel must be adequately trained to perform the activity
What role does DaVita’s P&P play? (3)
- provides evidence based guidance
- Meets CMS’ conditions for coverage (CfC)
- Complies with state and federal laws
What are the risks of performing activities your way?
Not providing safe evidence-based care can lead to Civil Liability
What are the 4 reasons that we document in the medical record?
- proof that care was rendered
- provides data continuity
- communication tool
- permanent legal record
List 6 occurrences when to document
- Change from baseline assessment
- Change in patient’s condition
- Procedure performed or treatment provided
- Medication given and patient response
- Patient teaching
- Care plan review and interventions
What does SMART communication stand for?
S: Simple - keep message clear and simple
M: Meaningful - think about what and why you are sending the message
A: Actual - just report the facts
R: Read - make sure you are sending the message you intend
T: Teach - teach others about SMART communication
What are the possible consequences of not using SMART communication? (4)
- exposes you and DaVita to liability
- reputational injury
- jeopardizes the recipient
- potentially care threatening
How do you document late entries? (3)
- If you’re not able to chart immediately at the time of service/observation, teammate has to make entry as soon as possible
- If documenting within electrical medical record, notation will automatically use your electronic signature, date, and time
- If you’re using paper chart, late entry has to be signed by the teammate making the late entry with time and date it was entered
How do you document charting errors?
Paper: Draw a single line through the entry, date/signature/teammate credentials, and then chart the correct information
Electronic: Follow your facility’s procedure for CWOW
What is the difference between data collection and assessment? Who is responsible for each?
Nurses - Assessment: Determines depth of edema, HR, heart rhythm, quality of heart sounds, respiration rate, rhythm, effort being put into breathing, identifying unusual lung sounds
PCTs - Data Collection: Noting presence of edema, counting the patient’s HR, respiration rate, recognizing unusual breath sounds, machine parameters, safety checks
What is the role of the licenses nurse prior to treatment initiation?
Assess abnormal findings from data collection, determine appropriate interventions (based on physician orders) and contact physician if needed
When is a pre-treatment assessment by the licensed nurse required?
patients with AKI - Always required
patients with CKD: depends on the State’s law or if data collection has abnormal finding
What is the role of the PCT prior to treatment initiation?
Complete data collection and PCT must notify the RN if there are any abnormal findings prior to initiation of treatment
What are the appropriate times for documentation? (4)
- prior to treatment initiation
- During pre-treatment patient data collection
- Observations during treatment
- During post-treatment data collection/assessment
What is the preferred location for taking a blood pressure?
Upper, non-vascular access arm
What BP reading error can be caused by an incorrect cuff size?
- cuff too small - reading may be higher than actual BP
*cuff too large - reading may be lower than actual BP
What is a normal pre-treatment blood pressure?
Systolic: equal to or less than 180 mm/Hg ; or equal to or less than 90 mm/Hg
Diastolic: Less than 100 mm/Hg or greater than or equal to 50 mm/Hg
What is normal heart rate range?
60-100 BPM
What is the normal respiratory range?
12-20 breaths/minute
What is a normal temperature?
Less than 100 degrees Fahrenheit or 37.8 degrees Celsius or less than 2 degrees Fahrenheit of baseline (pre-treatment reading)
The three words DaVita uses to easily recall the pre-treatment AVF/AVG access evaluation.
look, listen, feel
When is post-treatment assessment by the licenses state nurse required? (2)
- if required by state law
- if there were abnormal findings
