Planting the Seeds for Patient Centeredness: Tips for Your Home Dialysis Training Program

Patient-Centered

I asked those who do home dialysis who post on the Home Dialysis Central Facebook page to make suggestions for the perfect dialysis clinic. Here’s what they suggested.

Patient Education, Training, & Follow-Up:

• Offer group education to prospective home patients involving the MD and all other disciplines.
• Assure that home training nurses are knowledgeable about all modalities to provide education to prospective home patients.
• Provide accurate information on Medicare and employer group health plans, including applications and coverage.

• Expect the home dialysis patient to take as much responsibility for home treatment as possible to reduce care partner burnout and home HD failure rates.

• Offer training outside normal work hours.
• Offer training for home dialysis in the patient’s home.
• Start training a small group of patients and care partners on the HD machine in a classroom setting, using a training curriculum that allows patients in the group to move at their own pace. Make sure that each patient/partner pair feels comfortable with machine operation before training on other aspects of dialysis.
• Have an experienced RN teach cannulation to home patients.
• Make home visits for the first few home HD treatments to assure patients/care partners feel comfortable.
• Make monthly meetings with physicians optional with the potential to substitute with FaceTime or email.
• Perform the lab tests needed to meet patients’ needs and provide patients copies of all their lab test results.
• Provide NxStage patients the results from the NxStage dosing calculator.
• Give patients a written progress note after clinic appointments so they and their care partner can refer to it later.
• Consider having a suggestion box or comment cards to identify areas where improvement is needed.
• Train patients and offer in-center self-care in a section of the treatment room for those who can't do dialysis at home. Allow self-care patients to reserve their times and chairs online. Assign a single tech to oversee those patients.

Care Partners:

• Pair single home HD patients to be each other's care partners.
• Make it possible for dialysis patients to share a trained private pay tech to help with home HD treatments.
• Do not require all patients to have a care partner for home HD.

Individualizing Care:

• Individualize dialysis prescriptions. For example, ask if someone urinates to avoid taking off too much fluid.
• Use a more holistic approach to care, explaining common problems that ESRD patients have and making referrals as needed.
• Ask about the patient's needs, lifestyle, and listen to the patient. Patients choosing home dialysis are generally more involved in their healthcare and are well informed about their unique situation.
• Be open to changing policies and procedures if there is evidence to show that something else works better for a specific patient.

Supplies:

• Use something other than enuresis pads as leak detectors.
• Offer patients the option to use single needles.
• Provide all nocturnal HD patients with a heparin pump.

Staffing:

• Employ home training nurses who are experienced, calming, and know how to troubleshoot questions/concerns home patients may have about the equipment/supplies they’re using and treatment issues.
• Make sure that all home patients, including stable working ones, have enough access to social workers and dietitians. This may require reducing caseloads.
• Reduce turnover by doing what it takes to maintain continuity of staff (RN, RD, and MSW). Accept that some patients may have more home dialysis experience than staff.
• Employ staff who speak prospective and current home patients’ language(s) and can communicate well.

Most of those who responded were home HD patients or their care partners. You might want to ask your patients for suggestions of ways to improve your program’s “patient-centeredness.” Consider incorporating suggestions you get from your patients and those in this blog into your home program. Doing so might help you increase the number of new patients and retain the patients you already have while helping to improve your patients’ satisfaction.