I have a staff that I like very much as far as their degree of service and caring, nevertheless, I go to dialysis everytime, afraid of contracting a bacterial infection, because they do not follow asceptic technique. By this I mean, they do not wash their hands inbetween patients, they tape a small bag for dirtied dressings to patients' sidetables and they push the supply cart to each chair etc. They also do not have adequate technical knowledge (i.e silencing machine alarms, setting up machine wrong, unable to correct tx problems etc).

Please don't say to talk it over with my administrator; he is probably the one who is allowing the break with procedure. If I go to the doctor, that makes me the unit tattletale and I will be snubbed socially as well as neglected when I need care. Actually, I believe the doctors are aware shortcuts occur, but approve it. They approve our being understaffed for the profitability of the company and want the staff to be as efficient as possible. The reason I believe this is, because everytime I have asked my doctor about a choice in care that would be in my best interest, the answer is "no" because it doesn't lend to efficiency of the unit overall.

I very much need a solution to this ongoing problem without my being put in an adversarial position. I have enough problems with my kidney disease and do not have the physical reserves to oppose the company. We do not have a patient grievance system, so everything is onesided. Thanking you in advance for your assistance.

Sal--
You have a renal network that you can go to. These people are charged with ensuring that facilties receiving Federal monies are doing "the right thing". You can do this anonomously--please don't settle for poor care. Most of us really want to do a good job--those who don't need to be "brought up to speed". Good luck!

Renal RN,
I did contact my renal network, but it was anything but anonymous. They would not investigate the unit unless I entered into a formal, written complaint. I chose not to proceed as how was I to know that the network could be trusted? I didn't know them and my health and possible life was on the line. I did not feel that it was an equitable situation.

On a subsequent occassion, I spoke with my social worker who leveled with me that in all the years he had been a renal social worker (20 something), he had never once seen the renal network assist or protect a patient from what amounts to industry politics.

I was glad I had trusted my instincts not to cooperate with the renal network that day. I also subsequently talked with an official of the network and she devuldged to me that it is too bad that everyone won't come to the bargaining table and do whats in the best interests of patients and all concerned - its been like this for years.

It shouldn't have to take an Act of Congress for units to comply with safe practices and adequate training, but after 30 years of the ESRD program why is there not a grievance system for patients?

Would appreciate a reply from the moderator. Thanks in advance.

If you have concerns about the quality of the care that you and patients in your clinic receive you have several options and it's usually best to go up the chain of command. Every facility must have a grievance policy by federal regulation. Some post their grievance policy in their waiting room. Others give a copy to every new patient. If you don't have a copy, ask for one. This lets you know the chain of command if you have a complaint or concern.

Generally this is the chain of command:
1) Talk with the nurse manager or administrator. You said that you didn't think this would help, but it's to the financial advantage of the clinic for patients to stay healthy and not be hospitalized. Clinics cannot collect fees when patients aren't getting dialysis. If a nurse or technician doesn't follow sterile technique and infects a patient's access, there is a possibility that the patient will miss treatments at the clinic while getting treated for the infection. Be prepared to point out specific situations that you've observed. If possible come with solutions, not just problems.
2) Talk with the physician. Don't count on the doctor being aware of short cuts that take place. In many cases, they're not at the clinic often enough to see breaks in sterile technique. Point out to the doctor specific situations that you've observed. However, perhaps you could suggest that sterile technique could be a continuous quality improvement project for the clinic. If so designated, one or more staff members would likely be charged with observing what goes on in the clinic and reporting back problems to the CQI team.
3) If your clinic is part of a corporation you can go to the regional manager or higher. If your clinic is individually operated, it probably has a board of directors to whom you can take your grievance.
4) The Network has personnel (generally social workers or nurses) who handle patient complaints. Although they may know staff at clinics, this doesn't mean that they are biased toward clinic personnel. If you present your observations to them in an unemotional way, they should investigate your complaints.
5) You can contact the state health department (see www.medicare.gov for helpful contacts). Medicare contracts with state health departments to survey clinics to assure that quality care is provided. Most surveyors are nurses. Some have dialysis experience, but others do not. They are experienced surveying health facilities. When they survey, they generally spend a few days at the clinic, observe the clinic and staff going about their regular activities, read charts, ask questions about orientation, treatment procedures and staffing in interviews with staff, and ask patients about the quality of the care they receive. They review the facility's procedures manual, ask for documentation of staff education and training, ask for copies of minutes of meetings, etc. to be sure that the clinic is following all federal regulations.
6) You can ask to be trained to do home hemodialysis if you have someone (family member, friend, paid assistant) to help you. Unless you have a medical reason why you can't do it, if you have no partner, you could learn to do peritoneal dialysis.
7) You can change facilities. However, this may require you to change nephrologists. If you are concerned about your care and you've addressed concerns to the appropriate people without improvement and home dialysis isn't an option, this may be the only way you can be sure that the care you receive is appropriate. Before you change facilities, be sure to tour other facilities and talk with staff and patients. You might want to look at Dialysis Facility Compare (also at www.medicare.gov) to see what facilities are in your area. The clinical outcome data published (anemia, dialysis adequacy, survival)is somewhat old, but is the most recent data available.

Bottom line...the person that has the most to win or lose and the one that cares the most about you and your health is YOU. Don't be afraid to speak out. By doing so, you could not only be helping yourself and other patients, but you could be saving your clinic money that it surely would lose to hospitals if you or your fellow patients become ill due to poor sterile technique as a result of inadequate training or even staff sloppiness.

quote:

Originally posted by Sal:
Renal RN,
I did contact my renal network, but it was anything but anonymous. They would not investigate the unit unless I entered into a formal, written complaint. I chose not to proceed as how was I to know that the network could be trusted? I didn't know them and my health and possible life was on the line. I did not feel that it was an equitable situation.

On a subsequent occassion, I spoke with my social worker who leveled with me that in all the years he had been a renal social worker (20 something), he had never once seen the renal network assist or protect a patient from what amounts to industry politics.

I was glad I had trusted my instincts not to cooperate with the renal network that day. I also subsequently talked with an official of the network and she devuldged to me that it is too bad that everyone won't come to the bargaining table and do whats in the best interests of patients and all concerned - its been like this for years.

It shouldn't have to take an Act of Congress for units to comply with safe practices and adequate training, but after 30 years of the ESRD program why is there not a grievance system for patients?

Beacause they give you networks to make it seem the like the want to hear you .Network no resolve Dr no resolve Administrator and her supervisor no resolve. Never start with them Go to the health dept and the State Liscencing board that will get the ball rollind and start a investigation the may be able to give other sources good luck