Description of Unit
The Renal Services Program at the University of Florida consists of separate inpatient and outpatient units for pediatric and adult patients. The nursing staff collaborates with other team members to care for patients receiving renal replacement therapy, for acute renal failure or End Stage Renal Disease.
Staff in the acute/pediatric unit have been cross-trained and are competent to treat acute adult patients as well as acute and chronic pediatric patients. Hemodialysis coverage for these populations is provided at Shands UF 24 hours a day, 7 days per week. The inpatient adult unit (acute dialysis) is a 6-station special care unit located on the hospitals fifth floor. The adult unit serves the medical/surgical population as well as a certain percentage of stable ICU/IMC patients. All patients with hemodynamic instability have their dialysis procedures performed at their bedside. The pediatric outpatient dialysis unit is a 5-station unit also located on the fifth floor of the hospital adjacent to, but physically separate from the inpatient adult unit. Both the inpatient adult unit and the pediatric unit provide care to patients who require hemodialysis, peritoneal dialysis and continuous renal replacement therapy (CRRT)
The Adult Chronic Unit is located at 2409 SW Archer Road. This unit has 24 hemodialysis stations and a home-training area with 3 clinical rooms. Hours of operation for the chronic area are: 05:00 am to 4:30 pm, with two shifts of hemodialysis, Monday – Saturday. Average occupancy is 100% first shift and 80 – 85 % second shift.
Description of Patient Population
The Renal Services/Dialysis Department exists to provide quality care to residents of Gainesville and the surrounding area. Staff working in the Renal Service Program strives to achieve a new standard of excellence in caring for the patient populations requiring renal replacement therapy. The staff is committed to patient advocacy and innovative patient care through encouraging family participation in care and soliciting patient and family feedback. The patient population is made up of patients who have been diagnosed with End Stage Renal Disease (ESRD) or Acute Renal Failure and require renal replacement therapy.
The staffs of the Renal Program assess and treat the needs of the unit’s patient population. Clinical functions include hemodialysis, peritoneal dialysis, CRRT (acute settings), administration of blood products (acute settings), intravenous medication administration, vascular access studies, and kinetic studies per regulations
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute or chronic dialysis treatment. Modalities for acute and chronic patient population include Hemodialysis, Peritoneal Dialysis, and Continuous Renal Replacement Therapy. The dialysis unit/role specific job descriptions identify the patient populations, equipment utilized, skills required to perform treatments/procedures, clinical parameters monitored, safety precautions initiated, and emergency events encountered. Nursing activities consist of: perform safely and effectively dialysis treatment prescribed according to nephrologist prescription, respiratory management including pulse oximetry, oxygen therapy. Pain management including patient controlled analgesia (acute unit); assessment and management vascular access; medication management including blood product infusions (acute unit) & ESA (Aranesp) product administration; safety precautions and patient/family education and support.
Health Care Team
The Dialysis Units consists of medical director (acute, pediatric, & chronic unit), adult and pediatric nephrologist, physician assistant (acute & chronic unit), and nephrology fellows.
The nursing management structure consists of a Director, Clinical Nurse Leader, and Assistant Business Manager. The unit staff includes Registered Nurses, Certified Clinical Hemodialysis Technicians (CCHT). Receptionist / Clerks provide clerical support for the direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan.
Departments of nursing staff are provided training experiences to attain and maintain competence as defined by the unit-based specific job descriptions and the departmental education plan. Other members of the multidisciplinary care team include Social Worker and Dietitian at adult Chronic OP unit.
Collaboration on the units among nurses is fostered by the mentoring of staff, the participation in multidisciplinary care rounds, and commitment to a team approach to care. Patient assignments are made by Charge Nurse based on the identification of patient care needs and competency levels of the practitioner. All registered nurses are required to complete the clinical skill measurements required for orientation, maintain annual competence, and annual clinical skill measurements. Nursing staff are provided training experiences to attain and maintain competence in their role as defined by the job description for the specific role and the departmental education plan.