Policy
and Procedures of Nephrology Unit
Index
1.
2.
Vision
3.
Organizational Chart
4.
Committee frame of reference
5. Scope
of service
6.
Departmental organizational chart
7.
Annual Plan
8.
Departmental Organizational Goals
9. Internal
policy and procedures of HD:
10. Job
description
11.
Employee manual
12.
Orientation program
13.
Performance improvement program
14.
Quality management plan
15.
Incident reporting form
16.
Clinical review system
17.
Medical records
18.
Admission and discharge criteria
19.
Admission consent form
20.
Consent for operations and procedures
21.
Infection control plan
22.
Safety plan
23.
Information management plan
24.
Medical staff Bylaws
25.
Emergency Plan
1.
1.1 Mission statement:
We exist to prevent deterioration of kidney functions as much as we can,
and to make the quality of life for patients suffering from end stage renal
failure much better.
1.2 Major role:
Perform urgent dialysis.
1.3 Customers:
Patients who need nephrology care in:
1.3.1 Patients admitted allover the hospital especially ICU.
1.3.2 Patients coming from home for regular dialysis.
1.3.3 Patients in OPD & ER.
1.3.4 Visitors performing Hajj and Umrah.
1.4 Activities:
1.4.1 Manage nephrology cases during the daily round.
1.4.2 Do urgent dialysis, either hemo or peritoneal.
1.4.3 Do regular hemodialysis.
1.4.4 Evaluating patients in ER.
1.4.5 Follow-up of patients after discharge in OPD.
1.4.6 Participate in continuous medical education program of the hospital.
1.5 Finance:
Almost all the needed equipments and materials are supplied by MOH. Few
items are supplied by donation.
2.
Vision
After 5 years, we hope our unit will:
2.1 have 15 HD
machines.
2.2 have 1
Haemofiltration & plasmapheresis machine.
2.3 have 1 CAVH machine.
2.4 have a
consultant nephrologist.
2.5 have 2 more nephrologists.
2.6 have 2 more
residents.
2.7 have 6 more
dialysis technicians.
2.8 Expand working
hours to 16 hours/day.
3.
Organizational Chart
3.1 Manpower:
Hospital director
Medical director
Head of Nephrology
Consultant nephrologist (if any)
Nephrology specialists (older is senior)
Residents (older is senior)
Head technician
Dialysis technicians (older is senior)
3.2 Dialysis machines:
3.2.1 by brand: 8 Fresinius
& 2 Dialogue
3.2.2 by infection: 4 for hepatitis C
1
for HIV
2
for Unknown serology
3
for Negative
4.
Committee frame of reference
4.1
The unit is under the technical supervision of the general supervisor of
nephrology centers in the holy capital.
4.2
All the doctors of the unit attend the monthly meeting of Jeddah Nephro Club.
4.3
Annual report is sent to Saudi Council of Organ Transplant (SCOT).
5.
Scope of service
It is to give the nephrological care for patients in the area belonging
to the hospital and for patients in Mena which is very near to our hospital and
so crowded in Hajj.
5.1 Customers:
5.1.1 Internal customers: they are all inpatients in all
clinical departments who need nephro care. Cooperation with all other specialties
is essential.
5.1.2 External customers: they are:
·
Patients on regular HD.
·
Patients for follow up in OPD after discharge.
·
Patients referred from other OPDs.
·
Patients referred from primary health care centers.
5.2 Demography of customers: see monthly and annual statistics.
5.3 Outline: our unit offers nephrological support for all patients who need
this service and eligible for that. If a patient needs a service which is not
available in our unit, we refer him to
5.4 Hours of service provision: daily from 7:30 Am to 8:00 Pm we
have doctors and nurses. From 8:00 Pm to 7:30 Am we have on-duty nurse and
on-call doctor. Week end is covered by on-call doctors and nurses only.
5.5 Service providers: we have one nephrologist (HOD), 2 residents, and 6 dialysis
technicians.
5.6 Equipments:
·
10 HD machines
·
7 electrical beds
·
1 crash cart
·
1 ECG machine
·
6 sphygmomanometers
·
1 vital signs monitor
·
2 pulse ox meter
·
Stethoscopes
·
2 electronic weighing machines
·
Water treatment system with 2 chillers
·
Personal computer
5.7 Interdepartmental relationships:
5.7.1 Departments we help: all clinical departments specially
ICU. Discussion with other colleagues in those departments is case dependant.
5.7.2 Departments we depend on: our work depend on laboratory work
and radiology work to a great extent. Discussion and follow up with both
departments is very good but is irregular according to needs. We have a written
protocol with laboratory regarding chemistry forms and serology forms.
6. Departmental
organizational chart
Dr. Hamdy Mehelba
Dr. Mohammad Hassan Abbass
Dra. Safaa Abdulwahed
Tec. Abdurrahman Arrezqi
Tec. Abdulla Oioony
Tec. Hemdan Al-Ossaimy
Tec. Nazma Shaheen
Tec. Hossa Makki
Tec. Warda Saraby
7.
Annual Plan
At the end of the year after the hajj season, we do the following:
7.1
Collect the monthly statistics and spKt / V, and do the statistics for the
year.
7.2 Analyze the statistics of the last 2 years.
7.3
Determine the plan of the coming year regarding unit’s need of manpower,
equipment, supply and any other needed system.
8.
Departmental Organizational Goals
8.1
Increase the manpower.
8.2
Increase the HD machines.
8.3
Have more advanced equipment.
8.4
Working all together as teamwork.
9.
Internal policy and procedures of HD:
After taking dialysis consent, taking vital signs of patient, and
weighing patient if possible:-
9.1 Insertion of a central venous catheter:
9.1.1 Policy:
It is to have a temporary vascular access for hemodialysis quickly,
safely, and totally aseptic.
9.1.2 Equipment:
2 catheter sets, table, 4 sterile sheets, sterile gauze, wide plaster
tape, alcohol, Iodine, sterile gloves as 2 per operator, sterile gowns as one
per operator, masks, 2 eye shields, 2
sterile forceps, 5 syringes of size 10 and 20 cc, 2 syringes of 5cc size, 2
pointed scalpels, scalpel handle, needle holder, stitch 02, xylocaine 1% IV,
heparin, Saline, kidney basin, sterile
scissor, sterile bone-cutting forceps, tubes for blood specimens(CBC, chemistry,
APTT, and serology), and investigation
forms.
9.1.3 Procedure:
9.1.3.1 All staff put on their gowns, masks, gloves…..etc.
9.1.3.2 Disinfection by iodine then alcohol.
9.1.3.3 Insertion according to medical rules.
9.1.3.4 Fixation.
9.1.3.5 Dressing.
9.1.3.6 Check position and rule out complications by X-ray for jugular and
subclavian catheters.
9.1.3.7 Connect the patient to previously prepared dialysis machine.
9.2 Insertion of fistula needles:
9.2.1 Policy:
Insertion for regular dialysis with safety and
asepsis.
9.2.2 Equipment:
2 fistula needles 16 gauge, sterile gauze, alcohol, iodine for grafts, 3
syringes 20 cc, saline, heparin, plaster tape, sergicell, 2 non sterile gloves,
hand disinfectant, 1 sterile sheet, and 1 absorbing sheet.
9.2.3 Procedure:
9.2.3.1 Wear your glove, mask, eye shield if
needed.
9.2.3.2 Disinfect puncture site.
9.2.3.3 If patient request, give xylocaine first.
9.2.3.4 Insert the difficult needle first.
9.2.3.5 Insert the other needle more than 3 cm distant from the first. Remember
to change site of insertion regularly.
9.2.3.6 Ensure good flow of both needles.
9.2.3.7 Fix them firmly for safe free movement of patient’s arm.
9.2.3.8 Connect the patient to dialysis.
9.3 Terminating dialysis session:
9.3.1 Slow
blood pump to 50 ml/min.
9.3.2 Start termination carefully, avoid any air to pass to patient.
9.3.3 Remove needles and apply wise compression of puncture sites. Don’t stop
compression till bleeding stops. Use sergicell if needed. Call doctor if
needed.
9.3.4 Record
post dialysis vital signs.
9.3.5 Check post
dialysis body weight and record it.
9.3.6 Always
keep friendly with the patient.
10. Job
description
All staff in the unit must have BCLS & ACLS certificate.
10.1 Head of the unit:
10.1.1 Qualifications:
consultant or specialist registered nephrologist.
10.1.2 Skills:
medical, administrative, leading, planning and
ethical.
10.1.3 Link:
to medical director.
10.1.4 Duties:
10.1.4.1
Plans, coordinate, directs all unit activities.
10.1.4.2
Determine policy and procedures of the unit.
10.1.4.3 Determines and follows up unit needs regarding equipments, supply and
manpower.
10.1.4.4
Assigns doctors in different sites of the work.
10.1.4.5
Works for unit improvement and development.
10.1.4.6 Participates in committees related to the unit work.
10.1.4.7 Participates in medical management of patients and discussing it with
other doctors.
10.1.4.8 Supervises and participate in Continuous medical education program.
10.1.4.9
Evaluating unit’s doctors.
10.1.4.10 Supervising quality management and infection control programs in the
unit.
10.1.4.11 Reporting regular statistics to medical director.
10.1.4.12 Do his duty as consultant or specialist nephrologist.
10.2 Consultant Nephrologist:
10.2.1 Qualifications:
as by MOH.
10.2.2 Skills:
Excellent medical knowledge, communication, developing and improving.
10.2.3 Link:
HOD.
10.2.4 Duties:
10.2.4.1
Managing all patients medically.
10.2.4.2
Supervising and training juniors.
10.2.4.3
Replying consultations from outside the unit.
10.2.4.4 Planning and participating for medical education and training.
10.2.4.5
Sharing the on call system.
10.2.4.6 Do whatever ordered from HOD and related to his work and experience.
10.3 Specialist Nephrologist:
10.3.1 Qualifications:
as by MOH.
10.3.2 Skills:
Very good medical knowledge, communication, developing and improving.
10.3.3 Link:
Consultant nephrologist.
10.3.4 Duties:
10.3.4.1
Managing all patients medically.
10.3.4.2
Supervising and training juniors.
10.3.4.3
Replying consultations from outside the unit.
10.3.4.4 Participate in planning for medical education and training.
10.3.4.5
Chairing the on call system.
10.3.4.6 Insert Central venous catheters and difficult fistulas.
10.3.4.7 Do whatever ordered from HOD or consultant and related to his work and
experience.
10.4 Resident:
10.4.1 Qualifications:
as by MOH as a general practitioner and good experience in working in
nephrology.
10.4.2 Skills:
Good medical knowledge, communication, developing and improving.
10.4.3 Link:
Specialist nephrologist.
10.4.4 Duties (all under specialist supervision):
10.4.4.1
Managing all patients medically.
10.4.4.2 Supervising and training juniors and technicians.
10.4.4.3
Follow up of patients during HD.
10.4.4.4 Participates in medical education and training.
10.4.4.5
Chairing the on call system and night duty.
10.4.4.6 Insert Central venous catheters and difficult fistulas.
10.4.4.7 Doing all medical reports and discharge summaries.
10.4.4.8 Following all investigations.
10.4.4.9 Do whatever ordered from his seniors and related to his work and
experience.
10.5 Head
Technician:
10.5.1 Qualifications:
As by MOH and very good experience of working in dialysis and has a
leading skills.
10.5.2 Skills:
Administrative, leading, good English, operating HD machines, ability to
fix minor machine problems, ability to mange usual HD complications and to give
good nursing care.
10.5.3 Link:
HOD.
10.5.4 Duties:
10.5.4.1
Preparing HD machines for HD.
10.5.4.2
Connecting patients to HD.
10.5.4.3 Recording vital signs and managing patients during HD under supervision
of doctors.
10.5.4.4 Executing doctor’s orders.
10.5.4.5 Obeying safety and infection control rules.
10.5.4.6 Do whatever ordered from his seniors and related to his work and
experience.
10.5.4.7 Maintains the supply of his unit and plan for what is needed with HOD.
10.5.4.8 Organizing technicians to fulfill the work requirements, supervising and
teaching them.
10.6
Dialysis technician:
10.6.1 Qualifications:
as by MOH.
10.6.2 Skills:
Good English, operating HD machines, ability to fix minor machine
problems, ability to mange usual HD complications and to give good nursing
care.
10.6.3 Link:
To his seniors.
10.6.4 Duties:
10.6.4.1
Preparing HD machines for HD.
10.6.4.2
Connecting patients to HD.
10.6.4.3 Recording vital signs and managing patients during HD under supervision
of doctors.
10.6.4.4 Executing doctor’s orders.
10.6.4.5 Obeying safety and infection control rules.
10.6.4.6 Do whatever ordered from his seniors and related to his work and
experience.
11.
Employee manual
We don’t have a separate manual but we plan to create it. Currently,
employer can use the hospital employee manual. New staff can get the
information they need from the head of department verbally and they have to
read our policy booklet.
12.
Orientation program
Aim: It is to introduce the new comer either an employee or a visitor to the
unit and prepare the new employee to join the team.
Steps:
For visitors:
1. HOD introduces himself
to the visitor.
2. HOD introduces the
doctors, nurses to the visitor.
3. HOD and head nurse
accompany the visitor to show him the dialysis area, the water treatment
system, the filing system and the administrative work.
For new employee:
1. HOD introduces himself
to the visitor.
2. HOD introduces the
doctors, nurses to the visitor.
3. HOD and head nurse
introduce the new comer to the patients.
4. HOD and head nurse
show him/her the water treatment system.
5. One doctor will
explain to him the utility of patient’s file.
6. The new employee is
given a copy of the unit’s policy and procedures, infection control policy,
emergency plan and machines manual to read it and follow it.
13.
Performance improvement program
13.1
On monthly basis: check the blood of the regular dialysis patients for certain
parameters, through which we:
13.1.1 Adjust and modify the drug therapy of the individual patient.
13.1.2 Adjust and modify the dialysis prescription of the patient.
13.1.3 Estimate the efficacy of dialysis given to the patient through
calculating spKt / V using a sophisticated formula by
computer. When we find patients had received dialysis of poor quality,
we analyze the possible causes and try to correct it.
13.2
On monthly basis, check the dialysis water as follows:
13.2.1 for TDS.
13.2.2
Microbiologically for infectious hazards.
13.2.3 for
metals and minerals.
13.3
On monthly basis, check the dialysate for correct sodium content and also for
microbiology tests.
14.
Quality management plan
14.1
Monthly spKt / V report is sent to quality management department.
14.2
Our target spKt / V is 1.2-1.8
14.3
Every 6 months, a form supplied by quality management department is filled and
self-assessment is done.
15.
Incident reporting form
15.1
The head technician records any important event daily in a log book for endorsement.
15.2
The incident report form for needle pricks is that of the hospital.
16.
Clinical review system
16.1 Dialysis patients:
16.1.1 Daily check: vital signs, weight gain, general wellbeing, physical
examination if any complaint.
16.1.2 Monthly check: CBC, full chemistry, Dry body weight, Patient’s
medications. Modifications are to be done accordingly.
16.1.3 Other
investigations: see patient’s file system.
16.2 OPD patients:
16.2.1 On first visit: history, examination, kidney function tests (KFTs).
16.2.2 On each visit: CBC, KFTs, modification of treatment if needed.
16.3 Admitted patients:
16.3.1 On first visit: history, examination, KFTs, renal sonogram, urinalysis,
24 hours urine and specific tests according to diagnosis.
16.3.2 Daily: systemic review, vital signs and KFTs (biochemistry), intake
output chart, CVP.
17.
Medical records
17.1 File system:
17.1.1 Inpatients will have the same file system of the hospital.
17.1.2 HD
patients have a special file system (attached).
17.2 Medical reports:
17.2.1
Inpatients follow the hospital system.
17.2.2 HD
patients: 17.2.2.1
Brief report in Arabic.
17.2.2.2 Detailed report in English for transplantation.
17.2.3 All reports should be requested by the patient through hospital
administration.
18.
Admission and discharge criteria
18.1 Admission criteria:
18.1.1 for
inpatients: same as hospital criteria.
18.1.2 for HD
patients:
Admission is temporary for 5 hours per session, 3 times per week.
Criteria are ESRD, eligibility, vascular access, haemodynamic stability.
18.2 Discharge criteria:
18.2.1 for
inpatients: 18.2.1.1
Stable kidney functions.
18.2.1.2 Follow up plan: OPD, HD or cure with no follow up.
18.2.2 for HD
patients: 18.2.2.1
Completion of HD session.
18.2.2.2 Cessation of bleeding.
18.2.2.3 Stable vital signs.
19.
Admission consent form
19.1
For inpatients: same as the hospital.
19.2
For HD patients: a special consent form (see file system).
20. Consent
for operations and procedures
The same consent form for admission and procedures in the file system is
to be signed by the patient and his relative. For irresponsible patients a
hospital committee formed by medical director to decide the start of dialysis.
21.
Infection control plan
21.1 General precautions:
As the hospital infection control
manual regarding hand washing, disposal of sharp objects, no recap of
needles…..etc.
21.2 Specific precautions:
21.2.1 Hepatitis B patients to be dialyzed with a separate machine in a
separate room.
21.2.2 HIV patients to be dialyzed with a separate machine in a separate room.
21.2.3 Hepatitis C patients to be dialyzed with separate machines. Separate
room is advisable if available.
21.2.4 Negative patients should be dialyzed with separate machines, in a
separate room if available.
21.2.5 Assigned technician should not handle other patients with different
serology.
21.2.6 Dialysis technician should wear a separate glove for each patient.
21.2.7 Bed sheets and pillow covers should be changed and disinfected after
termination of each patient.
21.2.8 Disinfection of the dialysis machine should be done as follows:
21.2.8.1 Chemical disinfection of the inner tubing of the machine after each
dialysis session using the machine manufacturer recommendations.
21.2.8.2 Thermal disinfection of the machine at the end of the week.
21.2.8.3 Disinfection of the outer surface of the machine using Clorox 10%
except screen part by Alcohol after each use.
21.2.9 Water treatment and distribution
systems used for the production of dialysis fluid shall be treated to remove
bacterial and chemical contaminants and should be checked monthly and whenever
necessary by hospital maintenance according to hospital policy and procedure.
21.2.10 All hepatitis B negative patients and staff should have Immunization
according to medical rules.
21.2.11 Patient’s prick site should be disinfected with alcohol in fistulas and
with Iodine for grafts.
21.2.12 Central venous catheters should be dealt with absolute aseptic
technique and by a doctor if possible.
21.2.13 all personnel caring for dialysis
patients shall understand the risk of infection transmission and take
appropriate measure to prevent and control infection to and from patients and
personnel.
21.2.14 all personnel involved in patient
dialysis shall be educated and knowledgeable about the dialysis equipment including
water treatment system and all disinfection and sterilization strategies which
are necessary to prevent the transmission of infection before, after and during
dialysis.
21.2.15 Disposable dialyzers and tubes
should be used and discarded after each use.
21.2.16 Smoking, eating and drinking are
not allowed inside the dialysis area.
21.2.17 Hands must be washed with
chlorohexedine 4%.
21.2.18 anything in the dirty area beyond
the imaginary dirty line should not move back to the clean area.
21.2.19 Barrier precautions:
21.2.19.1 Disposable gloves should be worn by
staff members when handling patients, body fluids or dialysis machine parts.
21.2.19.2 Scrub suits and aprons should be
worn at all time while working.
21.2.19.3 Plastic visors should be worn to any
procedure in which splashing of blood is likely to occur.
21.2.20
Cleaning procedures:
21.2.20.1 Gloves should be worn for all
cleaning procedure.
21.2.20.2 Clean the outer surfaces of HD
machine as mentioned before after HD session.
21.2.20.3 Clean the entire dialysis
environment with Clorox 1000 ppm at the end of the working hours.
21.2.20.4 Wipe any blood and body fluids
promptly using a Clorox using the special kit and maneuver. This must be done
by the nurse himself.
21.2.21 disposal of trash and infectious
waste appropriately, following the general hospital policy.
21.2.22 Hepatitis and similar infections
prevention:
21.2.22.1 All patients and staff should be
screened for HBsAg and HBsAb, Anti HCV Ab, Hepa delta, HIV1,2, according to
fixed policy:
21.2.22.1.1 When they join to the unit to
determine basic serologic status.
21.2.22.1.2 Every three months.
21.2.22.1.3 When they return to the unit after
having HD elsewhere.
21.2.22.2 Hepatitis B vaccine must be given to
staff in the usual dose if found to be HBsAg negative and HBsAb negative/or low
titer.
21.2.22.3 Hepatitis B vaccine must be given to
patients as medical rules for HD patients (double dose, 0,1,2,6) if found to be
HBsAg negative and HBsAb negative/or low titer.
21.2.22.4 New patients entering the unit with
unknown serologic status are offered heamofiltration -if available and
applicable- until two serology results one week apart are received before they
are offered heamodialysis on the machine suitable to their serology. If
heamodialysis is mandatory, those patients must be dialyzed on a dedicated
machine for unknown serology patients only.
21.2.22.5 Staff members who have HBsAb on two
consecutive occasions at a level of at least 10 samples ratio units (SRU) need
only to be tested for HBsAb annually to verify their immune status. If HBs Ab
decreases to less than 10 SRUS or becomes undetectable, such persons shall be
considered susceptible and be re-vaccinated.
22.
Safety plan
22.1 Safety for patients:
22.1.1 Fire
fighting equipments should be available.
22.1.2
Emergency plan (attached).
22.1.3 Infection control precautions as mentioned.
22.1.4 Use of
modern machines which guarantee patients'
safety.
22.2 Safety for staff:
22.2.1 Fire
fighting equipment.
22.2.2
Emergency plan.
22.2.3
Infection control.
23.
Information management plan
23.1
Medical reports are given to information center of the hospital.
Other information about the work as a whole is given to hospital administration,
general supervisor of kidney centers in the holy capital and the Saudi Council
of Organ Transplant (SCOT).
23.2
Useful non-confidential information is published in our web page.
23.3
Feed back from our customers or public, can be received through our e-mail.
24.
Medical staff Bylaws
They are the same as those of the hospital.
25.
Emergency Plan
25.1 Electricity Shutoff (Power Failure):
25.1.1 As an experiment of generators:
25.1.1.1 HOD should be informed about it in advance regarding its date, time and
duration and he should agree to do the experiment.
25.1.1.2 The notice for experiment date and time should be placed in a clear
place in the unit. All the staff should be informed.
25.1.1.3 All dialysis sessions should be terminated 15 minutes before shutoff.
Don't remove needles or lines. After end of the experiment, dialysis sessions should
be completed as usual.
25.1.1.4 The time gap between shutoff and start of generators is noticed and
reported to administration.
25.1.2 Sudden unexpected electricity
shutoff:
25.1.2.1 All manpower (including porters) should hurry in dialysis area.
25.1.2.2 Medical staff should keep patients calm and quite and not allow any
corruption.
25.1.2.3 HD machines containing batteries is monitored, if batteries failed;
should be treated as non-battery machines.
25.1.2.4 Non-batteries machines should be operated manually (hand cranked) by
the technician, doctor or any person if no sufficient manpower.
25.1.2.5 If generators don't work quickly (within 10 min. approx.), HOD orders
termination of HD sessions manually, return the blood to patients, and they go
home. If electricity works back again, HD sessions are to be continued
normally.
25.2 Disaster and evacuation plan (Code red):
25.2.1 When code red is declared in hemodialysis unit?
If
there is fire or breakdown of the building …etc.
25.2.2 Hemodialysis unit site:
In
the floor of sunstroke building (see diagram).
25.2.3 Type of evacuation: Horizontal.
25.2.4 Evacuate to:
25.2.4.1 Main place: Emergency department, males to male
observation section and females to female observation section. ER trolleys
should be moved to examination area by ER team once code red in dialysis unit
is declared.
25.2.4.2 Secondary place: main hall of the hospital
reception, if fire is at the ER side.
25.2.4.3 Tertiary place: if the whole hospital to be
evacuated, our patients will be moved to outside hospital buildings.
25.2.5 Job description:
25.2.5.1 Job of HOD:
25.2.5.1.1 He is the leader of the whole process.
25.2.5.1.2 Determine the place to which evacuation should be.
25.2.5.1.3 Determine priorities for evacuation.
25.2.5.1.4 Medical supervision for patients till the end of process.
25.2.5.1.5 Participating as a member of the teamwork if manpower is less than
patients.
25.2.5.1.6 Ensures evacuation of medical records.
25.2.5.1.7 Helping other doctors.
25.2.5.2 Job of the
doctor (doctors):
25.2.5.2.1 Keeping patients calm and quite to avoid fatal complications.
25.2.5.2.2 Giving medical care to patients during evacuation process and dealing
with complications accordingly.
25.2.5.2.3 Working as a member of the teamwork if manpower is less than patients.
25.2.5.2.4 If more than a doctor is present, one goes with patients to ER, the
other stays in the unit till he moves with the last patient.
25.2.5.3 Job of head
technician:
25.2.5.3.1 Check for sufficient light either by opening doors or by emergency
light.
25.2.5.3.2 Shut the electricity main switch off.
25.2.5.3.3 Close main oxygen supply of the unit.
25.2.5.3.4 Immediate reporting code red to hospital director, deputy director, or
central operator.
25.2.5.3.5 Ordering one porter to open the door for evacuation and put the special
runway, then close the other door.
25.2.5.3.6 Participating in the activities as all other teamwork after finishing
doing his job.
25.2.5.4 Job of
dialysis technicians:
It is to perform evacuation activities.
25.2.6 Evacuation activities:
25.2.6.1 Head technician should disconnect electricity, oxygen supply.
25.2.6.2 Reporting code red as mentioned before.
25.2.6.3 HOD determines the place for evacuation.
25.2.6.4 Opening doors for evacuation.
25.2.6.5 Doctors start to keep patients quite.
25.2.6.6 Dialysis technician start to handle one patient as follows:
25.2.6.6.1 Stops dialysis machine.
25.2.6.6.2 Disconnects blood lines. Keep fistula needles clamped in place in
patient's arm. Fix it with additional tape. Don’t return blood in fistula
needles tubes to patient as it is time consuming and needs concentration. Leave
blood lines on the machine.
25.2.6.6.3 accompanies the patient on his bed (to avoid sudden hypotension) to
evacuation place.
25.2.6.6.4 Stays with his patient in ER to complete the evacuation process.
25.2.6.7 With last patient moving to evacuation place, all personnel leave the
unit to evacuation place and
close all doors.
25.2.6.8 In ER, technicians do the following:
25.2.6.8.1 Remove fistula needles and discard it aseptically.
25.2.6.8.2 Compress the insertion site for bleeding as usual.
25.2.6.8.3 Put dressing at the sites of pricks as usual.
25.2.6.8.4 Extract blood for CBC to check any need for blood transfusion. Patients
need blood should receive it in ER, patients need admission be admitted through
ER, and stable patients should be discharged home.
25.2.6.8.5 Evacuation is recorded in dialysis flow sheet.
25.2.6.9 Blood lines on HD machines should be discarded later as usual way
aseptically.
25.2.6.10 If manpower is less than patients, each technician or doctor should
handle one patient till he drop him to evacuation place, leave him to his
colleague and return back to handle another patient and so on.
Prepared
by Reviewed by
Dr. Hamdy M.
Mehelba Dr. M. Gamaluddin Makhdoom
Head of
Nephrology Medical Director
Approved by
Dr.
Abdurrahman Bakhsh
Hospital
Director