DEFINITION
Assessment of the patient’s conditions following haemodialysis treatment to evaluate the effectiveness of the treatment and whether the treatment goals were achieved. Additionally, to undertake further action if any problems remain unsolved.
PURPOSE
1. To ensure that a safe and effective treatment was given, and that the patient is fit to be discharged from the treatment centers.
2. To identify any issues that require further action and follow up to ensure that the patient receives individualized therapy and thus maintain optimum quality of care.
CONDITIONS
1. This procedure should be carried out by two-experienced dialysis nurse
2. Applies to all Registered Nursing Personnel working in dialysis centers in Oman.
3. This procedure can be performed by a nurse undertaking nephrology / dialysis training program, provided he/she is closely supervised by an experienced dialysis nurse at all times.
EQUIPMENT
1. Stethoscope
2. Blood Pressure apparatus
3. Weighing scale
4. Thermometer
5. Patient’s file
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Check and record vital signs Blood pressure Pulse: rate, rhythm, and volume Temperature | Vital signs should be in the normal range. If there is deviation from the normal range, the physician should be informed and further action taken. |
| SN | Nursing Action | Rationale |
| 02 | Evaluation of fistula and vascular access Bleeding stopped and site is clean and dry. Dressing applied and secured. Patient educated about dressing management. | To ensure that there is no excess bleeding and no haematoma, and that the patient is safe to leave the treatment centre. |
| 03 | Administration of medications Ensure that prescribed medications are given. Administer additional medications as required in the light of findings from post dialysis evaluation. Document and sign for medications given or not given and mention the reasons (if not) for not giving the medications. | It is essential that all medications to be given as prescribed, as this is an integral part of the dialysis treatment. It is essential to maintain accurate and complete records of the administration of medications to allow monitoring of treatment response and the detection and management of complications. |
| 04 | Mental status The patient is questioned to ensure that he /she is aware of his / her situation, and that they are fit to return home as an outpatient. | Patient is oriented to time and p[lace and is safe to leave the treatment centre. |
| 05 | Weight Following assessment of blood pressure. Weighing patient, ensuring that he/she is in the same clothes etc. as for pre dialysis weight. Observe general condition observing for complications such hypotension. Document findings and interpret information obtained. If any abnormalities detected, inform the physician for further action. | It is necessary to compare pre and post dialysis weight to evaluate whether the treatment goal has been achieved. Further action may be necessary if there are abnormalities detected which may result in a change in dialysis prescription. |
| SN | Nursing Action | Rationale |
| 06 | General evaluation for other conditions and complications General discussion with the patient to evaluate general well being following dialysis with some general advice for subsequent home care. | Further action may be necessary if there are abnormalities detected which may affect the discharge treatment, or result in a change to the dialysis prescription for a subsequent dialysis. |
| 07 | Documentation of findings Overall evaluation of the patient’s condition to be recorded and signed by the nurse undertaking the evaluation. Any notes or instructions for subsequent dialysis treatment must be clearly identified and documented by the nurse carrying out the evaluation. | There has to be accountability for the delivery of dialysis treatment and evidence of the therapy management to achieve the goals of the dialysis prescription. It is necessary to ensure that there is continuity of care from one dialysis treatment to the next to maintain patient safety and well being. |