Location of treatment:
Patient Number (MRN or Encounter):
There is consent to place a vascular access device.
There is a consent for hemodialysis (according to organization policy).
Hepatitis profile performed prior to dialysis or at time of first treatment.
Pre-dialysis weight is documented.
- Access (AVF, Catheter, etc.)
- Lenth of Treatment
- Blood flow rate
- Dialysate flow rate
- Dialyzer to be used
- Dialysate bath (k+, Ca++)
- Medications (heparin, other)
- Blood (if indicated)
There is a consent for blood (if ordered).
Protocols are documented on the record (i.e. if a hypotension protocol is ordered PRN, a copy of it is on the record or described in the order).
Completed dialysis flow sheet.
Care plans address dialysis.
All entries are timed, dated and authenticated.
Handoff communications are documented (if required by policy).
There is patient education documented regarding dialysis.
The blood or blood product is matched to the order.
The blood or blood product is matched to the patient.
There is a 2 person verification process (or one person if accompanied by automated identification technology such as bar coding).
One individual conducting the ID verification in the 2 person verification process is the qualified person administering the blood.
The second person in the verification process is qualified to participate in the process as determined by the hospital.
The blood tag is completed and returned to the blood bank at the conclusion of the transfusion.
Vital signs during transfusion are monitored according to hospital policy.
There is a policy addressing reactions to blood and blood products.
Mask worn properly.
Hand hygiene performed (staff).
Don new clean gloves.
Apply skin antiseptic and allow it to dry. (No contact with site after antiseptic)
Insert needles aseptically (mask/PPE).
Connect blood lines aseptically.
Remove gloves and perform hand hygiene.
Mask worn properly.
Perform hand hygiene and don clean gloves.
Disconnect from blood lines aseptically and activate needle retraction device.
Clean gloves worn to compress site.
Clean bandage applied.
Gloves removed and hand hygiene performed.
Mask / PPE appropriately donned.
Hand hygiene performed.
New clean gloves donned,
Catheter hub scrubbed with antiseptic.
Hub allowed to dry.
Blood tubes connected aseptically.
- Hand hygiene performed and clean gloves donned
- aseptically disconnect blood tubings from catheter
- new caps placed on catheter aseptically
- gloves removed
- hand hygiene performed.
Quality controls performed (water - RO/DI)
Machines are cultured.
Appropriate cleaning process between patients (machines and environment)
Patient privacy observed.
Dialysis machines listed in hospital biomedical equipment inventory (even if owned by contractor).
Dialysis machines risk rated as critical in inventory (failure in use is potentially life threatening)
Dialysis machines PM'd on schedule
Dialysis machine repair records shared with hospital.
Appropriate storage used in the assigned dialysis area.
Dialysis contractor reports quality controls to infection preventionist.
Outcome metrics reported to the hospital.