Chronic Kidney Disease and Dialysis

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Contents

Preface

Purpose of Clinical Practice Parameters

Role of the College of Physicians and Surgeons

Responsibilities of the College

Updating this Document

Volume 1: The Facility

CHAPTER 1.1 Introduction

CHAPTER 1.2 Program Organization and Administration

Overview
Program orgnization and administration

CHAPTER 1.3 Qualifications of Staff

Overview
Qualifications of Physicians
Quality Advisor
Medical Director
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Unit Manager
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Registered Nurse (RN)
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Registered Practical Nurse (RPN)
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Clerk/Receptionist
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Dialysis Technologist
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Dialysis Aide
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Dietitian
    Responsibilities related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility
Pharmicist
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff members
    Responsibilities Related to the Facility
Social Worker
    Responsibilities Related to Patient Care
    Responsibilities Related to Staff Members
    Responsibilities Related to the Facility

CHAPTER 1.4 Policies and Procedures
Overview

CHAPTER 1.5 Health Records
Overview
Health Records

CHAPTER 1.6 Providing Quality Care 
Overview
Monitoring Quality of Care

Volume 2: Chronic Kidney Disease Management

CHAPTER 2.1 Introduction 

CHAPTER 2.2 Staffing

CHAPTER 2.3 Policies and Procedures

Overview
Policies and Procedures

CHAPTER 2.4 Facilities, Equipment & Supplies

Overview
Clerical Area
Examination Room(s)
Office
    Additional Space Requirements
Building and Fire Codes
Infection Control

CHAPTER 2.5 Analyzing Patient Outcomes

Overview
    Anemia    
    Infection
    Blood Pressure Control
    Proteinuria
    Patient Nutrition
    Cardiovascular Risk Reduction
    Mineral Metabolism
    Preparation for Renal Replacement Therapy
Clinical Performance Measures
Analyzing Aggregate Patient Outcomes

Volume 3: Dialysis Access

CHAPTER 3.1 Introduction

CHAPTER 3.2 Staffing

Qualifications of Physicians
Qualifications of Physicians Administering Anesthesia
    Physicians Administering Regional Anesthesia
    Physicians Administering Sedation
Nurse Qualifications
Other Regulated Health Professionals

CHAPTER 3.3 Policies & Procedures

Overview
Policies and Procedures

CHAPTER 3.4 Administration of IHFs

IHF Levels
Anesthesia
Procedures Not Accepted at IHFs

CHAPTER 3.5 Equipment & Supplies 

General Physical Standards
Procedure Room/Operating Room Physical Standards
Recover-Area Physical Standards
General Safety Routines
Medication Standards
    General Medication Standards

CHAPTER 3.6 Procedures Standards 

Pre-Procedure Patient-Care Standards
    Pre-Procedure Requirements: Level 1
    Pre-Procedure Requirements: Levels 2 and 3
    Verification Process
    Pre-Procedure Staff Responsibilities
Intra-Procedure Patient Care for Sedation, Regional Anesthesia, or General Anesthesia
Post-Procedure Patient Care
Patient Discharge
Emergency Measures
    General Response to Emergencies
    Urgent Transfer of Patients

CHAPTER 3.7 QA Requirements

Monitoring Quality of Service
    Review of Performance
    Monitoring and Reporting Adverse Events    
    Review of Adverse events and other QA Monitoring
Infection Control
    Universal Precautions
Staff Safety
Regulated Waste

Volume 4: Home Dialysis Program

CHAPTER 4.1 Introduction

CHAPTER 4.2 Staffing

CHAPTER 4.3 Patient Care for Home Hemodialysis

Patient Assessment for Home Hemodialysis Training
Hemodialysis Training
Contract between Patient and Home Hemodialysis Program
Management of Established Home Hemodialysis Patients

CHAPTER 4.4 Patient Care for Peritoneal Dialysis

Patient Assessment for Home Peritoneal Dialysis Training
Peritoneal Dialysis Training
Management of Established Home Peritoneal Dialysis Patients

CHAPTER 4.5 Patient Outcomes

Home Hemodialysis
Peritoneal Dialysis
    Adequacy of Dialysis

Volume 5: Hemodialysis

CHAPTER 5.1 Introduction

Overview
Manageing End-Stage Kidney Disease (ESKT) by Dialysis
Hemodialysis

CHAPTER 5.2 Staffing

CHAPTER 5.3 Policies and Procedures

Overview
Policies and Procedures

CHAPTER 5.4 Analyzing Patient Outcomes

Overview
Patient Outcome Measures
    Anemia
    Infection
    Blood Pressure Control
    Patient Nutrition
    Adequacy of Dialysis
    Mineral Metabolism
Analyzing Treatment Options
    Kidney Transplantation
    Home Dialysis
Analyzing Aggregate Patient Outcomes

CHAPTER 5.5 Facilities, Equipment and Supplies

Overview
Nursing Station
    Dialysis Treatment Area
    Additional Space Requirements
    Electrical Supply
Building and Fire Codes
Infection Control
Water Quality
Requirements for Concentrate
Additional Services/Supplies

CHAPTER 5.6 Monitoring Care

Overview
    Pre and Post-Dialysis Assessment
    During Dialysis

APPENDICES

Appendix I

Independent Health Facilities Act - Ontario Regulation 57/92 - Amended to O.Reg. 14/95

Quality Advisor and Advisory Committee
Standards
Records of Employees
Patient Records
Books and Notices
Notices
Miscellaneous

Appendix II

Surgical Safety Checklist

Appendix III

Sample Contract for Home Hemodialysis

Home Hemodialysis Acceptance Criteria 
Home Hemodialysis Training Period

References