We are Dialysis Advocates who are keeping this site alive as a reminder of the history of the kidney dialysis field of medicine. Many of us have spent over a decade advocating for rights of dialysis patients. If you want to know more about us click the "About Us" link above and you could take a look at this introduction (also below).
And we've put together a list of the kinds of things we would like to see in dialysis:
Standards of Care!
1) Patient dismissals should be outlawed!
We give dialysis to prisoners - doing otherwise would be the same as denying food and water, and would be considered cruel and unusual punishment. Yet we routinely let the dialysis clinics dismiss non-violent patients for doing no more than questioning their care, leaving them to a slow and agonizing death. Meet some patients who nearly met this fate: http://dialysisadvocates.com/patient-stories/
2) Longer time on dialysis
"In Japan and Germany, one of the pay for performance targets for dialysis is that 85% of those on dialysis must be getting at least 4 hours of treatment 3x/week (this would translate to 2 hours x 6 days a week). I think that would be an excellent goal worth working toward here, particularly in light of the DOPPS (Dialysis Outcomes & Practice Patterns Study) data among 22,000 or so dialyzors that found a 30% drop in the risk of death for folks who got at LEAST 4 hours of treatment. IMHO, there is no excuse for anyone to be getting less than this, regardless of body size. It is not possible to get too much dialysis (though it is possible to remove too much water and leave people feeling wretched--this is actually quite common)."
3) Patient Staff Ratios
We've heard for years a ratio of 1 RN and 3 techs for 9 patients would be the proper staff to have. States such as Vermont have worked to get this implemented.
4) End reuse
This is the practice of taking the filter that cleans the blood, putting harsh chemicals through it, then reusing the filter again at the next treatment. Numerous reliable studies have shown this to be a dangerous practice.
5) End staff non-compete agreements
"The mud began to fly last year when the second-largest group of Denver kidney doctors, called nephrologists, ended their exclusive affiliation with DaVita and partnered with a Massachusetts dialysis company entering the Denver market." "DaVita quickly sued doctors, plus a nurse battling breast cancer who quit her job at a DaVita dialysis center and took one with Liberty."
"DaVita says it "paid millions" in 1998 to the doctors of Western Nephrology in Denver to retain them as medical directors of six dialysis centers in the metro area for 10 years. The doctors signed non-compete agreements, promising not to join forces with DaVita rivals or steal any of the California-based company's nurses."
6) A notarized "Request for Advocate" - signed by the patient - will be honored!
Sometimes the relationship between a patient and members of staff can become heated, not all patients can afford or wish for a lawyer. Bringing in a third party, experienced, and level-headed advocate can defuse the situation and get to the root of the problem.
P.S. For individual patient advocacy we recommend you contact dialysisadvocates.com
7) Patient will normally be allowed a dialyzer of their choice
If the dialyzer is a brand not normally used by the clinic, it will be obtained by the clinic possibly at a small premium? If the nephrologist of the patient has serious objections to the choice, it must be stated in writing and could be subject to arbitration
8) Blood samples (labwork) will be processed at local labs
Processing bloodwork at a local lab will save time and potentially catch serious problems more quickly. Faster processing may also help in getting a better snapshot of what is actually going on in the body and give more accurate information with which to make better medical treatment decisions.
9) Blood Transfusions will be done in a hospital
It appears at least one dialysis company is taking advantage of allowing dialysis clinics to do transfusions: "Some providers are associated with a significant increase in transfusion rates over the one-year (2011) time period (the rate increased 46 percent in DaVita units), while others show minimal changes (4 and 7 percent in Fresenius and hospital-based units, respectively)." Click_for_HemoDoc_article
10) The requirement that state inspection teams have to report complaints to the ESRD networks should be eliminated
Surprise state inspections are no longer a surprise when the networks tip off the clinics. For more on this see: dialysisadvocates.com And also take a look here: http://dialysisadvocates.com/discussions/?mingleforumaction=viewtopic&t=10
11) Cameras should be put in the clinics
See patient stories at http://dialysisadvocates.com/patient-stories/
And listen to: http://www.blogtalkradio.com/nnia1/2013/11/13/lets-talk-dialysis
More blogtalkradio broadcasts: http://www.blogtalkradio.com/dialysisadvocates
12) Crit-lines should be used at least every three months to help figure dry weight
The amount of fluid a patient needs removed can vary due to changes in weight and inaccurate assessments. Crit-lines use optical monitoring of the dialysis lines to help figure a patient's ideal dry weight. The National Institute of Health claims "The number of hospital admissions due to fluid overload may be reduced".