leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Aug 14, 2003 12:15 am Post subject: Hemoglobin
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Yesterday at dialysis it was the day our monthly care plans are 'discussed' with us. THis basically consist of a nurse shoving a sheet of paper in front of you on a clipboard and saying sign this.<
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>Overheard nurse explaining to one of the new patients "your hemoglobin is high this month" so we are stopping EPO until your hemoglobin gets low enough to re-started it and then we will restart at a lower dose.<
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>This seems very unethical to me and I wish there was something that could be done to the nurses license. Hemoglobin LOW!!! The only level reached was the level at which Medicare will pay for EPO. I am SURE that the patients hemoglobin was not HIGH by any ethical standards.
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Hemo RN
Joined: 24 Feb 2003
Posts: 17
Posted: Thu Aug 14, 2003 1:28 am Post subject: HGB levels
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Most units have an algorithm that has been developed by the physicians that is followed to dose epogen. Our algorithm holds epogen when the HGB rises over 15. Once epo is held weekly HGB/HCTs are obtained. When the HGB goes below 13.3, epogen is restarted at a dose that is 25% less than the previous dose. Ask your DON to explain to you how epogen is dosed in your clinic. If there is an algorithm that is followed it should be in your chart as well.
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Thu Aug 14, 2003 2:11 am Post subject: Hemoglobin
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Re Tx Care Plans - There's a simple response to facilities' practice of "shoving a piece of paper (care plans) in front of you on a clipboard and saying sign this" ---DON'T SIGN!!! For those of us who know better, we perpetuate the very things about which we complain when we become party to the shenanigans at dialysis facilities. In every "movement" about which I am aware, it has been the minority which has effected change for benefit of the majority. If the few of us persist in our demand for true care plans, eventual change will come, I believe.<
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>There may be, are, repercussions -- such as that which happened when my husband refused to sign a care plan given him under the circumstance as you described -- "they" stuck the plan in his file with note "Refused to sign". If enough "refused to sign" are found in medical records, investigations will be warranted.<
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>Re hemoglobin, I always thought that desired outcome of anemia mgmt was to "maintain" Hgb/Hct levels within certain ranges --- not too low, not too high -- dependent on pts individual medical conditions. "Maintenance" is the key word.<
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>New pts are subjected to exploitation because they lack knowledge, or they are held hostage due to their fears.<
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>Patients and us supporters who know better must take some responsibility for that units have been allowed to get away with. And, we, those of us who know better, must share info with new/other pts. We must help to educate pts and we must help to improve delivery of services at dialysis units.<
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>Lastly, my understanding is that the Medical Director is the one responsible for that going on at units. Have you thought about sharing that which you overheard with the Med Dir (anonymously?). Perhaps, the Med Dir is not aware of that being told pts.
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Home Girl
Joined: 01 Nov 2002
Posts: 5
Posted: Thu Aug 14, 2003 8:05 am Post subject: hgb
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I find it is next to impossible to educate new or existing patients, because most are in denial when it comes to sticking up for themselves. I never know if they are going to turn me in for telling them the truth. I would certainly totally fill a patient in if I saw that he wanted to fight back, but most don't. It's a strange phenominum, but I've come to the conclusion that that's people. Most people are not fighters in a situation like this. Many times, too, they feel beholden to the staff who is taking care of them and even if the treatment they receive is lousy, they tell themselves it's great or that they shouldn't rock the boat.<
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>I see patients all the time, too, who get preferential treatment, because they have things in common with many of the staff, like casino gambling, drinking and partying etc. So, most patients are not your best advocates and just take the path of leaste resistance. <
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>As far as Medical Directors go, I thought about telling mine what went on in our unit and did. He already knew all about it, which I figured he did (surely they don't get to become doctors by having a low IQ). His excuse for not doing anything - the patients wouldn't get any care at all if he fired the offending staff as he coudn't easily find replacements. Yeah right! If the Medical Director doesn't give a flip about his patients, so goes the unit. <
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>Not signing tx plans? I prefer to sign mine as there are no other units in town and eventhough they fudge on things like this they treat me pretty decently compared to a hell hole unit I was in before. Nevertheless, I will find a way to stick them for their care plan fraud as it is wrong and they must not get away with it.They see care plans as business as usual. It's just seen as excessive paper work to them. The RN is overworked and doing this, too, so no wonder its 6 months behind. But the govt. doesn't care so the unit get's lax and thinks why should they care either? The whole system is wrong. It starts with the govt.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Aug 14, 2003 1:42 pm Post subject: Care Plans
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I end up signing the care plan since there is not anything factually wrong on it. If there is, I ask them to correct it before I sign.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Aug 15, 2003 9:09 am Post subject: Dosing
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When my hemoglobin was too high (over 12) when I first started dialysis two years ago they held it, watched it drop like a bomb and then restarted it all the while doubting that I had a real reason to feel like crap. Now they titre the dose back, but don't stop it entirely. Even that can have it's problems, but is better than the former method. Recently I dropped down to 10 and didn't know it (in between labs) except for the fact that sparks flew from my behind hitting the pavement! Of course, they think a hemoglobin of 10 is almost perfect. I doubt those who make up the rules ever had a low hgb.<
>Low is alright I suppose if you sit around all day, but at my age I'm not ready for that. Lin.
