Dialysis Patient Needs In A Disaster

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Dialysis Patient Needs In A Disaster
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• CMS Disclaimer This presentation was developed
  by Northwest Renal Network while under contract
  with the Centers for Medicare and Medicaid
  Services, Baltimore, MD, contract
  HHSM-500-2006-NW016C. The contents presented do
  not necessarily reflect CMS Policy.
• Lynda Ball, QI Director,
• Northwest Renal Network
• Jim Curtis, QI Consultant,
• ESRD Network 16

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What is Dialysis?

• Dialysis is a medical treatment for people who
  have kidney failure.
• Dialysis patients come into a dialysis center
  three times a week to have the impurities cleaned
  out of the blood stream.
• Large needles are placed in a special access in
  the patients arm. Blood is pumped out of their
  body, cleaned, and then pumped back in.

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Dialysis Facilities

• Dialysis facilities are very dependent on
  electricity and water for their operations. They
  cannot operate without the required utilities.
• The nurses and technicians that perform the
  dialysis treatment have had specialized training.

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Facility Disaster Preparation

• Develop individual facility disaster plan
• Build relationship with utility representatives
• Build relationship with local disaster planners
• Educate the staff and patients on disaster plan

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Facility Disaster Preparation

• Secure the dialysis facility
• Secure equipment to minimize potential harm to
  persons or property
• Secure medical records
• Secure business records

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Emergency evacuation

• Clamp and Cut procedure to get off the dialysis
  machine quickly (leaves about 1 cup of blood
  behind)
• Designated gathering place
• Emergency evacuation box should have needed
  supplies for removing needles, etc.

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The Patient Connection to the Dialysis Unit

• Patients receive life sustaining treatment
• Spend a minimum of 15 hours a week at the
  dialysis unit
• Have a close connection to staff and other
  patients
• Feel the unit is a home away from home

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Home Dialysis Patients

• Home hemodialysis patients have treatment at
  their homes 3 to 6 times per week
• Difficult to take a hemodialysis machine and
  supplies with them in an evacuation
• Will have the same needs as a hemodialysis clinic
  patient

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Home Dialysis Patients

• Peritoneal dialysis patients perform treatment at
  home
• Can be done away from home
• Some patients will be able to take supplies with
  them and perform treatments away from home
• Greatest need will be a continuing source of
  supplies

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Dialysis is a Necessity not an Option

• Patients will become critically ill and perish
  without treatment
• This is basic life support that becomes more
  important than anything else during a disaster

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Patient Concerns if Treatment is Interrupted by a
Disaster

• Heightened sense of fear and confusion
• May be physically weak, dizzy, disoriented
• May have just begun treatment at time of disaster
  and will be concerned about next treatment

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Issues in Disasters

• Many dialysis facilities may be inoperable
• Patients can be scattered in the evacuation.
• Utilities and supplies can be scarce
• Local communication can be disrupted.

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Needs of Patients in a Regional Disaster

• Priority will be to find and receive treatment
• Patients should have some disaster preparation
• As a group, they will be weaker and sicker than
  the average person

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Patient Disaster Preparation

• Patients should be provided educational guides on
  surviving a disaster, such as those created by
  CMS and the National Kidney Foundation
• The information in these manuals is general and
  will not work for every patient in every
  situation
• Information includes Preparing for an emergency,
  gathering important medical info, alternative
  arrangements for treatment, emergency supplies,
  diet, disinfecting water
• Dialysis providers should provide additional
  patient education regarding their emergency plan

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Patient Disaster Preparation

• Unless they are told to evacuate, patients are
  instructed to stay at home as long as it is safe
  to do so
• Patients should take emergency supplies with
  them, as listed in these manuals
• Start the emergency/disaster diet (sometimes
  called the three day diet) immediately
• If patients must go to a shelter, to inform the
  person in charge of their special needs

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Dialysis Patient Special Needs During a Disaster

• INFORMATION!
• Greatest fear will be where and when will they
  receive treatment
• Will want to know who is in charge
• Will need to be reassured that their needs are
  understood

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Dialysis Patient Special Needs During a Disaster
- Diet

• Special diet reduces protein and potassium
• Sodium restriction is very important
• Patient disaster manuals have detailed meal plans
  included

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Dialysis Patient Special Needs During a Disaster
Fluid Restriction

• Fluid Restriction will be a primary concern in
  patient survival
• Fluid overload is a major threat to health that
  will lead to death if dialysis treatment is not
  received
• Fluid intake guidelines are included in the
  patient survival manuals

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Thank You! Questions?
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Links

• www.esrdncc.org
• www.kidney.org/help
• www.kcercoalition.com
• Special Thanks to ESRD Network 16
• for Developing This Resource!
• www.nwrenalnetwork.org