Dialysis Facility and Nursing Home Collaboration

During the past year, nursing homes and dialysis facilities in this region have begun a dialogue on how to go about improving care to patients they share in common. A range of issues have emerged, including transportation scheduling, policies that restrict eating while undergoing treatment, management of patients who are incontinent of stool, proper care of the vascular access site between treatments, and the need for a communication tool that keeps both organizations apprised of care details while in the respective settings.

The Network 8 Medical Review Board authorized a position statement last year that urged dialysis facilities and nursing home to work toward finding common ground through improved communications. Based on subsequent conversations with nursing homes, dialysis facilities and nursing home associations, there appear to remain significant opportunities for improvement.

To support the need for a focused effort, a needs assessment was conducted in February 2009 among a 30% sample of nursing homes and 100% of the dialysis facilities in Mississippi, Alabama and Tennessee. With a 70% response rate from dialysis facilities and a 23% response rate from nursing homes, it was learned that 72% of the dialysis facilities felt that they needed to improve communications between the dialysis unit and the nursing homes. 54% of the dialysis facilities were either not using a transfer form or not using it as it was intended. 67% of nursing homes indicated the need for improved communications between the two organizations and 59% stated that they were either not using the transfer form or not using it as it was intended.

The conclusion of the needs assessment is that there is a need to improve communication between the two organizations and there appears to be a need for a standardized transfer form to be available for facilities to use to improve this communication. There also appeared to be a need to for more education for the nursing home staff on the needs of the dialysis patients (84% of the Nursing Homes wanted more education).

The key Network partner in the project is the Mississippi Health Care Association, a statewide association of nursing homes, and the two organizations have formed a committee of dialysis facility and nursing home personnel. The committee has developed a model transfer form that can accompany residents on each treatment day and then be updated and returned with the resident following treatment. They will identify a methodology for use of the transfer form and pilot the process in small group of facilities. Following evaluation of the pilot, a determination will be made on expanding the pilot to the entire region.

The pilot phase of the project should be completed by summer 2009. For more information, contact Brenda Dyson, Community Outreach Coordinator.