Fluid Focus
As a general rule for optimal fluid management, a patient’s Interdialytic Weight Gain (IDWG) should ideally not exceed what percentage of their Target Weight?
5%. (Ideally 3-5%)
What is the most likely severe outcome/deficiency if a state or CMS surveyor observes a patient with a covered vascular access during treatment?
Deficiency, Condition, or Immediate Jeopardy citation
An Immediate Jeopardy (IJ) citation.
The PCT completes pre-treatment data collection and calculating the UF goal. They realize that even running at the maximum safe UFR, the patient will leave more than 1 kg above their Target Weight. Because this is an abnormal finding, when MUST the RN complete the pre-treatment assessment?
PRIOR to the initiation of treatment. (Since the patient cannot safely reach their prescribed goal, the RN must evaluate them before they are connected).
Hep B surveillance testing for patients with HepBsAg Neg, HepBcAB Pos, and HepBsAB >10
Monthly antigen and annual antibody?
If a patient is experiencing extreme thirst and high weight gains between treatments, what specific part of their machine prescription might the nephrologist decrease to help?
The Dialysate Sodium level
According to infection control guidelines, once a multi-dose medication vial (like Heparin) is opened or punctured, how many days is it good for before it must be discarded?
What physical documentation must be written on the label of that vial?
28 days
The date it was opened (punctured) and the initials of the teammate who opened it.
You are reviewing a flowsheet and see a patient's blood pressure tanked to 85/50. The PCT correctly documented giving a 200 mL normal saline bolus. What critical piece of documentation must appear on the flowsheet shortly after that bolus?
A follow-up blood pressure (and an RN assessment). Surveyors look for this "closed loop" to prove the intervention actually worked!
(True or False) Enhanced precautions for C. Auris may be discontinue with Infection Preventionist and MD approval and documented OGB.
FALSE (Identify correct timeframe)
A patient who usually handles fluid removal perfectly is suddenly crashing and cramping at a very low UFR (e.g., only 5 mL/kg/hr). Assuming they aren't sick or bleeding, what is the most likely clinical reason for this sudden intolerance?
They have lost real body weight (muscle/fat), meaning their Target Weight is now set too low. They are being pulled completely dry!
If a susceptible patient refuses to receive the Hepatitis B vaccine series, what specific piece of documentation must be placed in their medical record?
A signed Hepatitis B Declination / Refusal Form. (And surveyors will definitely look for it!)
A patient’s post-treatment weight shows they are 1.5 kg above their ordered Target Weight. According to policy, does this require an RN assessment prior to the patient leaving?
Yes! Leaving > 1 kg above or below Target Weight is considered an "abnormal" finding and requires the RN to evaluate the patient's symptoms (like listening to lung sounds) before they discharge.
TB surveillance, upon admission and annually. DaVita’s preferred surveillance test is the TST. If a patient refuses a TST for annual TB Surveillance, what can be accepted in lieu of the TST.
IGRA blood test (QFT-G or T-Spot)
If a patient is a "Fluid giver," what does that mean?
What is the Best Demonstrated Practice (BDP) we should request from the Medical Director to fix their fluid pulling parameters?
Meaning they lose more overall weight than what the machine was programmed to pull.
Ask for a physician's order to change the patient's machine parameters to NO Prime or NO Rinseback removal. (Since they naturally give fluid/weight during treatment, we don't need the machine to aggressively pull the extra prime/rinseback volume!)
When a brand new dialysis patient admits to your facility, what is the deadline to complete their initial comprehensive assessment and initial Care Plan?
Within 30 days or 13 outpatient treatments, whichever comes later.
To ensure the pressures in the extracorporeal circuit have properly stabilized, what is the exact timeframe per policy that a teammate must wait to record the baseline Dynamic Venous Pressure (DVP)?
2 to 5 minutes
Per P&P, the 2 approved ways to properly disinfect the dialysis station if patient has C. Auris
What is use 1:10 bleach x 3 with 10 minute contact time or use of CaviWipes 2.0?
Before we label a patient as a true, biological "Fluid Giver," what are the two most common controllable variables (or mistakes) we must rule out first?
1) Did the patient go to the bathroom during treatment?
2) Was there a weighing error? (e.g., They had their phone, heavy jacket, or keys in their pockets for their Pre-Weight, but took them off for their Post-Weight).
Where in CWOW can CCs locate and print the "Core Survey Prep Report" to audit facility readiness?
Name at least 3 data included in the report?
Under the "Reporting" menu.
1. General Facility Operations & Census
2. Infection Control & Isolation Data
3. Clinical Outcomes & Thresholds Surveyors use this data to compare your recent facility outcomes against national US thresholds. It typically covers:
Abnormal BP parameters for Pre-Inta-Post?
Pre -
Intra-
Post
How many consecutive negative sputum smears are required before a patient recovering from active pulmonary TB can return to the outpatient dialysis setting?
Three (collected 8-24 hours apart, and after at least 1 week of therapy).