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Policies,Clinical,UWHC Clinical,Department Specific,Hemodialysis

Scope of Services delivered by UWHC Inpatient Hemodialysis Department (1.0)

Scope of Services delivered by UWHC Inpatient Hemodialysis Department (1.0) - Policies, Clinical, UWHC Clinical, Department Specific, Hemodialysis

1.0

University of Wisconsin Hospital and Clinics
Inpatient Hemodialysis
Department 55400

TITLE: Scope of Services delivered by
UWHC Inpatient Hemodialysis
Department

POLICY #:1.0
REVISED: October 16, 2016
Page 1 of 2
Nurse Manager: Joan Watson, MS, RN
Director: Ann Malec, DNP, RN, NEA-BC
Medical Director: Alex Yevzlin, MD


I. PURPOSE
To describe the patient populations served and the scope of services delivered by University of
Wisconsin Hospital and Clinics (UWHC) Hemodialysis Department

II. POLICIES
A. Hemodialysis and Continuous Renal Replacement Therapy (CRRT) services are provided
by the UWHC Hemodialysis Department to patient located at the UWHC Clinical
Science Center (CSC), American Family Children’s Hospital (AFCH), and Williams S.
Middleton Memorial (VAH)
i. Patient populations served include:
1. Adult and pediatric in-patients requiring hemodialysis for Acute Renal Failure
(AKI).
2. Adult and pediatric in-patients with End Stage Renal Disease (ESRD) of
inpatient status.
3. Critically ill in-patients requiring continuous renal replacement therapy
CRRT.
4. Adult and Pediatric ESRD out-patients seen at the UWHC-CSC campus for
medical interventions and meet the following criteria.
a. Dialysis performed following or in connection with a dialysis-related
procedure such as vascular access procedure or blood transfusions;
b. Dialysis performed following treatment for an unrelated medical
emergency; e.g., if a patient goes to the emergency room for chest pains and
misses a regularly scheduled dialysis treatment that cannot be rescheduled,
c. Emergency dialysis for ESRD patients who would otherwise have to be
admitted as inpatients in order to receive hospital dialysis services.
i. MD to document signs and symptoms
1. Shortness of breath
2. Chest pain
3. Uremia (BUN, Cr levels)
4. Hyperkalemia (K > 6)
5. Metabolic Acidosis (Bicarb < 15)
6. ECG changes /arrhythmias
7. Other electrolyte or acid/base abnormalities
5. Pediatric ESRD outpatients who are expected to receive a kidney transplant at
AFCH within 3 months. Will need prior authorization if commercially

Page 2 of 2
insured or by arrangement thru fiscal if eligible to receive ESRD Medicare
benefits.
6. Adult and Pediatric AKI out-patients seen at the UWHC-CSC campus for
evaluation of recovered renal function, continued need for hemodialysis.
7. Adult and Pediatric transplant patients experiencing Delayed Graft Function
(DGF) and are receiving follow-up evaluation at UWHC Transplant Clinic.
B. Arrangements for the insertion and removal of temporary Hemodialysis or Aphaeresis
catheters can be scheduled thru the Hemodialysis department during normal business
hours based on room and nursing staff availability.
i. VHA patients should have temporary Hemodialysis catheters inserted at VHA
facilities unless patient condition requires emergent dialysis to be performed at
UWHC facilities.
ii. Patients scheduled for these services must be evaluated by ESRD fellow and/or
faculty prior to insertion and patients must meet criteria established in Hemodialysis
Departmental Policy 6.0, Roles and Responsibilities for Insertion and Removal of
Central Venous Catheters in the Hemodialysis Unit.
III. PROCEDURE
A. Hemodialysis Department’s normal hours of operation
1. Monday –Saturday, 0800-2000 including the following UWHC observed
holidays: New Years Day, Martin Luther King Birthday, Memorial Day,
Independence Day, and Labor Day.
2. Hemodialysis is closed on Sundays, Thanksgiving Day and Christmas Day with
limited staffing to cover emergent dialysis only.
B. Scheduling Dialysis Procedures:
1. During normal business hours, dialysis services are scheduled thru the Care Team
Lead reachable at 608-263-8748.
2. During off hours, dialysis services are arranged thru the Hemodialysis Nurse 1st
Call pager (0029) reachable by phone 265-7000 or web paging via U-Connect.
C. Priority for dialysis services is given to in-patients with acute renal failure.
D. In instances where dialysis resources and/or staff availability are limited the decision to
prioritize treatment for one or more patients shall be made jointly by the attending
nephrologists and members of the interdisciplinary team. If disagreements occur the
Medical Director of the Hemodialysis unit will be consulted with ultimate authority.
E. Patients receiving dialysis therapy are assigned a Nephrology Service/Attending
physician who is responsible for the care delivered in the Dialysis Department and any
coordination of care required with the Inpatient Primary Care Team.
F. Patients requiring emergent hemodialysis awaiting room placement in the Emergency
Department see UWHC Policy 2.1.1 Care of Emergency Department Patients Admitted
to Hospital Services to determine coordination of care.
IV. RESOURCES
A. Hemodialysis Departmental Policy 6.0, Roles and Responsibilities for Insertion and
Removal of Central Venous Catheters in the Hemodialysis Unit
REVIEWED: 12/1/2016
Revised JMW 10/16/2016