Maintaining Clinical Safety for Hospitalized Peritoneal Dialysis Patients

As a long-standing peritoneal dialysis (PD) nurse, one of the biggest challenges that my PD patients face is entering into a hospital setting while actively on PD. Typically, a hospital is where patients go to improve health and receive quality care. Unfortunately, the hospital can also be a place where PD patients get sicker or lose their ability to remain on their modality of choice. I often thought about how scary it would be for a patient to enter a hospital only to find out the health care workers did not know how to manage his or her care and therefore the patient would have to be the clinical expert during hospitalization. I have frequently received calls from patients during their inpatient stay expressing fear about the health care team’s inability to perform PD. It’s not a situation that has any easy solutions because the frequency is not high enough for hospitals to necessitate change. In addition, peritonitis that might result from PD given in a hospital setting is not reported as a hospital-acquired infection.

Solutions to consider—based on my experience—include the following actions related to training and reminders related to maintaining safety during inpatient stays:

• Prepare the patients and families by providing tips and material to help them feel empowered to guide clinical staff on their care during an inpatient stay.
• Encourage patients to bring instruction sheets and create an emergency kit to help maintain clinical safety if they are admitted to a facility where the staff is not familiar with their treatments.
• Review and remind patients of these tips every month and revisit the contents of their emergency kit.
• Encourage the family and patient to contact his or her PD nurse with any admission or visit to the emergency room (ER) so options for communicating with and educating the hospital staff can be explored.

I wish I could say that this challenge has improved over time, but it remains a top concern for many providers and patients. Proactive hospital-based education that is consistently provided is necessary. Some hospitals have a contractual relationship with a dialysis provider that supports PD services administered by a trained PD registered nurse; this can be a significant step to helping ensure continuity of care during inpatient stays. As we continue to expand PD services in the United States, we must continue to seek solutions that support quality care during inpatient stays or ER visits for PD patients.