It's well known in the renal community that patients do better when they have more dialysis treatments, and that home care often provides such an opportunity for well being. However, home care presents challenges too. Renal Business Today spoke with several dialysis lab experts (from Satellite Laboratory Services, RenaLab, and Spectra Laboratories) to find out what these challenges are, and how they can be mitigated.
First off, communication must be precise and frequent between lab companies and dialysis providers. Communication should also be clear between labs and patients. These processes are key, said Chris Nilson, director of client relations for Satellite Laboratory Services.
"We start with comprehensive and easy-to-understand instructions for the home hemo patient and for the professional at the clinic responsible for instructing that patient," he said. "This includes printed instructions, materials and tubes, special instructions on obtaining specimens, the centrifuge itself, a test-tube holder and shipping materials. We strive for consistency and clarity in process for both the clinic and patient, end-to-end."
Cindy Branch, client services manager at RenaLab, agrees that communication between the lab and the clinician is vital, and stresses that communication with at-home caregivers is also important.
"The home patient is given the date and times that they need to draw labs but if there is a breakdown in communication at all, the patient could be confused and could quite possibly not know when or how to make the draw," Branch said. "It is very important for the home nurse to communicate thoroughly to the patient and it is up to RenaLab to support them both."
Customer service reps should take the time to talk to caretakers, Branch continued. "They are taking care of their mothers, fathers and close friends, and we understand this is an emotional time for them. They are afraid that they are going to harm the patient or collect the sample incorrectly, and we develop a personal relationship with them so they do feel comfortable in calling and asking us for help."
It is up to the lab to train patients how to collect, process and ship their samples, Branch said.
"When needed we stay in constant communication with both the nurses and the patient," she added. "We have to be careful to communicate well with the home dialysis nurse, so they can properly answer the patient’s questions, but more importantly, we need to be available to properly answer questions when a patient reaches out to us."
Nurses and patients lean on labs, according to Branch's colleague, Cecile Humphreys, assistant vice president of lab services at RenaLab.
"It is most effective for the lab to have a process in place to be there for both, and to be willing to walk them through the process," Humphreys said. "When the nurse gets a new patient, RenaLab is provided with the patient information and this allows us to prepare individualized supplies for each patient. We know when they are going home and when they need us to ship their lab training manual and the supplies for their home collections. Problems with FedEx or the centrifuge can arise, and if they do, the patient knows they just need to call us."
Patient education is a crucial component to making a home patient experience successful, according to Pamela Anderson, BA, MAEd, director of field education and development for Spectra Laboratories.
"A laboratory can provide instructional materials to educate the patient on proper specimen tube collection and shipping procedures," Anderson said. "A full-service laboratory can provide the patient supporting equipment, such as a small centrifuge, packaging materials, and overnight shipping airbills. Even though blood work is a routine procedure for dialysis patients, it is good practice to provide patients simple instructions with the blood tubes, sampling materials and packaging to reinforce good specimen collection and handling techniques.
Collaboration between providers and laboratories can create a unique and meaningful educational program for the home training patient, said Anderson's colleague, Julia Brennan, executive director of national accounts for Spectra Laboratories
"This assists in ensuring a smooth home experience," Brennan said. "Proper lab specimen collection, processing and shipping guarantees reliable results and prompt reporting. This enables the patient care team to evaluate therapy and adjust prescription as needed."
Home hemo patients should be treated as thoroughly as if they were clinic patients, said Christine Koncal, director of marketing for Satellite Laboratory Services.
"We strive for simplicity and clarity of communication, and continual improvement in our processes to ensure optimal lab results," Koncal said.
Differences in Care
The main difference between home hemodialysis (HHD) patients and non are that home patients are more independent and are usually only seen monthly in the clinic, according to Brigitte Schiller, MD, clinical director of Satellite Laboratory Services.
"For PD blood is drawn during the visit, HHD patients usually bring the blood samples from home," Schiller said. "Transportation directly to the lab with an option of having the results available at the monthly visit is a huge advantage for coordinated patient care. Making blood draws easy and error proof is another mandate."
Since samples are not drawn or spun by clinical staff, but by patient caregivers at home, labs should be vigilant in their evaluation of samples, Humphreys said. Care must be given to see that they are collected and processed correctly.