RBT Roundtable: Dialysis Patient Comfort

IN DIALYSIS, AS WELL AS ALL OF HEALTHCARE, THERE IS ONE INESCAPABLE TRUTH: THE PATIENT NEEDS TO COME FIRST. This especially rings true with chronic treatments, such as dialysis, where patients are treated on a regular basis. This means clinics and providers need to be more attune to the changing needs of dialysis patients in order to make the otherwise grueling dialysis treatment more bearable. To learn more Renal Business Today asked the following renal community leaders their thoughts on dialysis patient comfort:

• Roberta Wager, RN, MSN, president of the American Association of Kidney Patients
• Doug Keeslar, president of Champion Manufacturing
• Sandie Guerra Dean, Corporate Social Worker with Fresenius Medical Care North America

What is your definition of ideal dialysis patient comfort?

Wager: This can be defined in many ways. However, from a patient’s perspective the definition of ideal patient comfort is a non-eventful dialysis treatment. Uneventful meaning no pain, no cramps, no low blood pressure. The access stuck correctly with no infiltrations nor clotting; therefore, the patient does not have to be sent to an access center to be de-clotted and then returned to the clinic to be dialyzed. Also, there were no mechanical problems causing treatment to be extended longer than the prescribed time.

Keeslar: Since our early beginning in innovating and development of medical treatment recliners in 1992, Champion has aggressively pursued the “ideal dialysis patient comfort.” It did not take us long to realize the impossibility of reaching perfect comfort for every patient. But we knew we could implement significant improvements.

While many companies are tempted to simplify the definition of comfort to “a more cushioned seat,” or a “softer feel,” what they are actually doing is missing the opportunity to create effective solutions, promoting yesterday’s babble, and masking their lack of interest in improving healthcare service.

The concept of “comfort” alone is too subjective. What is comfortable to one patient may not be comfortable to the next. What is comfortable to the caregiver may not be comfortable to the patient, etc. In addition, most individuals do not want to be a patient of any type, so their concept of comfort totally changes based on their current, frustrating circumstances.

Trying to attain “comfort” in the broad sense is like chasing a moving target. Champion designers needed to find the one idea that gave the most patients the highest degree of comfort. Our experience has taught us that the answer is patient empowerment. And empowerment leads to comfort.

As a dialysis patient, it is easy to start feeling invisible, as though your illness becomes your identity. We know that each patient sitting in a Champion recliner is a person with opinions, preferences, and ideas of their own. And no two patients are alike.

For instance, a clinic may treat a petite female patient who is always cold during dialysis, and who prefers to watch a movie during her treatment time so it is not such drudgery. So why not allow her to control her environment through the chair’s integrated heat system and a chair-mounted bracket that holds a dedicated flat-screen TV?

A different patient may be a very tall gentleman who experiences lower back discomfort and who likes to return emails during his treatment. So he controls his environment through an integrated massage feature to help him relax his back muscles during treatment and an over-lap tray to offer him extra work surface for his laptop.

Finally, the same clinic may treat a larger patient who has little muscle tone and is not ambulatory. Staff can swing open the arm of the chair to make transfer from a stretcher or wheelchair easier for, and more respectful of, the patient. This patient may find reclining the chair and sitting it back up manually too difficult; so his recliner may be equipped with a power recline system allowing him to control his position easily without becoming frustrated while he waits for staff assistance.

Champion learned a long time ago that this is not a “one-size-fits-all” proposition. Offering a wide range of optional features and “patient-controlled” accessories makes all the difference in a patient’s perception of their own comfort.

Guerra Dean: Ideal dialysis patient comfort means creating an environment where patients feel safe and confident in the care being received, know the staff will listen and respond to their comments, concerns or questions, and where staff and patients work together to find suitable solutions to meet the individual needs of each patient. Patients should feel confident in the caregiver’s level of understanding of the kidney disease process and the available treatment options. It is also important to consider that physical factors contribute to patient comfort, such as room temperature and treatment chairs.

On a day-to-day level, it’s a process of being attentive and responsive to each individual patient and his or her needs.