Dialysis Staffing

Question:

We are working on improving the dialysis process and wanted to know if there are any references that guide the dialysis staffing ratios. This will be most helpful as we have staffing challenges.

Answer:

There are several references for dialysis staffing but they all reference outpatient dialysis programs which are vastly different than the acute inpatient dialysis.  The outpatient guidelines do not fit for the inpatient model.

We were unable to find any published staffing norms for acute inpatient dialysis.  As a group what we do see is the following:

• Bedside dialysis: 1:1 care and the nurse or tech cannot leave the room.
• In the dialysis room:  It depends on the bed space you have.  In the hospital setting, we normally see 1:1 or 1:2 because the space only allows for a couple beds.
• In larger, single room spaces: We do see one RN and one tech for up to four patients 
• Dialysis provided to a Hepatitis Positive patient and they are being dialyzed in an adjoining room to the other inpatient dialysis bed space:  The Hep Positive is assigned 1:1 because you cannot address the urgent needs or keep eyes on Hep Positive in a separate room at the same time as manage the other patients.
• The above staffing assumes that there are written procedures to guide floor nurses to care for a dialysis patient in the event that the one dialysis RN is incapacitated while providing care.

This is observational not evidence based.