Dedicated to End-of-Life Care for Kidney Patients
Mission:
To promote effective interchange between patients, families,
caregivers, payers, and providers in support of integrated patient-centered
end-of-life care of chronic kidney disease (CKD) patients.
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End-of-Life Decisions in the Dialysis Unit
Dialysis units need to prepare for the possibility that patients die at the dialysis facility. Many units don’t have adequate private space to keep someone who has passed away. Building relationships with funeral homes and encouraging them to respond quickly may help. The dialysis unit should also incorporate do not resuscitate (DNR) policies and procedures and train all staff on how to deal with these situations.
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Model DNR Policy, developed by the Robert Wood Johnson Foundation's ESRD Peer Workgroup.
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The following forms, developed by the Kidney End-of-Life Coalition, should be included in the policy and procedure for DNR orders and disposition of the expired patient. These MS Word documents may be used and modified for individual unit needs:
An important skill for staff when discussing advance directives, cardiopulmonary resuscitation (CPR) or DNR orders with patients is to avoid using professional jargon. Words such as code, CPR, and vent should be avoided; instead, use words such as heart stopped, tried to start the heart, and breathing machine. Staff should not be afraid to use the words died and death; saying only that resuscitation was unsuccessful or that the patient expired will often risk misunderstanding.
The following educational program offers suggestions for planning an annual memorial service in a healthcare facility. This program was submitted by Dr. Laurence Carroll of Hypertension Kidney Specialists in Lancaster, Pennsylvania.
Other educational tools beneficial for staff:
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