‫اململكة العربية السعودية‬

‫مديرية الشئون الصحية بمحافظة الطائف‬

‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

Title: ROLE OF NURSING IN HOME HEMODIALYSIS

PROGRAM

TEAM
NORA MUFAREH AL OTAIBY TEAM LEADER
RAKAN AL NEMERY CHARGE NURSE
RABAA SAMY INFECTION CONTROL
LIZA MARIE ODUCAYEN QUALITY COORDINATOR
SAIF AL OTAIBY
EMAD AL MALKY STAFFS GOING FOR HOME
YOSEF AL GORASHI HEMODIALYSIS
ABDULLA
MYLA MOLINA ADAP COORDINATOR

Introduction:

Home hemodialysis is a modality of renal replacement therapy that can be

safely ,and independently perform or by the assistance of a home hemodialysis
nurse by an in need end stage renal disease patient. Home hemodialysis can be
done at the convenience of the patient according to their activities of daily living.
Home dialysis is initiated by a qualified and well trained dialysis staff nurse and is
usually supported by adequate education and training of the ESRD patients,
suitable set-up at home and back up services including storage for medical
devices and supplies, proper disposal of waste products and consultation of the
in-center hemodialysis unit. The duration of hemodialysis treatment can last to two
to three hours.

Home hemodialysis in Taif Saudi Arabia hade been launched last October of 2022
with the support of the Directorate of Health Taif. Staffs from King Abdulaziz
Specialist Hospital, Dialysis Unit spearheaded by the dialysis Unit Manager Nora
Mufareh al Otaiby and Head Nurse Jumaan Al Malky. From then on the program
is a big success and still continuing to these days. This is an opportune for the
dialysis community to analyze areas of strengths and weaknesses in home
modalities and to grow home modalities in an organized and sustainable fashion.
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

Why is there an urgent need to start HOME HEMODIALYSIS IN TAIF

REGION?

Home hemodialysis is not a new therapy; rather it is a therapy which interest

has been rekindled due to both the continually growing end stage renal
disease population. Health care officials have long sought to lower health
costs while improving the quality of care. Home hemodialysis has been
identified as a way to achieve both of these goals. It lowers the cost of
patients who have been staying in the hospital for long periods of time just for
their dialysis sessions due to the long distance of their home to the hospital. It
resolves a great majority of the total burden related to managing highly
compromised group of ESRD patients who are bed-ridden, wheel-chair-bound
, obese, demented or having CVA, elderly and amputations or non-union
fractures who have great difficulty to come to hospital without a need to call an
ambulance or an EMT. It was noted that it can decreased the hospital
expenses both patient and the facility. Home HD is also a gentle and benign
mode of HD with less reported intra-dialytic complications; attributed to the use
of ultrapure dialysate solutions other than the treated tap/well water used in
HD centers. The psychological status was significantly improved in those
patients with having their sessions at their homes without any added stressors
related to in-center hemodialysis. All these reasons had been identified and
considered before starting and implementing home hemodialysis here in Taif
Kingdom of Saudi Arabia.

PATIENT SELECTION AND SITE EVALUATION

PATIENT SELECTION

Optimal patient selection for home HD involves a balance between

enthusiastic program recruitment and careful shared decision-making to avoid
selecting patients who are either physically or mentally unsuitable for home
HD. These are the following criteria that are developed in selecting candidates
for home hemodialysis. Refer to table 1.
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

Table 1: Considerations for patient for home HEMODIALYSIS

1. Patients who are able to physically and cognitively manage the task
of care or have a support person who can.

2. Demented patients or having CVA.

3. Long staying in a hospital facility.

4. Severely obese, bed-ridden and wheelchair bound patients.

5. Amputated or non-union fractures.

6. distance of home to a dialysis facility.

Contraindications to Home HD

1. Unstable medical conditions (uncontrolled arrhythmia, seizure

disorder)

2. Lack of suitable vascular access.

3. Unstable behavioral problems ( uncontrolled psychosis or anxiety,

ongoing injection drug use, alcohol abuse)

4. Contraindication to anti-coagulant during dialysis.

5. Conditions that may cause abrupt loss of consciousness (severe and

unstable intradialytic hypotension).
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

SITE EVALUATION

The team will visit the home of the patient and decide whether it is suitable for
the treatment or need some renovations. The team will suggest materials
needed and location of the room of the candidate for home hemodialysis. Refer to
table 2.

Table 2. Treatment space should be equipped with the following:

1. The room chosen for HD should be functional and conducive to safe and
convenient home hemodialysis. The room should also be comfortable
and allow for the rooms’ other social requirements like family activities.
The room should also have adequate lighting, a low humidity and
comfortable temperature, no open or overt risky hazards like open
fireplaces and clutter and should be restricted with pets and kids during
dialysis. Surfaces and furnitures are easy to clean. Curtains and carpets
are generally undesirable and, if possible should be replaced with wet
wipes surfaces plastic/synthetic blinds, tiles, linoleum and hard flooring.

2. An appropriate electricity supply to accommodate HD. The supply

should be compatible with all the equipments, as recommended by the
manufacturer and compliant with the regulations of home hemodialysis

3. A space for the medical supplies and the machine.

4. Additional space for storing supplies which will last for 3 to 6 months.

5. The room must have O2 cylinder, glucometer, BP apparatus,

thermometer and emergency madications.

6. A bath room drain near to the room of the patient to drain treatments
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

fluids.

PRE INITIATION OF THE PROGRAM

After selection of site and the patient pre initiation of the program will proceed.
Like in any programs we must take into considerations the following:

1. Contact the availability of the machine from the company. The

machine must be set up by the company engineer before bringing to
the home of the patient. To make sure that the machine is functional
and ready to use.

2. Staff nurses are well trained and fit emotionally and psychologically.

3. Transportation will be also be discussed. Necessary in transporting

the staff to and from the house of the patients.

4. Staff nurses must check that all forms necessary for documentation is
complete.

5. All emergency drugs must be complete.

6. Collaborate with the patient and patient family in preparing the home
for dialysis.

7. Provide the patients supply.

 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

STAFF QUALIFICATION AND EDUCATION

PLANNING

1. Home hemodialysis leaders define the desired education,

skills ,knowledge and other requirements for the nursing staff.

2. Home hemodialysis leaders develop and implement processes for

evaluating and appointing staff.

3. There is documented hospital information for each staff member.

4. A staffing strategy for the home hemodialysis unit must be developed by

the home hemodialysis leaders identifies the number, types and desired
qualification of staff.

ORIENTATION AND EDUCATION ( ATTACHED JOD DESCRIPTION OF

HOME HEMODIALYSIS STAFF NURSE)

1. All staff members must be oriented to the home hemodialysis setting to

the service to which they are assigned, and to their specific job
responsibilities. Each staff received and will receive and in service
education and training programe to maintain or advance his/her skills
and knowledge.

2. Staff members who provide patient care are trained and can
demonstrate competence in resuscitative techniques.
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

MANAGEMENT AND SAFETY OF THE ENVIRONMENT

1. The management and safety of the environment is very crucial for staff
nurses who are going for home hemodialysis. This is to prevent
accidents, injuries, maintain safe and secure conditions for patients and
for themselves and to reduce hazards and risks.

2. Staff education on safety and security procedures will be done during the
orientation.

3. The quality measures are developed and monitored monthly in the

patient home with corrective preventive actions.

INFECTION CONTROL AND PREVENTION

The infection prevention and control programme is based on our hospitals

policy and procedure to provide information on preventive practices and
infections. This was developed to ensure reduction on risk of organization-
acquired infections throughout the HHD setting in patients and staff during the
hemodialysis procedure.

1. Medical Waste Management - Adhere to the policy on Infection Control

Guidelines. (refer to ND 017-07)

2. Sharp Disposal – Adhere to IPC Guidelines.

3. Cleaning and disinfection of hemodialysis machine – Adhere to the policy

on infection Control Guidelines. (refer to ND 010-07)
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

4. Proper utilization of PPE.

INITIATION OF THE PROGRAM

After a thorough preparation for this project it came to realization last October
of 2022. The team assured that before starting everything was prepared and
the team knows that a single loophole will make the project a failure.

Everything was reviewed from the forms, equipment, stocks of the patient, the
home of the patient, medicines needed, the machine to be used, the
transportation and specially the nurses who will do the procedure for the home
hemodialysis patients. The patient was also pre-screened again.

The team leader already made a schedule for the nurses who will go for the
home hemodialysis. They had a hard time making the schedule because it will
be a loss of staff for the unit since they will do it outside the hospital premises.
The staff nurses are hesitant at first to do the home hemodialysis because they
will be away and what if something happened to the patient. But as time goes
by nurses are already volunteering their services because they know that they
are not only helping this patients and their families but the Ministry of Health as
well because it will lower the cost of health expenses of this patients. The staff
also gained confidence already because of the in training programs that the
dialysis unit is offering to make sure that these staff nurses who are going for
home hemodialysis are equipped with the knowledge and skills. Even they will
face untoward reactions from the patient they will manage and not only with
the patient but knows how to trouble shoot the machine if there will be any
problem.

Transportation and the driver was also arranged already since the schedule of
the patient will be for three times a week.
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

Initially we had only one patient. Patient Mr. X was bedridden, overweight and
paraplegic. He was an eligible candidate for home hemodialysis because of
the factors presented.

PROCESS OF DOING HOME HEMODIALYSIS

Driver will fetch the nurses in the hospital and drive to

the home of the patient

Patient at home and in bed

ready for dialysis procedure

Before dialysis nursing assessment will be done

Patient for
YES
hemodialysis

1. Nurse will prepare hemodialysis

machine.
2. Check vital signs of the patient.
3. Prepare the access of the patient.
4. Perform hemodialysis procedure.
5. Assess patient every 45 minutes.
6. End dialysis after 4 hours.

Nursing
assessment for
patientsstability
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬
yes no

YES NO

Staff nurse will go back to Staff nurse will call

hospital facility. doctor on call for
further assessment

Nephrologist decide
wether to dialyze at
home or in a hospital
care facility or needs
admission.

EVALUATION:
 ‫اململكة العربية السعودية‬
‫مديرية الشئون الصحية بمحافظة الطائف‬
‫مستشفى امللك عبد العزيز التخصصي بالطائف‬

The program itself was a success and the patient and the family was satisfied
with the service that the team has given. It was observed during this time that
there is strong need for home hemodialysis program to manage the increasing
number of hospital based dialysis patients. The overall perception is that
home dialysis programs will promote a better quality of lifev for patients by
allowing less disturbance to their activities of daily living .

From the one patient that we had during the initiation of this program. At
present we now have ongoing three patients who are doing dialysis three
times a week. Staff nurses are allocated perspectively. The team is looking
forward to cater to more patients in the home hemodialysis program.