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1. How can Dialysis Technicians (DT) trained several ago years and who are certified as a CNA get DT added to his/her certificate?
2. Is there a dialysis RN to dialysis patient ratio specifically a patient ratio for the charge nurse?
3. Does the Office of Health Care Quality (OHCQ) and the Commission on Kidney Disease (CKD) surveyors have the authority to interpret the Nurse Practice Act and cite such interpretations as grounds for survey deficiencies at Kidney dialysis centers?
4. If an RN assess that there is an inadequate number of staff available to provide patient care that day (e.g. CNA-DT call out) What can the RN do? Can the RN refuse the assignment of the day until adequate staff is provided (e.g. contact agency for supplemental staffing?
5. Is it appropriate for a RN to be assigned to monitor up to 3 patients and be the nurse responsible for patient care (assessments, meds, etc.) for up to 6 patients including 3 patients he/she is monitoring?
6. Is the charge nurse allowed to run 3 patients on the floor at the same time as being charge?
7. Are CNA-DTs allowed to place oxygen on a patient under direct RN supervision?
8. Are CNA-DTs allowed to turn on oxygen for patients on maintenance oxygen?
9. Are CNA-DTs allowed to administer oxygen in emergency situations?
10. Dialysis Assistant (DA) - Can they monitor and record treatments including vital signs? This is a different job than CNA – DT
11. Does the MBON have the primary authority and responsibility for interpreting and enforcing MBON regulations?
12. Can current CNA-DTs precept new CNAs in the dialysis center?
13. For the survey period 11/22/06 to 5/22/07 the statistics represent how many completed surveys by OHCQ?
14. May a RN call in a prescription for a patient if she has a written prescription from the physician?
16. When will the renewal of the CNA-DT be available online?
17. Can RNs obtain the first initial informed consent/authorization for dialysis treatment from the patient?
18. I have a RN that has re-applied after having an expired RN license. He received a paper stating he has a license, but it is not online, but he is on the telephone verification system.
19. What can LPNs actually do in the clinic environment independently? Please be specific.
20. Can a CNA-DT collect pre-assessment data elements such as vital signs, check for edema; and report any abnormality to the RN and then start the patient’s treatment before the nurse does the assessment?
21. Do you think there is an overwhelming amount of responsibilities for a RN (charge nurse) for an ongoing understaffed dialysis setting? Do you think there should be a definite nurse: patient ratio in any dialysis clinic?
22. Can RNs review the CPR preference with the patient and have the physician co-sign?
23. Will there be a time when a CNA-DT could be trained as a medication technician to free up the RN for assessments in the dialysis facility?
24. Our nurses are paid for all the time-no lunch time deducted, are they considered on-duty the entire day? Therefore – one nurse in the facility meets the V432-Federal requirement. Is thus a correct statement?
25. In units with one nurse covering, can the RN leave the unit to take a break in the break room and still be considered physically present and available to the patients?
26. There is great concern about requiring each dialysis center to provide Hepatitis B isolation. Hopefully centers will not have many of these patients and ideally isolation areas will be used for only those patients with Hepatitis B. However, if the center is full and has only one Hepatitis B patient they will be more likely to put non-Hepatitis B patients in that area to obtain full utilization of available chairs. This can increase the risk of a patient being infected with Hepatitis B if the patient loses or does not have Hepatitis B antibodies. From a process and organization standpoint it make much more sense for a group of centers who are geographically close to designate one or more centers to care for these patients; That way staff always know that the Hepatitis B area has specific procedures and its use doesn’t “change” based on the patients status. This also is much more practical and safe from an infection control standpoint and promotes optimal use of existing chairs and staff. Could you give cohorting of patients careful consideration?
27. The proposed revisions to the Federal Conditions for Coverage include radical changes to the nursing assessment and other assessment processes. What is being done by the State to ensure that the state regulations do not contradict the revised Federal regs (when they are released)?
28. Are there guidelines for how to treat or handle psychiatric or behavior problem patients, so that a facility is not cited for not doing particular procedures for that patient? Especially after the facility documents, and holds meetings. The patient can be competent and slightly demented, and also be manipulative.
29. In some jobs, time management studies are performed i.e. how long does it take to do what. No time management studies have been done in the medical field. Why isn’t time management studied in the medical field?
30. Doesn’t every business book on management/leadership state that an individual should only work for one person? Why is it in the medical field most RNs work for 2 people? Doesn’t this lead to many communication problems?
31. Why are surveyors for the CKD and OHCQ now enforcing compliance with the same regulations in a manner that is inconsistent with prior survey practices and historic interpretations?
32. How many of the 60,000 RNs are providing clinical care? If the treatment requires RNs and there aren’t enough, how will care be rationed?
33. It seems 50% of nurses leave a position because of “other” than strictly job specific tasks i.e. attitudes etc. Some CKD or MBON rules alienate the RN. e.g. letting a CNA-DT cannulate patients all day long and then telling the CNA-DT he/she can not start oxygen on a patient. Why is it that no one understands how these rules puts the nurse in an awkward position and usually make the CNA-DT resent the RN?
34. When can the CNA-graduate of the DT training program practice after passing the test?
35. Recently in the Nurse Communicator the MBON stated that “readily available” in the chronic dialysis setting requires the RN to be “physically present” on the unit of care where the patient is receiving dialysis. As this statement has appeared in a nursing article, does the MBON intend to promulgate a regulation defining what constitutes “physically present on the unit” within the meaningful COMAR so that it has legal force and effect for nurses in all “structured settings”? If so, will the MBON allow a public comment period for nurses and providers in all “structured settings” to provide feedback to the MBON on the implications of such a new regulation?
36. Regarding to the CNA-DT on the certificate is there a possibility to fix the problem of the DT not showing up on the licenses?
37. Post data collection completed by the CNA-DT is different from the post assessment of a nurse. Is post data collection by the CNA-DT adequate for completion of dialysis treatment if the patient is stable?
38. How can compact state RNs verify CNA-DTs online?
39. When you say the CNA-DT cannot calculate a medication dose, does that mean the CNA-DT cannot draw up the medications? These medications are in multi-dose vials.
40. Define an example of “process in place to verify correct dosage from correct vial prior to
41. Regarding the review of the heparin administration (1,000 u per 1 ml) by the CNA-DT- does the nurse have to verify the bolus heparin administration?
42. Please clarify: Can CNA-DTs administer heparin mid-treatment as a bolus instead of infusion?
43. Please clarify: Does the RN have to draw up the heparin bolus i.e. bolus is 5,000 units using a 1000u/ml = 5 cc, can the CNA-DT draw up the heparin?
44. To recertify the CNA-DT, is formal heparin, normal saline or lidocaine training required?
45. What is required for employee files in regard to proof of experience?
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