Hemodialysis Team at South Texas Veteran's Health Care System
May 2022
Hemodialysis Team
at South Texas Veteran's Health Care System
Audie Murphy VA Hospital
San Antonio
,
TX
United States
Hannah Cliatt, RN, MSN, MHA, Nurse Manager; Ma Lourdes Garcia, BSN, RN-CNN, Assistant Nurse Manager; Manuwell Allen, MIT; Susan Bazan, MIT; Luis Beltran, MIT; Joe Bustos, MIT; Cynthia Chavez, RN; Rolando DeLaGarza, MIT;Ivan Fonseca, MIT;Jonathan Del Rosario, RN;Brigitte Johnson, RN-CNN; Ma. Isabel LaGuardia, RN; Jocelyn Mamaril, RN; Chikondi Matekesa, MAA-HA, RN, DNS-CT, CDN; Leizl Meeks, RN; Marlyn Nisperos, RN; Diana Norris, RN; Aurora Ortega, MIT; Maria Posada, RN; Christina Ramirez, MIT; Jose Rocha, MIT; Christiana Saahene, RN; Justin Villanueva, RN; Sudsawat Viphusiri, RN; Walter Voges, RN; Stephen Weser, CNA; Danielle Maldonado, MIT
Despite these challenging events, all 16 nurses and 10 technicians who represent the ALM VA Hemodialysis Unit have paradoxically elevated their level of exemplary care to provide unwavering compassion and support.
I have worked with several extraordinary hemodialysis teams over the past 26 years, and I believe that the ALM VA Hemodialysis Unit embodies the mission of the DAISY Foundation and vision of the DAISY Team Award. Over the past year, the ALM VA Hemodialysis Unit has seamlessly absorbed an unprecedented number of personal and collective hardships associated with Winter Storm Uri, the Covid-19 Pandemic, and mounting supply chain issues that have disrupted normal operating procedures. Despite these challenging events, all 16 nurses and 10 technicians who represent the ALM VA Hemodialysis Unit have paradoxically elevated their level of exemplary care to provide unwavering compassion and support to their patients, the patients’ families, and the nephrology department, and the San Antonio dialysis community. Here are examples of how this unit has typified the VA Mission and VA Core Values:
1. During Winter Storm Uri in February of 2021, over 400 San Antonio hemodialysis patients were unable to dialyze due to city-wide interruptions in their dialysis unit water supply. Through expedited activation of VA’s “Fourth Mission,” the ALM VA Hemodialysis Unit adjusted its outpatient dialysis shifts and staffing to provide emergency dialysis treatments to displaced San Antonio civilian dialysis patients. They were also able to successfully absorb the attendant surge in the ALM VA hospital hemodialysis inpatient census. Several staff took turns staying overnight in the hospital to care for these patients at a time when their own homes and families were without power and water. When I rounded on these patients, they consistently expressed appreciation and gratitude for the excellent care and compassion delivered by the ALM VA hemodialysis staff during this precarious time. Undoubtedly, some of those patients would not have survived without the emergent provision of those hemodialysis treatments.
2. During the Covid-19 pandemic “Delta” surge of 2021 and “Omicron” surge of 2021-2022, there were unprecedented spikes in the numbers of hospitalized hemodialysis patients who required “in-room” dialysis treatments mandated by Covid-19 isolation requirements. To accommodate this new workload pattern, the ALM VA Hemodialysis Unit diverted more nurses to these patients who required 1:1 care with full PPE for 4 hours at a time. Despite these challenges, every time I rounded on these patients, I saw the dialysis nurse greet the patient with a smile and provide compassionate care to the patient and their family members. In the ICU, critically ill hemodialysis patients and their family members were treated with expertise, grace, and compassion.
3. Over the past year, the ALM VA Hemodialysis Unit faced mounting “supply chain issues” of 2021-2022 that affected CRRT solutions, dialysis needles, dialyzers, and dialysis tubing supplies. They also battled the challenges of acquiring maintenance contracts for the Cyberren IT interface software program, B Braun dialysis machines, Baxter (peritoneal cyclers), Marcor (water purification hardware), and Tablo (dialysis machines). On several occasions, these problems threatened the operational readiness of the dialysis unit, potentially impacting delivery of hemodialysis to inpatient and outpatient veterans. Fortunately, innovative thinking prevailed, and these obstacles were successfully overcome without a single dialysis treatment loss. Additionally, ALM VA hemodialysis nurses played pivotal roles in a successful plan to transition delivery of Tablo dialysis in the MICU/SICU from HD RNs to ICU RNs, facilitating the conservation of a dwindling national supply of CRRT solutions.
The Mission Statement of the DAISY Foundation is “to express gratitude to nurses with programs that recognize them for their extraordinary compassionate, skillful care they provide patients and families. By honoring compassionate nurses, DAISY reinforces the importance of compassion in healthcare.” The DAISY Team Award is intended to honor collaborative effort by nurse-led teams who rise above the traditional role of nursing. I can’t think of a better way to honor the perseverance, innovation, compassionate care, and unwavering support that the ALM VA Hemodialysis Unit has provided to everyone throughout the challenges they faced over the past year, than to recognize them as a DAISY Team!
1. During Winter Storm Uri in February of 2021, over 400 San Antonio hemodialysis patients were unable to dialyze due to city-wide interruptions in their dialysis unit water supply. Through expedited activation of VA’s “Fourth Mission,” the ALM VA Hemodialysis Unit adjusted its outpatient dialysis shifts and staffing to provide emergency dialysis treatments to displaced San Antonio civilian dialysis patients. They were also able to successfully absorb the attendant surge in the ALM VA hospital hemodialysis inpatient census. Several staff took turns staying overnight in the hospital to care for these patients at a time when their own homes and families were without power and water. When I rounded on these patients, they consistently expressed appreciation and gratitude for the excellent care and compassion delivered by the ALM VA hemodialysis staff during this precarious time. Undoubtedly, some of those patients would not have survived without the emergent provision of those hemodialysis treatments.
2. During the Covid-19 pandemic “Delta” surge of 2021 and “Omicron” surge of 2021-2022, there were unprecedented spikes in the numbers of hospitalized hemodialysis patients who required “in-room” dialysis treatments mandated by Covid-19 isolation requirements. To accommodate this new workload pattern, the ALM VA Hemodialysis Unit diverted more nurses to these patients who required 1:1 care with full PPE for 4 hours at a time. Despite these challenges, every time I rounded on these patients, I saw the dialysis nurse greet the patient with a smile and provide compassionate care to the patient and their family members. In the ICU, critically ill hemodialysis patients and their family members were treated with expertise, grace, and compassion.
3. Over the past year, the ALM VA Hemodialysis Unit faced mounting “supply chain issues” of 2021-2022 that affected CRRT solutions, dialysis needles, dialyzers, and dialysis tubing supplies. They also battled the challenges of acquiring maintenance contracts for the Cyberren IT interface software program, B Braun dialysis machines, Baxter (peritoneal cyclers), Marcor (water purification hardware), and Tablo (dialysis machines). On several occasions, these problems threatened the operational readiness of the dialysis unit, potentially impacting delivery of hemodialysis to inpatient and outpatient veterans. Fortunately, innovative thinking prevailed, and these obstacles were successfully overcome without a single dialysis treatment loss. Additionally, ALM VA hemodialysis nurses played pivotal roles in a successful plan to transition delivery of Tablo dialysis in the MICU/SICU from HD RNs to ICU RNs, facilitating the conservation of a dwindling national supply of CRRT solutions.
The Mission Statement of the DAISY Foundation is “to express gratitude to nurses with programs that recognize them for their extraordinary compassionate, skillful care they provide patients and families. By honoring compassionate nurses, DAISY reinforces the importance of compassion in healthcare.” The DAISY Team Award is intended to honor collaborative effort by nurse-led teams who rise above the traditional role of nursing. I can’t think of a better way to honor the perseverance, innovation, compassionate care, and unwavering support that the ALM VA Hemodialysis Unit has provided to everyone throughout the challenges they faced over the past year, than to recognize them as a DAISY Team!