Dialysis Nursing Expert Comments on Patient Death During Treatment in Outpatient Dialysis Center

This case involves an elderly male patient who died while receiving treatment at a dialysis center. The patient presented to the dialysis center with an elevated heart rate and a prescription for antibiotics, which was suggestive of an active infection for which he was receiving treatment. He was not seen by his physician on arrival to the dialysis facility and, as a result, the physician did not evaluate his physical condition before dialysis treatment was begun. At some point while he was receiving treatment the patient went into cardiac arrest. Neither the physician nor any of the other personnel at the treatment center checked on the patient during the time he was there receiving treatment, which took several hours. Additionally, the patient’s vital signs were not monitored during the treatment. Staff at the dialysis center only discovered that the patient had died hours after he had begun treatment. It was alleged that the facility failed to adequately evaluate the patient’s condition, both during his arrival at the facility and during his dialysis treatment.

Question(s) For Expert Witness

1. Do you see patients in a dialysis center on a routine basis?

2. Given the condition of this patient, should a physician and/or a nursing staff member have evaluated him before beginning treatment?

3. If a patient presents to the dialysis center with a severely elevated heart rate and signs of infection, should he be sent to the emergency room?

4. What additional monitoring procedures during dialysis treatment must be adhered to?

Expert Witness Response E-007297

I am an RN, MSN and a CNN (certified nephrology nurse). I have practiced in chronic, acute and pre-end-stage-renal-disease settings, and have practiced in nephrology for over 20 years. I am currently an instructor for dialysis technicians for a major chain of dialysis treatment centers. I frequently see dialysis patients in treatment centers on a routine basis. It is critical that patients should be assessed before each and every treatment. Blood work should have been drawn, and the patient should have been sent to the ER following assessment and orders from the physician if conditions remained the same. The patient in this case appears to have been unstable when he arrived at the center. Monitoring of patients is continuous throughout treatment, and documentation of such is required at a minimum of every 30 minutes. For unstable patients, this is done more frequently. It is clear that there was a major failure to adequately monitor the patient's condition in this case.