| Assistance with the Dialysis Access |
Patient had a non functioning fistula for 18 months, so had to dialyze using a dialysis catheter, which was a concern due to the increase in potential for complications related to the catheter. The Kidney Tel nurse sent a fax back letter to the PCN and spoke to his PCN and the DU nurses personally regarding a plan to gets the fistula functioning. The Kidney Tel nurse was informed that the member was "non compliant" and never followed up with his appointments. During one of my conversations with the member, the member stated he had gone to several appointments to the vascular surgeon, and during each visit, the surgeon asked him to open and close his hand and said "OK, you need surgery.", however, no one ever scheduled the surgery. The Kidney Tel nurse contacted the Nephrologist to schedule the surgery and the Kidney Tel Nurse ensured the Nephrologist that a call would be placed to the member the day before the appointment to remind the member of the appointment. The Kidney Tel nurse also confirmed the surgery had been scheduled. As a result of the efforts of the Kidney Tel nurse, the surgery was scheduled and the member now has a functional fistula, and the dialysis catheter has been removed. Each time the Kidney Tel nurse contacts the member, the comment is “Thank you, I feel so much better." |
| Preventative Care to avoid complications |
Kidney Tel nurses recognize the importance of preventative measures in preventing complications related to diabetes and peripheral vascular disease in renal patients. A member, who is diabetic, shared with the Kidney Tel nurse, during an assessment of the member in regards to foot care that he had very dry scaly skin on the feet that did not seem to be resolved with the application of lotion. The Kidney Tel nurse was concerned that the dry skin might lead to cracks in the skin that could result in a wound or infection. The Kidney Tel Nurse facilitated an appointment with a podiatrist. As a result the member was treated and complications related to the dry skin were avoided. The member was very appreciative for the assistance from the Kidney Tel nurse. |
| Assisting Physicians and Providers |
Another member was identified by a Kidney Tel nurse to have had a dialysis catheter in for approximately 20 months. The member had not been successful in having a plan for fistula placement and catheter removal despite discussing with her Nephrologist. The Kidney Tel Nurse contacted the Nephrologist that same day. The Nephrologist was very appreciative that the Kidney Tel nurse had contacted him and he arranged that very day for the member to have the vascular access work-up and subsequent surgery for fistula. The member is doing well and has avoided the complications related to dialysis catheters. |
| Why the Kidney Tel Nurse inquires |
Kidney Tel Nurse determined during assessment that a member required intervention for poor healing wounds. The member had a history of a recent hospitalization that resulted in amputation of a finger. The wound had signs of infection and had an open wound. The member also had a history of amputation below the knee of both legs, and it was identified that the right leg had a wound. The Kidney Tel Nurse facilitated the member receiving the necessary care for the wounds and home health visits were arranged. |