CLINICAL PRACTICE GUIDELINES Bacaan Penuh ( bersaiz 7.2 MB)

N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 44 N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 45 A P P E N D I C E S N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 46 N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 47 Head of DepartmentUnit of Nephrology Consultant Nephrologist Clinical Specialist Dialysis Manager Medical Oicer Staf Nurse Assistant Medical Oicer Attendant APPENDIX 1 HAEMODIALYSIS UNIT ORGANISATIONAL CHART AT HOSPITAL WITH RESIDENT NEPHROLOGIST N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 48 State Nephrologist Designated Nephrologist Clinical Specialist Dialysis Manager Medical Oicer Staf Nurse Assistant Medical Oicer Attendant APPENDIX 2 HAEMODIALYSIS ORGANISATIONAL CHART AT SPECIALIST HOSPITAL WITHOUT RESIDENT NEPHROLOGIST Head of Medical Department N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 49 APPENDIX 3 HAEMODIALYSIS ORGANISATIONAL CHART AT HOSPITAL WITHOUT SPECIALISTS State Nephrologist Designated Nephrologist Dialysis Manager Medical Oicer Staf Nurse Assistant Medical Oicer Attendant Hospital Director N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 50 APPENDIX 4 NEPHROLOGY WARDCLINIC ORGANISATIONAL CHART AT HOSPITAL WITH RESIDENT NEPHROLOGIST Sister Consultant Nephrologist Staf Nurse Attendant Clinical Specialist Medical Oicer where nephrology wards are available N e p h ro lo g y S er v ic es O p er a ti o n a l P o li c y 51 APPENDIX 5 ORGANISATIONAL CHART OF THE NEPHROLOGY MANAGEMENT COMMITTEE AT NATIONAL LEVEL National Advisor for Nephrology Services MOH Planning Development Committee Technical Evaluation Committee Human Resource Committee Technical Speciications Committee Ethics Clinical Governance Committee Nephrology Training Committee N e p h ro lo g y S er v ic es O p er a ti o n a l P o li c y 52 APPENDIX 6 ORGANISATIONAL CHART OF THE NEPHROLOGY CLINICAL COMMITTEE AT NATIONAL LEVEL National Advisor for Nephrology Services MOH General Nephrology Research Audit Kidney Transplant Diagnostic Interventional Nephrology Haemodialysis Critical Care Nephrology CAPD N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 53 APPENDIX 7 LIST OF RECOMMENDED EQUIPMENT Essential Medical Non-Medical Equipment For Haemodialysis Unit • Haemodialysis Machines • Dialysis Chairs • Automated Dialyser Reprocessors • Water Puriication Systems, Reverse Osmosis • Automated Clotting Timers ACT • Sitting weighing scale • Oxygen supply • Dressing trolleys • Emergency cart trolley with deibrillator • Non-invasive blood pressure monitoring NIBP sets • Pulse oxymeters • Volumetric infusion pumps • Electrocardiographs ECG machine • Glucose monitoring set • Refrigerator • Computer with Internet connectivity Optional items for Haemodialysis Unit • Online Haemodiailtration machine HDF • Continuous Renal Replacement Therapy CRRT machine • Portable Reverse Osmosis Water System • Non Invasive Vascular Access Monitoring • Slow Extended Daily Dialysis Machine SLEDD • Dialyzer rinsing machines • Bioimpedance analyser N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 54 Essential Medical Non-Medical Items For PD Unit • PD cyclers • PD sets • Hanging scale • Sitting weighing scale • Oxygen supply • Dressing trolleys • Emergency cart trolley with deibrillator • Non-invasive blood pressure monitoring NIBP sets • Volumetric infusion pumps • Electrocardiograph ECG machine • Glucose monitoring set • Refrigerator • Computer with Internet connectivity Other Essential Medical Non-Medical Items For Nephrology Services • Ultrasound • Renal biopsy equipment • Urine phase contrast microscope • Ambulatory blood pressure monitor N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 55 APPENDIX 8 LIST OF MEDICATIONS 1. Transplant drugs • Cyclosporine • Tacrolimus • Mycophenolate Mofetil • Mycophenolate Sodium • Azathioprine • Prednisolone • Methylprednisolone • Sirolimus • Everolimus • Monoclonal and polyclonal antibodies e.g. thymoglobulin, ATGAM • IV Immunoglobulin • Basiliximab

2. Dialysis drugs

• Erythropoieitin stimulating agents ESA IV and subcutaneous • Vitamin D and analogues IV and oral • Desferioxamine IV • Iron IV and oral • Phosphate binders calcium carbonate, lanthanum carbonate, sevelamer The list of medications may be updated as new drugs become available. N e p h ro l og y S e r v i c e s O p e ra t i o n a l Po l i c y 56 APPENDIX 9 INFECTION CONTROL IN THE HAEMODIALYSIS UNIT 1. Universal Precautions a Wash hands in between patients. • Use soap and clean running water or an alcohol-based hand rub or foam. • Hands-free tap shall be provided. b Wear gloves. • Change in between patients. • Wash hands after removal of gloves. c Do not recap needles. d Use designated sharps bin. • Place as close as is practical to the point of use. • Sealed and disposed when full. e Staf attire. • Wear plastic gown. • Remove protective wear as soon as possible on completion of treatment. • Ensure clean work attire for every shift.

2. Clean trolley preparation of medication

a A clean area shall be designated for preparation of medications and syringes. b Medications and syringes used in the patient’s station shall not be returned to the clean area. c Single-use vials are strongly encouraged. Multiple-use vials e.g. heparin if used, are to be prepared in a clean area and all doses to be drawn in the same session. DO NOT REUSE needles or syringes.

3. Disinfection of machines, external surfaces and equipment

a Clean exterior surface of machines in between patients and at the end of the day.