Medical professionals rallied to keep dialysis patients safe during water crisisWritten by Danielle Stanton | | firstname.lastname@example.org
As Toledo Mayor D. Michael Collins and his administration hunkered down in crisis mode during the Aug. 2-4 “no drink advisory” that sent Toledo residents scurrying for bottled water, there were others in the city tasked with jobs equally important — jobs in which the lives of kidney patients literally hung in the balance.
When word of the advisory reached local hospitals and clinics, nurses, doctors and technicians scrambled to protect vulnerable patients with acute and chronic kidney failure who need dialysis, a process that uses a machine to filter waste and excess water from blood when kidneys can’t. The process involves the use of water.
“Dialysis patients are unique in that they require life-sustaining treatment. It doesn’t take a vacation. Your body needs to have it,” said Vince Hancock, communications director for DaVERT (DaVita Village Emergency Response Team). “Their kidneys no longer function properly – they need these life-saving treatments, three times a week for four hours weekly.”
Locally-trained DaVERT nurses and doctors sprang into action after the mayor’s office issued the water advisory after the toxin microcystin was found at the water treatment plant, affecting drinking water for up to 500,000 area residents.
DaVERT is a crisis management operation based out of Denver, Colorado, that trains local, regional and national healthcare professionals in crisis management situations from earthquakes to hurricanes to dialysis treatment snarls, said the head of DaVERT, Alexis Garcia. DaVERT is part of DaVita, a leading provider of kidney care in the country.
“Because we’ve got clinics close to the affected clinic, we were able to transport patients to another clinic,” Garcia said. “We jumped on it and made some phone calls and set up a process where people took charge. Once we knew what was going on … (we had) a plan to resolve the situation.
Some patients in Toledo dialysis clinics were sent to medical centers outside the Toledo water region for treatment and other clinics brought in water tankers. In the case of dialysis services at Flower Hospital, DaVERT was able to improvise with special at-home machines that don’t use water.
“Because we were part of the hospital and had patients who needed triage and couldn’t relocate patients – we had to keep them in the hospital bed – the company (DaVita) wanted to approach the situation in the safest way possible so we found alternative methods without the use of water,” said Roxanne Myers, a registered nurse and the facility administrator for DaVita inpatient dialysis services at Flower Hospital.
The traditional dialysis machine takes the place of the kidneys that remove toxins from the blood. This traditional machine filters blood using water that runs through a reverse osmosis filtration process in combination with dialysate, an electrolyte-based solution. The NxStage CRRT machine uses just the solution in higher volumes with no water source needed, Myers said. They are normally used for at-home care.
The eight NxStage machines borrowed from neighboring DaVita programs in Michigan and Indiana allowed Flower Hospital to continue renal replacement therapy for patients over two to three days, Myers said.
After being notified of the crisis Aug. 2, a plan was in place for Flower Hospital’s inpatient treatment facility by Aug. 3 and patients were beginning treatment that same day. Treatments on the portable machines lasted through Aug. 5. Six patients were treated with the NxStage CRRT machines for a total of 12 treatments, Myers said.
The patients at Flower Hospital could not be relocated because they were too critically ill, Myers said. So the team had to come up with alternatives to achieve the highest level of safety. The use of the NxStage machines was a “very new idea” and one of the leaders of the crisis response team suggested it, Myers said. A DaVita representative came down on site to assist in how to use the equipment and there was a phone line set up for the hospital to troubleshoot.
“There was just so much happening in such a short amount of time. It was amazing how much was able to be accomplished,” Myers recalled. “Saturday night [Aug. 2] they were on site with equipment showing us how to set up. It was an amazing collaboration between the entire DaVita team, the bio-med leadership, who specialize in equipment, the DaVERT risk managers, who deal with emergencies, and the Promedica team, the hospital partners on conference calls for the day, keeping everyone informed.”
And the technology worked “fantastically,” she said.
“The portability of it for the patients who were not able to be moved worked out well for us. It was pretty amazing the whole experience, the collaboration. And the patients were taken care of and everybody went the extra mile to make that happen.”
Other clinics in Toledo opted to continue to use the traditional machines that require water. The procedure was safe, according to Tom Weinberg, general council for US Renal Care that owns four clinics in Toledo, Wildwood Dialysis, Alexis Dialysis, Northwest Ohio Dialysis and Talmadge Road Dialysis.
The machines are equipped with a very “strict” filtration system – the reverse osmosis treatment, plus two other kinds of filters, Weinberg said. They tested the water and did find a bacteria, he said. Weinberg was not certain if it was the microcystin toxin, but it was found to be a bacteria. After they filtered the water, they found the water to be clean, he said. They also spoke with the Lucas County Department of Health.
“When we learned of the issue in the city, we went back and confirmed with our technician the safe guards we have in our water treatment. We also tested the water and confirmed that indeed the filtering system filtered out the issue with the water,” Weinberg said. “We sampled before and after the system. And the system cleaned the waste and we were able to go on with normal operations.”
The clinics’ chief medical officer, the chief director and the biomedical technicians – specialists who install the machines and maintain them – all lent a hand, he said.
“They worked on this and made sure we were comfortable putting patients on dialysis,” he said.
In other outpatient facilities who also use traditional water-based machines, DaVERT brought in big tanker trucks and ran lines into many of the units to supply the machines with water that they knew was pure, Myers said.
Some patients have end-stage renal disease, which they will never recover from unless they have a kidney transplant. In acute renal kidney failure, the kidney’s may recover with the proper care. Treatment on a dialysis machine generally lasts three to four hours several times a week.
DaVERT responds to crisis situations across the country. It responded to the recent 6.0 earthquake in California and also did work during Hurricane Sandy and Hurricane Arthur earlier this summer, Garcia said.
“I came away with it in amazement in the resources we have at our fingertips,” Myers said. “It seemed to go very smoothly with what happened. And everyone was all hands on deck. Nurses floated from Akron, educators floated and leaders came in. I felt very, very supported from my own team. And it really made me feel like I want to give back. It was a very challenging experience to go through.”
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