16 Del. Admin. Code § 3330-11.0

Current through Register Vol. 28, No. 3, September 1, 2024

Section 3330-11.0 - Patient Assessment

11.1 The dialysis center interdisciplinary team:

11.1.1 Must consist of at a minimum:

11.1.1.1 The patient or patient representative;

11.1.1.2 A registered nurse;

11.1.1.3 A social worker;

11.1.1.4 A dietitian; and

11.1.1.5 A physician treating the patient for ESRD.

11.1.2 Is responsible to conduct an individualized and comprehensive assessment of each patient, which is used to develop the patient's treatment plan and expectations of care.

11.2 Each comprehensive assessment must include, but is not limited to evaluation and documentation of the following:

11.2.1 The current health status and medical conditions;

11.2.2 The appropriateness of the dialysis prescription;

11.2.3 Blood pressure and fluid management needs, including:

11.2.3.1 Pre/intra/post and interdialytic blood pressures;

11.2.3.2 Interdialytic weight gains;

11.2.3.3 Target weights; and

11.2.3.4 Intradialytic symptoms.

11.2.4 Laboratory profile;

11.2.5 Immunization history, including but not limited to:

11.2.5.1 Pneumococcal immunization;

11.2.5.2 Hepatitis immunization;

11.2.5.3 Influenza immunization; and

11.2.5.4 Tuberculosis screening.

11.2.6 Medication history, including allergies and all medications (prescription and over the counter) and supplements;

11.2.7 Factors associated with anemia;

11.2.8 Factors associated with renal bone disease;

11.2.9 Nutritional status by the dietitian;

11.2.10 Psychosocial needs by the social worker;

11.2.11 Dialysis access type and maintenance;

11.2.12 The patient's abilities, interests, preferences, and goals, including the desired level of participation in the dialysis care process;

11.2.13 The preferred modality (hemodialysis or peritoneal dialysis) and setting (in-center or home);

11.2.14 The patient's expectations for care outcomes;

11.2.15 The suitability, or reason for non-referral, of a transplant referral;

11.2.16 Family and/or other support systems;

11.2.17 Current physical activity level to determine if the patient is a candidate for referral to vocational and/or physical rehabilitation services;

11.3 Frequency of comprehensive assessments for patients new to dialysis

11.3.1 Patients changing dialysis modalities or returning to dialysis from a failed transplant are considered new patients.

11.3.2 An initial comprehensive assessment must be completed on each new patient within the latter of 30 calendar days, or 13 hemodialysis treatments, of admission.

11.3.3 A follow up comprehensive assessment must be completed three (3) months after the completion of the initial comprehensive assessment.

11.4 Comprehensive reassessments must be completed as follows:

11.4.1 Annually for stable patients; and

11.4.2 At least monthly for patients with the following:

11.4.2.1 More than three (3) hospitalizations in one (1) month;

11.4.2.2 Marked deteriorations;

11.4.2.3 Any event that interferes with the patient's ability to follow the treatment plan; or

11.4.2.4 Concurrent poor nutritional status, unmanaged anemia and inadequate dialysis.

11.5 Adequacy of the dialysis prescription must be assessed as follows:

11.5.1 Hemodialysis patients

11.5.1.1 At least monthly calculations of the Kt/V or an equivalent measurement.

11.5.2 Peritoneal dialysis patients

11.5.2.1 At least every four (4) months by calculations of delivered weekly Kt/V or an equivalent measurement.

16 Del. Admin. Code § 3330-11.0

22 DE Reg. 853( 4/1/2019) (final)