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* What is the job of a Patient Care Technician (PCT)?

To monitor patient care and assist patient in recieving safe andeffective dialysis.
What is CKD?
Chronic Kidney Disease
What is the main goal of dialysis treatment?
To acheive the highest level of wellness possible by removing wastes and excess liquid from the
blood.
Who makes up the dialysis care team?
Technicians,Nurses, Dieticians,
Social Workers, Doctors
& Patients.
What are some factors which affect one's overall health?
Age, Activity Level, Treatment Plan, Other Illness & Support System.
Which are the two most common types of Dialysis?
Periotoneal (PD) and Hemodialysis (HD).
How is ESRD treated?
Dialysis
What 3 functions does dialysis replace?
1. Removes wastes from blood,
2. Removes excess fluid,
3. Balaces electrolyes.
What are electroyles?
Electrolytes are the salts in the body. The most common salts are sodium ions, potassium ions,
and chloride ions that carry an electrical charge.
Why are electrolytes important?
The electrolytes in the blood serum produce an electrical charge, which permit cells to preform
their normal functions.
what happens if the electrical charges amongst the electrolyes become unbalanced?
The nerve and muscle cells within the body, including the brain, may fail to conduct nerve
impulses, leading to cramps and confusion. Further electrolyte imbalances can lead to heart
failure, siezures or water retention.
What is an Ion?
An electrically charged particle
What is a dialyzer?
A synthetic or organic devise that serves as the artificial kidney. It has a blood compartment and a
dialysate compartment.
What does the dialyzer permit?
It allows for the counterflow of dialysate and blood, which are seperated by a semipermiable
membrane or hollow microfibers.

Describe the flow of fluids through the dialyzer.


Blood flows through the microfibers (blood compartment) and dialysate flows around the
microfibers (dialysate compartment).
What is a semipermiable membrane?
A barrier with microscopic pores which allow for the passage of some substances but not others,
depending on size.
In (HD) Hemodialysis, what is the delivery system?
The dialysis machine.
What does the delivery system control?
Blood flow (Extraction and Return), Saftey Parameters, Dialysate Mixing and the Delivery of
Dialysate.
Typically, how often is HD preformed?
Three times per week, 4 hours each treatment.
How much kidney function does (HD) dialysis replace?
About 15% of kidney function is restored through Hemodialysis.
Can HD be done independantly at home?
Yes, short treatments 5 to 6 times per week or longer treatments at night 3-7 days a week.
Term
When was the first CELLULOSIC MEMBRANE used for dialysis?
Definition
In 1943, by Willem Kolff in a rotating drum.
Term
The greatest advancements in primitive dialysis were made during which three year period?
Definition
The Korean War 1950-1953
Term
Who created the "shunt"?
Definition
(1960) Dr. B. Scribner
Term
What is a shunt?
Definition
A form of vascular acess by which the artery and vein are linked extracorporally by a plastic tube.
Term
Why are shunts rarely used today?
Definition
There is a high risk of infection and clotting.
Term
Six years after the shunt was created, who pioneered the fistulae procedure?
Definition
(1966) Dr. James Cimino
Term
What is a AV fistula or native fistula?
Definition
An arteriouvenus connection underneath the skin between a vein and an artery.
Term
When was the first hollow fiber dialyzer mass marketed?
Definition
1960

Term
What was the dialysis dilemma between 1960-1973?
Definition
There were not enough dialysis machines to treat pts with kidney failure.
Term
Regarding renal failure, prior to 1973, what was the "Death Committe"?
Definition
It was a group of people and clergy who chose which ESRD patients would not recieve care
based on age, maturity, education, dependants, economic status and their relative contribution to
society.
Term
Prior to 1973, why did some people choose death over dialysis?
Definition
Primarily because the cost of dialysis care was extremely expensive, and financially burdensome.
Term
How did government interceed on behalf of families affected by ESRD?
Definition
In 1972 Congress passed a law "92-603" and created the ESRD Program to provide Medicare
benifits to pts entitled to Social Security benefits.
Term
What does the ESRD 92-603 law ensure?
Definition
That SS eligible pts are entitled to Medicare benefits which pay up to 80% of allowable costs.
Term
Of all the life threatening diseases, such as hepatitis, and HIV, which disease has it's own
Medicare Program?
Definition
Renal Disease, through the ESRD Medicare Program.
Term
What changed the dynamics of dialysis care?
Definition
Government intervention and Government funding.
Term
What was a major benifit of the ESRD Medicare Program?
Definition
More independant centers began to open as free standing, non hospital based clinics devoted to
dialysis care.
Term
What is a LDO?
Definition
Large Dialysis Organization
Term
What does the LDO do?
Definition
Purchase, or own smaller dialysis centers across the country.
Term
How does medicare pay for treatment?
Definition
Composite Rate
Term
What is a Composite Rate?
Definition
A payment based on an individul's age, weight, height and is based on that individuals need of
overhead, staff, drugs, training and equipment.
Term
Who calculates the composite rate?

Definition
Congress calculates the rate, and adjusts the rate by legal decree.
Term
When was the composite rate last adjusted?
Definition
In 2002.
The average rate was $130.50 per treatment.(63K annually)
Term
At the current composite rate, are centers making a profit by serving pts whose only form of
payment is made by composite rate?
Definition
No.
ESRD medicaid composite rate payments cause centers to suffer a loss of about $10 per
"Medicare only" patient.
Term
How much does private insurance generally pay per patient?
Definition
$126K per patient annually.
Term
In 1978, Medicare contracted HOW MANY AGENCIES to provide oversight(Quality Control)
throughout the United States?
Definition
18 (ESRD Networks)
Term
What type of oversight is provided by these networks?
Definition
Quality Improvement
Rehabilitation
Collect and Report Data
Provide Resources
Collect Grievances
Term
What is Quality Care?
Definition
The degree to which services rendered actually increase the likelyhood of a desired outcome, all
of which are consistent with current professional knowledge.
Term
What is IOM?
Definition
Institute of Medicine.
Term
What does the IOM do?
Definition
It assesses the US healthcare system.
Term
What is a strategy promoted by the IOM to improve care?
Definition
The "Six Aims" of Improvement.
Term
What are the Six Aims?
Definition
Safe, Effective, Patient Centered, Timely, Efficient & Equitable Care.
Term
What was the original purpose of the Medicare ESRD Program?
Definition
To keep patients alive, and help them to stay active, employable and able to pay taxes.

Term
How do the reports generated by ESRD Networks help law makers?
Definition
It help congress to decide if dialysis treatments paid for by the ESRD Program actually help to
meet the goal set by the ESRD Program of 1972.
Term
What is the greatest pressure of any clinic?
Definition
To assess and treat the overal condition of it's patients, and show that it has been providing cost
effective quality care.
Term
How is QUALITY CARE checked?
Definition
It is checked by comparing centers to PRESET STANDARDS (Quality Assurance).
Term
What happens if a center does not meet the Quality Assurance Standards already set by
Medicare?
Definition
The center risks loosing it's Medicare Certification to provide ESRD services.
Term
Who is CMS?
Definition
he Centers for Medicare and Medicare Services"
Term
What main service does CMS provide?
Definition
Oversight and the inspection of Medicare funded facilities.
Term
Who is the DHS?
Definition
It is a state agency, the Department of Health Services
Term
What is the CMS's relationship to the DHS?
Definition
The federal agency contracts(CMS) the state agency (DHS) to facilitate the actual inspections
and to report back to the CMS.
Term
What do these contracted DHS surveyors do?
Definition
They visit Medicare funded clinics with PRESET GUIDELINES (Quality Assurance Checklists)
and report if the clinic has met these standards.
Term
Why is important to work each day as if it were to be inspected?
Definition
Because mishaps and oversights can cause a center to loose it's main source of funding or
medicare certification.
Term
Aside from the CMS standards, who else has set Quality Assurance Guidelines?
Definition
The Regional ESRD Networks, Joint Commissions on Healthcare Organizations (JCAHO) and
the Association for the Advancement of Medical Instrumentation (AAMI).
Term
JCAHO has focused its QA standards in which area?
Definition
Hospital Based Clinics
Term

ESRd Network has focused its QA standards on what two areas?


Definition
Patient care and Patient Outcomes.
Term
AAMI has focused its QA standards in which area?
Definition
Water Treatment Standards, Dialysate Preparation Guidelines, Dialyzer Reprocessing Standards.
Term
The FDA has focused its QA standards in which area?
Definition
The safety and effectiveness of all medical equipment and devices. (Dialyzers, tubing, monitoring
devices, alarms, machines, reprocessing, water treatment systems).
Term
If there is a problem with a device, equipment or there are adverse events what federal entity
requires that a report to be made?
Definition
The FDA.
It requires all healthcare providers to fill out special reports for manufactures and the federal
goverment, disclosing adverse events relating to problems with medical equipment.
Term
Who is USRDS?
Definition
The United States Renal Data System.
Term
What does the USRDS provide?
Definition
USRDS provides reports comparing data from every dialysis center in the United states annually.
Term
What do the ESRDS annual reports disclose?
Definition
National averages which include:

MORALITY RATE
Number of Patients
&
Cost of Treatment.
Term
What publically disclosed report can be used to evaluate patient outcomes in a particular clinic or
in a particular region?
Definition
The USRDS Annual Report
Term
What is the CPM Project?
Definition
The Clinical Preformance Mesures Project is a joint effort between the CMS, and ESrD Networks
and Dialysis Centers that compare the quality of "MEDICARE ONLY" Dialysis to preset guidelines
set by the National Kidney Foundations's Quality Initiative Goals.

Term
The CPM Project Annual Report provides data based on which criteria?
Definition
Adequacy of treatment, Vascular Access, Anemia, and Albumin Test Results.
Term
What are two major pt outcomes measured against the Q.A. standards for Dialysis Care?
Definition
Morbidity & Morality
Term
What is morbidity?
Definition
Sickness
Term
What is morality?
Definition
Death
Term
What do the clinical practice guidlines outlined in Core Curriculum actually provide?
Definition
Improved outcomes for all patients.
It provides the best approach to care and treatment based on current scientific and professional
knoweledge.
Term
What is anemia?
Definition
A medical condition, by which there is a shortage of oxygen carrying red blood cells in the blood.
Term
What are symptoms of anemia?
Definition
Fatigue, low blood pressure and chills.
Term
After (HD) treatment, how can a tech help reduce anemia?
Definition
1. By preventing the dialyzer from clotting.

2. Making sure that the maximum amount of blood is returned to the patient.

3. By preventing excess blood loss when removing needles.


Term
How can techs ensure that pts get adequate dialysis?
Definition
1. Correclty preform blood draws.

2. Ensure that pt gets at least the minimum tx.

3. If needed, explain why pts should stay on the entire prescribed time.
Term
How can techs ensure that pts access sites are preserved and protected?
Definition
1. Techs can protect and preserve pt accesses when proper technique is used to access the site.
2. When the proper pressure is used after removing needles after treatment.
3. When access problems are reported to nurses or doctors as soon as possible.
Term
Generally, what is the ongoing goal of all patient care centers?
Definition
Continuous improvement & improving pt outcomes by delivering high quality, efficient care in the
dialysis industry.
Term
What is the difference between CQI and QA?
Definition
Continuous Quality Improvement focuses on how things presently work, and the steps required to
make them better, which would prevent future problems while Quality Assurance focuses on the
survey of data in order to screen for potential deficiencies or problem areas.
Term
What is the difference between Top Down and Bottom Up QCI?
Definition
Quality care iniciatives can begin with management (Top to bottom) or it can begin with the
service workers (bottom up)
Term
What are examples of Clinical QCI?
Definition
Improvements in anemia, tx adequacy and access issues.
Term
What are examples of Technical Quality Care Iniciatives?
Definition
Improvements in water treatment, dializer reuse or personal protective equipment.
Term
What are examples of Organizational Quality Care Iniciatives?
Definition
Improvements in accountability, Work Friendly Hours of Operation, Patient Saftey, Pt Scheduling
and Staff Scheduling.
Term
What is the CQI Planning Process?
Definition
1. Identify an area of concern.
2. Analyze the problem.
3. Identify or define the root cause of the problem.
4. Plan it, Do it, Check it, Act on the results.

Term
In a dialysis treatment center, who has the most direct pt contact amongst the care team?
Definition
The Patient Care Technician
Term
What does it mean to demonstrate professionalism?
Definition
To behave and preform duties in a courteous, conscientious and generally business like manner.
Term
Why is important to address pts by their titles?
Definition
Because using first names or nicknames may errode proffessional boundaries.
Term
Why is it important to remember to say "please" and "thank-you"?
Definition
Appreciation, and kind modes of speech demonstrate respect, and allows pts to retain dignity.
Term
Why is it important to wear a name badge and/or introduce yourself to new pts before attempting
to interact with them?
Definition
Proper introductions and titles demonstrate professionalism, common courteousy. It also helps
pts to feel more safe and comfortable while being rendered treatment.
Term
What are 3 ways to boost pt confidence?
Definition
1.Be on time.
2. Be prepared.
3.Adhere to Clinical and Proffesional Modes of Practice.
Term
Why is important to never talk about your personal life to clinical staff or patients?
Definition
It errodes the proffessional boundaries and may make others feel uncomfortable.
Term
Why is important never to talk around patients as though they aren't there?
Definition
It creates an uneasy enviroment, that may make the pt feel diminuative, ignored or aggitated.
Term
Why is it important to protect every patients privacy and confidential information?
Definition
Because it is the law!
(HIPPA)
Term
Why is it important to wear appropriate and clean clothing in a healthcare setting?
Definition
It demonstrates good hygine, fosters pride and promotes trust within the clinical setting.
Term
Why must one never shout accross the treatment area?
Definition
The level of noise must be kept to a minimum, so that confidentiality of each patient is protected,
and so that pts generally feel safe.
Term

Why must one avoid rushing or running through a tx area?


Definition
Pts may become worrisome or generally begin to feel unsafe.
Term
Why must the pt care area be visibly neat, clean and free of blood?
Definition
It demonstrates that efforts are being taken to create an enviroment where the highest possible
quality of can be rendered.
Term
What is the MOST IMPORTANT aspect of professional behavior?
Definition
Knowing how to maintain boundaries.
Term
What is the second most important aspect of professional behavior?
Definition
Respecting and Maintaining Everyone's Privacy.
Term
Proper Discipline, Professional Knowledge, Personal Commitment & Self Confidence all lead to ?
Definition
Positive Outcomes
Term
How many national certifications are presently available for (HD) technicians?
Definition
Three.
Term
Which test is offered as an entry-level COMPETENCY exam for individuals with at least 6 months
experience?
Definition
CCHT Exam
This exam is offered by The Nephrology Nursing Certification Commission.
Term
How long is the NNCC's CCHT certification valid?
Definition
Two Years.
Term
Who wrote the CCHT exam and where can study materials be found for this exam?
Definition
Both NANT and the ANNA wrote this exam.

Study materials can be found by visiting their websites.


Term
What does the CCHT exam measure?
Definition
Basic competency in the area of HD.
Term
What are the four types of Questions covered by the CCHT Exam?
Definition
50% Clinical Aspects of Care

23% Technical Aspects of Care

12% Role Play


15% Enviromental Aspects of Care
Term
To take a practice exam for the CCHT which website should be visited?
Definition
www.nncc-exam.org
Term
Once a tech has completed 12 consecutive months of employment or graduated from an
accredited dialysis course, one may then become eligible to take which exam?
Definition
The BONENT CHT Exam.
Term
What does the CHT exam measure?
Definition
Technical Proficiency in 5 Areas of Practice:
65% Patient Care
10% Machine Technology
5% Water Treatment
5% Reprocessing
15% Personal Development/Education
Term
The CHT Exam has online practice exams at www.goamp.com/bonent, but the actual exam has
how many questions?
Definition
150 multiple choice, to be answered in 180 minutes.
Term
Once a tech has completed 12 consecutive months of work experience and has mastered the
principles of dialysis, patient care/assesment, machine operation and preparation he/she may
take which exam to measure his/her current level of competence as a technician?
Definition
The CCNT exam.