Section 246-826-303. Minimum standards of practice and core competencies of hemodialysis technicians.

The following standards are the minimum competencies that a health care assistant, category G, must hold to be certified to practice in the state of Washington. The competencies are statements of skills and knowledge, and are written as descriptions of behaviors, which can be observed and measured. All competencies are performed, as required by chapter 18.135 RCW, under the direction and supervision of a health care practitioner as required by RCW 18.135.020. The level or depth of accomplishment of any given competency is appropriate to the "assisting" role of basic hemodialysis care under supervision of a health care practitioner.

Patient care.

(1) Data collection and communication. The hemodialysis technician must:

(a) Verify patient identification and dialysis prescription.

(b) Gather predialysis patient information necessary for treatment as required by facility protocols.

(c) Accurately calculate patient fluid removal and replacement needs.

(d) Monitor and verify treatment parameters during dialysis as required by facility protocols.

(e) Gather post dialysis patient information necessary to conclude treatment as required by facility protocols.

(f) Communicate and report patient, family or other care providers' concerns and/or needs to the nurse.

(g) Provide written documentation to the patient's medical record related to both routine treatment and unusual events.

(h) Recognize, report and document signs and symptoms related to:

(i) Hemodialysis vascular access complications.

(ii) Patient treatment complications.

(iii) Complications due to operator or equipment error.

(iv) Complications associated with allergic reactions.

(v) Complications associated with treatment anticoagulation.

(2) Basic hemodialysis treatment skills. The hemodialysis technician must be able to:

(a) Set up dialysis related supplies and equipment as required by a licensed health care practitioner prescription and facility policies and procedures.

(b) Prepare and mix additives to hemodialysis concentrates as required by facility procedure based on patient prescription.

(c) Prepare and administer heparin and sodium chloride solutions and intradermal, subcutaneous, or topical administration of local anesthetics during treatment in standard hemodialysis doses.

(d) Provide routine care for and cannulate hemodialysis vascular accesses for treatment as required by facility policies and procedures.

(e) Initiate hemodialysis treatment as required by facility policies and procedures.

(f) Provide routine care for, initiate, and terminate hemodialysis treatments using central catheters as required by facility protocols.

(g) Terminate hemodialysis treatment as required by facility policies and procedures.

(h) Provide routine care for equipment post dialysis including rinsing, disinfecting and shutting down as required by facility policies and procedures.

(i) Draw required samples for laboratory testing as required by facility protocols and procedures.

(3) Hemodialysis treatment interventions. The hemodialysis technician must be able to:

(a) Administer oxygen to patient by cannula or mask.

(b) Initiate CPR.

(c) Provide initial response to patient complications and emergencies during treatment per facility procedures, including, but not limited to, the administration of normal saline per facility protocol.

(d) Respond to equipment alarms and make necessary adjustments.

(4) Education and personal development for hemodialysis technicians: The hemodialysis technician should be able to demonstrate a basic understanding of the following subjects:

(a) General orientation subjects for the new hemodialysis technician.

(i) Common manifestations of renal failure.

(ii) Principles of dialysis.

(iii) Dialyzer and concentrate use and prescription.

(iv) Basic concepts of hemodialysis water treatment and dialyzer reuse.

(v) Principles of fluid management.

(vi) Hemodialysis treatment complications and emergencies.

(vii) Standard precautions and the use of aseptic techniques.

(viii) Hazardous chemical use in the hemodialysis setting.

(ix) Use and care of hemodialysis vascular accesses.

(x) Common laboratory testing procedures and critical alert values.

(xi) Basic concepts related to dialysis patient dietary/nutrition requirements.

(xii) Common psychosocial issues related to aging, chronic illness and dialysis therapy.

(b) Facility requirements as required by written policies and procedures. The hemodialysis technician must:

(i) Maintain current CPR certification.

(ii) Demonstrate an understanding of facility requirements related to infection control and the use of hazardous chemicals.

(iii) Demonstrate knowledge of facility disaster plans and emergency evacuation routes.

(c) The hemodialysis technician must be able to demonstrate a basic understanding of the proper body mechanics for patient and self.

(d) Maintaining patient confidentiality related to medical and personal information.

(e) The hemodialysis technician must be able to demonstrate a basic understanding of the patient's rights and responsibilities per facility policies.

(f) The hemodialysis technician must be able to demonstrate a basic understanding of the Uniform Disciplinary Act of the state of Washington, chapter 18.130 RCW.

(g) The hemodialysis technician must be able to demonstrate a basic understanding of the role of hemodialysis technician patient care as it relates to professional interactions with:

(i) Patients, family members and other care providers.

(ii) Supervisory and administrative health care providers.

(iii) Peers and other facility employees.

[Statutory Authority: RCW 18.135.030 and 18.135.020. WSR 02-06-115, § 246-826-303, filed 3/6/02, effective 4/6/02.]

RCW 18.135.030 and 18.135.020. WSR 02-06-115, § 246-826-303, filed 3/6/02, effective 4/6/02.