Cross Training

[jfboyer]

Have any of you been cross-trained in different departments, or are you just forced to do more than one job?

Our dialysis crew have trouble keeping nurses because nurses here are spoiled rotten.  No one wants to do on-call.  So the few dialysis nurses we have are working 60-80 hours a week.  A couple of clinics have closed so we are seeing an increase in sickle cell pts and doing more therapeutic aphaeresis's.  Being a workaholic I want to see if I can get part of the action.  Have any of you had experience with this?  Any ruled or regulations in place for having certain certifications or credentials?

[David Saikin]

 

You should be able to run an apheresis instrument.  I don't know of any regulatory problems however you will have to be able to provide treatment if a patient decides to crap out during a procedure - that is a major consideration.

[OxyApos]

Our Blood Bankers used to perform apheresis.  It became a drain on our staffing ( which the hospital didn't care about) but it was also risky to these very sick patients.  As David points out, the patient can code, have severe side effects to the procedure, etc and traditionally MTs are not fully trained to deal with that.  This was ages ago, but once the machine malfunctioned & wouldn't return the patients blood/plasma.  Talk about an oh $!-!I+ look between techs!!!

 

[DebbieL]

Many years ago, my hospital decided to start a therapeutic apheresis program and gave it to the BB. (!!??!!) We had a few regular out patients with myasthenia gravis that we could schedule according to our workload. The ones that were a problem were the patients that arrived in a bad state due to TTP or ITP and needed their first treatment STAT. They would have to get a port placed and then the treatment would begin. We might have to start the procedure at 11 PM by the time the port was in. Only about 4 of us were competent and we could be called in at any time during the night or weekend for the first treatment. Some physicians would order the procedure when they didn't have anything else to offer the patient. It was the new miracle treatment. The pathologists we had then would allow them to order daily or every other day procedures for weeks at a time. We hated every minute of it. My thoughts were, we were not nurses and we were messing with ports that we shouldn't be messing with. (Think clots close to the heart) We didn't know what we didn't know. If a patient crashed, we would not have been able to deal with it other than push the button and call a nurse or call a code.

Thankfully, dialysis came to us and said they wanted to add it to their procedures. We celebrated when they were out of earshot, we didn't want them to know how happy we were that they took it from us. Think very carefully before you take this on because dialysis will give it all to you and your department because it sounds like they don't want it either. It will take one person out of your department for 4 to 6 hours or someone will have to be called in. The machine has to be set up and then the procedure could take about 2 to 4 hours. Dialysis nurses are the most qualified because it is somewhat similar to dailysis and nurses are better qualified to deal with a crashing patient. I really don't think a med tech is qualified to deal with the same things nurses deal with. I wouldn't want them trying to ID antibodies. Think very carefully and go into it with open eyes. My opinion, I would run as fast as I could in the other direction.

According to CAP standard TRM.42245, there has to be a physician in charge of the program and they also have to meet specific qualifications so check on that too.

[David Saikin]

You should try a manual plasma exchange - what a trip.  did one once, took 16 hrs but you could actually watch the patient come back to life every time you saw her.  I was able to get a machine after that, primarily for plts, but it did allow us to accept a new breed of patient.  We trained the critical care nurses but they did it so infrequently that we ended up doing most procedures.  The nurses were there to provide pt care.