Unit of competency details

HLT07 Version 4

HLT07 Version 5

Comments

HLTRNL602B Provide support and management of the client undergoing peritoneal dialysis therapy

HLTRNL602C - Provide support and management of the client undergoing peritoneal dialysis therapy

Unit updated in V5.

ISC upgrade changes to remove references to old OHS legislation and replace with references to new WHS legislation. No change to competency outcome.

Descriptor 

This unit of competency describes the knowledge and skills required to support the client undertaking peritoneal dialysis and to use current technologies in peritoneal dialysis including the safe administration of medications via dialysis

Application 

The unit involves application of specialised skills and knowledge by Enrolled/Division 2 nurses or Aboriginal and/or Torres Strait Islander health workers, for clinical assessment and follow up of client care plans under direct or indirect supervisory arrangements in line with jurisdictional and regulatory requirements.

For Enrolled/Division 2 nurses the knowledge and skills described in this unit of competency are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements.

Enrolled nursing work is to be carried out in consultation/collaboration with registered nurses and under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements.

For Aboriginal and/or Torres Strait Islander health workers, this unit of competency addresses the delivery of renal health care services in Aboriginal and/or Torres Strait Islander communities.

Work performed by Aboriginal and/or Torres Strait Islander health workers is to be carried out in consultation/collaboration with registered nurses and/or medical practitioners under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements.

Pre-requisite units 

This unit must be assessed after successful achievement of the following related units of competency:

• HLTRNL601C Support the client with chronic kidney disease
• HLTRNL602C Provide support and management of the client undergoing peritoneal dialysis therapy

AND  one of the following units :

• HLTEN519C Administer and monitor intravenous medication in the nursing environment

OR 

• HLTAHW606B Manage medicines in Aboriginal and/or Torres Strait Islander health care

Employability skills 

This unit contains employability skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element.

ELEMENT 

PERFORMANCE CRITERIA 

1. Establish a therapeutic relationship with the client

1.1 Provide the client with the opportunity to ask questions and discuss areas of concern

1.2 Ask the client questions clearly, in an appropriate manner, level and pace, and in a way that encourages the client to provide full answers

1.3 Provide accurate feedback and education, appropriate to the client's needs and concerns, within scope of role and responsibilities

1.4 Encourage client independence throughout the procedure according to their level of capability

2. Assess physicalhealth status of client undergoing peritoneal dialysis

2.1 Complete a dialysis assessment of the client through observation and interview and report to other members of the health care team if required in accordance with scope of work role and organisation guidelines

2.2 Review pathology results, identify significant variations and report to other members of the health care team according to organisation policies and procedures

2.3 Examine the catheter and exit site to identify any problems

2.4 Obtain specimen swab from catheter site if necessary, according to organisation policies and procedures, and send for microbiological analysis

2.5 Identify any significant physical health issues in relation to dialysis prescription and requirement for adjustments and report to other members of the health care team in accordance with scope of work role and organisation guidelines

2.6 Recognise and refer actual and potential problems that vary from the client's normal health status to other members of the health care team as required in consultation with registered nurse and within scope of work role and organisation guidelines

3. Assist the client in self-care management of peritoneal dialysis treatment

3.1 Review the client's understanding of the procedure in accordance with legal requirements and organisation policies and procedures

3.2 Assess the client's self-care strategies

3.3 Appraise the client's technique for dressing exit site and provide effective education as required

3.4 Assist the client as necessary with their peritoneal exchange according to organisation policies and procedures and infection control guidelines

3.5 Assess the client's peritoneal dialysis exchange technique in accordance with organisation and infection control guidelines

3.6 Monitor the client during treatment within scope of work role and within organisation guidelines and refer to other members of the health care team

3.7 Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment

3.8 Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis

3.9 Assess the client's response to treatment within scope of work role and organisation policies and procedures

3.10 Document and report outcomes to appropriate members of the health care team

3.11 Assist the client manage peritoneal dialysis consumables

4. Perform peritoneal dialysis exchange for the client unable to undertake procedure

4.1 Examine the peritoneal dialysis exit site and perform exit site dressing as required

4.2 Prepare peritoneal dialysis additives for dialysis bag in line with delegation

4.3 Perform peritoneal exchange according to organisation policies and procedures and infection control guidelines

4.4 Monitor client during treatment within own scope of practice and within organisation guidelines and refer to other members of the health care team

4.5 Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment

4.6 Assess the client's response to dialysis additives as administered within scope of work role

4.7 Recognise acute and delayed adverse reactions to dialysis additives and respond within scope of work role

4.8 Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis

4.9 Assess the client's response to treatment within scope of work role and organisation policies and procedures

4.10 Document and report outcomes to appropriate members of the health care team

4.11 Assist the client manage peritoneal dialysis consumables

5. Assess physical health status of the client at completion of peritoneal dialysis

5.1 Complete the post-dialysis assessment of the client

5.2 Evaluate the client's response to treatment within scope of work role and organisation guidelines

5.3 Document and report outcomes to the appropriate members of the health care team

5.4 Provide feedback to the client on physical health assessment in order to maintain optimal health status

5.5 Encourage the client to voice concerns and respond appropriately

5.6 Incorporate referral to community services into advanced care planning strategies in consultation/collaboration with registered nurse and other members of the health care team

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Application of infection control principles, including environmental hazards, relating to peritoneal dialysis
• Common pathology tests to diagnose and monitor CKD and their interpretation
• Concepts of ideal weight and assessment of ideal body weights in clients undergoing peritoneal dialysis
• Consumables and equipment relating to peritoneal dialysis
• Fluid, electrolyte and acid base balance
• Health status monitoring of client undergoing peritoneal dialysis
• Immunity and the importance of vaccinations
• Medications associated with the dialysis process such as intra-peritoneal antibiotics, heparin and insulin including basic mechanism of action, precautions, contraindications and side effects
• Medicines in common use in management of clients with Stage 5 CKD including basic mechanism of action, precautions, contraindications and side effects
• Organisation policies, procedures and protocols relating to peritoneal dialysis
• Pathophysiology of Stage 5 chronic kidney disease (CKD)
• Physiological principles of osmosis, diffusion, ultra filtration and convection
• Principles of peritoneal dialysis including:

• dialysis adequacy
• dwell time
• fluids - osmotic agent, volume
• frequency of exchanges
• modalities
• number of exchanges
• the differences of performing peritoneal dialysis in a variety of environments

• Relevant medical/medication terminology and approved abbreviations
• Reportable limits for patients vital signs and biochemical and haematological results for clients undergoing peritoneal dialysis
• Signs and symptoms of actual and potential problems associated with peritoneal dialysis and the appropriate response
• Structure and function of the peritoneum
• Structure and function of the urinary, cardiovascular, lymphatic and immune systems
• Understanding of own role and responsibilities and those of other health care team members in the delivery of care to clients with CKD

Essential skills:

It is critical that the candidate demonstrate the ability to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Apply formulae for drug calculations for administration of medications via dialysis
• Apply interpersonal skills, including working with others, using sensitivity when dealing with people and relating to persons from differing cultural, social and religious backgrounds
• Collect specimens in accordance with organisation and infection control guidelines
• Correctly instruct client in the preparation for peritoneal dialysis
• Correctly prepare equipment for peritoneal dialysis
• Demonstrate accountability for personal outputs and broad client group outcomes
• Evaluate the impact of peritoneal dialysis treatment on the client - physically, psychologically and emotionally
• In consultation with the health care team contribute to effective plans of care to meet the needs of the peritoneal dialysis patient
• Monitor the health status of the client undergoing peritoneal dialysis
• Perform emergency treatment for a client experiencing an adverse response to medications administered via dialysis
• Perform, and assist client to perform, a peritoneal dialysis exchange
• Recognise actual and potential problems associated with peritoneal dialysis and respond appropriately
• Safely administer additives to a peritoneal dialysis bag (e.g. antibiotics, heparin, insulin)
• Use appropriate communication skills (non-verbal, openness, sensitivity and non-judgemental attitudes)
• Use oral communication skills (language competence) required to fulfil job roles as specified by the organisation/service, including:

• interviewing techniques
• asking questions
• active listening
• asking for clarification

• Use written communication skills (literacy competence) required to fulfil job roles as specified by organisation/service at a level of skill that may range from reading and understanding client documentation to completion of written reports
• Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate competency in this unit

• Candidates must demonstrate their ability to apply essential knowledge identified for this unit of competency before undertaking workplace application
• Observation of performance in a work context is essential for assessment of this unit of competency
• Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion
• Assessment of medication administration must include a written calculation test with 100% mastery

Context of and specific resources for assessment

• This unit of competency is most appropriately assessed in the clinical workplace and under the normal range of clinical environment conditions

Method of assessment

• Observation in the workplace
• Written assignments/projects
• Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice
• Questioning - verbal and written
• Role play

Access and equity considerations

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and/or Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and/or Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Clients are limited to:

• Adolescent
• Adult

Assessment of physical health status may include:

• Blood pressure, pulse and respiration
• Weight
• Evidence of uraemia and electrolyte imbalance e.g. lethargy, confusion, anorexia, nausea and vomiting
• Signs of fluid overload e.g. dyspnoea, tachypnoea, ankle oedema, weight gain over a short period of time and high blood pressure readings
• Signs of dehydration e.g. dry mouth, dizzy, postural drop in blood pressure, low blood pressure and weight loss over short period of time
• Blood sugar levels
• Pathology results from routine testing for dialysis clients
• Peritoneal dialysis exit-site status
• Abnormalities of peritoneal dialysis fluid
• Returns on peritoneal dialysis exchanges
• Evidence of infection

Peritoneal dialysis may include:

• Continuous ambulatory peritoneal dialysis (CAPD)
• Automated peritoneal dialysis (APD)

Members of the health care team may include:

• Enrolled/Division 2 nurse
• Registered nurse
• Nurse practitioner
• General practitioner
• Renal physician
• Chronic disease management team
• Dietitian
• Social worker
• Pharmacist
• Podiatrist
• Aboriginal and/or Torres Strait Islander health worker

Scope of work role refers to:

• Enrolled/Division 2 nurses
• Aboriginal and/or Torres Strait Islander health workers

Pathology resultsmay include:

• Haematological tests:

• haemoglobin
• iron studies

• Biochemical tests:

• urea
• creatinine
• calcium
• phosphate

• Dialysis adequacy tests:

• Kt/Vs
• urea reduction ratio
• fraction reduction urea

Catheter and exit site problemsmay include:

• Exit site infection, signs and symptoms:

• redness and tenderness at exit site
• exudate at exit site
• soiling of exit site dressing with blood-stained or pus discharge

• Cracking, splitting and discolouration of the catheter
• Cuff extrusion
• Mobile catheter
• Tension of catheter
• Extravasation to surrounding tissue or along inguinal canal to scrotum or labia
• Contamination of catheter or 'Y' line on bag during exchange process
• Leakage from site, extravasation or bag
• Blocked catheter due to constipation, catheter movement, fibrin plug

Actual and potential problemsmay include:

• Peritonitis, signs and symptoms:

• fever
• cloudy bag
• abdominal pain
• nausea and vomiting

• Hypertension/hypotension
• Fluid imbalance:

• dehydration
• fluid overload

• Electrolyte imbalance:

• hyperglycaemia

• Inadequate dialysis
• Malnutrition/obesity
• Large amount of weight loss
• Failure of peritoneal fluid to drain in or out of peritoneal dialysis cavity during an exchange
• Excessive or insufficient ultra filtration leading to overload or dehydration
• Infusion of incorrect peritoneal dialysis fluid:

• incorrect osmotic agent
• incorrect volume
• incorrect concentration of osmotic agent

• Raised intra-abdominal pressure

Provide effective education includes:

• Develop lesson plan
• Time management of education session
• Evaluating education session
• Evaluating client learning
• Recognising teachable moments
• Assessing teaching and learning resources

Infection control guidelines may include:

• Standard and additional precautions
• Aseptic technique
• Collection site preparation
• Sample collection procedures
• Waste handling and disposal

Response to treatment may include:

• Change in client's hydration status
• Signs and symptoms of uraemia
• Move towards client's ideal weight
• Stabilisation of blood pressure

Documentation may include:

• Record of test procedures
• Complete and sign request form
• Medical record notation
• Labelling specimens and all documents
• Data entry on paper and electronically

Management ofperitoneal dialysis consumables may include:

• Stock management principles:

• stocktake

• ordering cycle
• count stock on hand
• ordering supplies
• method of ordering
• check expiry dates

• Delivery mode
• Timeframes
• Storage requirements
• Requirement to rotate stock
• Check equipment

Prepare peritoneal dialysis additives must include:

• Identification of contraindications of medications
• Confirmation of client identity and check for known allergies
• Identification of the purpose and function of prescribed medication
• 100% accurate calculation of medication doses for administration as prescribed
• Contributing to the provision of information provided to clients and carers on side effects of medication administration

Peritoneal dialysis additives may include:

• Heparin
• Antibiotics
• Insulin

Delegation refers to:

• Conferring of authority to perform specific medication administration activities to a worker not usually authorised but who has been determined as appropriate for the task by the delegating health professional
• Delegation is within the context of a care plan or other written instruction
• Where delegation is provided verbally it must be confirmed as soon as practicable according to organisation procedures in writing and incorporated in the care plan
• The authority is specific to an individual client within a specific care context and is not transferable
• Delegation instructions must include:

• medication and its purpose
• dosage and related instructions
• route
• contraindications
• any other relevant instructions or information, especially information specific to the client