Nursing: the live dialysis session

Nursing runs the session from chair to sign-off. The console captures the whole haemodialysis run as it happens, so the clinical record and the SHA evidence are a by-product of doing the work, not a second job at the end.

Role: nurse (and clinical lead in a small clinic, where one person is both nurse and doctor).

The floor

The floor shows every chair: who is on, how far through the session they are, and any alert on the chair. An intradialytic-hypotension alert is raised automatically from the vitals you record (see Clinical decision support), so a falling blood pressure surfaces on the board without anyone watching a number.

Pre-session

Open the patient’s session and complete the pre-session checks: the prescription, the pre-dialysis weight and blood pressure, and the access. The pre-dialysis blood pressure is the baseline the system compares later readings against, so record it accurately.

Residual kidney function is optional on the same screen and is worth recording whenever you ask it. Enter roughly how much urine the patient passed and the number of hours it was collected over. If a urine and a serum urea were done, enter both in the same unit; the system reads them as one ratio. A measured zero is anuria and is worth recording as a fact: it is not the same as leaving the field blank, and the two produce different adequacy readings on the chart. Nothing here can block a check-in or a start, and nothing here decides whether the patient should move from two sessions a week to three.

The live flowsheet

During the run, record the hourly observations: blood pressure, pulse, and the machine settings and fluid figures. Each row is checked against safe bands as you enter it, and two rules flag intradialytic hypotension: a systolic below 90 mmHg (below 100 mmHg when the pre-dialysis systolic was 160 or above), or a systolic drop of 20 mmHg or more from the pre-dialysis reading. Either one alone flags the row, and the banner tells you which one fired and on what value. The absolute floor matters most for a patient who starts low: falling from 100 to 82 is hypotension that a drop rule alone never sees. The flag is a prompt to look, not a diagnosis; clinical judgement stays with you.

Post-session and sign-off

At the end, record the post-dialysis weight and blood pressure and complete the session. The treatment record is the printable, signed monitoring document: the prescription, the pre and post checks, the hourly chart and the sign-off in one page. It is generated from what you captured, so it cannot disagree with the flowsheet.

What the session feeds

Everything you capture flows forward. The treatment record and treatment summary become SHA evidence, the diagnosis and report are the clinical paper trail, and the itemised bill is built from the session, not typed again. Capturing well during the run is what makes the claim clean.