Patient Guide

Information Book for Patientsand their Families

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Contents

Foreword 3

Welcome to your Dialysis Clinic 4

Your Health and Safety Matters 5

Hygiene and Infection Control 8

Understanding Haemodialysis 9

Vascular Access 12

Blood Tests 15

Living with Haemodialysis 16

Diet 18

Talk to us 20

Sources of Information 22

Your Clinic is:

Your Clinic Manager is:

Your named Nurse is:

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At Fresenius Medical Care Renal Services we want to makeyour dialysis journey with us as comfortable as possible. Wehave created this Patient Guide in close collaboration withdialysis patients and nurses. For over 20 years we have beendedicated to providing patients who suffer from a kidneydisease with the best level of care.

Your care is jointly provided between the local NHS hospital andourselves. This guide will help to explain what you shouldexpect from our services, together with some hints and tipsabout living with dialysis.

This guide is an introduction for new dialysis patients as well astheir families and carers. We want to help you come to termswith dialysis and this guide will provide answers to many of thequestions you may have and encourage you along the way. Itwill also serve as a useful reference book for patients who arealready being treated at a dialysis unit.

Sue Willetts Managing Director

Foreword

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Your Unit Team

Your unit will have either a Clinic/Unit Manager and a DeputyManager. These senior staff will be supported by some or allof the following – Team Leaders, Registered Nurses, DialysisAssistants, Healthcare Assistants and a unit Secretary.

When new to a unit you will be allocated a named nurse.They will be your main point of contact and will be primarilyresponsible for assessing, planning, coordinating andevaluating your care needs on an individual and ongoingbasis. Your treatments will also be provided by othermembers of the nursing team.

Treatment is provided in accordance with the policies andprocedures set out by Fresenius Medical Care RenalServices in alignment with your referring NHS Renal Unit.

Your Confidentiality

It is vitally important that wekeep your medicalinformation private andconfidential. When youbegin your dialysis journeywith us, you will be given apatient card on which datawill be stored about yourdialysis treatment. You willbe given the card each timeyou attend for treatment atthe unit and it will be usedto record your weight.

Whilst you are undergoingdialysis, the machine isrecording information aboutyour treatment. We alsohold this and other clinicalinformation on a securecomputer system calledEuCliD. This computersystem allows information tobe shared with your NHSConsultant Nephrologistabout your treatments. Thenurse will record informationon a handheld computersuch as your blood pressureand temperature. At the endof the session the card islocked away until your nextvisit.

Welcome to your Dialysis Clinic

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During your visit to the unit, it is important tous that you stay safe and any potentialhazards are minimised so far as isreasonably practicable. Your unit staff areregularly trained on health and safetyprocedures but as a patient you can alsohelp contribute to a safe environment. Hereare some guidelines to assist you inreducing the risks to your own health andsafety and that of our staff. Slips, trips andfalls are the most common of hazards withina healthcare environment, so please observethe following:

1. Never rush aroundalways take your time when movingaround the unit.

2. Take care when climbing any stairsthat may be present in the unitalways hold on to the handrail; alwaysuse lifts where provided (except in theevent of a fire).

3. Never enter prohibited areasif an area is off limits to you, it is for areason.

4. Take care when getting on and off yourdialysis chairensure your clothing is not caught onanything before you stand up. Ideally youshould put the chair in the uprightposition and lower to a comfortable levelbefore getting off.

5. Never leave items on the floorthey are a trip hazard to yourself, otherpatients and the staff; always keeppersonal belongings on the tablesprovided alongside your dialysis chair inthe treatment area, or on your knee in thewaiting areas.

6. Do not walk around the unit withoutwearing shoes you are more likely to slip in stockingedfeet.

7. Observe and follow any hazardwarning signsthey are there to inform you of anyhazards, which may be present.

8. After treatment always take your timewhen leaving your dialysis chairsometimes standing up too quickly canlead to light headedness, which couldpotentially make you lose your balanceand fall.

9. Pay attention and take your time whenstanding on and off the weighingscalesensure your access to them is clear. If indoubt ask for assistance.

Your Health and Safety Matters

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10. Never overreach to get somethingalways ask for assistance, our staff arealways happy to help.

11. If you accidentally spill somethingsuch as a drinkplease inform a member of staffimmediately in order that it is cleaned upquickly to prevent anyone slipping.

12. If you wish to report any hazardswhich you see during your time withinthe unit, please inform a member of staffwho will ensure that it is dealt with.

If you feel there are aspects of yourtreatment where additional assistance maybe required please inform a member of staff.

• SmokingSmoking is not permitted on any part ofthe premises, entrances or grounds ofFresenius Medical Care Renal Services atany time. Where units are located on NHSpremises, local agreement and designatedareas apply.

• Fire EvacuationThe possibility of a fire occurring is highlyunlikely; however it is important that youare familiar with the evacuation procedureand location of emergency exits. Youshould receive information about the fireevacuation procedure when you beginyour dialysis with us.

• Behaviour and toleranceFresenius Medical Care Renal Services hasa statutory obligation to provide a safe andsecure environment for its staff and othersas well as a moral duty to take allreasonable steps to protect and supportits staff. Any form of violence, abusive,racist or sexist behaviour against its staff,patients or visitors will not be tolerated.

• Protecting and safeguarding individualsFresenius Medical Care recognises itsresponsibility to prevent the abuse ofVulnerable Adults, and Children at risk. Allemployees have a duty of care tosafeguard those in their care. Healthcareprofessionals have a key role insafeguarding, firstly in the identification ofabuse, harm and neglect, and secondlyresponding appropriately to it.Safeguarding is integral to complying withlegislation, regulations and deliveringeffective safe care.

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• What is abuse?Abuse can be physical, sexual, verbal,financial, and psychological or an act ofneglect or discrimination. Anyone can bean abuser e.g. relatives, professional staff,friends or other service users, and it cantake place in any setting.

• Signs of abuse

Examples can include:

– Unexplained injuries, multiple bruising,abrasions or finger marks

– Withdrawal, mood changes, extremeanxiety, low self esteem

– Deterioration of health for no apparentreason

– Inadequate clothing, hygiene needs notbeing met

– An unwillingness to be alone with aparticular carer

– Unwillingness of a carer to allow accessto a person

If you or another person are beingabused or suspect abuse:

Tell someone you can trust as soon as youcan e.g. relative, friend, member of nursingstaff, social worker.

Your unit staff can give you a list of usefullocal contact numbers on request e.g. socialservices, police, age concern. You do nothave to tell them the reason for yourrequest.

What happens next?

• If you tell a member of unit staff they willinform their line manager.

• They will document what you have toldthem.

• Advice will be sought from the localsocial services who will help andsupport you to stop the abuse fromhappening.

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• Always use the hand rubwhen you arrive andleave the unit

• If you have a fistula,always wash your accessarm before your dialysistreatment begins, sinksare located close to yourstation

• If you bring in any foodwith you, keep this atyour own station anddon’t share with otherpatients

• Keep bags away from thetop of trolleys and bins

• Always ask the nurse forgloves if you are handlingyour own access site andalways ensure your handsare clean on leaving yourdialysis station

• Understand the differencebetween the waste bags– black is general wasteand the coloured bag(yellow or orange) isclinical waste such asused dressings and lines.The yellow boxes are forthe disposal of sharpitems

• Finally, remember toalways use the foot pedalto open the bin not yourhands

• Do not place anything ontop of any bins or boxes.

Just as health and safety is important so is hygiene andinfection control. There are many ways in which you canhelp to minimise the risk of infection when you are at thedialysis unit.

Hygiene and Infection Control

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You probably already know what the kidneyslook like and where they are in your body. It’simportant to also know what the kidneys dofor the body. Once you know this, you’llunderstand what the nursing team and youyourself must do to ensure you continue tofeel well far into the future.

The kidneys are bean-shaped, about thesize of the fist, sitting beneath the lowest rib.They perform many vital tasks for the body,these include:

• They expel excess water and metabolicend-products (waste) out of the body as urine

• They play a central role in regulatingblood pressure

• They play an important role in bloodformation and the development ofbones

How does dialysis work?

It replaces some of the functions yourkidneys normally perform, such as theremoval of extra water from the body andthe removal of waste products that build upin the blood stream

What does Haemodialysis do?

Haemodialysis is a treatment that replacessome of the functions your kidneys normallyperform, such as the removal of extra waterfrom the body and the removal of wasteproducts that build up in the blood stream.When your kidneys are not working properly,waste products and fluid build up in yourblood and can cause:

• Sickness and vomiting

• Loss of appetite and weight loss

• Hiccoughs

• Anaemia

• Trouble sleeping

• Tiredness

• Itching

• Leg cramps at night

• Swelling, often of your ankles

• Difficulty breathing

Dialysis will help you manage theseproblems. However if you are not receivingenough dialysis this will show up in yourblood results and you may still suffer someof these problems. Getting the right amountof dialysis is important as it has been provento make you feel better and live longer.

Understanding Haemodialysis

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How does dialysis work?

When a person has kidney failure thehaemodialysis machine and dialyser, (alsoknown as an artificial kidney) work togetherto take over some of the work that thekidneys can no longer manage. This workincludes the removal of toxins or wasteproducts and excess water from the blood.You may hear unit staff referring to theseprocesses as clearance and ultra filtration.

To enable these processes to happen yournurse will programme the dialysis machineaccording to your dialysis prescription. Thiswill include your treatment time and amountof excess fluid to be removed. You will thenbe connected using bloodlines and your‘dialysis access’ which may be a fistula,graft or catheter.

Throughout the haemodialysis treatmentyour blood is then pumped by the machinefrom your access through the bloodlinecircuit and dialyser. The dialyser is made up

of a semi permeable membrane – toxinsfrom the blood pass through this semipermeable membrane in the fluid that flowsthrough the dialyser. This fluid is calleddialysate.

Pressure inside the dialyser ‘squeezes out’any excess fluid. The toxins and excess fluidthen go down the drain whilst the blood isreturned to you. This process is continuousduring treatment but only a small amount ofyour blood is in the circuit at any one time.

Your nurse programmes the machineaccording to your Consultant Nephrologists’prescription; this ensures you receive thecorrect haemodialysis treatment. Yourindividual prescription is based on yourblood results.

How much dialysis do I need?

It is found that to live longer and stay fit andhealthy most people need haemodialysisthree times a week. Each dialysis session

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should last at least four hours making a totalof 12 hours of dialysis each week. It istherefore very important to complete yourfull treatment and not come off the machineearly.

What are the complications associatedwith haemodialysis?

Between treatments the levels of toxins inyour blood rise. During dialysis these levelscan drop quickly and can affect people indifferent ways. Haemodialysis patients canexperience some or all of the following:

• Dizziness

• Feeling sick

• Headaches

• Muscle cramps

Many patients do not experience any ofthese complications and dialyse with no illeffects at all. The nurses will be monitoringyou closely during your dialysis treatment. Ifyou experience any of these complicationsor feel unwell during your treatment it is veryimportant to alert a member of the nursingteam immediately.

The symptoms described are commonlydue to hypotension (low blood pressure).This can be caused by taking too much fluidoff you during your dialysis or by removing ittoo quickly. Your nurse can adjust yourtreatments to minimise these occurrencesbut carefully adhering to your fluid restrictionwill help reduce the risk of these symptomsoccurring.

Blood pressure medication can also make adifference to how you feel on dialysis andalong with the fluid removal can cause yourblood pressure to fall. If this happens yourConsultant Nephrologist can discuss yourmedication with you and make anynecessary alterations to your prescription.

Muscle cramps are again related to the fluidremoval but also the removal of salt. Yournurse can adjust your dialysis to helpalleviate these symptoms.

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Fistula(also know as an AVF or Arterio VenousFistula)

A fistula is the best form of access for mostpatients because it lasts longer and hasfewer problems such as clotting or infection.It requires a small operation to join an arteryand vein together, usually in your arm. Alarge vessel will then develop over a 4-6week period and this will then allow fordialysis needles to be inserted each dialysissession so you can be connected to thedialysis machine.

Graft

A graft is the second best choice to a fistula.This requires a small operation where a softsynthetic tube is attached to an artery andvein, joining them together. This type ofaccess is often made if your own bloodvessels are too small to make a fistula.

Patients with a fistula or graft can use a localanaesthetic spray (Xylocaine), cream orinjection to help reduce any discomfort thatmay be associated with insertion of theneedles. We can provide the injection andyour GP can prescribe Emla cream orXylocaine spray.

Vascular Access means access to your blood so we can perform dialysis. There are differenttypes of access – fistula, graft or haemodialysis catheter – and the Consultant Nephrologist atyour renal unit will advise on the best option for you. A fistula or graft is usually formed a fewweeks before you need to start dialysis.

Vascular Access

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Caring for your fistula or graft

It’s really important to look after whichever type of accessyou have carefully so please follow the instructions youreceive from your nursing team.

• Do check the buzz at least once daily. If you can’t feelthe buzz, you must contact the renal unit immediately asyour fistula/graft may have stopped working. Do not waituntil your next dialysis treatment

• Do keep your fistula/graft area clean by washing it withsoap and water every day

• Do report any increased pain, swelling, bruising,bleeding or increased heat over the area to the nurseson the dialysis unit

• Do remove old dressings from cannulation sites when itis safe to do so (nursing staff will advise)

• Do check the buzz if you feel dizzy or if your bloodpressure is low

• If possible, wash your fistula or graft site when you arriveat the unit for treatment or ask for assistance to do this

• Do not wear restrictive clothing and jewellery over theaccess site

• Do not carry heavy objects with a fistula or graft arm

• Do not expose to extremes of hot and cold temperature

• Do not allow any blood samples, injections or bloodpressure readings to be carried out on your fistula orgraft limb

• Do not allow yourself to become dehydrated

• Do not sleep on an access arm

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• A haemodialysiscatheter may bereferred to by differentnames including a line.Permcath or centralvenous catheter (CVC)

• The exit site refers towhere the catheterenters your skin

• To help keep thecatheter secure and toreduce the risk ofinfection a dressingshould cover the exitsite at all times

• The catheter shouldalways be kept dry as adamp catheter providesthe ideal environmentfor bacteria

• Anyone using thecatheter or touching thecatheter exit site mustfirst wash their handsthis includes the patient,or healthcare staff

• Contact your dialysisunit immediately if younote any swelling, pain,redness, or oozing fromthe exit site or if youhave a temperature

• If there is bleeding fromthe exit site applypressure and contactthe dialysis unit foradvice. If bleeding isheavy or doesn’t stopwhen applying pressurecall 999 to obtainprompt medicalattention

• Do not pull/tug thecatheter as it maybecome dislodged. Ifplaying sports tape theline securely to yourchest. Contact sportsare not advised

• Your dialysis cathetershould only be used fordialysis unless there is amedical emergency

Haemodialysis catheter

Haemodialysis catheters are usually only used as a temporary access as they carry morerisks of infection. A small plastic tube (the haemodialysis catheter) is inserted into a large vein,usually in the neck or in a vessel running alongside your collarbone.

Caring for your Haemodialysis catheter

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Blood tests are performed routinely andshow how effective your dialysis is and howyou are responding to your diet andmedications. A group of blood tests aretaken every month to monitor certainsubstances in your blood. Your Nurse,Consultant and Dietician review the resultseach month. The results, and any change inyour treatment will also be discussed withyou. Monthly blood tests usually include thefollowing:

• Urea – measures how well you aredialysing and gives an indication of theamount of protein you are eating.

• Calcium & Phosphate – monitored toenable you to be prescribed the rightdose of phosphate binders. Gettingthose levels right will help reduce orcorrect renal bone disease.

• Potassium – too high or too low canhave an adverse affect on your heart.

• Sodium – low levels can cause cramp;high levels can cause thirst, fluid gainsand high blood pressure.

• Albumin – an indication of how wellnourished you are.

• Haemoglobin – Hb is the level of redblood cells in your body. Too few (a lowHb) means you are anaemic. YourConsultant Nephrologist will prescribeyour Erythroprotein (EPO) dosedependant on this result.

It is a standard safety procedure in all UKhaemodialysis centres to test for a numberof infections (viruses) that are transmitted inthe blood. These include Hepatitis B Virus(Hep B), Hepatitis C Virus (Hep C), and HIV.These tests are taken when you first

commence haemodialysis treatment andthereafter approximately every 3 months forHep B and C and annually for HIV althoughthis may vary depending on your own unit’sspecific schedule. Should you go for holidaydialysis abroad the frequency of these testsis also likely to increase for a short time onyour return.

Your Consultant Nephrologist may ask forother blood tests to be taken from time totime, these will be explained to you by thedoctor or your nurse.

Blood Tests

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Having kidney failure and needing to be onhaemodialysis means adapting your lifestyle.How you handle the changes and yourfeelings are important factors in maintainingyour health.

The staff at your dialysis unit can offer youadvice and support through difficulties youand your family may be experiencing. Thestaff can also put you in contact with othersupport workers such as a social workershould you request it.

You are encouraged to lead as normal a life aspossible whilst maintaining your dialysis dietand regime. This will help you cope with thechanges your illness has brought to your life.

Commonly asked questions

Here, we answer some of the commonquestions we receive about living withhaemodialysis.

Can I work or go to college as normal?

You are encouraged to return to youroccupation or continue with your education.Every effort will be made to arrange yourdialysis around your work or collegeschedule. The nursing staff will advise youas to any particular care that should betaken with your access.

Will my sex drive be affected?

Possibly, many patients experience adecrease in sexual activity due to changes inphysical and emotional health. Impotencemay occur. If you have any problems pleasedo seek advice. You can, if you wish,choose to talk to a member of staff who isthe same sex as you. There may be medicalintervention that might be of help to you oryou could ask to discuss your problems witha trained counsellor.

Am I able to eat out?

Yes. You can eat out even though you areon a renal diet, by following the advice givento you by your dietician and nurses. If youare eating out for one meal you can alwaysadjust the amount of other food eaten athome on that day. Be especially careful withdrink and food containing fluid for examplesauces, gravy and custard as this can oftenbe your biggest temptation when socialising.

Can I still do regular exercise?

Yes. A regular exercise programme hasmany benefits for a dialysis patient.Physically it can increase red blood cells andas a result increase your energy levels. Itmay also lead to improved muscle strengthand a lower level of blood fats.Psychologically, exercise can lower anxiety,improve self-esteem and give you a sense ofcontrol over your body.

Can I still go on holidays?

Yes. Being a dialysis patient doesn’t meanyou cannot travel for business or pleasure. Itdoes mean you will need to make plans toreceive treatments in a dialysis centre nearwhere you are visiting. Your nurse can helpmake these arrangements.

Living with Haemodialysis

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Holiday dialysis and you

• What do I do first?

The first thing you need to do is decidewhere you would like to go and then finda dialysis centre in that area, which canprovide you with holiday dialysis. Do notconfirm any bookings or pay any holidaydeposits before this has been done.

• Where can I go?

Your local unit or kidney patientassociations should be able to advise youof dialysis units in other areas both in theUK and abroad. Many of the FreseniusMedical Care Renal Services units willoffer holiday dialysis. If you are going onholiday within the European Union e.g.Spain, France, Canary Islands etc., youwill need a European Health InsuranceCard (EHIC).

Information on where to find this form isgiven below:

Online: www.ehic.org.uk

Telephone: 0845 606 2030

Or collect a form from your local post office.

The EHIC is normally valid for three to fiveyears and covers any medical treatment thatbecomes necessary during your trip,because of either illness or accident. Thecard gives access to state-provided medicaltreatment only and you’ll be treated on thesame basis as an insured person living in thecountry you’re visiting. Remember, thismight not cover all the things you’d expectto get free of charge from the NHS in theUK. You may have to make a contribution tothe cost of your care. The EHIC also coversany treatment you need for a chronicdisease of pre-existing illness. You need tomake arrangements in advance for kidneydialysis and oxygen therapy.

It is also important to take out travelinsurance, which covers you for a pre-existing medical condition. Most standardpolicies do not provide this cover. TheNational Kidney Federation website has a listof companies that may be able to help if youhave problems getting insurance. It isadvisable to sort out insurance before youbook your holiday.

How long does it take to arrange?

You are responsible for arranging yourholiday, the staff will help you by ensuringthat the correct documentation is sent toyour holiday unit in good time. You need togive your unit at least two months notice toenable them to do this.

If you have any queries the team at your unitare only too happy to help you. HappyHolidays!

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Haemodialysis patients require a specialdiet, which helps reduce waste productsbuilding up in your blood stream betweendialysis sessions. The dietary informationyou are given has the potential to reducecomplications associated with yourtreatment and therefore has the benefit ofimproving your overall health. You will see adietician at regular times either at yourregular Consultant Nephrologistappointment or at your unit. Your dieticianwill give you advice on what foods you mayeat and what drinks to take and to avoid.Some of this advice is general to mostpatients on dialysis while some will betailored to your individual needs asdetermined by your blood results. We havefocused on the nutritional areas which are ofrelevance to all patients – sodium, proteinand fluid restriction.

Sodium

Sodium (salt) is a mineral found in nearly allfoods and helps the body maintain its waterbalance and regulate blood pressure. Toomuch sodium can cause thirst, waterretention and high blood pressure. The mainsource of sodium comes from adding salt toyour meals and in processed foods and

ready meals. This means you should notadd salt to your food. We do notrecommend that you use salt substitutes asthese contain potassium. Your dietician willbe able to give you very clear advice onwhat foods to avoid or limit. When you areshopping, check the label to see how muchsalt is in the food per 100g. Then you canwork out if the food is high, medium or lowin salt using the figures below.

Protein

Protein is required for the growth,maintenance and repair of body tissues. Thekidneys normally remove the breakdownproducts of protein from your body. Whenthe kidneys fail this function is lost.Haemodialysis removes this waste protein(urea). It is important for you to eat proteinbut too much can make you feel sick, tiredand itchy. The protein intake you need isvery specific to you and the dietician willdiscuss with you exactly what amount isright for you.

Fluid Restriction

Controlling your fluid intake is an importantconsideration when you are havinghaemodialysis. The amount of fluid you areallowed differs from person to person anddepends how much the kidneys are makingand the amount of urine you are passingeach day. This may decrease over time.

Fluid removal is therefore a vital part of yourtreatment, however the dialysis machinecan’t remove as much fluid as the kidneyswould naturally remove. Watching your fluidintake is important as fluid overload may puta strain on your heart.

As a general rule, the amount of weight youcan gain safely depends on your body size.Between dialysis sessions try not to exceed

Diet

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a weight increase of 2-3kg above your dryweight. Always stick to the advice given byyou by your healthcare team.

Your fluid allowance includes everything thatyou drink including tea, coffee, milk, squash,fizzy drinks and alcohol. Remember thatfluid is also found in food such as yoghurt,ice cream, gravy, soup and jelly.

Potassium

Potassium can be very important for somerenal patients. Potassium helps the nervesand muscles in your body function properlyand extra potassium is normally removed byyour kidneys. Too much potassium can havean effect on your heart. You may needadditional information on this depending onyour blood results, however your doctor ordietician will advise.

Phosphate

Phosphate can also be important for somerenal patients. Phosphate is a form of themineral phosphorous and is needed to

make, maintain and repair bones. Thekidneys control the amount of phosphate inthe body, however as kidney failureprogresses, the kidneys lose their ability todo this. Most people on dialysis will need toeat less phosphate in order to control thelevel in their blood however your doctor ordietician can advise you on this.

Breads, Cereals and Potatoes

Bread, cereals and potatoes containcarbohydrate (starch) which provides us withenergy, fibre and some vitamins andminerals. These foods should be included ineach meal to provide a constant energysupply. Higher fibre choices such aswholemeal, granary and rye breads, oatsand wholegrain cereals such as weetabix,are recommended rather than more refinedchoices such as white bread, rice krispiesetc. Higher fat, lower fibre options such aschips, roast potatoes, waffles, hash browns,sugar or chocolate coated breakfast cereals,fried rice, and pasta with creamy saucesshould be eliminated where possible, or keptto a minimum.

Fruit and Vegetables

All fruits and vegetables are low inphosphate. If you are on a potassiumrestriction, remember to follow your lowpotassium advice regarding fruit andvegetable intake and limit to no more than 5servings per day. Most fruit and vegetablescontain some potassium, howeverpotassium is lost if they are boiled whencooked. To retain the potassium content ofyour vegetables when you cook them youmay wish to steam, bake or microwavethem (with minimal water). Fruit andvegetables provide protection against heartdisease from the antioxidants and thesoluble fibre they contain.

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For new patients we want to reassure youabout your forthcoming journey at one ofour dialysis units. For patients who havebeen dialysing with us for some time, youwill have already developed a relationshipwith the nursing staff and other patients.

Patient Satisfaction Survey

One way you can give us your feedback isthrough our annual Patient SatisfactionSurvey. This is handed out to all our patientsin all our units and is your opportunity to giveus feedback on your dialysis unit, yourdialysis arrangements and the staff.

The survey results are shared with the localNHS renal unit and the Care QualityCommission. A summary of the results andactions will be shown on the patient noticeboard.

How to make a complaint

If you or your family/carer wish to make acomplaint please speak to a member of stafffrom the unit or put it in writing and addressit for the attention of the Clinic Manager.Fresenius Medical Care Renal Services valuethe comments and suggestions frompatients and their families as we arecontinuously striving to improve our servicesto you.

Should any patient, relative or visitor wish tomake a complaint or a suggestion thefollowing guidelines, which have been basedon the National Health Service procedureshould be followed:

Should you wish to make a complaintregarding your care you should initially referit, in writing or verbally, to your Clinic or UnitManager who will acknowledge receiptwithin two working days of receiving thecomplaint.

All complaints will be sympathetically dealtwith within two weeks or where aninvestigation takes longer a letter ofexplanation will be sent. Once the complainthas been investigated you will receivewritten confirmation of the investigation andactions taken.

If you are not satisfied with the explanationand want the matter investigated further, youshould write to:

Clinic Services DirectorFresenius Medical Care Renal Services LtdFacet RoadKings NortonBirminghamB38 9PT

Talk to us

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You are also entitled to make a complaint tothe Care Quality Commission (CQC) who willinvestigate any issues. The address forcomplaints to the CQC is displayed on thenotice board in the waiting area. Staff will behappy to provide you with a full copy of thecompany complaints procedure should yourequest one. Your family members/carersmay also make a complaint. In this case theabove procedure should be followed.Should you or your family/carer wish tomake a complaint the staff at your unit willprovide support in how to follow theprocess.

A copy of all complaints will be sent to theClinic Services Director and wherenecessary will engage the involvement of theCare Quality Commission.

As you are a NHS patient you can also usethe NHS complaints procedure. If you areunhappy with the treatment or service youhave received from the NHS you are entitledto make a complaint, have it considered,and receive a response from the NHSorganisation or primary care practitionerconcerned. The NHS complaints procedureapplies to the NHS in England, except forNHS Foundation Trusts.

Every NHS trust has a Patient Advice LiaisonService (PALS) to help people have a say intheir local health services. If you want tomake a complaint about a trust, the PALSwill explain how to do this and discuss waysof getting your complaint dealt with. It willalso take up some types of complaints foryou.

Contact your local PALS through the PALSwebsite www.pals.nhs.uk or through theNHS Choices website at www.nhs.uk

Other organisations

You may find the followingorganisations useful:

Diabetes UKwww.diabetes.org.uk

Royal National Institution for the Blindwww.rnib.org.uk

British Heart Foundationwww.bhf.org.uk

Blood Pressure Associationwww.bpassoc.org.uk

Health and Social CareAct 2008

As an independent providerof health care we areregulated by the CareQuality Commission (CQC).We must comply with theHealth and Social Care Act2008 (Regulated Activities)Regulations 2010 and theCare Quality Commission(Registration) Regulations2009. These regulationsdescribe the essentialstandards of quality andsafety that people who usehealth care services have aright to expect. Ourcompliance with theseessential standards iscontinuously monitored bythe CQC.

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National KidneyFederation (NKF)

The National KidneyFederation is the only UKcharity run by kidneypatients for kidney patients.

Its aim is to promote,throughout the UnitedKingdom, the best renalmedical practice andtreatment, the health ofpersons suffering fromkidney disease or renalfailure, and to support therelated needs of thoserelatives and friends whocare for kidney patients.

A list of all the KPAs can befound on the NationalKidney Federation website.

Tel: 0845 6010209www.kidney.org.uk

British Kidney PatientsAssociation (BKPA)

Founded in 1973 byElizabeth Ward, whose sonTimbo was diagnosed withkidney failure at the age of13. The BKPA is concernedwith helping the materialand physical needs ofpatients and their families. Italso lobbies for improvedfacilities, increasedGovernment funding andthe need for kidney doctors.

Tel: 01420 541424www.britishkidney-pa.co.uk

There are many national and local organisations that provideinformation and services to local kidney patients and theirfamilies. Your local Kidney Patient Association (KPA) or amember of your unit staff can help you with contact details.

Sources of Information

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Fresenius Medical Care Renal Services Ltd • Facet Road • Kings Norton • Birmingham • B38 9PT

7112 04/2013