Dedicated to End-of-Life Care for Kidney Patients
Mission: To promote effective interchange between patients, families, caregivers, payers, and providers in support of integrated patient-centered end-of-life care of chronic kidney disease (CKD) patients.

End-of-Life Decisions in the Dialysis Unit

Dialysis units need to prepare for the possibility that patients die at the dialysis facility. Many units don’t have adequate private space to keep someone who has passed away. Building relationships with funeral homes and encouraging them to respond quickly may help. The dialysis unit should also incorporate do not resuscitate (DNR) policies and procedures and train all staff on how to deal with these situations.

• Model DNR Policy, developed by the Robert Wood Johnson Foundation's ESRD Peer Workgroup.
• Advance Directive for a Do Not Resuscitate Order in the Dialysis Unit, Model DNR Policy Addendum A, developed by the Robert Wood Johnson Foundation's ESRD Peer Workgroup
• Recommendations for Advance Preparation for Death, Model DNR Policy Addendum B, developed by the Robert Wood Johnson Foundation's ESRD Peer Workgroup
  
  ESRD Peer Workgroup. Completing the Continuum of Nephrology Care. Robert Wood Johnson Foundation National Program, Promoting Excellence in End-of-Life Care. Available at: http://www.promotingexcellence.org/i4a/pages/Index.cfm?pageID=3689.

The following forms, developed by the Kidney End-of-Life Coalition, should be included in the policy and procedure for DNR orders and disposition of the expired patient. These MS Word documents may be used and modified for individual unit needs:

• Patient Resuscitation Statement
• Funeral Home Information Form
• Personal Possessions Form

An important skill for staff when discussing advance directives, cardiopulmonary resuscitation (CPR) or DNR orders with patients is to avoid using professional jargon. Words such as code, CPR, and vent should be avoided; instead, use words such as heart stopped, tried to start the heart, and breathing machine. Staff should not be afraid to use the words died and death; saying only that resuscitation was unsuccessful or that the patient expired will often risk misunderstanding.

• Guide for Planning Memorial Services in the Dialysis Unit *NEW*
• Quick Reference Card for Pronouncement of Death
• Ways to Provide Support to Staff after Patient Deaths (developed by the Kidney End of Life Coalition)
• Personal Death Awareness Exercises (developed by the Kidney End of Life Coalition)
• Teach Your Patients about CPR

Other educational tools beneficial for staff:

• The National Kidney Foundation's Council of Nephrology Social Workers has prepared a 1-page hospice and dialysis care resource to help educate social workers and others on Medicare coverage for hospice services while receiving dialysis. *NEW*
• Preparing for a Death in the Dialysis Clinic is a document developed by the Kidney End of Life Coalition to help staff be more prepared in responding to a death occurring in the dialysis clinic. *NEW*
• Network 5’s End-of-Life Module is an educational tool that provides a complete in-service training session, which defines palliative care and helps participants identify end-of-life issues that might arise in the facility as well as possible resources and support.
• Understanding End-of-Life Care: The Social Worker's Role is an online course developed and offered by the National Association of Social Workers. Social workers can earn CEUs for participation.
• Dying Well (online course) is part of DIA Learning's Ethics Education Series. This course contains high-quality video documentary, text, and quiz components and is approved by the National Association of Social Workers-Missouri Chapter for 12 continuing education hours.
• American Nephrology Nurses’ Association’s (ANNA) “Techniques to Facilitate Discussions for Advance Care Planning (ACP)” Module is the first in a series of educational modules on EOL Decision Making and the Nephrology Nurse, an in-depth, national program to promote education for nurses and improve end-of-life care.