This presentation will discuss how we managed a unique personality patient within our busy in-centre haemodialysis unit….. (And survived!!)

We found a variety of research on the depressed patient and dialysis but little on other mental illness that may affect dialysis patients such as bi-polar, schizophrenia, and the multi personality disorder.

Our objective was to successfully dialyse this patient within the confines of an acute/chronic in-centre unit safely….for the patient, the staff and other patients therefore we put into place a set of management/treatment guidelines that all staff (nursing and medical) could follow and adhere to, this would allow new members of the team to feel comfortable in dealing with this patient and adapt the principles to other patients.

We began with numerous staff meetings, which included nursing staff, the patients’ consultant, clinical psychologist and input from the guardian board. During this time, we were able to identify staff’s fears and misgivings regarding this patient. We were able to also identify staff members who felt “comfortable” dealing with anti-social behaviours.
From these meetings it was decided that 1 senior staff member would become the primary care giver. This person would be closely supported by senior staff.

Numerous interventions were put into place, these ranged from an agreement of care between the patient and staff, to seeking a limited guardianship order from the guardianship tribunal of NSW.

Three years later, we are still successfully caring for this patient. Treatment guidelines remain in place and been successfully adapted to manage other patients.