It is an honor to recommend South Texas Veterans Healthcare System’s (STVHCS) Hemodialysis Unit for the prestigious DAISY Award for Extraordinary Nurses in Patient Safety. Our Nursing Dialysis Team was nominated by the Chief Medical Officer of Nephrology and was awarded the 2022 Team Daisy Award for STVHCS. Our Hemodialysis unit serves America’s Veterans by providing high-quality patient care to 49 chronic dialysis Veterans while also serving the Veteran population in the inpatient units.

Each team member displays a commitment to ensuring their patients have a safe, timely, efficient, effective, and outstanding experience during their dialysis treatment, which is evident through the activities they support and performance measures. The culture of the Hemodialysis Unit embodies the evidence-based practices of Team STEPPS and Clinical Teams Training that assist in the positive patient outcomes experienced. This can be seen through their consistency in quality performance measures. To date, the unit has reached the unattainable ZERO! There have been zero dialysis catheter-related infections, AV-Fistulas, or grafts for the past four years. This is not only a testament to the team’s adherence to evidence-based practices, assessments, and education, but it is also a testament to their commitment to the safest care possible for America’s Veterans.

In addition, the Hemodialysis Unit has maintained dialysis adequacy greater than 95% for the past four years, superseding the national average of 67%! These performance measures indicate the efficiency of the dialysis treatment. STVHCS Hemodialysis’ dialysis adequacy percentage indicates a commitment from both nursing and provider teams to ensure their patients have the superior dialysis treatments that improve their outcomes. The Hemodialysis team is a family that forms bonds between staff and patients. Not only do these nurses find ways to celebrate special moments in Veterans' lives, but they also partner with them to improve their experience in our organization.

As most of their patients are wheelchair dependent for mobility, the nursing team created a wheelchair project in collaboration with the Prosthetics Department to evaluate the safety of their assistive devices. Each month a Veteran is selected to receive a Full-Service Detail to their wheelchair/motorized scooter free of charge. During their dialysis treatment, the veteran’s wheelchair/motorized scooter is taken to the prosthetics for a full inspection of the safety and functionality of the device. Any issues found are addressed on the spot. Once the device passes the safety inspection, the team gives the wheelchair or scooter a detailed cleaning. Upon completion of dialysis treatment, the wheelchair/scooter is returned to the Veteran, sparkling clean, with a certificate of a passing inspection. There are no words to describe the sheer joy that can be seen by the Veterans when they receive their wheelchair/scooter. The Hemodialysis team sets the bar, not only for STVHCS dialysis patients but for others, by demonstrating the impact nurses have on Veteran safety and experience.

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Over the past year, the STVHCS Hemodialysis Unit has seamlessly absorbed an unprecedented number of personal and collective hardships associated with Winter Storm Uri, the COVID-19 pandemic, and mounting supply chain issues that have disrupted normal operating procedures. Despite these challenging events, all 16 nurses and ten technicians who represent the STVHCS Hemodialysis Unit have paradoxically elevated their level of exemplary care to provide unwavering compassion and support to their patients, the patients’ families, the nephrology department, and the San Antonio dialysis community. Here are examples of how this unit has typified the VA Mission and VA Core Values:

1. During Winter Storm Uri from February 13-17 of 2021, over 400 San Antonio hemodialysis patients were unable to dialyze due to city-wide interruptions in their dialysis unit water supply. Through expedited activation of the VA’s “Fourth Mission,” the STVHCS Hemodialysis Unit adjusted its outpatient dialysis shifts and staffing to provide emergency dialysis treatments to displaced San Antonio civilian dialysis patients. They were also able to successfully absorb the attendant surge in the STVHCS hospital hemodialysis inpatient census. Several staff took turns staying overnight in the hospital to care for these patients at a time when their own homes and families were without power and water. When I rounded on these patients, they consistently expressed appreciation and gratitude for the excellent care and compassion delivered by the STVHCS hemodialysis staff during this precarious time. Undoubtedly, some of those patients would not have survived without the emergent provision of those hemodialysis treatments.

2. During the COVID-19 pandemic “Delta” surge of 2021 and “Omicron” surge of 2021-2022, there were unprecedented spikes in the numbers of hospitalized hemodialysis patients who required “in-room” dialysis treatments mandated by COVID-19 isolation requirements. To accommodate this new workload pattern, the STVHCS Hemodialysis Unit diverted more nurses to these patients who required 1:1 care with full PPE for 4 hours at a time. Despite these challenges, every time I rounded on these patients, I saw the dialysis nurse greet the patient with a smile and provide compassionate care to the patient and their family members. In the ICU, critically ill hemodialysis patients and their family members were treated with expertise, grace, and compassion.

3. Over the past year, the STVHCS Hemodialysis Unit faced mounting “supply chain issues” of 2021-2022 that affected CRRT solutions, dialysis needles, dialyzers, and dialysis tubing supplies. They also battled the challenges of acquiring maintenance contracts for the Cyberren IT interface software program, B Braun dialysis machines, Baxter (peritoneal cyclers), Marcor (water purification hardware), and Tablo (dialysis machines). On several occasions, these problems threatened the operational readiness of the dialysis unit, potentially impacting the delivery of hemodialysis to inpatient and outpatient veterans. Fortunately, innovative thinking prevailed, and these obstacles were successfully overcome without a single dialysis treatment loss. Additionally, STVHCS hemodialysis nurses played pivotal roles in a successful plan to transition the delivery of Tablo dialysis in the MICU/SICU from HD RNs to ICU RNs, facilitating the conservation of a dwindling national supply of CRRT solutions.