F048 04 (CHS32) Agree and implement changes to the dialysis therapy
About this Unit
This workforce competence is about weighing up medical data, information on the patient’s
medical condition and preferences in order to judge whether their dialysis therapy needs to
change. Sometimes changes will be made because of underdialysis. At other times changes
will be needed because of new treatment developments. Adjustments can also be needed to
accommodate some aspect of the patient’s social, work or domestic life. Adjustments and
compromises should concur with evidence for the overall benefits on patients’ wellbeing.
Scope
The scope is here to give you guidance on possible areas to be covered in this Unit. The terms
in this section give you a list of options linked with items in the performance criteria. You
need to provide evidence for any option related to your work area.
Dialysis therapy includes:
 Haemodialysis
 PD/CAPD
 haemodiafiltration
Location includes:
 Main unit
 satellite unit
 home
Measurement of dialysis performance includes:
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fluid removal
solute clearance
length of time on
rate of dialysis
Parameters of dialysis care plans includes:
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machine set-up
frequency
rate
duration
bag strength
Patient’s lifestyle includes:
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domestic responsibility
dietary habits
work
social life
Benchmarks for decision making includes:
 evidence-based practice
 national guidelines
 patient preferences
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
Review and revision of dialysis therapy includes by or taking into account the views of
the:
 multidisciplinary team (eg renal physician, renal nurses, dietician, renal pharmacist,
social worker)
Plan of care includes:
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treatment plan
length and regularity of dialysis
supply of equipment and materials
logistics
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
SPECIFIC EVIDENCE REQUIREMENTS FOR THIS UNIT
Simulation:
 Simulation is NOT permitted for any part of this unit.
The following forms of evidence ARE mandatory:
 Direct observation: Your assessor must observe you in real work activities which
provide a significant amount of the performance criteria for most elements in this
unit. For example how you communicate with the individual to make an assessment
of their wellbeing and their feelings about any change to their dialysis routine.
 Reflective Accounts/professional discussion: These are recordings of your real
work practice, which show your understanding of the individual’s condition and how
the treatment they are receiving affects this. You will need to describe and explain
the methods you use to monitor the treatment and describe how you interpret the data
and make changes to the plan of care.
Competence of performance and knowledge could also be demonstrated using a variety
of evidence from the following:
 Questioning/professional discussion: May be used to provide evidence of
knowledge, legislation, policies and procedures which cannot be fully evidenced
through direct observation or reflective accounts. In addition the assessor or expert
witness may also ask questions to clarify aspects of your practice.
 Expert Witness testimony: Can be a confirmation/authentication of the activities
described in your evidence which your assessor has not seen. This could be provided
by a work colleague or an external individual you deal with on a regular basis.
 Products: For this unit, products may include records and reports related to the
treatment of an individual. You need not put confidential records in your portfolio;
they can remain where they are normally stored and be checked by your assessor and
internal verifier. If you do include them in your portfolio they should be anonymised
to ensure confidentiality
 Assignments/projects: you may have studied infection control and renal failure
related to your job role, and have completed some formally assessed work as part of
an in service course, this may provide evidence of knowledge and understanding
which your assessor can use.
GENERAL GUIDANCE
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Prior to commencing this unit you should agree and complete an assessment plan with
your assessor which details the assessment methods you will be using, and the tasks
you will be undertaking to demonstrate your competence.
Evidence must be provided for ALL of the performance criteria, ALL of the
knowledge and the parts of the scope that are relevant to your job role.
The evidence must reflect the policies and procedures of your workplace and be
linked to current legislation, values and the principles of best practice within the
Health Sector. This will include the National Service Standards for your areas of
work and the individuals you care for.
All evidence must relate to your own work practice.
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
KNOWLEDGE SPECIFICATION FOR THIS UNIT
Competent practice is a combination of the application of skills and knowledge informed by
values and ethics. This specification details the knowledge and understanding required to
carry out competent practice in the performance described in this Unit.
When using this specification it is important to read the knowledge requirements in
relation to expectations and requirements of your job role.
You need to provide evidence for ALL knowledge points listed below. There are a
variety of ways this can be achieved so it is essential that you read the ‘knowledge
evidence’ section of the Assessment Guidance.
You need to show that you know, understand and can apply in
practice:
Communication and interpersonal relationship skills
1. A working knowledge of how to identify and respond to the concerns
which patients may have regarding dialysis and the way in which it
affects their lives
2. A working knowledge of how to give feedback to the patient on the
performance of dialysis
3. A working knowledge of the effects of dependence and independence
on the patient, carer and the provision of the service
4. A working knowledge of how to obtain from patients a valid picture
of their goals, aspirations, feelings and expectations
5. A working knowledge of the importance of providing patients with
opportunities to ask questions and increase their understanding
Information and knowledge management
6. A working knowledge of information that should be available in the
plan of care
7. A working knowledge of recording of agreements
Equality, diversity and anti-discriminatory practice
8. A working knowledge of the importance of treating individuals fairly,
and how to do so
9. A working knowledge of the effects of culture and religious beliefs on
individual communication styles
10. A working knowledge of the different features services must have to
meet people’s gender, culture, language or other needs (e.g.
interpreters)
Generic healthcare knowledge and skills
11. A working knowledge of evidence-based practice and how to use it in
decision making
12. A working knowledge of how to make decisions from the multiple
perspectives of a team
Specialist healthcare knowledge and skills
13. A working knowledge of the nature of renal failure and the function of
renal replacement therapy
14. A working knowledge of how dialysis works for the patient and how
its performance is measured
15. A working knowledge of the nature and significance of parameters of
dialysis care plans (e.g. machine set-up, frequency, rate, duration, bag
strength) and how circumstances may allow or require these to be
varied
16. A working knowledge of evidence of the relationship between
patients’ lifestyles and their wellbeing
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
You need to show that you know, understand and can apply in
practice:
17. A working knowledge of the effect of nutrition on measures of a
patient’s health
18. A working knowledge of the relationship between dialysis, nutrition,
medication and measures of the patient’s health (e.g. blood pressure,
anaemia) and procedures for controlling these
19. A working knowledge of risks involved in changing dialysis therapy
and how to manage them
Context-specific knowledge and skills
20. A working knowledge of how the patient can adapt the treatment to
their personal needs and lifestyle without excessively compromising
their treatment
21. A working knowledge of preferences of individual patients (e.g. in the
way they like to be supported, how much of the procedure they take
charge of themselves)
Employment and organisational policies and practices
22. A working knowledge of the organisation’s policy on use of resources
for individual patients
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
Performance criteria
DO
RA
EW
Q
P
WT
1. discuss with the patient and the
multidisciplinary team possible changes in
the plan of care to accommodate the
patient’s goals and aspirations without
excessively compromising the patient’s
health or use of resources
2. discuss with the patient and inform them of
the risks and benefits of options and check
that they understand the implications and
what would be required of them
3. weigh up with the patient and colleagues the
pros and cons of altering ongoing dialysis
therapy, taking into account evidence of the
effects on wellbeing of dialysis regimes,
acceptability to patients and the needs of the
unit
4. negotiate any revised treatment plan with the
patient and relevant members of the
multidisciplinary team respecting patient
confidentiality
5. identify potential problems for the patient
that may arise from their ability or
preference to work with a new regime
6. work with the patient to ensure that they
understand and will act on the demands of
any revised plan (e.g. medication, dialysis
times, self-measurement, recording)
7. agree the role and benefits of ongoing
monitoring with the patient
8. document all changes and make these
accessible to all members of the renal team
who need to be informed (e.g. electronic for
remote access)
DO = Direct Observation
EW = Expert Witness
RA = Reflective Account
P = Product (Work)
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
Q = Questions
WT = Witness Testimony
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F048 04 (CHS32) Agree and implement changes to the dialysis therapy
To be completed by the Candidate
I SUBMIT THIS AS A COMPLETE UNIT
Candidate’s name: ……………………………………………
Candidate’s signature: ………………………………………..
Date: …………………………………………………………..
To be completed by the Assessor
It is a shared responsibility of both the candidate and assessor to claim evidence, however, it
is the responsibility of the assessor to ensure the accuracy/validity of each evidence claim and
make the final decision.
I CERTIFY THAT SUFFICIENT EVIDENCE HAS BEEN PRODUCED TO MEET
ALL THE ELEMENTS, PCS AND KNOWLEDGE OF THIS UNIT.
Assessor’s name: …………………………………………….
Assessor’s signature: ………………………………………....
Date: …………………………………………………………..
Assessor/Internal Verifier Feedback
To be completed by the Internal Verifier if applicable
This section only needs to be completed if the Unit is sampled by the Internal Verifier
Internal Verifier’s name: ……………………………………………
Internal Verifier’s signature: ………………………………………..
Date: ……………………………………..…………………………..
Unit: F048 04 (CHS32) Agree and implement changes to the dialysis therapy
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