Table 1.

Key features of coronavirus disease 2019 checklists

Checklist and Major SectionExamples
Dialysis preparedness checklist
 Infection prevention and control policies and training for HCWsImportance of HH
Respiratory hygiene
Cough etiquette
CPR in COVID-19–positive patients
 Education and culturally appropriate communication with patientsCOVID-19 (e.g., symptoms, how it is transmitted)
The importance of continuing to attend dialysis as scheduled
Patients receive advice to minimize risks if dialysis duration or frequency has to be reduced due to staffing shortages
 Process for rapidly identifying and isolating patients with confirmed or suspected COVID-19Unit has a system to receive and triage phone calls from patients with symptoms of fever or respiratory infection
Signs are posted in triage areas advising patients with fever or symptoms of respiratory infection to immediately notify triage personnel so that appropriate precautions can be put in place
Unit has a process to ensure that patients with confirmed or suspected COVID-19 are placed in the designated COVID-19 triage or treatment area
 Patient placement and testingUnits limit as far as practicable use of waiting rooms, with patients being taken directly into dialysis units
The unit identifies a specific isolation room for the testing of patients for COVID-19
Unit has a plan for cohorting patients and HCWs if they are dialyzing multiple patients with confirmed COVID-19
 Transmission-based precautionsUnit has a procedure for assessing supply (inventory) of PPE and other infection prevention and control supplies (e.g., HH supplies)
HCWs receive appropriate training, including “just in time” training on selection and proper use of (including putting on and removing) PPE, with a required demonstration of competency
 Movement of patients with undiagnosed respiratory infection and/or confirmed or suspected COVID-19 within the dialysis unitPatient movement outside of the isolation room (isolation station) will be limited to essential purposes
The unit has a plan for wearing of PPE by patients (e.g., face mask)
 HH and environmental cleaningHH supplies, including alcohol-based hand sanitizer, are readily accessible in inpatient care areas, including areas where HCW put on and remove PPE
Unit has a process to ensure that shared or nondedicated equipment is cleaned and disinfected after use and according to the manufacturer’s recommendations
 Monitoring and managing HCWUnit has sick leave policies that are nonpunitive, are flexible, and allow ill HCWs to stay home
Unit has considered cohort staffing to minimize the risk of transmission between HCWs
 Visitor access and movement within the dialysis unitUnit has a plan to restrict nonessential visitors
Visitors are screened for symptoms of acute respiratory infection before entering the unit
 Unit management structure and situational awarenessSmaller units should identify support networks with regional and/or state partners
Unit knows where COVID-19 testing is being performed locally and has a plan to refer patients who need COVID-19 testing if not available at the unit
 TransportationUnit has explored options for patients to travel individually to dialysis either by private car or by single-occupancy taxi
If patients must come in group shuttles, the unit has liaised with transport providers to use screening questions before boarding transport and have developed an infection control plan in collaboration with the transport provider
AKI preparedness checklist
 Meet/liaise with ICU to determine management plan for AKIDetermine ICU capacity for CRRT and/or SLED
Evaluate access to water in the ICU or other high-dependency care areas to enable HD
Is there a plan for the transition of care of the dialysis-dependent patient with AKI discharged from the ICU?
 What capacity does the renal unit have for intermittent HD for AKI?Determine whether HD can be performed in designated COVID-19 ward(s)? (water access, isolation, cohorting of staff, clinical COVID-19 expertise, etc.)
Assess use and capacity of spare HD machines
Assess capacity of dialysis staff to provide dialysis out of the usual HD unit?
 Managing patients with COVID-19 in the dialysis unitPlan for cohorting of COVID-19–positive patients with AKI
Isolation/infection control protocols in place?
Staff adequately trained?
 Other issuesVascular access placement in COVID-19–positive patients—access to nontunneled and tunneled central line
Acute PD—capacity for PD catheter insertion in COVID-19–confirmed/suspected patient
Nephrology follow-up procedures in place for patients with AKI after discharged home?
Workforce preparedness checklist
 Sick leave policies and health of staffNonpunitive, flexible sick leave policies
Influenza vaccination for all HCWs in renal facilities, recognizing that this may be done in accordance with local immunization policies
 Communication strategiesConsider communication strategies in advance, particularly if a staff member was to test positive for the virus
Consider how news of an infected staff member may be communicated to patients
 Cohorting of staffConsider restrictions to staff socializing (e.g., joint lunch breaks) and access to shared spaces, such as tea rooms or lockers
 Units have considered how to redeploy specialist nurses to maximize number of staff able to perform HD and have retrained staff as appropriateEstimate/chart in advance your minimum required safe staffing levels to remain capable of providing treatment to your patient population, recognizing that modifications to usual practices may be needed in case of significant workforce shortages
Consider employing nonspecialist nurses (e.g., theater nurses) within renal units to help monitor patients on dialysis if this will reduce the number of experienced nurses required per shift
 Unit management structure and situational awarenessConsider stopping rotation of junior staff between renal units
Consider allied health workers and administrative and cleaning staff attached to renal units; make attempts to minimize rotation between units/other areas of the hospital
 AdvocacyThe specialized nature of their work makes renal nursing staff members hard to replace with other nursing personnel from other streams
  • HCW, health care worker; HH, hand hygiene; CPR, cardiopulmonary resuscitation; COVID-19, coronavirus disease 2019; PPE, personal protective equipment; ICU, intensive care unit, CRRT, continuous RRT; SLED, sustained low-efficiency dialysis; HD, hemodialysis; PD, peritoneal dialysis.