Nephrology Service Plan

---
name: nephrology-service-plan
description: |
  Design a realistic, measurable service plan for patients with kidney disease, including dialysis patients as a nephrologist.
  TRIGGERS - Use when a nephrologist needs a service plan design for patients with kidney disease, including dialysis patients in a renal unit and dialysis centre.
category: Nephrology
license: MIT
version: 1.0
---
# Service Plan Design — Nephrology

Design a realistic, measurable service plan for patients with kidney disease, including dialysis patients as a nephrologist. The deliverable is a written plan with goals, actions, owners, timelines and review dates.
This skill is written for a nephrologist working with patients with kidney disease, including dialysis patients in a renal unit and dialysis centre.

## When to use
- You are a nephrologist preparing, delivering or reviewing this part of your work in a renal unit and dialysis centre.
- You need a defensible, repeatable approach that produces a written plan with goals, actions, owners, timelines and review dates.
- A colleague, auditor or client asks how this was done and what evidence supports it.

## Key Concepts
| Term | Meaning |
|------|---------|
| Dialysis | artificial filtering of the blood when kidneys fail |
| GFR | glomerular filtration rate, a measure of kidney function |
| Fistula | a surgically created connection used for dialysis access |

## Workflow
1. **Step 1** - Start from the assessment findings and agree goals with patients with kidney disease, including dialysis patients — specific enough to measure against dialysis adequacy scores
2. **Step 2** - Break each goal into actions sequenced for a renal unit and dialysis centre, naming who does what and by when
3. **Step 3** - Build the plan around dialysis prescriptions so progress, changes and decisions are recorded in one place
4. **Step 4** - Price or resource the plan honestly: time, haemodialysis machines and materials, with contingencies for missed hyperkalaemia
5. **Step 5** - Set the review date and the trigger points that would change the plan, and confirm the plan with all parties

## Profession-Specific Components
| Component | Details for Nephrology |
|-----------|-------------------------------|
| Core documentation | dialysis prescriptions; fluid balance charts; transplant assessments; blood result reviews |
| Core tools & equipment | haemodialysis machines; dialysis access devices; ultrafiltration monitors; laboratory systems |
| People involved | patients with kidney disease, including dialysis patients; the nephrologist; colleagues and other services in a renal unit and dialysis centre |
| Primary record | dialysis prescriptions — keep it current, dated and attributable |

## Output Format
**Context:** [Situation in a renal unit and dialysis centre] | **Objective:** [What this must achieve] | **Audience:** [patients with kidney disease, including dialysis patients and other stakeholders]

The finished output is a written plan with goals, actions, owners, timelines and review dates, structured as:
1. Summary of position and evidence
2. Detail, following the workflow above
3. Decisions, actions, owners and dates
4. Review point and escalation route

### Action Plan
1. **Immediate:** Confirm scope, consent and the evidence available in dialysis prescriptions.
2. **Short-term:** Complete the workflow steps and record outcomes against dialysis adequacy scores.
3. **Medium-term:** Review results, close actions, and update local procedures in a renal unit and dialysis centre.

## Success Metrics
| Metric | Target | Method |
|--------|--------|--------|
| dialysis adequacy scores | Agree a local target and track the trend | Measured from dialysis prescriptions and reviewed on a set cycle |
| vascular access infection rate | Agree a local target and track the trend | Measured from dialysis prescriptions and reviewed on a set cycle |
| fluid management compliance | Agree a local target and track the trend | Measured from dialysis prescriptions and reviewed on a set cycle |
| transplant workup timeliness | Agree a local target and track the trend | Measured from dialysis prescriptions and reviewed on a set cycle |

## Guardrails & Quality Checks
- Never let this happen: missed hyperkalaemia.
- Never let this happen: dialysis access infection.
- Never let this happen: fluid overload.
- Work only within the competence and authority of a nephrologist; escalate or refer anything beyond it.
- Record facts and observations, not speculation, and keep records confidential to a renal unit and dialysis centre's rules.
- Verify names, dates, figures and measurements twice before anything is issued or signed off.
- Use only real, verified information from the case in hand — never invent results, credentials or evidence.

## Example (illustrative)
A nephrologist in a renal unit and dialysis centre applies this workflow for patients with kidney disease, including dialysis patients: they open
dialysis prescriptions, work through the five steps using haemodialysis machines, and close by recording
the outcome against dialysis adequacy scores and agreeing the next review date. (Illustrative example only —
replace with the real details of the case in hand.)