‘Home Visits – So much more than just a cup of tea’

Mr Peter Tregaskis1, Mrs Maria Buena1

1Alfred Health, , Australia

Introduction:

The International Society of Peritoneal Dialysis (ISPD) empirically recommend that home visits should be part of any Peritoneal Dialysis (PD) program though, there are no clear recommendations around frequency/format of assessment. The perceived benefits of a robust and consistent home visit program are: reduced PD related infections, therapy longevity, reduced PD-related admissions and improved patient satisfaction.

Method:

In 2013, the PD team at Alfred Health developed a triage risk assessment tool along with a form-based assessment tool to stratify patients and consequently guide frequency (and specific goals) of home visits. Covering 6 domains of technique, troubleshooting capacity, environment, stock management, clinical and well-being parameters, the tool subcategorises patients as either low, moderate or high risk to therapy.

Results:

Introduced in conjunction with the development of a percutaneous Tenckhoff insertion program, the implementation of this tool has been associated with significant overall improvement in PD outcomes. Mean peritonitis episodes per patient year fell from the pre-intervention era (2008 – 2012) 0.48 episodes per patient year to post-implementation (2013 – 2018) 0.18 episodes per patient year with a median time on therapy (transplant censored) of 686 days. Assessment and home-visit frequency (approximately 30-35 home visits/month for a cohort of ~ 100) was maintained during, and contributed to, a significant increase in total patient numbers from n=47 in 2012 to n=110 in 2015.

Conclusion:

The next phase is to audit the existing tool for currency in the context of a review of current practice recommendations to identify areas of potential refinement.


Biography:

Has worked in renal nursing for 15 years both in Australia and overseas. Has a post-graduate diploma in renal nursing and a masters of Nurse Practitioner. Took on the PD coordinator role in 2010 and evolved the role into a Nurse Practitioner role, becoming endorsed in 2013. Has seen the unit grow in numbers from 22 patients in 2010 to a peak of 110 patients in 2015 all while maintaining excellent patient outcomes. Currently leads a dynamic team of 5 PD nurses with aspirations for constant innovative and patient centred ideas.

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