Evaluation of a peritoneal dialysis assessment tool: One unit’s experience

Christie McKellar, Leanne Linehan1, Bianca Hickman1

1Monash Health, ,

Introduction:

A Peritoneal Dialysis Unit (PDU) located in South East Victoria. Following a two day education sessions anyone who expressed an interest in Peritoneal Dialysis as a preferred therapy is then invited to come into the PDU for further education. The selection criteria for commencing on the PDx program has shown to be effective in highlighting medical, social concerns.

Method:

The PDU initiated a checklist as a tool to utilise with potential patients and their families. All potential patients are invited to a one on one assessment with a PD nurse, to assess his/her suitability for PDx. The assessment tool discusses any medical and social barriers that may prevent a successful candidate. Any cause for concern is identified and discussed and the option for further evaluation if required can be recommended.

Results:

The following data has been collected over a two year period of 2018 to 2019. The data collected include total amount of PD chats and total amount of patients who progress onto the program. This data also highlights patients who have commenced other treatment options and the reason why they did not progress to PD.

Conclusion:

The purpose of the review is to investigate the current practice of the assessment tool prior to commencing PDx. The assessment tool has shown the efficacy of performing this pre dialysis discussion in identifying any problems early avoiding unnecessary placement onto the PDx program and the benefit to the patients and the healthcare provider is invaluable.


Biography:

Bio to come

Supporting skills development for peritoneal dialysis trainers

Prof Josephine Sau Fan Chow1,2,3, Doctor Yeoungjee  Cho4,5, Ms Keri-Lu  Equinox6, Professor Ana  Figueiredo7, Ms Serena  Frasca8, Associate Professor Carmel Hawley4,5,9, Professor Kirsten  Howard2, Professor David Johnson4,5,9, Professor Matthew  Jose3, Ms Anna Lee10, Ms Moira  Maley11, Ms Jo-Anne  Moodie12, Ms Peta  Paul-Brent9, Ms Elaine  Pascoe9, Ms Donna  Reidlinger9, Dr. Genevieve  Steiner13, Ms Melinda  Tomlins14, Dr. David  Voss15, Dr Paula  Woodward16, Professor Neil  Boudville11

1South Western Sydney Local Health District, Liverpool, Australia, 2University of Sydney, Camperdown, australia, 3University of Tasmania, Hobart, Australia, 4University of Queensland, QLD, Australia, 5Princess Alexandra Hospital, Hospital, Australia, 6Cairns Hospital, CAIRNS, Australia, 7Pontifícia Universidade Católica do Rio Grande do Sul, Brazil, Australia, 8Central Northern Adelaide Renal Transplant Service, Adelaide, Australia, 9Australasian Kidney Trials Network, QLD, Australia, 10Illawarra Shoalhaven Local Health District, Wollongong, Australia, 11University of Western Australia, Perth, Australia, 12The Royal Melbourne Hospital, Melbourne, Australia, 13Western Sydney University, Penrith, Australia, 14Hunter New England Local Health District, Newsastle, Australia, 15Middlemore Hospital, Auckland, Australia, 16Science and Medical Communications, NSW, Australia

Introduction:

Nurses are responsible for training patients in the technique of Peritoneal Dialysis (PD) which is a home-based therapy. There has been no published randomised controlled trial (RCT) evaluating any specific protocol for nurses delivering PD training and patients being trained. We hypothesised that a standardised education package based upon best available evidence and utilising modern educational practices may lead to improved patient outcomes. This paper outlines the process to develop a standardised, evidence-based curriculum for PD trainers.

Methods:

A literature search and clinical audit were conducted to identify current practice patterns and best practice that also aligned with guidelines from the International Society for Peritoneal Dialysis (ISPD). Delphi technique was used in the development of the “Train the Trainer” curriculum and its supporting material.  Results were reviewed by a focus group of practitioners comprising PD nurses, nephrologists, consumers, a medical education expert, and an eLearning expert. From this, a training curriculum and modules were developed.

Results:

A comprehensive PD training curriculum which includes training modules for PD nurses have been developed. The package comprises 2 introductory modules and 2 clinical case modules. The curriculum is designed with interactive digital media.  Assessment is also addressed.

Conclusion:

There have been no published RCT data evaluating any specific protocol for training PD nurse trainers. It is highly likely that there are unrealised gains to be made for PD clinical outcomes with the adoption of best practice guidelines. A comprehensive PD training curriculum has been developed by experts, utilising adult learning principles and eLearning techniques, following the guidelines outlined by the ISPD.


Biography:

Coming from a career specialty background as a renal nurse, Josephine Chow is currently the Director Strategy and Partnerships of South Western Sydney Local Health District and manages a team of staff in supporting a large number of innovations, major contracts/tenders and model of care redesign.  She is also the Co-Director of the Renal Clinical Research Centre in Liverpool Hospital and very active in both clinical trial and clinical researches.  Josephine also contributes to academic activities with the number of publications in local and international journal and has supervised a number of post graduate and PhD students in nursing, psychology and management degree.

She completed her PhD, Master of Business Administration, Diploma of Project Management, Diploma of Government.  In 2012, Josephine was awarded the prestigious Winston Churchill Fellowship and travelled oversea to investigate strategies for improving the uptake of home-based dialysis therapies.  She is the Project Lead for a number of local and international awards and funding grants.  Her research interests include home dialysis, end of life management, model of care telehealth and integrated care.

Josephine is the Chair of a number of state-wide and national-wide high cost equipment and consumables tender.  She is advisor for a number of national and international committee on business model in health care.

 

Targeted Education ApproaCH to Improve Peritoneal Dialysis Outcomes (TEACH-PD) – Feasibility Study

Prof Josephine Sau Fan Chow1,2,3, Ms Kelly  Adams4, Dr Yeoungjee  Cho5, Dr Peter Choi4, Ms Keri-Lu  Equinox7, Professor Ana  Figueiredo8, Professor Carmel  Hawley5,6,9, Professor Kirsten  Howard2, Professor David W. Johnson5,6,9, Professor Matthew D.  Jose3, Ms Anna Lee10, A/Professor Maureen  Longergan10, Ms Karine E  Manera11, Ms Jo-Anne  Moodie12, Ms Peta-Anne  Paul-Brent5,9, Ms Elaine M  Pascoe5,9, Ms Donna  Reidlinger5,9, Dr. Genevieve Z.  Steiner13, Ms Melinda  Tomlins4, Dr Allison  Tong11, Dr David  Voss14, Professor Neil  Boudville15

1South Western Sydney Local Health District, , Australia, 2University of Sydney, , , 3University of Tasmania, , , 4Hunter New England Local Health District, , , 5The University of Queensland, , , 6Princess Alexandra Hospital, , , 7Cairns Hospital, , , 8Pontifícia Universidade Católica do Rio Grande do Sul, , , 9AKTN, , , 10Illawarra Shoalhaven Local Health District, , , 11The Children’s Hospital at Westmead, , , 12The Royal Melbourne Hospital, , , 13Western Sydney University, , , 14Middlemore Hospital, , , 15University of Western Australia, ,

Introduction:

There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients.  The aim of this study was to test the feasibility of implementing the TEACH-PD curriculum in real clinical practice settings.

Methods:

This study used mixed-methods including questionnaires and semi-structured interviews (pre- and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over six months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis.

Results:

Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 hours (range 6-17) and 24.9 hours (range 15-35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow up. Three (21%) patients were transferred to haemodialysis due to non PD-related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient).

Conclusion: This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.


Biography:

Coming from a career specialty background as a renal nurse, Josephine Chow is currently the Director Strategy and Partnerships of South Western Sydney Local Health District and manages a team of staff in supporting a large number of innovations, major contracts/tenders and model of care redesign.  She is also the Co-Director of the Renal Clinical Research Centre in Liverpool Hospital and very active in both clinical trial and clinical researches.  Josephine also contributes to academic activities with the number of publications in local and international journal and has supervised a number of post graduate and PhD students in nursing, psychology and management degree.

She completed her PhD, Master of Business Administration, Diploma of Project Management, Diploma of Government.  In 2012, Josephine was awarded the prestigious Winston Churchill Fellowship and travelled oversea to investigate strategies for improving the uptake of home-based dialysis therapies.  She is the Project Lead for a number of local and international awards and funding grants.  Her research interests include home dialysis, end of life management, model of care telehealth and integrated care.

Josephine is the Chair of a number of state-wide and national-wide high cost equipment and consumables tender.  She is advisor for a number of national and international committee on business model in health care.

The Renal Steps Project: Building engagement for improved health outcomes

Mr Brendan Zornig1

1Logan Hospital, Metro South Health, Meadowbrook, Australia

Introduction:

Participating in regular physical activity is known to improve outcomes relating to chronic disease. This poster will present a quality initiative aimed at encouraging home and in-centre dialysis patients to participate in regular physical activity to improve their health outcomes.

Methods:

Over a two-month period, patients were provided with a pedometer and encouraged to participate in a series of walking challenges using the 10,000 Steps program. Patients set their own goals relating to physical activity and weight loss. Health measures including weight, blood pressure, and glycaemic control were measured pre- and post-intervention.

Results:

A total of 15 patients participated in the program. All patients lost weight, with an average weight loss of 1.6kg. A modest improvement in blood pressure was observed, with an average reduction of 3.9mmHg and 3.7mmHg for systolic and diastolic respectively. For diabetic patients, HbA1c was reduced by 1.0 on average. Four patients achieved more than 200,000 steps throughout the course of the program. These four patients lost an average of 2.4kg, had their systolic blood pressure reduced by 14.2mmHg, and experienced an average reduction in HbA1c of 2.0.

Conclusion:

The universal improvement in the health outcomes measured indicate some potential tangible benefit in the uptake of regular physical activity in the dialysis patient population.  Moreover, this project has built engagement amongst this cohort of patients, increasing awareness and motivation to participate in physical activity.


Biography:

Brendan Zornig is the clinical facilitator of the Renal Dialysis Unit of Logan Hospital, Queensland. Brendan’s practice involves patients on home-based peritoneal dialysis, as well as in-centre haemodialysis.

Home & satellite haemodialysis patients: A comparison of outcomes in a matched cohort

Dr Emily K Yeung1, Dr  Kevan R Polkinghorne1,2,3, Dr Peter G Kerr1,2

1Monash Health, Clayton, Australia, 2Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia, 3Department of Epidemiology & Preventative Medicine, Monash University, Clayton, Australia

Introduction

Home haemodialysis (HD) has been associated with improvements in clinical and non-clinical outcomes, including in blood pressure control, recovery time after HD, hospital days, and quality of life and survival. We compared outcomes of home HD and satellite HD patients treated at a tertiary health service.

Methods

Adult prevalent home HD patients from Monash Health were included as of January 2008, and incident patients were added to the end of June 2017. Three satellite HD controls were matched to each home HD patient on age, gender and cause of end stage kidney disease (ESRD). Survival analysis was performed by dialysis modality, and patients were followed until death, transplantation or June 30, 2017.

Results

555 patients were included with 2192 person-years of data. Mean follow-up was 4.0 years. Incidence rate of death was 7.2 per 100 person-years in satellite dialysis and 2.5 per 100 person-years in home dialysis patients. After adjusting for age, BMI, gender, racial group, cause of ESRD and comorbidities, home dialysis patients experienced a significantly reduced risk of death (HR=0.31, 95% CI 0.18-0.55).

Transplant rates were comparable between home and satellite dialysis patients – 49.7% and 45.7% (p=0.374) with graft survival at 6-months of 100% and 99.5% respectively. The proportion of patients with haemoglobin < 100g/L and with phosphate > 1.80mmol/L was not significantly different between groups.

Conclusion

This study has demonstrated a significant survival benefit for patients on home compared to matched satellite dialysis patients, with comparable rates of transplantation, transplant survival and biochemical marker control.


Biography:

Biographies to come

Magnesium based phosphate binder caution

Dr Yun Hui Sheryl Wong1, Ms Ann Berwick1, Ms Anne Nguyen1, Ms Kate Morley2, Dr Mark Thomas1

1Royal Perth Hospital, Perth, Australia, 2Amity Health, Albany, Australia

Introduction: As chronic kidney disease progresses through the 5 stages, hyperphosphataemia occurs, resulting in bone demineralisation, vascular and soft tissue calcification, cardiovascular disease and secondary hyperparathyroidism. Dietary restriction of phosphate alone becomes insufficient over time to counteract this process and various phosphate binders are commonly prescribed to reduce the absorption of phosphate from the gastrointestinal tract.

Magnesium based phosphate binders have been shown to be non-inferior to sevelamer for the management of hyper-phosphataemia. However, there is a vast array of commercial magnesium-based supplements available to the Australian consumer.

Methods: We discuss these supplements and present them in a table.

Results: Considerable heterogeneity exists not only in their magnesium content, but the concentration of other additional ions like calcium, potassium and phosphate.

Conclusion: The clinician should note that caution should be exercised when prescribing these supplements, particularly to the chronic kidney disease population.


Biography:

Sheryl completed her basic physician training in Melbourne at the Alfred Hospital, did a short general medicine stint at Royal Hobart Hospital in Tasmania and is now a Nephrology Advanced Trainee in Royal Perth Hospital in WA. Her interests include home dialysis, interventional nephrology and indigenous health.

Keeping HD patients home using AVF plastic cannula

Ms Dong Wang1, Mr Matthew Harvey1, Ms Rita Carmel  O’Neill1, Ms Ellen Ramas1, Ms Kate  O’Brian1

1Eastern Health Victoria, Melbourne, Australia

Introduction

Home haemodialysis improves survival and quality of life compared with haemodialysis delivered in hospital-based units. Access damage caused by poor technique is the main reason that leads to a hospital stay, surgery, loss of lifelines. AVF plastic cannula was introduced to our unit to determine the reliability of using plastic cannula on home haemodialysis patients.

Method

A literature review was conducted to evaluate and provide the rationale and justification for this project, followed by a plan including staff training, patient selection, and measuring instruments. Budget costs are itemised to compare the current programme with using plastic cannula. The patient training programme is tailored to meet the individual circumstances, ongoing evaluation and monitoring to ensure that patient safety is not compromised during project.

Results

As of July 2019, a total of 8 patients were trained using plastic cannula successfully at home. Two patients were discharged as they had received kidney transplants and one patient was transferred to satellite units due to unresolved access issues. Two patients were discharged from home therapy as deterioration of medical and cognitive condition; three patients continued home haemodialysis using plastic cannula.

Conclusion

We found that using plastic cannula can reduce access-related issues, patients also reported significantly increased satisfaction with home therapy due to less fears and anxiety. As no sharps are produced, it is proven to be safer and more cost effective compared to existing programmes using metal AVF needles for home based haemodialysis patients.


Biography:

I aspire to conduct myself in my chosen profession as an advanced level specialist renal nurse. I have been involved in the development of nursing evaluation tools and treatment planning skills for myself and fellow nursing professionals, and have expertise in haemodialysis (acute and chronic), peritoneal dialysis, nurse education, patient training and independent patient assessment. I also have participated in number of research projects pertaining to advancing renal health care.

As a nurse, I believe that we should be prepared to be challenged and keep current with new developments.  I completed my Nephrology care certificate in 2007 and, in 2013, I completed a Master of Nursing degree specializing in renal care.

 

Patient centred care – beyond the selection criteria for home haemodialysis patients

Ms Ya-ling Tu1, Ms Yasko Takatori1

1RNSH – Sydney Dialysis Centre, St Leonards, Australia

Introduction:

Patient selection can be considered one of the most essential foundations of building a successful and sustainable home haemodialysis program. Patients who need to overcome barriers for home haemodialysis are usually excluded. Contemporary nursing is closely connected to patient-centred care which provides healthcare with dignity and respect to all patients and their decisions about their own health. Recently, SDC has trained a number of patients with barriers to home haemodialysis successfully and we would like to share our experiences in this poster.

Methods:

Patients who successfully trained in home haemodialysis had barriers that included advanced age, learning difficulties, non-English speaking backgrounds, physical disabilities and palliatives. These were reviewed to identify the strategies of successful training.

Findings:

The successful training strategies needed to overcome these barriers included: health professionals’ encouragement, increasing the length of training when necessary, modifying the practices to suit different individuals, simplifying and modifying training manuals to meet patients’ abilities, encouraging family involvement, obtaining essential medical resources, providing extra equipment support and more frequent nursing home visits in the first a few months after training.

Conclusion:

If a patient has the motivation to consider home therapies, their wishes should be respected. If they do not meet the selection criteria for home haemodialysis, new training strategies should be considered. By providing successful training strategies to help patients with barriers to home haemodialysis commence their treatment at home; we can increase their happiness, independence, mental health and confidence.


Biography:

Ya-Ling Tu is a clinical nurse specialist in Sydney dialysis Centre and also an acting clinical nurse educator in Acute Dialysis Unit at Royal North Shore Hospital. She received a bachelor’s degree in Nursing from University of Technology Sydney and a postgraduate certificate from University of Tasmania. She received the 2017 exceptional people award in patient-centred care in Northern Sydney Local Health District. Ya-Ling is interested in nurse and patient education and patient self-management.

 

Yasko Takatori is a home haemodialysis nurse working in Sydney dialysis centre. Yasko completed  a diploma of nursing and trained in Japan. After migrating to Australia, Yasko completed a Bachelar of Nursing at Sydney University.  Yasko has been working in renal for last 20 years including 11 years as a home therapy nurse. Yasko’s major area of interest is encouraging suitable patients to undertake home training and educating those patients to manage dialysis and their health by themselves. She has witnessed patients gain confident taking control in their self-care when they start home therapy. She enjoys observing patients dialysing in their familiar environment surrounded by their loved family.

‘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.

The logistics of peritoneal dialysis stock in the Northern Territory

Mrs Nadine Tinsley1

1Renal Home Therapies, Royal Darwin Hospital, Darwin, Australia

Introduction:

Top End Renal Home Therapies Team look after Peritoneal Dialysis (PD) patients in the Top End, which consists of an area of 245,000km2.  The logistics of arranging PD stock to be delivered to remote locations can be quite hair raising.  The considerations are our distance, temperature, wet season and cyclones.  How do we think outside the square to get things done in such a large area of land?

Methods:

In a single centre, the KPI of the length of time it took for PD stock to be packaged and delivered from provider to patient and the amount of stock required was reviewed. Quantitative amounts were reviewed to assess the level of stock, lead times and emergencies.  Qualitative feedback from patients and remote clinic staff was received and reviewed to improve the service.

Results:

This resulted in adjustment of transport lead times, type of transport, communication between transport provider and patients and amount of stock for different seasons and emergencies.

Conclusion:

Our patients’ stock travels 3032km by road from Adelaide to Darwin, then it travels out to remote communities by road or barge up to a further distance of 480nm barge for Nhulunbuy patients.  Sometimes stock is in transit for 3 weeks. By reviewing the KPI service was improved to ensure that patients received their stock within the most appropriate time possible with improved communication to the patient about delivery and any delays, without running out.


Biography:

Nadine has been a nurse with the Top End Renal Service for 8.5 years.  She has always had a passion for PD, however has worked across the renal spectrum, as inpatient  renal ward nurse, haemodialysis hospital and satellite, transplant and now peritoneal dialysis.  Nadine believes that providing education to CKD patients, general public and clinical staff has contributed to the increased uptake of PD in the Top End.  With the centralisation of the Renal Home Therapies Service in the Top End, there has been an increase of home therapies.  Now is the time to see how we can improve further.

About ANZSN

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The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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