Renal News Annual Edition, 2021 - Year in Review

3RD EDITION

RENAL NEWS ANNUAL EDITION 2021 Year in Review

Celebrating teamwork and collaboration in a year of adversity

CONTENTS Welcome

1

Message from BC Renal Executive Director

2

About Our Network

4

Meaningful Outcomes

6

PROMIS

8

Patient and Family Engagement

10

BC Children's Hospital Renal Program

12

Education and Knowledge Translation

14

Annual Campaigns

22

Improvements Driven by BC-Wide Committees

28

Improvements Driven by BC-Wide Professional Groups 44 Connect with BC Renal

ii

58

WELCOME

Welcome to the third annual edition of Renal News. Here, we bring you a snapshot of many of our network’s initiatives over the past year, and the committees and groups that make them happen.

Throughout, you will find links to related parts of the BC Renal website, BCRenal.ca, where you can learn more. We hope you enjoy getting to know our BC Renal community and provincial network better through this special edition!

BC Renal is responsible for planning, coordinating and funding outstanding patient care, and acts as a catalyst for research, knowledge translation and innovation.

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CELEBRATING TEAMWORK AND COLLABORATION

in a year of adversity

MESSAGE FROM BC RENAL EXECUTIVE DIRECTOR Dr. Adeera Levin Executive Director, BC Renal

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Dear BC kidney community, 2021, much like 2020, was a year of unprecedented challenge, hardship and loss. The ongoing pandemic, compounded by severe weather events due to climate change, had a profound impact on our personal worlds as well as the health system and our roles within it. We continued to learn more about the devastating impacts of colonialism and systemic racism on Indigenous peoples, and we joined new collective commitments to action.

Within this extraordinary context, I am humbled by the ongoing dedication and efforts of our care teams across BC who put the needs of patients first, adapting to constant

change along the way.

Behind the scenes in 2021, patient partners, provincial committees and professional groups across our network continued to seek opportunities to improve care and quality of life for people living with kidney disease. This resulted in new provincial initiatives and resources, many of which are described in this publication.

The road ahead will all but certainly have many twists and turns. One of my favourite quotes in these situations remains, “When you walk to the edge of all the light you have and take that first step into the darkness of the unknown, you must

believe that one of two things will happen: There will be something solid for you to stand upon, or, you will be taught how to fly.”* We at BC Renal extend our sincere thanks to everyone in our kidney care network for your continued dedication, courage and compassion.

We believe in your ability to find the ground, or your wings, when the need arises.

With respect and admiration,

Dr. Adeera Levin Executive Director

*Quote by Patrick Overton

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CELEBRATING TEAMWORK AND COLLABORATION

in a year of adversity

About OUR NETWORK Our network model is unique in Canada and internationally, designed to improve kidney patient quality of life and outcomes, and to support sound fiscal management and system sustainability. No matter where kidney patients live in the province, we provide a fully coordinated system of care.

Strategic Priorities 2018-2023:

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•

Optimal patient experience and outcomes

•

Innovation and research in kidney care

•

Sustainable funding solutions

•

The right technology solutions

•

A sustainable renal network

How We Serve BC

the northern way of caring

6 12 13 13 16 29

HEALTH AUTHORITIES HOME HEMODIALYSIS TRAINING SITES PERITONEAL DIALYSIS CLINICS HOSPITAL DIALYSIS UNITS CKD CLINICS

for registered non-dialysis kidney patients

COMMUNITY DIALYSIS UNITS

OUR PARTNERS BC Children's Hospital Renal Program (province-wide)

17,649

Registered non-dialysis kidney patients in BC

3,655

•

BC Transplant

•

Can-SOLVE CKD

•

CHÉOS

•

First Nations Health Authority

•

Kidney Foundation of Canada - BC & Yukon Branch

•

PKD Foundation of Canada

•

University of British Columbia

Kidney patients on dialysis in BC 5

CELEBRATING TEAMWORK AND COLLABORATION

04

in a year of adversity

MEANINGFUL OUTCOMES Together over the past 20+ years, BC Renal and our provincial network of health authority renal programs and other partners have made progress in improving patient experiences and the delivery of care for people living with kidney disease.

BC clinical outcomes data meet or exceed national standards

Highest survival rate in the country

Highest rates of patients on independent dialysis in Canada

Most extensive financial support for kidney medications in Canada across 4 pharmacy formularies

PROMIS: BC-wide integrated registry and clinical information system for kidney and transplant patients 6

7

 PROMIS team virtual group photo, November 2021

PROMIS

Web info & resources: BCRenal.caHealth Professionals Professional Resources PROMIS 8

PROMIS – the Patient Records and Outcome Management Information System – is the only province-wide integrated registry and clinical information system for kidney disease and transplant patients.

Featured Accomplishment

PROMIS team and BCCDC Panorama team partner to provide accurate vaccination data

Without a doubt, COVID-19 vaccination data was a health care priority in 2021. It was also the subject of a collaboration between the PROMIS team and BCCDC’s Panorama team that maintains the Provincial Immunization Registry (PIR). These two groups worked together to ensure accurate and up-to-date vaccination data for kidney and transplant patients was available in PROMIS through an interface (connection) with PIR. Doing so for these patient groups, many of whom are considered clinically extremely vulnerable, was a key driver of the partnership. However, the scope of the work also included ensuring all vaccines administered and registered in PIR - including non-COVID-19 ones were updated on the PROMIS patient record as well.

Capturing this by interfacing the two data systems rather than by duplicate data entry is a more efficient use of our valuable health care human resources, improves data quality and completeness, and increases the timely availability of important health data for making clinical decisions and reporting.

“Working on a project that has an immediate positive impact – in this case for our user community as well as patients – was very rewarding. We saw an immediate boost in COVID-19 vaccination rates for our patient populations as a result of improved data completeness. We compared the data pre- and post-initiative and we had thousands of patients with more accurate data, and thousands of manual entries were saved.”

- Karin Jackson Director of Operations, PROMIS

Other Key Initiatives PROMIS

Classic Phased Migration to PROMIS 4 - Work continued on migration with dialysis prescriptions, vascular access, and recipient immunology modules all moving to PROMIS 4 in 2021.

Program

Specific Patient Overviews - 2021 saw the release of new program-specific patient overview pages, allowing for a patient overview tailored to a user’s primary program: renal, transplant, or post-COVID recovery.

Continued

support for provincial Post COVID Recovery Clinics, including a project in partnership with PHSA Office of Virtual Health to enable patient-submitted questionnaire data via a third-party app.

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PATIENT AND FAMILY ENGAGEMENT

BC Renal Patient & Family Engagement Advisory Committee is established

Featured Accomplishment

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In 2021, the Patient & Family Engagement Framework Working Group evolved into an ongoing committee to continue its vital role. The Patient & Family Engagement Advisory Committee provides guidance for the implementation of the framework and development of policies and resources to support authentic and meaningful engagement across BC Renal committees and

key activities. The ultimate goal is to shift the culture and enable true person- and family-centred care at a provincial level. Members include: • five patient partners; • regional health authority representatives; and • representatives from the Kidney Foundation - BC & Yukon Branch and BC Renal.

Who are patient partners?

A patient partner is a patient, or family member/caregiver of a patient, who: • has lived experience with (or is at risk of) kidney disease • is interested in making a difference in kidney care • is open to sharing their experience and working with health care professionals and other partners.

 Participants in the BC Renal Patient Partners Connect session of BC Kidney Week 2021

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Patients & family members in the network

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Active patient partners*

Engagement opportunities

“This project has given kidney patients and their families a way to be heard.

It has also given them a way to gain knowledge and to provide the tools that they may use to advocate for themselves.

I am grateful that our work in conjunction with other committees will provide a safe and better place for all patients past, present and future to feel empowered.”

Advancing Insights Opportunities for patient and family involvement and education in the kidney community

Other Key Initiatives Launch

of Advancing Insights - A newsletter designed by BC Renal patient partners to keep our network of patients and family members updated on engagement and educational opportunities in the kidney community.

Development

of Partnership Matters videos - BC Renal committee chairs and patient partners share their stories as members of the Palliative Care Committee and ADPKD Advisory Committee. The short videos illustrate their partnerships as well as the evolution and impact of patient and family engagement in BC Renal.

- Randy Spensley, patient partner, co-chair, BC Renal Patient & Family Engagement Advisory Committee

Web info & resources: BCRenal.ca  About  Accountability Patient and Family Engagement 11

BC Children’s Hospital Renal Program Web info & resources: https://www.bcchr.ca/nephrology http://www.bcchildrens.ca/our-services/clinics/renal-program

“I am excited that this project will inform knowledge translation initiatives for pediatricians across the province. I think the next phase of the project will be the most rewarding aspect: engaging pediatricians and developing Continuing Medical Education (CME) sessions are key ways we can improve the delivery of pathwayrecommended patient care.”

- Laura Kim, Medical Resident

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Featured Accomplishment

Pediatrician perspectives improve the Childhood Nephrotic Syndrome Clinical Pathway

At its inception, a fundamental goal of the Childhood Nephrotic Syndrome Clinical Pathway was to empower pediatricians who care for children with this common kidney condition. However, information about pathway uptake and usefulness in different communities was limited — until recently.

With help from a UBC medical resident and the BC Pediatric Society, pediatricians across BC were surveyed about their awareness of the pathway, their access to pathway-recommended resources, such as dietitians and ophthalmologists, and their comfort with managing various aspects of nephrotic syndrome care. Results suggest that while pediatricians feel the pathway is useful, there is more to be done to better support them in caring for children with nephrotic syndrome. Work in this area is ongoing but preliminary improvement strategies include: • Promoting the pathway across broader platforms and to more diverse audiences; • Developing a library of needs-based educational programs for on-demand delivery in different communities; and • Engaging local “pathway champions” to act as regional knowledge brokers with expertise in both the pathway and an understanding of their local community.

The feedback received from this study has been invaluable for ensuring that not only is the pathway accessible and locally relevant, but the care provided for children with nephrotic syndrome is consistent and equitable across the province. Survey results were shared at the BC Kidney Week 2021 conference.

As an extension to this survey, a quality improvement study is underway to explore pathway fidelity (how close pathway recommendations are to being achieved) and clinical outcomes among various BC Children’s Hospital regional clinics.

Other Key Initiatives Identification

of risk factors for chronic kidney injury in our local population of children with a solitary kidney Development

of a nomogram (diagram) for the uniquely large and rapid growth of solitary kidneys in children Creation

of an early risk-assessment tool for children with a solitary kidney (in progress) 13

Education & KNOWLEDGE TRANSLATION 14

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Learning and EVENTS

Web info & resources: BCRenal.ca  Learning  Events 16

Joyful Eating with Kidney Disease patient education webinar, available on BC Renal's YouTube channel

BC Renal is committed to comprehensive education and knowledge translation opportunities. In 2021, we provided many clinical and patient sessions across BC. Our audiences include kidney health professionals, primary care providers, patient partners and any British Columbian living with kidney disease.

Our goal is to offer the latest research, care practices and resources for care teams and patients.

to Kidney Care Staff Education and from CKD E-Learning for Primary Care to Patient Education Webinars.

The revised Learning and Events section of our website is a convenient “one stop” source for all members of our kidney community, with a range of helpful materials in categories ranging from Province Wide Rounds WEBINAR!

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Speakers will include staff working in the Transplant Centre at Vancouver General Hospital. Also speaking will be a person who has had a kidney transplant and a person who donated their kidney to someone else.

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17

BC Kidney Week 2021 Web info & resources: BCKidneyDays.ca

18

While COVID-19 has presented people and organizations with countless challenges, silver linings continue to surface. BC Kidney Week is one of them. A variation on our traditional in-person BC Kidney Days conference, we shifted the focus from two days of broad conference offerings to virtual meetings providing peer connection and collaboration over a period of five days, topped by two events that brought the whole network together.

Nine different clinical groups and the patient partner group participated in their own profession-specific sessions built around diverse and comprehensive content.

Included were roundtable discussions, Q&As and breakout groups for robust opportunities to connect, reflect, learn and look ahead.

The week wrapped up with an expanded E-Poster Forum highlighting the top 10 posters as well as the presentation of the Wilma Crockett Memorial Award, which takes place annually to recognize a member of the kidney care community for outstanding contributions locally and provincially.

345 people registered for this year's event.

Wilma Crockett Memorial Award Mary Lewis, 2021 recipient The Wilma Crockett Memorial Award is named in honour of a dedicated dialysis nurse who made a huge impact on her professional community, both locally and across BC. The 2021 recipient is Mary Lewis, a home hemodialysis educator at Providence Health Care. Together with the home hemodialysis team, she has ensured optimal patient care for all of her patients dialyzing at home throughout BC and the Yukon.

Mary has worked for 35 years in nephrology nursing, with 30 of those years in patient education.

As nominator Sarah Thomas noted in her submission, “Mary has been a mentor to many new nurses, myself included. She puts as much care into her teammates as she does her patients. She is able to share that passion in a way that enables others to feel passionate, too. Shared passion makes team members soar in their accomplishments and mission. Mary has inspired many new nurses, fellows and allied health professionals by stirring a desire.”

Read more about Mary’s remarkable kidney care contributions here: BCKidneyDays.ca  Wilma Crockett Award 19

 Pediatric Nephrology Clinical Pathway Development Team at BC Children’s Hospital

RESEARCH AND QUALITY IMPROVEMENT Web info & resources: BCRenal.ca  Research BCKidneyDays.ca  E-Posters

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BC kidney health professionals are engaged in a range of local, provincial and international research and quality improvement (QI) projects, many in collaboration with BC's educational institutions. Their work is frequently published in peer-reviewed journals.

as well as patient partners who are part of research and quality improvement teams. In sharing the stories, the aim is to help translate knowledge into regular practice so our patients benefit from evidence-based care and experience the best possible health outcomes and quality of life.

BC Kidney Research in Focus In spring and fall 2021, BC Renal was excited to produce the first two issues of BC Kidney Research in Focus. The new semi-annual research newsletter features stories about recently published projects, people profiles, and links to the latest publications.

In consultation with a scientific editorial team, the newsletter aims to highlight the depth and breadth of studies and projects carried out by health professionals

publications and presentations including those via Province Wide Rounds and more (see the BC Renal YouTube channel for recordings of many of those).

E-Poster forum and QI reports

The people profiles provide a behind-the-scenes look at project leads, research staff and patient partners to offer insight and inspiration to those who may be considering a project and would like to learn more about what’s involved.

Refreshed web pages In 2021, the Research section of the BC Renal website was reorganized and updated to more clearly provide relevant information to everyone interested in kidney research and quality improvement projects in BC. A foundation of the section that continues to be a source of knowledge is the Publications page that provides links to publications in peer-reviewed journals organized by year. In 2021, there were dozens of

In addition, the BC Kidney Week E-poster Forum showcased 10 studies of 18 submitted, and BC Renal distributed two new QI reports that summarize the quality improvement projects conducted by the regional health authority renal programs and BC Renal over the past year.

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ANNUAL CAMPAIGNS 22

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KIDNEY HEALTH AWARENESS  Island Health staff celebrate World Kidney Day with cookies

Web info & resources: BCRenal.ca  Health Info  Prevention & Public Health  Kidney Health Month

Kidney Health Month Every March, through Kidney Health Month campaigns and World Kidney Day, BC Renal promotes public awareness about how to keep our kidneys healthy, risk factors for kidney disease, and early diagnosis.

In 2021, for the third year in a row, we partnered with the Kidney Foundation of Canada - BC & Yukon Branch on a light-hearted video, print, transit, web, and social media campaign called, "Could you Lose 80%?” The campaign 24

messaging guides the public to KidneyHealthCheck.ca and BC Renal’s online Kidney Health SelfAssessment tool.

Available in English, Chinese and Punjabi, the tool provides a highlevel assessment of kidney disease risk factors, and encourages those at higher risk to discuss kidney function testing (a simple blood test) with their primary care provider/family doctor.

New in 2021 was the World Kidney Day theme of “Living Well

with Kidney Disease.” Our related campaign centred around sharing BC Renal and partner resources for kidney patients and health professionals, covering important topics such as self-management, symptom assessment and management, transitions in kidney care, mental health and social work.

In addition, a Province Wide Rounds online learning session, Enhancing Patient Self-Management with Motivational Interviewing and Brief Action Planning in Kidney Care, was held.

 Watch the "Could You Lose 80%?" video here

Also new in 2021, BC Renal promoted the World Kidney Day organization’s “8 Golden Rules of Kidney Health” and linked our social media followers to related information and resources available on the Kidney Foundation and BC Renal websites.

For more about our variety of campaigns, see our Kidney Health Month web page.

New in 2021, BC Transplant and BC Renal partnered to raise awareness during the first week of October about living kidney donation, also known as living donor kidney transplant.

Social media and news media campaigns took place highlighting the benefits of living kidney donation and the many resources available to patients, potential donors and health professionals. Check out #LKDW2021 on Facebook, Twitter and Instagram for a wide variety of stories, images, resources, videos, webinars and news coverage that were part of this successful campaign. For more information, visit BCRenal.ca Health ProfessionalsClinical Resources  Transplant 25

EMERGENCY PREPAREDNESS

 Watch the "How Dialysis Patients Can Prepare for Power Outages and Other Disasters" video here

“ While we don't know what a disaster will bring, we do know how to do our best to survive one and assist our patients and others who may be less fortunate...Disasters present logistical challenges, whether it is transferring prescriptions or patients.

Through planning and practising, we can be prepared.”

Web info & resources: BCRenal.ca  Health Professionals  Professional Resources  Emergency Preparedness

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-Dan Martinusen, Interim Chair through October 2021, BC Renal Emergency Management Committee

2021 was a year to appreciate the importance of being ready for anything British Columbians know emergencies can happen at any time: in 2021, extreme summer heat and destructive autumn wind and rain storms presented unprecedented challenges and underscored the importance of being prepared when disaster strikes.

Comprehensive emergency resources for kidney patients and caregivers 2021 saw the latest addition to BC Renal’s emergency preparedness resources with the release of a short, animated video. Titled How Dialysis Patients Can Prepare for Power Outages and Other Disasters, it provides a concise overview of what patients should do in advance of events such as floods and wildfires that may disrupt access to dialysis. The video is available with closed captions in English, Chinese and Punjabi on BC Renal’s YouTube channel and via the BC Renal website.

Other key multi-language emergency prep materials refreshed in 2020 are also available, including: • • • • •

Emergency Preparedness Information for Dialysis Patients booklet Planning for Disaster wallet cards Planning for Disaster poster Kidney patient emergency information forms Emergency disconnect procedures for home dialysis patients

Emergency Preparedness Month May is Emergency Preparedness Month across the BC Renal network. This initiative promotes emergency preparedness to all kidney patients and health care professionals, with an aim to increase our collective abilities to prepare for and respond to disasters.

BC Renal’s patient and health professional resources are complemented by the Provincial Renal Emergency Management and Business Continuity Plan, which is maintained by our provincial Emergency Management Committee.

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Improvements Driven by BC-Wide Committees 28

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Kidney Care Committee (KCC)

Transplant First moves towards implementing enhanced pre-transplant clinical processes across BC Featured Accomplishment Receiving a kidney transplant is the best treatment option for many people facing kidney failure.

The Transplant First initiative, a collaboration between BC Renal 30

and BC Transplant, is focused on standardizing pre-transplant processes. This is to ensure every kidney patient who is a potential transplant candidate is identified, assessed and supported along the path toward transplantation, including assistance in finding a living donor.

roles and responsibilities of the various kinds of health professionals involved and supporting better communication across settings and teams as well as with patients. Doing so provides clarity on where patients are at in the process and on who is doing what at each step along the way.

An important part of the pretransplant process is establishing

With the launch of the second phase of Transplant First, a

steering committee and various working groups were established, including participation from clinician and administrative groups across kidney care clinics, regional transplant clinics and the provincial transplant centres as well as patient partners.

The dedication and collaborative spirit among these groups to provide input and support this work has been tremendous.

In just over a year’s time, the following has been accomplished: • Pre-transplant processes standardized and agreed upon • A project evaluation plan created and approved

Other Key Initiatives Implementation

of a Home Blood Pressure Monitoring initiative in KCCs Integration

of virtual care into the KCC service delivery model, with an evaluation of the impact on quality of multidisciplinary chronic kidney disease care and patient-provider interactions and relationships (evaluation is in progress) Evaluation

of the provincial ADPKD initiative to assess standardization and delivery of care for patients with ADPKD in the KCC setting, including creation of the first ADPKD annual report

“It’s been a great learning experience to work with clinicians and administrative groups from both renal and transplant who are part of the Transplant First initiative.

As we worked together, we were able to build greater awareness of each other’s experiences through the pretransplant process and how working together will better support patients through this journey.”

- Sharon Gradin, Project Manager

• PROMIS updates to support new processes developed • A full education and implementation plan crafted As the initiative moves towards implementation in 2022, the project team looks forward to the ongoing support from staff at the various clinics and centres involved to ensure a successful launch and sustainment of the standardized processes.

 Drs. Mike Bevilacqua, Olwyn Johnston & Jag Gill, Transplant First Co-Chairs

Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Kidney Care (Non-Dialysis)

Committee background: Terms of Reference

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Glomerulonephritis

(GN) Committee Web info & resources:

BCRenal.ca  Health Professionals  Clinical Resources  Glomerulonephritis

Committee background: Terms of Reference

“A lot has been done to ensure that patients living with chronic kidney disease are properly supported and connected to groups of similar patients. But it is the first time in BC that we have a group of organizations working together to better understand the support and connection needs of patients living with GN – a condition that is relatively rare and often leads to patients feeling isolated and under-supported. Our ultimate goal is to build a BC-centred empowerment network and library of resources that will help such patients feel connected and supported and will inspire them to better advocate for their care.”

-Dr. Sean Barbour, GN Committee Chair

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Featured Accomplishment

GN Committee conducts a support needs assessment of people living with GN in BC

People living with rare kidney diseases, such as various types of glomerulonephritis (GN), may lack connection to appropriate community resources and social support, and feel isolated in managing their chronic condition.

To better understand these needs of patients and family caregivers living with GN in BC, the GN Committee and BC Renal partnered with the Kidney Foundation of Canada – BC and Yukon Branch and formed a working group with representatives of these organizations, including clinicians, administrators, quality improvement experts and patient partners. The working group designed and conducted two virtual focus groups and several individual virtual interviews with GN patients and their family members.

The content from the focus groups and interviews was analyzed for common themes related to perceptions about support needs and what support might look like for patients and families living with GN. Various types of support were highlighted by participants: • informational support • emotional support • appraisal support • support for enabling person- and family-centred GN care When a patient is newly diagnosed or experiencing an abrupt decline in health, they may need more support.

All focus group and interview participants recognized that peer support can be helpful as it encompasses informational, emotional and appraisal support, and may help enable a holistic approach to GN care through enhanced connection, reduced uncertainty of what to expect in the kidney journey and better understanding of health information.

Based on the results of the analysis, the working group is currently developing a support strategy for GN patients and family caregivers with a particular focus on establishing a BC-focused support network, patient resources and peer support options and opportunities.

Other Key Initiatives Developed

and implemented pneumocystis jirovecii pneumonia prophylaxis guidelines for patients living with GN who are treated with immunosuppressant medications Developed

and implemented a rituximab funding policy for patients living with membranous nephropathy Developed

a strategy to handle the entry into the Canadian market of rituximab biosimilar drugs

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Home Hemodialysis (HHD) Committee Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Home Hemodialysis

Committee background: Terms of Reference 34

“I am very excited to see the results of the CRASH curriculum.

It is a novel way of approaching patients who start dialysis in an unexpected manner. Traditionally, these people remain on facility-based hemodialysis. I am hopeful we can start to optimize home dialysis care for these folks.”

- Dr. Mike Copland, Provincial HHD Medical Director

Featured Accomplishment

CRASH curriculum developed and piloted to support patients with unplanned and suboptimal dialysis starts

The Curriculum to Recruit Acute Starts to Home Dialysis (CRASH) project restarted in April 2021 to better support the needs of unplanned hemodialysis patients with little or no modality selection education. These patients often get missed in the usual education channels of the kidney care clinic, and face increased levels of challenges and anxiety.

using a standardized approach.

Nurse navigators applied this approach to guide and support informed, patient-centred modality selection decisions.

Other Key Initiatives Provincial

rollout of AK 98 equipment initiated Development

of the Provincial Key Clinical Quality Indicators report specific to home hemodialysis

This curriculum outlines home dialysis education and transition in three phases

“Never before have we managed to see the pathways with such detail for these folks who start in a suboptimal manner.

This information will help inform leadership regionally and provincially about the true population of patients who could be successful on home therapies.”

- Dr. Mike Copland, Provincial HHD Medical Director

CRASH Patient Journey to Home Dialysis “I’m not feeling well…

I have just found out I have advanced kidney disease and need urgent dialysis."

CRASH Curriculum to Recruit Acute Starts to Home

Visit BCRenal.ca to learn more about kidney care and treatment options

1. Dialysis Stabilization May include: medication & dialysis prescription adjustments, blood pressure management, goal setting, introduction to kidney options.

Within week 2 Within week 4

Within week 6

5. Home Dialysis Training May include: peritoneal dialysis or home hemodialysis training, dialysis access support and monitoring, home visits from the kidney team.

After 6 weeks

6. Home Dialysis • Ongoing dialysis treatment at home • Regular clinic follow-up • Dialysis Access Support and Monitoring • Other supports and services

4. Monitor May include: further stabilization on hemodialysis, dialysis access monitoring, waiting for home dialysis training, and home assessment.

2. Home Dialysis Introduction May include: introduction to self-care, home dialysis options, dialysis access care, peer support, tour of home dialysis training unit.

3. Meet the Home Dialysis Team May include: consultation with home dialysis nurse, nephrologist and social worker. Work with care team to formalize a treatment plan.

Kidney Team and Nurse Navigator Works closely with you and your family to support you during your kidney journey BC Renal Resources can be found at: BCRenal.ca ⊲ Health Info • Learn about Treatment Options • Transitions in Kidney Care • Managing your Care • Mental Health • Home Dialysis Curriculum

Nurse Navigator: Contact Info:

If you have any questions, please contact your Nurse Navigator at:

Aim your cell phone camera at this code or visit: BCRenal.ca ⊲ Health Info ⊲ Learn About Treatment Options ⊲ Home Dialysis Curriculum

the northern way of caring

 CRASH patient materials, 2021  35

Peritoneal Dialysis (PD) Committee

Key Initiatives Home

fellowship with a provincial focus 5-year

review of the PD Assist program

Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Peritoneal Dialysis

Committee background: Terms of Reference

36

Featured Accomplishment

BC rollout of the AMIA with Sharesource cycler machine completed The provincial rollout of the Baxter AMIA with Sharesource cycler to each regional health authority PD program was completed in 2021.

Despite the challenges posed by pandemic restrictions, this project continued strong and added virtual nurse training where possible. In the past year, Island Health, Fraser Health, Northern Health and Providence Health Care PD programs finalized training, and the programs are embracing remote monitoring to support assessment and evaluation of PD treatments.

“Timing of the introduction of the AMIA cycler was fortuitous. The main advantage is its ability to relay important information between patients and the care team without in-person clinic visits or calls.

While we never anticipated a scenario where this would be ‘mandatory,’ having it available this year ensured that patients and their families felt well supported. It is another tool to help understand how home dialysis is going and how we can help", says Dr. Suneet Singh, Provincial PD Medical Director.

In 2022, the PD Committee will focus on expanding knowledge about how best to use this technology to support PD care across the province.

“Our PD committee has had many important provincial projects over the last few years, but I am especially proud of the PD community for the success of implementation of the new AMIA cycler machine despite the many challenges of the COVID-19 pandemic. Each PD program across the province made the AMIA cycler rollout a priority to complete by the end of 2021 despite having to alter their day-to-day practice to continue to care for patients doing dialysis at home.”

- Dr. Suneet Singh, Provincial PD Medical Director

About the AMIA cycler The AMIA cycler machine supports patients in managing their PD therapy at home with features such as voice guidance, a touchscreen control panel and the Sharesource remote patient management platform.

Sharesource allows members of the kidney care team to securely view their patients’ recently completed treatment data, and enables them to remotely adjust their patients’ prescription without requiring them to travel to the clinic.

- Adapted from the Baxter website 37

Hemodialysis (HD) Committee

BC’s hemodialysis units adapt to changing COVID-19 requirements

Featured Accomplishment The Hemodialysis Committee worked with kidney and infection control practitioners across BC to support HD units in navigating the ever-changing waters of 38

the COVID-19 pandemic. While many health care services could be delayed or offered in another way during the pandemic, HD treatments are life-sustaining and require patients to travel to a hospital or community dialysis unit three times weekly. Services need to continue without interruption throughout the pandemic, regardless of risk factors and/or COVID-19 status.

To support the HD units, the committee developed the following: • A provincial guideline for the screening and management of HD outpatients during the COVID-19 pandemic (with regular updates as the pandemic situation changed) • A provincial guideline for the use of personal protective

equipment (PPE) for vascular access-related activities during the COVID-19 outbreak • A provincial guideline for travelling HD patients during the COVID-19 pandemic (with regular updates as the pandemic situation changed) • A standardized COVID-19 screening questionnaire.

Every patient is screened for COVID-19 symptoms at every HD treatment. This data is used to identify infection control precautions above and beyond the usual precautions for HD patients, as well as whether laboratory testing for COVID-19 is recommended.

Screening data is entered into the PROMIS information system and trends are analyzed in combination with laboratory results.

• Several provincial resources for HD patients about changes to processes during the COVID-19 pandemic (e.g., Q&A sheet, use of masks) Dr. John Antonsen, Chair of the Hemodialysis Committee says, “The guidelines and patient resources developed as part of the HD Committee COVID-19 response were utilized by HD units across BC to promote best practices in HD care. In developing these tools, we considered available evidence as well as real

life experience to optimize both patient and staff safety during the COVID-19 pandemic. Discussions and decisions were carried out collaboratively, after a review of the evidence and experience of clinicians working on the ‘front line’ with patients.”

Other Key Initiatives Recruiting

up to 3 patient partners to participate on the committee to bring a new and important dimension to the committee’s direction and work Developed

a new guideline on dialyzer selection, with clinical requirements, contractual obligations for provincial dialyzer use and cost all considered in the selection algorithm

“It has been very rewarding to have the opportunity to work with a group of kidney and infection control practitioners on such an important and timely initiative that impacts the everyday life of patients on hemodialysis. We have had to evolve our thinking and decisionmaking in ‘real-time’ to stay in sync with the evidence.”

Vascular

Access Educators Group worked with the PROMIS team to implement an updated Dialysis Access module in PROMIS

- Dr. John Antonsen, Chair, Hemodialysis Committee

Hemodialysis -19) (COVID atients avirus yP Coron n for Kidne Novel io & at u Fl form sis ant In odialy Import e Hem d d Hom nza an o attend: PD an wh g influe

se e durin y disea best car with kidne 20 ts with the 12, 20 e you out to patien March provid e and ing this hand . ne saf vid port you t p everyo, we are pro and sup your curren lp lp kee he s son he To here to you visit ha rus sea ics We’re ic coronavi clinics tinue. the clin lysis clin • PD will con make sure modia – for r care me he person ed ase you int n ple • Ho crowd you tha efully. Also her tha ssure visit rat t exposed to car l rea t ua to ou nt virt nd no We wa read this ha ed to a e you are chang sur Please information. may be This will en t ic visit one. contac k. your clind by teleph ht be sic ahead, cte n. weeks y be condu ople who mig in-perso In the pe see you le, it ma other examp rooms and best to it’s if g e waitin nic determin of these ist will the cli ve any phrolog you ha me to Your ne clinic if you co call the before it, please ) to do rson vis ________ What an in-pe ____ uled for e #: ______ ) ed gh phon are sch onic cou If you ms (Clinic what to ning chr ath ns on sympto ver or worse of bre tructio en ins • Fe h (new onset / shortness t and giv ug ing intmen • Co a nurse breath l appo ficulty one by y be: a virtua • Dif r the ph tion of , you ma the op ptoms questions ove ed sym vid pro have t ditional ent or If you patien ked ad pointm the ap in r • As you ilable to next c do next postpone are ava ect you as e clini itizers dir ked to t to th nd san ic staff will • As ic. Ha you ge the clin VID-19, clin when entering flu or CO to do the before s What of nd ms your ha ve sympto clean ha Always area. If you g waitin

Web info & resources: steps.

We ask everyo

ne to wear a

Patients

mask:

When walking through publ ic areas on your When in comm way to dialysis on areas such as the waiting When you are room or hallw on dialysis and ay are not eating Masks are recom or drinking mend 





ed as a barrie air when the perso r to help preve nt respiratory n wearing the droplets from mask coughs, people with difficu traveling into sneezes, or talks. lty breathing or the They are not mask without who cannot remo recommended help. ve the for

Key points abo



ut masks

Wash your hands before putting on a mask Do not touch the mask when you are weari ng it Wear masks with two or more layers (preferably 3)  Wear the mask over your nose and mouth it under your and secure chin  If you wear glasses, use a mask that has a nose wire. 



How to wear

a mask:

1

BCRenal.ca  Health Professionals  Clinical Resources  Hemodialysis

Committee background: Terms of Reference 39

 Watch the "My Symptom Checklist: A Guide for Patients" video here

PALLIATIVE CARE Committee Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Palliative Care

Committee background: Terms of Reference

40

“Just watching the group come together to build this algorithm and this framework was quite remarkable. Everyone was worried, everyone was tired, no one knew where COVID was going – but the dedication this group put into this was really a joy to be a part of.”

- Sarah Thomas, Project Manager, speaking about the health professionals and patient partners who made up the working group that quickly mobilized to develop the BC Renal network ethical framework for dialysis allocation during pandemic times

Featured Accomplishment

Improvements made to symptom assessment and management through patient engagement

After key stakeholders identified areas of focus to improve the system assessment and management process, a multidisciplinary working group including patient partners was formed. This working group carried out several initiatives: • Converted My Symptom Checklist into a fillable PDF (available in multiple languages) • Updated the clinician information sheet • Produced educational videos for clinicians and patients • Developed an original idea for a potential future patient portal that would include symptom assessment and management

Other Key Initiatives Publication

in the Clinical Journal of the American Society of Nephrology highlighting a first-of-kind initiative, Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic - A Proposed Ethical Framework for Dialysis Allocation; related story in BC Kidney Research in Focus, BC Working Group Creates Globally Unique Tool to Balance Acute and Chronic Dialysis Needs During Pandemic

“My favourite highlight of our work in 2021 was the opportunity to collaborate with patient partners. These dedicated individuals were instrumental in providing meaningful input that guided the significant improvements to My Symptom Checklist. This tool is used by kidney clinicians across all treatment options to assess and manage pain and symptoms experienced by patients living with chronic kidney disease.

Enhancing symptom treatment will help optimize quality of life for our patients, which is a primary objective of the BC Renal Palliative Care Committee.”

- Dr. Gaylene Hargrove, Chair, Palliative Care Committee

41

PHARMACY & FORMULARY COMMITTEE Key Initiatives Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Pharmacy & Formulary

Committee background: Terms of Reference

42

New

drugs were evaluated to guide the committee’s decisions around the medications BC Renal funds Contracts

were managed to minimize disruptions and other changes during the pandemic Oral

nutritional supplement funding was extended to kidney transplant patients as a pilot project to support patients in need

“As with all the clinical pathways that guide drug usage based on evidence, the anemia management protocol has resulted in very tangible benefits to patients and to BC Renal. It is a great example of putting evidencebased medicine into practice. As with all pathways, it has changed as new evidence becomes available. It also changes based on community feedback and the desire to make it more user-friendly.”

Featured Accomplishment

Anemia management protocols updated Conceived 20 years ago, BC Renal’s anemia management protocols have undergone several changes over the years. These updates have not only reduced drug costs significantly but have also managed to get patients into target ranges sooner and stay within them longer. This avoids either the potential harm from too much drug intake or the drawbacks of a poorer quality of life from too little.

-Dan Martinusen, Chair, Pharmacy & Formulary Committee

What is anemia of chronic kidney disease?

In spring 2021, based on earlier feedback from nurses, basic updates to clarify the protocol algorithms were made available. Later in 2021, more clarity was added and substantive updates were made to reduce workload for nurses and nephrologists by improving processes and streamlining workflow. These latest changes to the protocol algorithms are expected to be available on the BC Renal website by early 2022.

• It is an iron deficiency anemia complicated by a lack of the hormone erythropoietin (EPO) normally produced by the kidneys.

Symptoms develop slowly and more commonly in people with diabetes and those over 60 years old.

The committee recognizes that introducing changes in these difficult times of the pandemic is not ideal but hopes that ultimately they will make the protocols easier to follow and will consume less of everyone’s valuable time.

• Symptoms can include fatigue, tiredness, shortness of breath, unusually pale skin, weakness, body aches, chest pain, dizziness, fainting, fast or irregular heartbeat, headaches, sleep problems, and trouble concentrating.

Peritoneal Dialysis Anemia Management Protocol The following protocol, on order of physician, transfers anemia management of hemodialysis patients to non-physician staff (i.e. RNs and renal pharmacists). This protocol is intended to serve as a guide and cannot replace clinical judgment. The recommendations included may be inappropriate for specific clinical situations (e.g. patients with hemochromatosis, thalassemia, PRCA, allergy to IV iron or an erythropoiesis stimulating agent (ESA), history of stroke, active malignancy, history of malignancy, etc.). The lowest ESA dosage to achieve acceptable Hgb range should be used. This algorithm is based on the assumption that the patient is compliant to medication and blood work. Note: ESA refers to both epoetin alfa (Eprex®) and darbepoetin alfa (Aranesp®).

Any change in Hgb greater than or equal to 15 g/L, OR if Hgb is less than 85 g/L OR if Hgb is greater than 139 g/L AND on ESA (or ESA on hold) → Notify nephrologist Hgb less than 95 g/L

Anemia

Hgb 95 to 115 g/L and stable

ocol Management Prot

Receiving YES sts). The following NO RNs and renal pharmaci ESA? (e.g. patients ician staff (i.e. specific clinical situations lowest ESA patients to non-phys inappropriate for CKD non-dialysis y, etc.). The included may be management of to y, hx of malignanc , transfers anemia Note: ESA refers NO t. The recommendations hx of stroke, active malignanc n and blood work. on order of physician clinical judgemen (ESA), The following protocol, serve as a guide and cannot replace an erythropoiesis stimulating agent that the patient is compliant to medicatio or n to • Check that the previous allergy to IV iron Check that the protocol is intended is based on the assumptio thalassemia, PRCA, iron studies have been used. This algorithm previous iron with hemochromatosis, range should be appropriately monitored and nephrologist acceptable Hgb → Notify (Aranesp®). hold) studies have been alfa on tin dosage to achieve ESA (or addressed prior to increasing on ESA (Eprex®) and darbepoe No ESA than 139 g/L AND both epoetin alfa is greaterappropriately the dose. required.

85 g/L OR if Hgb monitored and than less is Hgb • If TSAT less than 22%, g/L 115 Continue to to 15 g/L, OR if than addressed prior to greateriron Hgb consider load instead of greater than or equal monitor Hgb increasing the dose.

Any change in Hgb and stable increasing ESA dosage. at the regular Hgb 95 to 115 g/L blood work g/L Hgb less than 95 cycle.

CKD Non-Dialysis

NO

Receiving ESA?

Receiving ESA?

YES NO

Check that the previous iron studies have been appropriately monitored and to addressed prior increasing the dose.

Suggested initial dose: epoetin 50 units/kg/wk or darbepoetin 0.22 mcg/kg/wk. Obtain an order from MD to start anemia protocol.

previous • Check that the been iron studies have and appropriately monitored to increasing addressed prior the dose.

22%, • If TSAT less than g PO iron consider increasin g IV iron dosage or prescribin

YES No ESA

required.

Continue to monitor Hgb at the regular blood work cycle.

in the past 5 weeks, • If no dose increase as per ESA Dosage increase ESA dose Adjustment Tables. in past 5 weeks, maintain • If dose was increased blood work. that dose until next Hgb at the regular blood • Continue to monitor after work cycle. is not in target range • Notify MD if Hgb increases. Refer to ESA 3 consecutive dose s Flowchart.

Hyporesponsivenes

AFTER Hgb STATUS BC Renal • BCRenal.ca

ASSESS ASSESSMENT ABOVE,

Maintain ESA dose and continue to monitor Hgb at the regular bloodwork cycle.

Hgb greater than 115 g/L

Home Hemodialysis Anemia Manage

Receiving ESA?

YES

Maintain ESA dose and continue to monitor Hgb at the regular bloodwork cycle.

ment Protocol

Receiving ESA?

The following protocol, on order of physician, transfers anemia management of home hemodialysis patients to This protocol is intended to serve non-physician staff (i.e. RNs and renal as a guide and cannot replace clinical pharmacists). judgment. The recommendation situations (e.g.

patients with hemochromatosis, thalassemia, ESA on ESA on PRCA, allergy to IV iron or an erythropoiesis s included may be inappropriate for specific clinical NOhistory of malignancy, malignancy, stimulating agent (ESA), history of etc.). The hold or lowest hold or ESA dosage to achieve acceptable stroke, active Hgb range should be used. This discontinued the patient is compliant to medication and discontinued algorithm is based on the assumption blood work. Note: ESA refers to both epoetin alfa (Eprex®) and darbepoetin that because Hgb because Hgb alfa (Aranesp®).

YES Any change in Hgb greater above target than or equalabove to 15target g/L, OR if Hgb is less than 85 g/L OR if Hgb is greater than 139 g/L No ESA AND on ESA (or ESA on hold) → Notify required. nephrologist Hgb less Continue tothan 95 g/L Hgb 95 to 115 g/L and stable Hgb 116 monitor Hgb Hgb greater Hgb 116 to 125 g/L Hgb greater than 115 g/L to 125 g/L • Restart ESA at at the regular than 125 g/L a reduced dose blood work based on the cycle. dose before hold.

Refer to protocol • If no doseReceiving increase in the past 5 weeks, If change If change is Receiving ESA Dosage NO • If there has been no is greater increase ESA dose as per ESA Dosage less than or • HoldYES ESA ESA? ESA? in the Adjustment dosage reduction than 10 g/L equal to 10 • Measure Hgb Adjustment Tables.

Tables. past 5 weeks, reduce from last g/L from last in 2 weeks and • If dose was increased in past 5 weeks, maintain • Continue Hgb ESA on ESA dosage as per hemoglobin, hemoglobin, reassess Hgb that dose until next blood work. monitoring at then resume then protocol ESA Dosage status and ESA hold or NO• Continue to monitor Hgb at the regular NO blood regular blood ESA at continue to dosage.

Adjustment Tables.• Check that discontinued the the work cycle. Check that work cycle. hold ESA. • If Hgb isprevious reduced dose.

• If there have been iron studies Hgb previous have because been Refer to iron greater than • Notify MD if Hgb is not in target range after dosage reductions appropriately target studies protocol monitored have been 125 g/L after 12 and 3 consecutiveYES dose increases.above Refer to ESA in the past 5 weeks,addressedweeks of hold, ESA Dosage appropriately prior to increasing Hyporesponsiveness Flowchart. maintain current dose.

Adjustment Tables.

No ESA the dose. discontinue No ESA monitored and • Measure Hgb at the ESA - no ESA required.

• If TSAT less addressed prior to required. than Continue to monitor Hgb at the regular blood work required. 22%, Continue 116 to 125 g/L consider Hgb increasing iron Continue to load the insteadregular dose. of bloodwork cycle. to Hgb greater cycle.

Hgb 116 monitor Hgb increasing ESA dosage. monitor Hgb than 125 g/L to 125 g/L at the regular at the regular blood work • Restart ESA at work blood AFTER Hgb STATUS ASSESSMENT ABOVE, ASSESS IRON STATUS. Refer to page 2 for ferrous fumarate or intravenous iron protocol. a reduced dose cycle. cycle. based on the If change is If change is BC Renal • BCRenal.ca Reviewed April 2021, Updated Nov 2021 hold.

Consider starting less than or dose before • If no dose increase • Hold ESA greater in the past 5 weeks, 10 to no Hgb equal been Refer to protocol ESA. • Measure increase ESA dose as per ESA Dosage than 10 g/L • If there has g/L from last in the in 2 weeks and ESA Dosage Suggested initial from last Adjustment Tables. dosage reduction hemoglobin, , reassess Hgb Adjustment reduce hemoglobin dose: weeks, epoetin 5 • If dose was increased in past 5 100 past then weeks, maintain status and ESA Tables. then resume units/kg/wk or ESA dosage as per that dose until next blood work. continue to dosage.

ESA at • Continue Hgb Dosage ESA darbepoetin ESA. greater protocol hold is • 0.45 Continue to monitor Hgb at the regular • If Hgb reduced dose. monitoring at blood mcg/kg/wk. Obtain Adjustment Tables. than 125 g/L work cycle.

Refer to regular blood after 12 weeks of an order from MD • If there have been protocol • Notify MD if Hgb is not in target work cycle. range after hold, discontinue ESA Dosage to start anemia dosage reductions 3 consecutive dose increases. Refer ESA - no ESA to ESA Adjustment Tables. in the past 5 weeks, protocol.

Hyporesponsiveness Flowchart. required. dose. the maintain current

Consider starting ESA. Suggested initial dose: epoetin 100 units/kg/wk or on ESA darbepoetin 0.9 or 2 weeks. hold mcg/kg/ edan order Obtain discontinu fromHgb MD to start because targetprotocol. anemia above

to page 2 for ferrous

Maintain ESA dose and continue to monitor Hgb at the regular bloodwork cycle.

.

ous iron protocol

fumarate or intraven

Reviewed April 2021,

Updated Nov 2021

AFTER Hgb STATUS ASSESSMENT BC Renal • BCRenal.ca

ABOVE, ASSESS IRON STATUS.

Receiving ESA? ESA on hold or discontinued because Hgb above target

YES

Hgb at Continue to monitor cycle. regular bloodwork

the • Measure Hgb at regular blood work cycle.

IRON STATUS. Refer

Receiving ESA?

• Restart ESA at a reduced dose based on the dose before hold.

Refer to protocol ESA Dosage Adjustment Tables.

• Continue Hgb monitoring at regular blood work cycle.

NO

No ESA required.

Continue to monitor Hgb at the regular blood work cycle.

• If there has been no dosage reduction in the past 5 weeks, reduce ESA dosage as per protocol ESA Dosage Adjustment Tables.

• If there have been dosage reductions in the past 5 weeks, maintain current dose.

• Measure Hgb at the regular blood work cycle.

Refer to page 2 for ferrous fumarate

ESA on hold or discontinued because Hgb above target

YES

Hgb 116 to 125 g/L

Hgb greater than 125 g/L

• Hold ESA • Measure Hgb in 2 weeks and reassess Hgb status and ESA dosage.

• If Hgb is greater than 125 g/L after 12 weeks of hold, discontinue ESA - no ESA required.

Hgb 116 to 125 g/L

If change If change is is greater less than or than 10 g/L equal to 10 from last g/L from last hemoglobin, hemoglobin, then resume then ESA at continue to reduced dose. hold ESA. Refer to protocol ESA Dosage Adjustment Tables.

Continue to monitor Hgb at the regular bloodwork cycle.

• If tests suggest that a person’s kidneys aren’t making enough EPO hormone, they may need a manufactured form called an erythropoietin-stimulating agent (ESA).

or intravenous iron protocol.

Reviewed April 2021, Updated Nov

2021

43

Improvements Driven by BC-Wide PROFESSIONAL GROUPS 44

45

RENAL EDUCATORS GROUP (REG)

Key Initiatives Conducted

a 12-session CNeph(C) study group with over 40 registered participants/potential CNeph(C) exam candidates Participated

in the development and vetting of various COVID-19-related documents

Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Hemodialysis

Committee background: Terms of Reference 46

Participated

in the review and refresh of various guidelines, including the ones for travelling patients, infection control, acuity assessment, etc.

Featured Accomplishment

Renal Educators Group completes guideline to address complications during hemodialysis treatment

The Renal Educators Group completed over two years of work on the development of an extensive guideline that provides practical recommendations to nursing staff in hemodialysis units across the province. The guideline lays the foundation for standardizing the management of complications during hemodialysis with a focus on the most common complications that can occur.

Structured to be a practical guide and a fast reference resource, the guideline introduces standard, visually distinct sections for each complication, and describes possible causes, signs and symptoms, and the nursing management algorithm for each. Some of the common complications described in the guideline include the following: • intradialytic cardiac arrest • anaphylaxis • air in the bloodline • nausea and vomiting • vascular access complications such as arterial or venous needle dislodgement • acute vascular access rupture • infiltrated needle while on dialysis The guideline is now available on the BC Renal website and was presented to the BC Renal community during BC Kidney Week in November 2021.

“This guideline is a very important and long-awaited document and tool. Reducing the variation in practice and standardizing the way our nursing staff across the province deal with common complications during hemodialysis will have a positive effect on patient outcomes and experience, and will also boost the confidence of care providers faced with such situations.”

-Moses Arcedo Chair, Renal Educators Group

47

Home Hemodialysis Educators (HHDE) Group Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Home Hemodialysis

Committee background: Terms of Reference 48

“I will NEVER take having the machine at home for granted…EVER! I have so much appreciation for the program and work you do to give patients like me some sense of normalcy, flexibility and confidence when life throws us a curve ball and our health is out of our control. I am a huge advocate for this program and would be happy to do whatever I can to give back.”

- Patient, Fraser Health

Featured Accomplishment

Home hemodialysis nurse mentorship program developed to help prepare the new generation of nurses

“2021 was another year of resilience displayed by all of the regional health authority Home Hemodialysis programs, BC Renal and our vendors. It takes a village so they say, and I am very proud to be part of this village. Looking forward to a stronger and brighter 2022.”

The Home Hemodialysis Educators Group has developed a mentorship program to support the transition of new home hemodialysis nurses. This work engages both new and experienced staff to share knowledge and offer practical solutions to common home hemodialysis challenges.

To further encourage leadership within the group, all members rotate and share the chair role, which helps provide a sense of belonging and inclusiveness.

Other Key Initiatives Home

renovation coordination process evaluated

- Angela Robinson, Chair, HHDE Group

New

Baxter AK98 machine rolled out

49

PD Nurses Group

 Surrey Memorial Hospital PD program inauguration, May 2021

Key Initiatives Redesigned

PD RN meetings to promote opportunities for peer-to-peer networking with a focus on clinical practice and outcomes

Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Peritoneal Dialysis

Committee background: Terms of Reference 50

Developed

the training and implementation process to expand the scope of practice of the PD Assist caregiver to include the Baxter AMIA cycler machine Developed

new standardized PD procedures and reviewed existing procedures to support clinical practice in BC

Featured Accomplishment

Resources for rural and remote populations implemented to better support community facilities providing care for PD patients across BC To better support peritoneal dialysis patients living in rural and remote areas, BC Renal, in collaboration with health authority partners and patients, developed the following: • comprehensive modules consisting of basic principles of PD • clinical care paths for managing PD complications • PD procedures videos Following extensive consultations, pilot testing and evaluation, these resources provide standardized step-by-step information to support health care clinicians caring for PD patients in rural and remote community facilities. Introduction and implementation of the resources was provided over the past year using a virtual approach to more than 15 community sites in Northern Health. Webinars are currently scheduled for other health authorities across the province.

“I had the opportunity to collaborate with BC Renal and PD clinicians to develop useful, supportive resources for our rural and remote patients.

We were able to connect with many nurses and educators in small communities in Northern Health to offer PD education by webinar. Building these connections, providing support as they care for PD patients and seeing increased confidence to do PD procedures was rewarding.”

- Karen Walkey, Patient Care Coordinator, UHNBC Peritoneal Dialysis Clinic 51

Hemodialysis Technical Group

HD Technical Group, in collaboration with PHSA Supply Chain, completes water systems vendor selection Featured Accomplishment The delivery of hemodialysis therapy depends on having a reliable, large-scale supply of purified water that is used during treatments. This supply 52

of high-purity water is usually obtained through the use of industrial-grade reverse osmosis systems, which are installed in all hemodialysis units across British Columbia.

an extensive effort to find new vendors and consolidate all systems sales and maintenance across all health authorities under the same set of contracts with similar terms.

As the contracts to supply and maintain these systems to BC hemodialysis units were expiring, the HD Technical Group and PHSA Supply Chain undertook

As part of this process, a comprehensive Request for Proposal was designed and launched. Expressions of Interest were collected from the vendors

and thoroughly reviewed and scored by HD Technical Group and PHSA Supply Chain experts against predetermined criteria.

Shortlisted vendors were asked to deliver a round of presentations and demonstrations/Q&A sessions. Finally, complex contract negotiations took place, culminating in the selection of Canadian Water Technologies Ltd. and Baxter Corporation as the providers of non-portable reverse osmosis systems and maintenance services to the provincial renal network.

The new provincial agreements introduce a set of standard processes and key performance indicators (KPIs) that will help to reduce or eliminate variation in service across the province. A robust and ongoing mechanism for the review of contractually mandated KPIs and a process of quarterly business reviews with the vendors have also been established.

Key Initiatives Provided

technical expertise and guidance during the HD machine Request for Proposal design and vendor response evaluation process Initiated

discussions on standardizing the design of acidresistant drains and piping for provincial dialysis units

“Consolidating all reverse osmosis procurement and maintenance for the province will allow the renal network to be more cost-efficient. What’s equally important is that this consolidation will facilitate the implementation of standard processes, response times, performance indicators and communication channels for all HD programs across BC, which will ultimately benefit patients and help biomedical engineers and technicians provide better service.”

- Jennifer McGill, Chair, HD Technical Group

Web info & resources: BCRenal.ca  Health Professionals  Clinical Resources  Hemodialysis

Committee background: Terms of Reference 53

Renal Dietitians Practice Group Web info & resources: BCRenal.ca  Health Info  Managing My Care  Diet

Committee background: Terms of Reference 54

“Collaborating with other committees, organizations and professionals on the Nutritional Supplement Policy was very rewarding. It provided an extremely positive and invaluable learning opportunity. We are aligning, and this ‘one voice’ is helping patients receive consistent and trusted nutrition information.”

- Dani Renouf, Co-Chair, Renal Dietitians Practice Group

Featured Accomplishment

Nutritional supplement program expanded

In 2021, the Renal Dietitians Practice Group was able to expand the nutritional supplement program to include kidney transplant recipients. This was achieved using data from a nutrition research collaboration among nephrologists, pharmacists, statisticians and dietitians. The group also updated the related nutritional supplement policy.

Other Key Initiatives Expanded

nutrition handouts in multiple languages on the BC Renal Diet web page and participated in research projects to help patients access better nutrition and physical activity programs Formed

new working groups to address metrics in nutrition assessments and to standardize nutrition practice province-wide Had

prominent Australian psychologist and author, Glenn Mackintosh, as a workshop guest during BC Kidney Week to support members in clarifying and connecting with personal values, setting boundaries and managing expectations in supporting patients' behaviour change

cy lement Poli 21 p p u S l a n io ly 20 Nutrit Updated Ju Developed

ittee ulary Comm y and Form nal Pharmac ans Group Renal Dietiti and the BC

by the BC Re

i the northern

way of caring

55

Social Workers Professional Practice Council Web info & resources: BCRenal.caHealth Professionals Clinical ResourcesSocial Worker Support

Committee background: Terms of Reference 56

 Co-chair Kristie Nagata (pictured) was joined by new co-chair Karla Ramsay in June 2021

Featured Accomplishment

Renal social workers group reconvenes to continue work of advocating for and supporting kidney patients despite the pandemic

During the first several months of 2021, because of the demands of the pandemic, projects of the Social Workers Practice Council were on hold. However, a new team of co-chairs began working together in June to help guide collective efforts moving forward (with new co-chair Karla Ramsay stepping up to join long-serving co-chair Kristie Nagata).

The social workers group reconvened and resumed its role of addressing challenges and inequities within our societal and medical systems. This included a vibrant focus on advocacy for kidney patients with the goal of supporting the wellbeing of all.

One of the projects the group has been discussing is how to reduce barriers (including social, geographical and financial) that some patients face in accessing kidney transplantation – the gold standard of treatment for those medically eligible. The group plans to explore this further and find ways to overcome these barriers for the best health outcomes for all.

The Social Workers Practice Council has also continued to put a high priority on clinical support, collaboration and professional excellence.

“BC social workers in health care were acknowledged in 2021 with a Canadian Association of Social Workers Distinguished Service Award. In presenting the award, the BC Association of Social Workers recognized that this group is: ‘...at the frontlines of the struggle to contain the pandemic. In their many roles, we know that they are working hard to ensure that individuals, families, and communities have the resources they need to manage and that they are providing comfort to critically ill patients and their families.’

BC social workers in kidney care were honoured to be among the broader group recognized for our work that has been extra challenging during the pandemic.”

- Karla Ramsay, Co-Chair, Social Workers Professional Practice Council

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CELEBRATING TEAMWORK AND COLLABORATION

in a year of adversity

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WORKING TOGETHER FOR BETTER KIDNEY HEALTH BC Renal plans, coordinates and funds health care services for patients with kidney disease in BC.

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