Appendices: Clinical Director plans and good practice tabulation

3 Bradford Teaching Hospitals NHS Foundation Trust cont...

Do you have any examples of good practice that can be shared?

1. Bradford is the only centre in UK where we use expertise of an interventional radiologist for insertion of PD catheter under fluoroscopy with excellent catheter function rates. The unit also offers PD catheter salvage with fluoroscopic manipulation for any catheter flow dysfunction.

2. Since June 2021, a team of extremely enthusiastic laparoscopic colorectal surgeons have started to offer advance laparoscopy technique of PD catheter insertion with adjunctive procedures. This has not only improved catheter functions rates, but also meant we can offer PD to patients with high Body Mass Index (BMI), previous abdominal surgeries, presence of hernia requiring repair, etc.

3. We have been at the forefront of introducing validated patient decision aids (Yorkshire Dialysis Decision Aid [YoDDA] and Yorkshire Dialysis and Conservative Care Decision Aid [YoCDA]) to standard practice in our AKCC, supported by our Cultural and Health Improvement Officer (a unique role in the UK).

4 Wirral University Teaching Hospital

What are your plans for increasing home dialysis?

1. Participation in KQuiP QI project focusing on increasing HHD numbers (examples of change ideas to follow).

2. Increase access to NxStage/portable HD machines for patients unsuitable for static machine.

3. Focus on patient education, pre dialysis, ICHD and PD. Develop video showing patient experience of HD.

4. Shared HD programme to be developed.

5. Identify failing PD pts and unsure home HD considered and progressed if appropriate.

6. Engagement of all MDT in raising awareness of home HD.

Do you have any examples of good practice that can be shared?

Patient video showing personal home HD journey and benefits to their care due to be available in next few weeks.

5 Royal Cornwall Hospital

What are your plans for increasing home dialysis?

Well as soon as this procurement process is completed, we have 10 patients ready to go. We are refashioning a side ward next to the dialysis unit as a home training centre (£57k to start work on the 12th September). We are expanding our home dialysis staff. We are moving into a limited version of assisted PD (difficult in rural Cornwall) and taking steps to rework the CKD pathway to extol home dialysis more than we have done recently. Before the demise in our machine availability, we had 14.3% on home dialysis. Once we get the machines, that will immediately lift us to 15.8%, and we believe our plans will take us well above the target 20% on home dialysis.

Do you have any examples of good practice that can be shared?

No.

6 Royal Devon University Healthcare NHS Foundation

What are your plans for increasing home dialysis?

1. We have recently started a Percutaneous TK catheter insertion service to increase access to PD.

2. We have recently started an Acute Start PD service.

3. We continue to grow our NxStage Home HD numbers.

4. We are fully engaged in the South West (SW) Renal Operational Delivery Network (ODN) Home therapies QI work stream.

5. We have undertaken a PD peritonitis project to deep dive all aspects of PD care to reduce episodes of peritonitis.

6. We run an in house assisted PD team.

7. We continue to provide timely education and choice for home therapies.

8. We are trying to expand our Advanced Kidney Care Clinics to all the geographical areas we support.

9. We would like to restart home therapies with face to face education events when Covid allows.

10. As host Trust for the SW Renal ODN we are pushing the importance of choice and access to home therapies and continue to encourage regional collaboration and sharing of good practice.

Do you have any examples of good practice that can be shared?

See previous answer.