Appendices: Clinical Director plans and good practice tabulation

10 GHNHSFT (Gloucester)

What are your plans for increasing home dialysis?

To renew dialysis contract with new provider. KPI’s targets to be set to increase HHD by the new provider.

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

About eight years ago, we had the Commissioning for Quality and Innovation (CQUIN). Having a performance target made us achieve four HHD patients within a calendar year. However, in the last eight years as the current incumbent dialysis provider had no interest in increasing HHD due to poor planning or prioritising profits, we have had only three patients onto HHD during entire eight years.

11 Wessex Kidney Centre Portsmouth

What are your plans for increasing home dialysis?

To renew dialysis contract with new provider. KPI’s targets to be set to increase HHD by the new provider.

1. Large HHD and PD programme, we have a home first culture and do not exclude patients. HHD - We offer experience the different sessions for patients who want to try HHD. We now offer a choice of machines (Quanta or NxStage). Continued education, a dedicated home HD team. Dedicated training space including respite area, minimal exclusion criteria, PD to HHD transition. Our nursing team both train and look after the patients in the community to ensure continuity and are HHD consultants to ensure expertise.

2. PD - Dedicated team and space (separate from HHD but collocated). No limit placed on assisted APD to ensure option or all. MDT working with dedicated consultants. Both teams have monthly MDTs and excellent communication between the MDT and frequently as required.

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

1. Education in pre dialysis clinics and HHD link nurses in dialysis units.

2. All patients seen by HHD consultant before training to discuss expectations, goals and options. Team do home visits before training.

3. Short training time (12 sessions on average to independent at home).

4. All excess types accepted.

5. Excellent MDT approach.

6. Individualisation of therapy, putting patient in the driving seat.

What are your plans for increasing home dialysis?

1. Relocation of our home therapies training area which is combined home PD/HHD area and does not have enough training space to sustain a growing home therapies programme.

2. Use of shared care to shorten training and allow patients to be trained for home HD outside of our limited capacity of HHD training area.

3. Promotion of PD amongst pre dialysis patients as well as HHD. Encouraging de-novo HHD training at the start of dialysis.

4. Shortening training with the use of educational material we are generating, videos.

5. Increase staff engagement and education through some four to six monthly education days on home therapies as part of a rolling programme or nurse/doctor education.

6. Exploring simpler technologies such as use of a Pisidia as portable therapy.

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

1. We have a significant expansion in shared care with a number of patients in the last year being fully trained on HHD within the main/satellite dialysis units thereby alleviating capacity issues for training in our home therapies area.

2. Use of combined portable/non-portable HHD treatment to promote uptake of HHD so that a portable therapy is offered as a ‘flagship’ treatment.

3. Ability to insert medical PD catheters within 24h except at weekends.

4. Having a PD/home HD team that share physical training space to allow cross-fertilisation of ideas and staff skills to allow patients to move from PD to HHD in a seamless way.

5. Use of incremental dialysis in the home setting both for PG and HHD as well as for in -centre dialysis so we utilise patients residual function level to individualise.

6. We proactively reimburse patients for their energy costs in HHD and HPD with an allocated member of staff responsible for this.

7. Patients on home therapies have good access to our renal support team including support from our renal social worker in assisting with re-housing where required and that also includes a benefits advisor.

8. All patients in home therapies have a high level of continuity of care with a named consultant in HHD and a PD consultant.

9. Organisationally we coordinate our home therapies team through a Home Therapies Operations group that meets monthly, and this group regularly reviews gains and losses of patients to the home therapies programme.