Appendices: Clinical Director plans and good practice tabulation

13 Hull University Teaching Hospital

What are your plans for increasing home dialysis?

1. To incorporate a home HD assessment with the PD home assessment.

2. Early review of all crash landers by home HD staff and PD staff.

3. Ongoing shared care within the HD unit.

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

1. Early review of crash landers by PD staff.

2. PD home visit for assessment and education early on in the journey through the pre dialysis clinic for all patients unless contraindication to PD or patient adamant they don’t want PD or home treatment.

3. Introduction of NxStage machine to enable more patients to access home HD.

14 Liverpool Alder Hey Children’s Hospital

What are your plans for increasing home dialysis?

1. Our HHD programme is in its infancy. Currently we have one patient training for HHD. If this is successful, then the other patients on the in centre haemodialysis unit hopefully will be encouraged to opt into the programme.

2. We had one patient using the NxStage in centre and has recently had a transplant. It was noticeable that their clinical parameters including blood pressure control, PTH and weight improved. The patient also reported that they could think more clearly which was important for their year academically. The clinical team have observed these outcomes and have adopted a favourable approach to using the NxStage.

3. Aiming for patient information to be translated into the patient’s first language.

4. Ensuring that there is a core of nurses working on the in centre dialysis unit that are trained and use the NxStage machine.

What are your plans for increasing home dialysis?

1. We are currently in the process of integrating the home therapies team (PD & HHD) to support cross cover of each home therapy creating a wider team to support each therapy.

2. Involvement in HD KQuIP – involves other units focusing on home therapies – we will be looking at learning from other units and adapting successful processes.

3. Home therapies involvement in CKD pathway QI project to streamline pathway into home therapies to support growth into the programme.

4. Planned move into a new hospital – will allow for focus on development of shared care in the in-centre dialysis unit.

5. Currently looking at developing a robust protocol for acute start PD.

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

At present the Home Therapies department is undergoing a review due to new clinical and nursing leads in post. There are a lot of changes in progress due the Trust merger and planned move to a new hospital, unable to highlight areas for good practice until review complete.

16

London: Barts Hospital, Renal Unit

What are your plans for increasing home dialysis?

1. Increase home HD and PD training capacity with building the independent treatment centre.

2. Those who can do haemodialysis independently but do not have suitable housing, to create a home from home environment.

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

1. MDT working in the home HD team with weekly planning meetings.

2. Fortnightly MDT business meeting in the PD team.

3. Close working between AKCC and PD/home HD to identify who is suitable for home therapies.