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Appendices: Clinical Director plans and good practice tabulation
17 London: West London and Renal Transplant Centre, Imperial College Healthcare
What are your plans for increasing home dialysis?
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We continue to grow our NxStage Home HD numbers.
Do you have any examples of good practice that can be shared?
The Trust QI team assisted in analysing the needs of the pathway through a transformation project which informed us how to adjust the service pathway and workforce. The strategic change lead spent time in the unit to review practice and look for efficiencies and analyse the needs. We then used this as a business case to move resource from the satellites to home therapy. Workings can be shared. (Table below). Have added a table below which runs to May 22. Have had a number of transplants in PD and numbers have plateaued. Would recommend factoring the impact of transplantation into the outcomes.
18 London: Royal Free Hospital
What are your plans for increasing home dialysis?
We plan to expand our home dialysis programme through increased education and awareness in our patient cohorts. We have an area at one of our satellite units we would like to dedicate to PD training (we currently do not have a training programme), as well as home HD assessment and education. Our HHD staff currently consists of one Band six nurse shared with our supported self-care unit. We hope that giving an allocated area will help the increase but will also aid the low clearance team with education. In addition, we have created a combined low clearance/home therapies specialist nurse role and hope this will encourage the uptake from low clearance.
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London: Royal Free Hospital cont...
Do you have any examples of good practice that can be shared?
Our low exit site rates are an example of good practice. Our patients currently use an antimicrobial ointment on their exit sites and are also taught to use a shower pouch. We think this contributes to low incidents.
19 London: Kings College Hospital NHS Foundation Trust
What are your plans for increasing home dialysis?
Business case submitted for further expansion of home haemodialysis capacity from 50 to 75, following successful expansion from 20 to 50 over last two years. Ongoing growth of PD currently 113 patients. Recent successful business case to support expansion of assisted Ambulatory Peritoneal Dialysis (APD) programme from 10 to capacity 30 patients (23 patients to date) improving patient access especially for frail and elderly patients. We can also provide respite. PD Access, plan for two Urology surgeons to train with Frank Dor to complete advanced laparoscopic technique such as rectus sheaths tunnelling, adhesiolysis and partial omentectomy to support complex patients. We need to increase our estates footprint to provide extra space for PD training and assessment as well as Acute APD.
Do you have any examples of good practice that can be shared?
1. Recent successful business case to support expansion of assisted APD programme from 10 to capacity 30 patients (23 patients to date) with three more in the pipeline improving patient access especially for frail and elderly patients. We can also provide respite and early discharge following acute PD catheter insertion and supporting late referred patients pre PD training. This service has won a Dignity Awards at Kings due to positive patient feedback. The Band fours are also trained to provide refresher training to support enhanced training to prevent losses to the programme due to peritonitis adding value to the programme and reducing losses.
2. Kings has the capacity to provide PD catheter insertion using percutaneous seldinger technique under local anaesthesia to support late referred or crash landing patients within 24 hours. This service is nurse led performed by two nurses and two nephrologists trained to perform these procedures along with an associate specialist who can perform PD catheter removal and reinsertion along with creating new sites and removal of infected cuffs allows us to prevent unnecessary transfers to haemodialysis due to infection. We also provide day-case PD catheter repositions under local anaesthetic preventing losses due to PD catheter migration or blockage.
3. We have further trained three urology surgeons to complete our laparoscopic glycated albumin PD catheter procedures. We can have an urgent glycated albumin PD catheter placed within one week for emergent patients.
