Appendices: Clinical Director plans and good practice tabulation

20 Oxford Kidney Unit

What are your plans to Increase HD?

We have a home HD strategy meeting and aim to double numbers by the end of the year. As a result of focused efforts, we have 14 in the pipeline to train for home. We have increased shared care on Quanta and have this machine in centre. We have done some staff education and consultant education to reduce bias. We do fast tracking (in 14 days) and education pre HD.

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

1. Home grown assisted PD service of 13 years (not commercial sector), greater flexibility / cheaper / patients remain on programme extended times / useful for admission avoidance / most vulnerable get 365 home visits / enables us to take service to patients home and variety of other centres respite / rehab ots then receive right care by right team in right place. Reduces in patient time, give patients / relative a rest of just a valuable modality option either as a 1st treatment or if patient is failing PD and PD is not failing patient. Staff retention in the service is excellent a very enjoyable renal job / rewarding / lots of variety.

2. Home therapies nurse led service - open door policy for troubleshooting PD issues / other renal home therapy patients i.e. transplantation / low clearance in real time (Monday - Friday core hours service) then back up out of hours from renal ward. Reduces medical input / prevents need for admission / reduces clinical delays / utilises skills of very experienced renal nursing staff. Again, right place, right speciality in a timely way prevents admission / disease complications / improves patient wellbeing and experience / most cost effective and efficient.

3. Home haemodialysis migrated to being under the reporting structure of the vascular access nurse in the HD department some two years ago. This has had the benefit in that this team are more knowledgeable and experts in haemodialysis. The team work more closely with HD units so have an active role in promoting the therapy to in centre patients, in addition to working with the low clearance team from where we hope to secure and source more interest at an earlier stage in home HD.

4. The renal vascular access nurse is currently Chair of the South East region network collaborative working on the KQuIP MAGIC project and also is a member of the South East region working on the KQuIP DAY Life project aiming to increase the numbers of patients able to undergo haemodialysis at home.

5. We are able to offer the full range of PD services as a first modality PD/AP/D/aAPD with the full fluid profile available.

21 Sheffield Kidney Unit

What are your plans for increasing home dialysis?

1. Introduced a medical PD catheter insertion programme since August 2020, which has led to an increase in PD numbers from 55 patients to 83.

2. Appointment of home therapies clinical fellow to drive quality improvement within the service.

3. Introduction of an acute start PD protocol.

4. Continued growth of shared HD programme.

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

We have developed a Patient Report Experience Measure around PD catheter replacement, the Patient Reported Experience Measures (PREM) will drive quality improvement within the service.

22 Shrewsbury

What are your plans for increasing home dialysis?

1. Departmental agreement about benefits of home therapies.

2. Promote home therapies in CKD, dialysis and transplant pathways.

3. Explore HHD options with established HD patients.

4. Continued education of staff and patients.

5. Ready access to medical PD insertion.

6. Planned transition from PD to HHD.

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

1. Departmental agreement about benefits of home therapies.

2. Promote home therapies in CKD, dialysis and transplant pathways.

3. Explore HHD options with established HD patients.

4. Continued education of staff and patients.

5. Approximately 50% of incident patients commence home therapies.

6. Improved infection control.

7. Planned transition from PD to HHD.