Appendices: Clinical Director plans and good practice tabulation

25 Daisy Hill, Newry, Southern Trust

What are your plans for increasing home dialysis?

1. We consistently focus on home therapy as an ideal option for Low Clearance Clinic (LCC) patients in terms of quality of life outcomes. We participated in the Frail Elderly Patient Outcomes on Dialysis (FEPOD) study and have been early adopters of assisted PD in Northern Ireland since its inception in the region. We currently have 11 patients on APD and nine of these patients are aAPD, so our HT population are an elderly population. It is a lot of work to get these patients on the programme and time spent on treatment is short (so actual numbers on home haemodialysis therapy fail to reflect the activity of our HT staff who have a relatively high incident take on rate due to the nature of our population). We feel for elderly patient’s aAPD is hugely preferable to in-centre HD from a quality of life perspective.

2. We had an unprecedented surge in transplantation in NI in 2020-21 and this converted many of our home treatment cases to transplant, so our HT numbers don’t fully reflect our focus on the HHT option which remains our default dialysis option when possible.

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

We have secured local anaesthetic PD lists with interventional radiology which expands our options for those patients keen to do assisted PD but are too high risk for glycated albumin. This has been enormously important for frail patients keen on dialysis who would not get a glycated albumin and is the single most important development in or service over the past five years.

26 NHS Grampian, Aberdeen Royal Infirmary and associated satellites in Orkney, Shetland, Peterhead, Banff, Stonehaven, Elgin, Inverurie

What are your plans for increasing home dialysis?

1. Offering home visits to ALL low clearance patients at first low clearance clinic.

2. Standardised approach in low clearance clinic with early discussion regarding transplant first if appropriate, followed by home therapy discussion focussing on ‘would you like treatment at home or hospital’.

3. Recent appointment in last years of dedicated shared care nurse who will take on additional responsibilities for HHD patients.

4. Offering APD to all patients opting for PD.

5. Offering to go straight onto APD so train on manual but straight to train on APD same week.

6. Offering days off to patients on CAPD (if first RRT and RRF allows) and dry days to patients on APD.

7. Financial help with electricity costs as this is something that could end up a negative as energy costs increase.

8. Revisiting HD patients to see if they would like to consider PD after initially opting for HD.

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

1. Low clearance multi-disciplinary team consisting of 6.2 Working Time Equivalents (WTE) Home therapy specialist nurses, Renal Dieticians who are promoting more home therapy.

2. Consultant with QI interest who is part of the Scottish Renal Registry QI subgroup and leading on Shared Care.

3. Consultants with special interest in home HD and PD - two consultants.

4. PD numbers have increased over past year from around 21-31. Down to offering flexibility in start on PD (dry days).

5. Appointment of dedicated shared care nurse in March 2021, have doubled HHD numbers from three to six in last three months with dedicated shared care/self-care HD room and training by shared care nurse.

6. Shared care numbers in total since the beginning of programme in March 2021-22 participating-most doing part of care, some virtually all and of these two have gone on to HHD and three have been transplanted.

7. Upgraded five healthcare support workers to promote, support and assist with shared care and HHD, so we have a team of six nurses on the dialysis unit.

8. Staff education programme being developed which we hope will in turn helps us to progress with shared care and HHD.

9. We have also developed a patient training programme which has been tried and tested by the patients.

10. Promotional video of shared care starring a full self-care patient promoting it as a step to HHD by posters. Available on NHS Grampian YouTube site and also shared with Public Health Scotland.

https://www.youtube.com/watch?v=P5DckRKPxys