Appendices: Clinical Director plans and good practice tabulation

27 Crosshouse Hospital / John Lynch Renal Unit

What are your plans for increasing home dialysis?

1. Now Covid-19 restrictions are lifting we will be restarting our education programme with low clearance patients. Group education sessions and patient experience have proved successful in the past.

2. We can now offer two dialysis machines giving greater choice and flexibility to our patients.

3. We have recently recruited and trained a Home Haemodialysis Support Worker who is able to support patients who need additional support/assistance and prevent a return to in centre dialysis.

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

1. The recruitment of the HDSW has resulted in direct benefit to home patients, their families and careers including:- Support for patients enduring chemotherapy, making it possible for them to be assisted at home with their dialysis, removing the burden of coming into the renal unit three times per week. Support for a family who suddenly lost their main carer. The HDSW has been able to assist with dialysis at home, allowing the daughter to continue with her own profession and care for her father prevented him coming back into the renal unit to dialyse. Support for the two nurses during annual leave. Previously allocation of work would be organised around two staff members. Any sickness absence or annual leave would have had an impact on the renal unit staff.

2. Patients, carers with increased friability require additional assistance with their dialysis treatment in order for them to continue to make the choice to dialyse at home.

3. If these patients were to dialyse within the renal unit, they would require hospital transport to and from the hospital and they would put further strain on an already under pressure service. We can now offer assistance to these patients and their families to allow them to remain at home.

28 Dumfries and Galloway Health Board

What are your plans for increasing home dialysis?

1. Continue to promote home therapies through the kidney care planning clinics.

2. Have an education day at the renal unit with patient involvement.

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

All the patients approaching Kidney Replacement Therapy (KRT) are counselled at home by our kidney care planning nurse at the patient’s home along with the patient’s family.

29 Renal Medicine, Royal Infirmary Edinburgh

What are your plans for increasing home dialysis?

We have a dedicated home haemodialysis nurse who promotes self-care and then home based haemodialysis if the patients wish. We have introduced NxStage recently to help extend our home haemodialysis options. We have doubled our number of patients performing haemodialysis at home in the past 12 months.

30 University Hospital Kilmarnock, Scotland

What are your plans for increasing home dialysis?

1. We continue to promote HHD in our pre-dialysis education and have been successful in recruiting that way. We no longer present dialysis as a modality choice but rather as a venue choice. Once someone has decided to go home then it is a discussion about PD or HD at that stage. The options presented in order of (our) preference would be transplant/home/hospital HD.

2. We are utilising different machines and contracts – essentially tailoring the experience to the patient. For those that like to travel or who have little space we are using a compact machine. For those with no likelihood of transplant we use Hemodiafiltration (HDF) on a machine that we buy and maintain. For those likely to get a transplant soon we are leasing machines on a per-treatment basis.

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

1. We are happy to look at home adaptations to suit the individual. Some are in the home and others in the garden. We utilise local tradespeople who are getting more familiar with our requests!

2. Electricity is reimbursed at an agreed rate (may need to be re-agreed).

3. I think one of our biggest assets is our home haemodialysis team who are passionate about what they do. If it wasn’t for the support and positivity that they bring to the program I doubt we would be as successful as we have been up to this point. We do it because it is the right thing to do!