2152
A 6 YEAR RETROSPECTIVE REVIEW OF NURSE LED PATIENT PATHWAY FOR INSERTION OF PERITONEAL DIALYSIS CATHETERS
Knaggs A, Martin J, Lewis D, Department of Renal Medicine Salford Royal Foundation Trust Hannay H, Baxter Healthcare Lappin L, University of Salford
PROBLEM: It is widely recognised that the patient journey from advanced chronic kidney disease (CKD) to dialysis can be traumatic (McIntyre and Rosansky, 2013). Previously, there was no established pathway for this cohort of patients in their transition to a life on dialysis. There were frequent operative delays or cancellations due to sub-optimal management of pre-operative risks such as abnormal blood results and continuation of medicines contra-indicated prior to surgery. Consent was usually obtained on the day of surgery by junior doctors who had little knowledge of the procedure. From a service perspective there was poor utilisation of resources. In order to make the transition smoother and less stressful, a nurse-led clinic was developed for patients who had chosen Peritoneal Dialysis (PD). The clinics were set up alongside the established PD clinic, which was consultant led, and enabled the PD specialist nurse to discuss pertinent issues around dialysis with the patient prior to admission. A clinical examination is undertaken, appropriate pre-operative investigations requested and informed consent obtained by the nurse. A planned surgery dateis then agreed with the patient. The patient remains under the care of the PD team before and after catheter surgery. This integrated approach enables a more co-ordinated pathway for the patients’ journey from CKD clinic to surgery and commencement of dialysis.
PURPOSE: The aim of the study was to review the effectiveness of the nurse-led clinic in establishing a smooth pathway for patients undergoing surgical PD catheter insertion, and if this impacted on the patient experience within the renal service.
DESIGN: Patients experience will be measured by reviewing the length of hospital stay, number of cancelled operations and PD training times. The impact on PD modality patient numbers will be reviewed over a six year period.
FINDINGS:Audit data has shown a reduction in the number of cancelled operations and a decrease in the overall in-patient stay from three days to 1-2 days since the onset of this clinic.Length of time to train for PD has been reduced from an average of 4.5 days to 2.5 days. The utilisation of the service had seen a steady increase for the first 3-4 years, but it has been identified that there has been a decline within the last 12 months with no obvious cause.
CONCLUSION: The need for specialist teams to work together to ensure a timely transition between CKD and dialysis is paramount to patient experience.
RELEVANCE: This clinic is delivering a greatly improved patient experience and utilisation of NHS resources. The nurse-led clinic has also enabled expansion of the role of the PD specialist nurse, utilising non-medical prescribing and clinical examination skills. The findings show the benefit to patients of specialist nursing ownership of the pathway from CKD to PDand have provided an invaluable patient centred approach to the management of CKD patients, which builds upon skills such as counselling, teaching and health promotion which are the very cornerstone of contemporary nursing practice.