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SHARED HAEMODIALYSIS CARE – A QUALITY IMPROVEMENT PROGAMME FACING THE SUSTAINABILITY CHALLENGE

Wilkie M1, Laboi P2, Hancock K1, Barnes T1 Howard M2 on behalf of the Yorkshire and Humber Shared Haemodialysis Care Team.

1 Sheffield Teaching Hospitals; 2 York Teaching Hospital.

A quality improvement programme requires a strong team and energetic leadership. Many initially successful programmes fail to be sustained. In 2010 we developed a Health Foundation supported innovation in Yorkshire and the Humber to support in-centre haemodialysis patients to take on some of the 14 tasks relating to their treatment. This we called Shared Haemodialysis Care (SHC) to emphasise partnership between patient and health care professional.

Components of the programme include

1.  A four day training course for nurses to equip them with the skills necessary to support patients to learn tasks relating to their dialysis treatment. This course was developed with nursing and patient input, was externally evaluated and received a gold Training Journal award (Nov 2013). It had been positively reviewed by delegates.

2.  Training materials for patients – including a training manual to work through tasks and document competencies.

3.  Patient leaflets and promotional SHC posters.

4.  A series of measures to document of the level of engagement –

a)  % of HD patients undertaking at least five aspects of their haemodialysis care.

b)  % of patients who have been asked about participating in SHC.

c)  % of patients who would recommend shared SHC to another patient.

5.  A website where nurses can access resources necessary to establish a SHC programme, access e learning and input unit data (www.shareddialysis-care.org.uk ).

6.  Research to explore patients and health care professionals experience of SHC(1).

7.  An annual learning event for patients, carers and health care professionals.

Run charts from participating centres at shareddialysis-care.org demonstrate

A : % patients undertaking of 5/14 dialysis tasks .

B : % of patients asked whether they would be interested in participating in SHC.

A B

Steps taken to promote sustainability

1.  Inclusion of SHC in the National Service Specification for HD.

2.  Dissemination though publications and presentations at meetings.

3.  An e learning course for nurses (freely available).

4.  Design of a CQUIN with the objective of 10% of patients undertaking 5/14 tasks.

5.  Continuing the nurse training course on a cost basis.

6.  High quality research proposals submitted to grant awarding bodies (NIHR).

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Conclusion

There is much to do before SHC becomes embedded in the culture of UK dialysis. Multiple approaches are required to build sustainability which is easily threatened by competing external pressures. Achieving sustainability is difficult : an exploration of the components necessary to ensure sustainability should form an early part of quality improvement programs.

1. Glidewell L et al. Implementation Science 2013. 8:118.