09:30 registration / coffee/ network opportunity · kquip launch event . donor education early...
TRANSCRIPT
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09:30 – 10:00 REGISTRATION / COFFEE/ NETWORK OPPORTUNITY
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Kidney Quality Improvement Partnership (KQuIP)
South West
SW Team Transplant
11th April 2019
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10:00 – 10:15
Introductions and Welcome
[Dr Paul Cockwell – KQuIP Co-chair]
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10:15 – 10:30
Current Transplantation activity in the South West
[Dr Steve Dickinson – Royal Cornwall Hospital, Truro]
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South West Team Transplant
KQuIP Launch Day
11 April 2019
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How did we get here?
KQuIP South West Regional Day 4 October 2018
• Home therapies
• Vascular Access
• Transplant First
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• Set the scene with NHS Blood and Transplant (NHS BT) data – National data – Living kidney donor – Deceased kidney donor – Listing information
• Creation of SW Team Transplant
• Aspirations for the SW
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National performance
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Kidney only transplants pmp 1 April 2014- 31 March 2017
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Living Kidney Donation
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Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and TransplantSource: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant
Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and TransplantSource: Annual Report on Kidney Transplantation 2016/17, NHS Blood and Transplant
Transplants (living)
kidney living donor transplant rates
Low rate (8.8-<12.7 pmp)
Low-Medium rate (12.7-<15.5 pmp)
Medium-High rate (15.5-<16.5 pmp)
High rate (16.5-41.6 pmp)
21.4
15.8
16.5
15.5
41.6
12.1
8.8
13.9
14.1
15.9
12.7 17.6
11.5
Figure 2.7 Living donor kidney transplant rates (pmp) by recipient country/Strategic Health
Authority of residence
2016/17
Living donor Kidney transplant rates (pmp)
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11/1/2019 Kidney Quality Improvement Partnership |
West Midlands Regional Day 17
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Deceased donor transplants
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Deceased donors
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Transplants (deceased)
kidney deceased donor transplant rates
Low rate (21.5-<33.8 pmp)
Low-Medium rate (33.8-<36 pmp)
Medium-High rate (36-<38.1 pmp)
High rate (38.1-45.3 pmp)
26.1
38.1
22.2
38.5
36.0
35.7
37.3
38.1
33.8
45.3
21.5 42.8
35.1
Registrations
kidney registration rates
Low rate (32.20-<41.90 pmp)
Low-Medium rate (41.90-<44.10 pmp)
Medium-High rate (44.10-<46.20 pmp)
High rate (46.20-71.20 pmp)
42.4
45.6
41.5
56.5
40.3
56.5
46.2
41.9
44.5
71.2
32.2 44.1
43.1
Figure 2.6 Comparison of kidney registration rates (pmp) with deceased donor transplant rates (pmp) by recipient country/Strategic Health Authority of residence
Low-Medium rate
(41.9 - <44.1 pmp)
Low rate
(32.2 - <41.9 pmp)
Medium-High rate
(44.1 - <46.2 pmp)
High rate
(46.2 - 71.2 pmp)
Kidney registration ratesKidney deceased donor
transplant rates
Low-Medium rate
(33.8 - <36.0 pmp)
Low rate
(21.5 - <33.8 pmp)
Medium-High rate
(36.0 - <38.1 pmp)
High rate
(38.1- 45.3 pmp)
Registrations Transplants (deceased)
Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and TransplantSource: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant
Patients active on the waiting list pmp
Transplants (deceased) pmp
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Listing
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11/1/2019 Kidney Quality Improvement Partnership |
West Midlands Regional Day 22
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11/1/2019 Kidney Quality Improvement Partnership |
West Midlands Regional Day 23
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How did we get here?
KQuIP South West Regional Day 4 October 2018
• Home therapies
• Vascular Access
• Transplant First
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How did we get here?
• Quality Improvement (QI) Leads at each of the six SW Renal centres
• 13 December 2018 QI Leads meeting, Plymouth
• Leadership Training Shortsmoor 6 & 7 Feb ’19, Ilminster
• 21 March 2019 QI Leads meeting, Taunton
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Where are we now?
South West Team Transplant
‘As many people transplanted with as short a wait as possible with the best experience’
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How will we achieve this aim?
Drivers:
• Supporting communities
• Education and awareness for all
• Reducing delays
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Topics…
• Bristol- Referral protocol • Dorset- Transplant pathway • Exeter- Avoiding barriers and delays • Gloucester- Waiting times and organ turn down
rates • Plymouth- Cardiology pathway • Truro- Donor experience
• Presentations from SW patients • Dr Kerry Tomlinson
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Enjoy the morning!
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10:30 – 11:30
Overall Aim – South West Team Transplant
‘As many people transplanted with as short a wait
as possible and with the best experience’
[Unit presentations]
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KQuIP South West Launch Event - 11th April 2019
‘As many people transplanted with as short a wait as possible with the best experience’
Heather Atkins Living Donor Transplant Nurse
Karen Steer Transplant Specialist Nurse
Lynsey Webb Consultant Nephrologist
Barriers and delays in renal transplant work up and living kidney donation
…how to resolve them
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Investigations required during workup
Patient choice
Blood tests
BMI Variability
Communication and Co-ordination
Barriers, delays & how
to resolve them
• Education • Shared protocol
between Bristol & Plymouth laboratories
• Being frank re: the delay to Tx if BMI is high
• Dietician input
• Weight loss clinics
• Standardisation of BMI
• Improve existing lines of communication • Improve electronic communication
• Secretarial support for teams
• Earlier eGFR to start work up
• Document decision
• Provision of low clearance clinics for all patients – MDT input
• A South West peninsula work up pathway
• Raise patient awareness of impact of non-compliance • Psychological support
• Secretarial support
• Creating a contact lists in peripheral Trusts
• Generic NHS e-mail
• Inform PTN of decision to assess for Tx
Pre-Transplant Nurse
Pre-Transplant Nurse
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Volume of work
Not being just an LKD nurse
Living Kidney Donation - Barriers
Waiting….for HLA results, renal ultrasound, out-patient appointment and further investigations
Number of appointments, time off from
work etc.
Difference in LKD acceptance criteria Waiting for the recipient’s suitability
Preparing and sending LKD information between Units
Unsuitable donors
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Marginal gains can result in significant improvement
Go SW Team Transplant
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Kidney Quality Improvement Partnership
(KQuIP)
Gloucestershire Hospitals NHS Foundation Trust
Jim Moriarty, Helen Giles
Nephrologist, Lead Nurse
@HotKidneyAction
@HelenGi21436714
@Renalservicesg1
#SWTTx
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Kidney Quality Improvement Partnership | South West
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Donor Experience
Emma Johns
Susan Durkin 11 April 2019
KQuIP Launch Event
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Donor
Education
Early discussion
Empowerment
Experience
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Education
Peer support
Buddy system
Increase publicity & awareness
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Early discussion
With recipient at CKD clinic when
GFR 25 +/- rate of decline factor
Compatibility? GP obtain Bld grp
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Early discussion
Kidney failure
risk equation
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Empowerment
Encourage open & honest
discussions with family & friends
Pre-emptive living donor
transplant - the best option
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Experience
Measure donor experience after:
work-up, donation, & 1 year.
Introduce improvements based
on feedback.
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11:30 – 11:45 COFFEE
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11:45 – 12:00
Patient Experience
[Keith Bucknall]
[Deborah Duval]
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Kidney Quality Improvement Partnership (KQuIP)
[Keith Bucknall]
[Patient representative]
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Donor - Doner
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time
emotions
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Kidney Quality Improvement Partnership (KQuIP)
[Deborah Duval]
[Patient representative]
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Kidney Quality Improvement Partnership | South West
The proposed running order is (all slide presentations except where indicated): 1. Introduction by the Transplant Recipient Co-ordinators 2. Verbal presentation from a psychologist 3. Having a living-donor kidney transplant (one of the LD Co-ordinators) 4. Kidney transplant - the operation (presented by one of the surgeons) 5. What happens on the ward after your transplant (by a ward sister) 6. All about your transplant medicines (by a renal pharmacist) 7. Follow-up transplant clinic (by one of the clinic sisters) 8. Verbal presentation by a transplant recipient 9. Summary The session is designed to last around 2 hours without a break, but we (i.e. patients reviewing the slides) suggested inserting a 20-minute break in the middle to make it less of a marathon.
Transplant Education Session – must be attended by all patients to be listed
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Kidney Quality Improvement Partnership | South West
This education session is regarded as a key part of transplant pathway, which runs as follows:
Referral from Nephrologist Work-up tests Primary surgical review Patient education session MDT agreement to activate on the list Recipient Co-ordinator confirms activation status to patient.
Transplant Pathway
One reason why it’s key is to outline not just benefits but also risk of transplantation in order to ensure informed patient consent - especially important following the Montgomery decision: https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent
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12:00-12:30
World Café session
[All delegates]
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World Café Session
1. Measurement – what shall we measure and how? [Kerry Tomlinson]
2. Objectives – Do we have any targets? If so, what are they? Are they South West targets or unit targets?
[Steve Dickinson]
3. Patient experience – How do we measure and improve? [Keith Bucknall and Deborah Duval]
4. How do we raise the profile of South West Team Transplant locally and regionally?
[Jim Moriarty]
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• Four tables
• Your choice where you start
• You have 7 minutes to listen and discuss the table
topic
• After 7 minutes, move to your next choice of table
• Everyone should visit all four tables
How a World Café Session works
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World Café Session • Measurement
• Objectives
• Patient experience
• Raising our profile
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12:30-12:45
‘Implementing change – barriers and how to overcome them’
[Dr Kerry Tomlinson – Transplant First Project Lead]
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Data: transplant listing
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Data collection: working with RR
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Data : Enhanced Dashboard
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Reason patients are “missed”
0
10
20
30
40
50
60
Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017
Invalid category
Missing
Delays in system
Medically Complex
Patient DNA on at least 3separate assessmentAppointments
Referred for Assessment wheneGFR < 15
Referred for assessment within1 year of predicted date ofreaching ESRF
Excluding Unsuitable but not documented
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
“Missed” patients
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12:45-13:00
Route map – dates of future meetings, programe,
goals and end date
KQuIP support
Summing up
[Dr Steve Dickinson – Royal Cornwall Hospital, Truro]
[Rachel Gair - Quality Improvement Programme Manager]
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64
Kidney Quality Improvement Partnership | South West
Preparation phase
Regional Day
•To bring together the region
•To review national and region level data
•To decide on a regional quality improvement priority
QI meeting
•Engagement
•Develop a shared purpose
•Begin collaboration within the region
•Begin planning the year
Leadership
•To provide an understanding of effective leadership
•To build greater understanding of each other and different ways of working / thinking / strengths
Leadership into Action
•To consolidate learning from leadership course and how it can be applied to DAYLife
•To continue planning the DAYLife programme (data/ drivers/ outcomes)
•To plan the launch event together
Engage Mobilise Learn Co-design Plan
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65
Kidney Quality Improvement Partnership | South West
Project phase
Launch event
•Agree a project plan - Co-design outcomes and measures
•Launch project - Co-design methods
Introduction to QI
1 day
•Quality improvement and tools
•Measurement / Life QI
•Project Model and NHS Change Model
•PDSA
Sharing and learning
1 day
•Reflection on progress and overcoming challenges
•Peer assist (informal learning)
•Sign posting to tools and information
•Sustainability
Maintaining momentum
1 day
•Review of progress
•Sustainability
P-D-S-A Measure Share learning Collaborate Peer assist
Mo
nth
ly sup
po
rt visits to u
nits o
ffere
d fro
m K
Qu
IP
11th April 2019
11th June 2019
24th September
2019
December 2019
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66
Kidney Quality Improvement Partnership | South West
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67
Kidney Quality Improvement Partnership | South West
My role…
Support to connect teams – collaboration Assimilate and communicate learning between KQUIP collaboratives – action learning sets, webinars Website resources and communications Support for organising and providing training /meeting venues / sponsorship
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KQuIP…
IS…
Facilitative
Enabling
Local ownership - teams are responsible for the decisions, results and actions
Keeping the energy, momentum, drive
Tailored support
Kidney Quality Improvement Partnership | South West 68
IS NOT…
The subject matter expert or owner of the project
Directive
Inflexible or rigid
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69
Kidney Quality Improvement Partnership | South West
Project phase
Launch event
•Agree a project plan - Co-design outcomes and measures
•Launch project - Co-design methods
Introduction to QI
1 day
•Quality improvement and tools
•Measurement / Life QI
•Project Model and NHS Change Model
•PDSA
Sharing and learning
1 day
•Reflection on progress and overcoming challenges
•Peer assist (informal learning)
•Sign posting to tools and information
•Sustainability
Maintaining momentum
1 day
•Review of progress
•Sustainability
11th April 2019
11th June 2019
24th September
2019
December 2019
P-D-S-A Measure Share learning Collaborate Peer assist
Mo
nth
ly sup
po
rt visits to u
nits o
ffere
d fro
m K
Qu
IP
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13:00– 13:30 Lunch and networking
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13:30 – 15:30 QI leads