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Home Therapies

(formerly Improving Choice)

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Home Therapies Project Leads e-seminar

e-seminar

30th April 2012

Chair: Clare Beard, Programme Lead

NHS Kidney Care

Agenda

Item Topic Speaker10.00 Welcome and Introductions Clare Beard10.05 Yorkshire and Humber update Rebecca Campbell10.15 Reading update Leo Bailey10.25 West Midlands update Mandeep Jagpal10.35 Brighton and Sussex update Cristina Osorio

10.45 St Helier update Ginny Quan10.55 Evaluation Clare Beard11.05 Project Assurance Clare Beard

11.15 Communications Clare Beard

11.20 AOB All

Home Therapies: Yorkshire & Humber

updatee-seminar

30th April 2012

Rebecca Campbell

Network Manager

Yorkshire & Humber Kidney Network

6

Yorkshire & the Humber Renal Network

Improving ChoiceRebecca Campbell

Network Manager, Yorkshire & the Humber Renal NetworkRebecca.Campbell@barnsleypct.nhs.uk

30th April 2012

7

Background

• NHS Kidney Care Problem-Solving Funding (£25k) – Clinical Lead appointed

• Y&H Home Therapies & Self-Care Forum established• Y&H Home Therapies and Self-Care Strategy 2011-2013

– includes 17 recommendations• Health Foundation ‘Closing the Gap through Changing

Relationships’ Funding (£400k) for 2.5 year programme – to implement ‘Shared Haemodialysis Care’

• NHS Kidney Care Improving Choice Funding (£43k) accessed to appoint a Nurse Educator (South Yorkshire)

• Programme Manager & 2.2WTE Nurse Educators in post• Initial pilot in Sheffield & York

8

Progress to dateShared Haemodialysis Care Programme

• Project Plan – next phase agreed: spread to Hull & Leeds• Staff Training Course – formal evaluation undertaken

following the first course undertaken for York & Sheffield in September, further dates agreed. 3-tiered approach agreed

• Patient Handbook – printed and piloted in 2 Units• Qualitative Research – interviews completed, report drafted• Further work to develop stakeholder engagement –

Stakeholder Communication & Engagement Strategy agreed

• Spread & Sustainability work stream established

9

Progress to date (2)Shared Haemodialysis Care Programme

10

Measures (1)Shared Haemodialysis Care Programme

Outcome Measures - Directly related to the aim of the project:• % of haemodialysis patients undertaking all aspects of their

haemodialysis care• % of haemodialysis patients undertaking at least five aspects

of their haemodialysis care• % of renal unit staff who have completed the purpose-

designed training programme

11

Measures (2)Shared Haemodialysis Care Programme

Process Measures - Measuring the activities/processes introduced to achieve aim; measures of whether an activity has been accomplished:• % of staff who are enrolled on the training programme• % of patients who have been asked about participating in

shared haemodialysis care• % of patients able to establish access (putting needles into

their fistula)

12

Measures (3)Shared Haemodialysis Care Programme

Balancing Measures – Measuring any unintended consequences:

• % of patients satisfied or very satisfied with their dialysis care [score 5 or above]

• % of staff satisfied with providing dialysis care [score 5 or above]

13

Run Charts (1)Shared Haemodialysis Care Programme

14

Run Charts (2)Shared Haemodialysis Care Programme

15

Other Developments

• E-Seminar on developments in York and visit to Jonkoping, Sweden

• Draft Support Manual under development• HQIP Funding for multi-centre audit of PD catheter function• Yorkshire Dialysis Decision Aid (YoDDA) – trial phase• Advancing Quality Alliance (AQuA) – Shared Decision

Making Collaborative• Y&H Home Therapies & Self-Care Forum –29th May• Care Planning – NHS Kidney Care Funded Project

(applications for further funding)

16

Next Steps

• ‘Roll-out’ to Hull & Leeds, and develop plans for Doncaster & Bradford

• Further course sessions – 5 courses (of 3 days) planned up to July 2012

• Printed course curriculum and materials• Stakeholder Communication & Engagement – ongoing work,

including patient stories blog, posters, leaflets & newsletter• Develop sustainability plans• Learning Event – 26th June in Leeds

17

18

Dr Martin WilkieMartin.wilkie@sth.nhs.uk

Rebecca CampbellRenal Network ManagerYorkshire & the Humber

01226 433604 / 07825 906159Rebecca.Campbell@barnsleypct.nhs.uk

http://www.yhscg.nhs.uk/renal-network.htm

Any questions or comments?

Home Therapies: Reading update

e-seminar

30th April 2012

Leo Bailey

Renal Matron

Royal Berkshire Foundation Trust

Home Therapies ProjectRoyal Berkshire Foundation Trust

NHS Kidney CareLeo Bailey

Dr LC BarkerBarbara Dollery, Michele Ismay, Angela Clarke

April 2012

Presentation title here

21

Background- Initial submission at launch of the NHS Kidney Care project - First meeting of 3 centres in June 2011- Joint submission with funding shared by Reading, Oxford and

Portsmouth- Problem of lack of stakeholder engagement in original objectives- Objectives of 3 units related but differed in outcome. Presented

problems in clarity- Project lead role change - Project not progressing – new direction needed Dec 2012

Presentation title here

22

- April 2012 - Funding equally divided between the 3 centres- Revised Project Profile submitted- Agreed way forward with the 3 centres- New lead and project team at RBFT- Simplified and clear set of outcomes/goals identified- Complements work already being done at RBFT in aAPD and

HHD within ‘Home Therapies Team’- Project close now set at December 2012 with a clear timeline

Where are we now?

Presentation title here

23

Project Objectives- To offer an expanded and sustainable full range of home RRT

therapies- Increase the number of patients on aAPD (10) and HHD (5 with

funding for 7)- Increase aAPD by expansion of HCA hours- Deliver education and training to patients at off-site facilities in satellite

units - Embed the culture of services ‘Closer to home’ with patients and staff- Promote patient involvement in making informed choices- Widen the training and increase staff/MDT awareness- Produce a full and varied range of educational material (including

making own DVD)

Home Therapies: West Midlands update

e-seminar

30th April 2012

Mandeep Jagpal

Commissioning Projects Manager for Renal Services

West Midlands Kidney Network

West Midlands Home Therapies

Mandeep Jagpal

Develop a regional service to improve access and facilitate the development of Home Therapies

◦ Increasing patient numbers for home dialysis

◦ Shared decision making

◦ Review and Improve Education

Background

Worked with renal units to develop a service Home Therapies service specification

Communications issued and started discussions re. procurement routes with units

Identified work groups to push forward the work within the units and scheduled meetings to kick start the process

Establish working relationship with the HIEC to review education programmes

The Beginning

Health Trust Europe (HTE) ◦ Specification developed for tender◦ 5 Units engaged and ready to go◦ Procurement Specialist Lead

Issues◦ Gaps in specification◦ No Patient Representatives

However…

Working closely with HTE◦ Restricted procurement ◦ Evaluations◦ Patient Rep◦ Gap analysis of specs ◦ Framework Contract Award envisaged May 2012 ◦ WMRN liaised and recruited and additional unit with 2 others interested

SDM – AQuA programme ◦ First meeting in May ◦ Working with Clinical teams to encourage patients to be involved in

choosing appropriate treatment and mgt options

HIEC◦ work underway with 3 demonstrator sites, we await further update

Achievements

Procurement award in May

Transfer of c.10-20 patients (Excl figures from latter unit)

Obtain an update from HIEC

AQuA meeting in May to kick start the SDM project

Moving Forward…

Mandeep JagpalWest Midlands Commissioning Projects

Manager for Renal ServicesTel:    0121 695 2525

Email: mandeep.jagpal@wmsc.nhs.uk

Further Information

Home Therapies: Brighton and Sussex

updatee-seminar

30th April 2012

Cristina Osorio

Matron for Renal and Imaging

Brighton and Sussex University Hospitals NHS Trust

Improving Choice e-seminarCristina Osorio

Sussex Kidney Unit30th of April 2012

Home Therapies : Improving Choice e-seminar

Sussex : April Update

• Modular Programme has enabled patient discharge with recall to finish specific module, i.e. buttonhole cannulation after access matured

• 5 days / week short training sessions, proving popular with patients and staff

• Staff cross-training will take on a more formal structure, starting 1st of May with and update on buttonhole cannulation

• Patient survey agreed and being rolled out in 1st week of May. It invites follow up on carer and peer support.

• Focus on patient recruitment into home dialysis

Improving Choice in Sussex Continuing development

• Expert patient groups and 21st century network

• Further enablement of informed choice for patients and relatives

Home Therapies: St Helier update

e-seminar

30th April 2012

Ginny Quan

Consultant Nephrologist

St Helier Hospital

Initially:•self care based and homehaemodialysis training based around one satellite unit •The option for homehaemodialysis rarely discussed once patients start dialysis•pd discussed with most pre-dialysis patients but not homehaemodialysis

Aim: To ensure equal access for all our patients to home based therapies To increase the number of home haemodialysis patients so all patients who want to dialyse at home can do so.

Home Therapies At St Helier

Patients on homehaemodialysis patientsApril 2012

year No of home hd

Leaving home hd

total

2007 1 12008 1 22009 4 62010 7 132011 6 -2 172012 4 -1 20

Patients training for home haemodialysis April 2012

• Currently 3 training due home May, June and July

• Currently 5 referred for training and assessed as suitable 3 predialysis, 1 awaiting fistula, 1 waiting home conversion

• 4 patients on dialysis awaiting assessment

Expansion of home haemodialysis, improving choice at St Helier

What have we asked NHS Kidney care for?

• Development of the DVD to educate both pre-dialysis and current dialysis patients in home therapies – Carry out workshops/roadshows promoting home therapies in the

satellite units to engage both staff and patients• Update our homehaemodialysis protocols• Funding to improve the efficiency of our home haemodialysis nurses

– Centrifuges• Funding to help with the safety of homehaemodialysis patients

especially solo patients– Enuresis alarm

• Funding to help with the buttonholing program– Doppler and bioplugs

What have we done ?

• DVD filmed! first cut delivered this morning• Doppler purchased, first training day completed and date

identified for 7 further dialysis nurses to train• Bioplugs and needles purchased and in use• Enuresis alarms purchased-one training patient

expressing an interest in nocturnal haemodialysis • Sessions for our expert buttonholers set up to train other

nurses in the technique

What have we not done ?

• Still need to update our protocols and written material

• Roadshows for self care and promotion of home therapies hope to start in May/June

• Given up on centrifuge purchase

Main issue is home haemodialysis nurse time

Evaluation update

Home Therapies Project Lead e-seminar

30th April 2012

Clare Beard

Programme Lead,

NHS Kidney Care

To ensure consistency and allow NHS Kidney Care to make an overall assessment of the impact of each/all of the Improving Choice projects it is proposed that a list of measures which, with the agreement of project groups, can be collected at least twice within a six month period by each of the kidney units involved and included as part of the evaluation from each project in their final report.

Evaluation aim:

Data measuresPercentage of patients undertaking at least one aspect of self-care.

Percentage of patients in hospital and satellite units dialysing independent of nursing support.Percentage of haemodialysis patients with established button hole access.

Number of Improving Choice training sessions / courses planned for staff before the end of February 2012.

Percentage of staff who will have completed Improving Choice training by the end of October 2011.

Percentage of planned start patients who have had an opportunity to discuss dialysis options.

Percentage of un-planned start patients who have had an opportunity to discuss dialysis optionsNumber of patients about to start dialysis identified for home dialysis / self-care training in the last 4 monthsNumber of patients about to start dialysis who have completed or are in home dialysis / self-care training over the last 4 monthsPercentage of patients dialysing at home.

Patient satisfaction survey use.

Baseline data

Measure West Midlands (RWH) Yorkshire & Humber (Sheffield and York)

B&H St Helier

RBFT OUH Portsmouth

% of haemodialysis patients undertaking at least one aspect of self care

5% (HEFT: 6.8%)

87.5% 10% 15%

% of patients on in-centre/satellite haemodialysis who are independent of nursing support

0.3% (HEFT: 1.4%)

0% 5% <1%

% of patients on haemodialysis with a functioning AVF/AVG who are using button-hole technique

10% (West Midlands range 3-28%)

9% 6% 5%

% of planned start patients who have had the opportunity to discuss dialysis options

100% Not collected 100% 97%

% of unplanned start patients who have had the opportunity to discuss dialysis options

100% Not collected 100% 45%

Number of patients about to start dialysis identified for home dialysis/self care in the last 4 months

36 (6HHD 30 PD) Counselled but some may be longer than 4 months ago

15

6 2

Number of patients about to start dialysis who have completed or are in home dialysis/self care training in the last 4 months

1 HHD 7 PD

5 8 1

% of patients dialysing at home (CAPD & home haemodialysis)

27% (HEFT: 15%)

21% 10% 15%

Project Assurance update

Home Therapies Project Lead e-seminar

30th April 2012

Clare Beard

Programme Lead,

NHS Kidney Care

March monthly reporting

Risks:• Maternity leave• Need to agree project mandates

Key learning:• Need to develop joint working across network• Positive patient feedback• Stakeholder engagement

Communications update

Home Therapies Project Lead e-seminar

30th April 2012

Clare Beard

Programme Lead,

NHS Kidney Care

Communications

• BRS poster

• Ideas for future external e-seminars and how to guides

• Future events

Peer support

Making peer support work for your patients e-seminar

Wednesday 23rd May, 12.00-13.30

Register via NHS Kidney Care website

Key links

• NHS Kidney Care website:http://www.kidneycare.nhs.uk/Default.aspx

• Home therapies project lead forum:http://www.networks.nhs.uk/nhs-networks/improving-choice-for-kidney-patients-learning