british columbia updates - bc renal agency. bc provincial … · 2016 (n=3249) % dialysis patients...
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British Columbia updates
Presented by:
Dr. Suneet Singh & Sushila Saunders
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Introduction
Current stats in BC
PD assist in BC
Accomplishments this year
Areas of focus
Facing our challenges
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# PD Patients in BC: Years 2012-16
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
0
100
200
300
400
500
600
700
800
900
2012(n=3064)
2013(n=3109)
2014(n=3036)
2015(n=3072)
2016(n=3249)
% Dialysis Patients on PD #
Dial
ysis
Pat
ient
s on
PD
CAPD APD %PD
# Pts on Dialysis:
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BC PD Program Activity in Year 2016
36
21 29 31
24
34 34 32 24
37 30
24
-21 -22 -31
-24
-35 -27 -24
-31 -34 -28
-32 -25
-40-30-20-10
010203040
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
# Pa
tient
s
New PD Pts
# PD Patients on Jan 1 2016: 802 # PD Patients on Dec 31 2016: 833
Net plus of 31 patients (22 first-time start on PD, 9 returning to PD from Transplant)
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BC Annual PD Attrition Rates
050
100150200250300350400450
2012 2013 2014 2015 2016
# PD
Exi
ts/1
000
PD
patie
nt-y
ear
All Reasons
Death
Transplant
TechniqueFailure
All Reasons 21 22 23 23 26 Death 26 26 24 32 30 Transplant 24 29.5 30 25 29.5 Technique Failure 13 14 19 14 22
Median Months on PD:
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Catheter Insertion (Bedside vs. Surgical)
50 54 56 50 45 41
50 46 44 50 55 59
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014 JAN-JUN
(n=193)
2014 JUL-DEC
(n=158)
2015 JAN-JUN
(n=209)
2015 JUL-DEC
(n=204)
2016 JAN-JUN
(n=196)
2016 JUL-DEC
(n=192)
% P
atie
nts
Bedside
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BC Peritonitis Rate
0.200.210.220.230.240.250.260.270.280.290.30
# Pe
riton
itis
Epis
odes
/Pat
ient
-Yea
r on
PD
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PD assist provincial rollout
As of Feb, 2017, two Health authorities accepting patients for long term or respite PDA • St Pauls: 5 long term • VGH: 6 long term, 1 respite • RCH: 11 long term • ARHCC: 5 long term, 1 respite
Rollout will continue in a phased approach by each HA. External service provider contracted to provide PD assist is Nurse Next Door.
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Patient education
PD patient training modules- online, self paced training modules to supplement patient education provided by programs
access via BCPRA website
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Provincial renal TB screening BC renal programs routinely screen all incident dialysis patients for TB TB screening questionnaire, Chest xray Interferon Gamma Release Assay (IGRA) blood test (high specificity and sensitive, effective test in immunocompromised populations) Since March 1, 2016
116 PD patients screened 8 reactive IGRA
TB screening guidelines for PD programs – BCPRA website
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Provincial standardized PD nursing procedures
The PD RN group leading the work of developing provincial standardized PD nursing procedures: Completed to date: Capping a PD catheter (1) Flushing a PD catheter (3) Exit site procedures (7) Invasive procedures (2) PD Leaks (3)
Development of 10 procedures planned for the next year.
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Educational achievements Completion of the British Columbia Institute of
Technology NSNN 7425- Advance PD nursing course Mohammed
Alhaj-hassan Chelsea Bruce Melanie Campbell
Annick Couture
Wendy Harasimiuk Jane Meyer
Margie Kensah
Monique LeBlanc
Anne Schmuck
Kimiko Simpson Karen Walkey
Shelbi Wong
Breanne Crowell Lana Howe Cassandra Ma
Julia Shaefer Bonnie Vaughan
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Accomplishments
Publications Bevilacqua MU, Turnbull L, Saunders S, Er L, Chiu H, Hill P, et al. Evaluation of a 12-month pilot of long-term and temporary assisted peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial. 2016 Dec 1;
Submitted for publication
The Value of Patient and Provider Reported Experiences in Evaluating Home-Based Assisted Peritoneal Dialysis. Micheli U. Bevilacqua, Helen Chiu, Sushila Saunders, Linda Turnbull, Paul A. Taylor, Rajinder S. Singh, and Vincent Salyers
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Challenges and moving to solutions
Identified in 2016 Outcomes/Updates
Equitable PD catheter access services for all patients in BC Assessment of new technologies
• Advocating at the provincial level for mandatory surgical PD catheter procedures wait times targets for each HA
Evaluation of new PD cyclers
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Challenges and moving to solutions
Identified in 2016 Outcomes/Updates
PD programs- changing nursing workforce (retirements, new hires) , transitions to and from PD programs etc.
• Developing best practices
guidelines for PD programs- a structured approach to PD care will contribute to quality outcomes in BC
• Transition to and from PD
support tools for patients and programs
• BCPRA sponsoring tuition for
new or current PD nurses to complete BCIT NSNN advanced PD online course
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Areas of Focus for 2017-2018
Best practices guidelines for PD programs in BC
Transition to PD- support tools for staff and patients
Remote and rural community PD support tool
ISPD 2018
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Thank you to all BC PD colleagues for their hard work
and efforts this year!