Yorkshire & the Humber Programme for Shared Haemodialysis Care

Renal Strategy GroupYorkshire and the Humber

Preventing people from dying prematurely

Enhancing quality of life for people with long-term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Effectiveness

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Patient experience

Safety

The framework will be organised around 5 national outcome goals / domains covering the breadth of NHS activity

How EFFECTIVE the care provided by the NHS isWhat the patient EXPERIENCE is likeHow SAFE the care provided is

These will help the public and Secretary of State for Health to track:

The NHS Outcomes Framework will set direction and provide enhanced accountability

Engaged empowered

patient

Organised proactive

system

Partnership

= Better outcomes

Confirmation of the Evidence base Management of all long term conditions

Standards of conduct, performance and ethics for nurses and midwives

• You must support people in caring for themselves to improve and maintain their health

• You must recognise and respect the contribution that people make to their own care and wellbeing

General Medical Council : Duties of the doctor • Give patients information in a way they can understand • Respect the rights of patients to be fully involved in

decisions about their care

The current situation

• At present patients receiving haemodialysis either have it at home, where the patient self cares, or in the hospital where nurses deliver treatment and, in general, the patient is the passive recipient.

• This may be because of an incorrect assumption about how much patients are able to do for themselves. It might also be because in busy units involvement from patients is discouraged as it is perceived to slow “the throughput”.

Why change?

• Patients who contribute to their own treatment are likely to feel empowered by the process.

• Patients who have become more involved in aspects of their care have described a greater sense of control and feeling more positive about their treatment.

• The experience may also lead patients to request that they are considered for home haemodialysis.

Expected benefits

• Effectiveness – eg enhanced care interaction• Efficiency – eg nurses being involved as problem

solvers and trainers• Patient centredness – becoming empowered

through the experience of self-care• Equity – access to self-care in the hospital• Safety – greater patient understanding• Timeliness – no need to wait for tasks to be

done

What we propose.

• We plan to initiate self-care haemodialysis at the dialysis centres across Yorkshire and Humber.

• We will to this by – – Setting up a course to teach dialysis nurses how to

support patient to learn aspects of their own dialysis.

– Supporting willing patients to learn as much of their own dialysis as they wish to.

Training the trainers course

Sharing the care in haemodialysis

QI

Comm

unications

Qualitative evaluation

Health econom

ic evaluation

QI

QI

QI

QI

QI

Expected benefits

• Effectiveness – eg enhanced care interaction• Efficiency – eg nurses being involved as problem

solvers and trainers• Patient centredness – becoming empowered

through the experience of self-care• Equity – access to self-care in the hospital• Safety – greater patient understanding• Timeliness – no need to wait for tasks to be

done

Training the trainers

Training nurses in the skill necessary to facilitate and support patients who want to learn more about their own treatment

A programme of continuing education is required to strengthen resilience across the team, this will be embedded in the Closing the Gap Project.

Tell me, I’ll forget

Show me, I’ll remember

Involve me, I’ll understand

Self care task categoriesObservations

Infection controlAccess including needlingPrescription management

Running dialysisAlarms and safety

Setting up and stripping downWaste disposal

Quality Improvement MeasuresOutcome Measures - Number (%) of patients performing observationsNumber (%) of patients able to establish accessNumber (%) of patients able to line & prime machine

(alternative – set-up pack)% of staff involved in the programmeProcess Measures -Number (%) of Staff who are enrolled on the courseNumber (%) of Staff who have completed the courseNumber (%) of patients who have registered an interest /

enrolled/ agreed to/ expressed an interest in the programme

Balancing Measure

To monitor whether performance in other important areas is getting worse whilst efforts are concentrating on the project - want to ensure that these are maintained or even improved

A measure of staff & patient experience/ mood using a monthly 'satisfaction poll' along the following lines:

"How has the Shared Haemodialysis Care Programme affected your treatment (alternatives: experience/ care) today?"

Please Mark along the following line:

Most Postive Most Negative

Stakeholder communication & engagement group

Advise project on anticipated cultural changeOversee actions outlined in the equality impact assessmentDevelopment and implementation of Communication StrategyEnsure appropriate stakeholder engagement, including the

development of staff & patient forums at each unitEnsure wider patient & public involvementSupport development of ‘promotional’ materials, including

newsletters, posters, presentations, leaflets and written reports

Development of logos and brandingIssues relating to intellectual property

Qualitative evaluation• A pilot study - to capture the experience

through directed interviews with patients and staff

Health economic evaluation• To demonstrate improved care at the same

cost• Pilot service evaluation based on –

– Time task study– Hospitalisation and safety reports.

Potential barriers

• Lack of patient and staff buy-in into the process• Lack of motivation and inertia from staff and

patients.• Clinical risk problems relating to patients being

involved in the process of care• Nervousness from patients• Language barriers• Increased time on the dialysis unit required – leading

to problems with dialysis scheduling and capacity.

Posts to support the program

• 2 nurse clinical educators• Project manager• Clinical champions• A team of enthusiastic patients, carers, and

health care professionals

Timeline

• Set-up phase : Jan – Jun 2011• Phase 1 : Sheffield and York from Jul 2011• Phase 2 : Leeds, Bradford, Hull and Doncaster

from Jul 2012.

• By summer 2013 our aim is that 1400 of 1800 unit based dialysis patients across Y & H will have some involvement in their own care.

This project is supported by - Heath Foundation - £400 000 NHS Kidney Care - £50 000

and the enthusiasm of patients, carers and health care personnel

Group discussions

• Nurse training course design – Christine Stubbs, nurse lead– Andy Henwood, patient lead

• Sharing the learning – Stephen Boocock, patient lead

• Measuring success – Jackie Parr, commissioning lead

• Making sense of patient and staff experience – Liz Glidewell, research lead