P190
MOVING FORWARD WITH CHANGES IN PRACTICE THROUGH A
MULTIDISCIPLINARY RENAL DEVELOPMENTS MEETING
Lynn Ridley and Louise Wells on behalf of the Multidisciplinary Renal Team
(MDT), York Hospital NHS Foundation Trust, York.
INTRODUCTION: Our renal unit opened in January 1999. During the last 14 years
the unit has expanded, opened two satellite units, a self care unit and runs outpatients
services at various healthcare settings across our locality. As the service has grown the
time available for discussing the detail of new developments at the Directorate meetings
or Senior MDT meetings have become more dilute due to other service priorities. It
was agreed that a new monthly meeting would be set up to provide an opportunity to
discuss and implement service improvements through a meeting structured for this
purpose.
METHODS: A specific time and venue was agreed for a 1 hour monthly meeting. The
first meeting discussed commitment expected from the MDT, numbers and
representation to ensure the meeting was quorate, who was going to chair meetings and
take minutes. Requests for agenda items were circulated the week before the meeting
was scheduled. The initial agenda items originated from new work looking at changes
in practice, patient safety alerts, root cause analysis investigation into sepsis associated
with dialysis lines, changes in practice following audit presentations, or updating
current practice in line with new guidance and cost pressures.
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RESULTS: It was agreed that to be quorate the meeting needed a minimum of one
renal consultant, one specialist nurse and two other members of the MDT e.g. dietician,
pharmacist, or social worker. The meeting was chaired by a member of the MDT (but
not a Consultant). We had three or four meetings initially where we were establishing
the ground rules and gaining an appreciation the types of work to bring to the group for
discussion, review or approval.
The table below lists some of the completed work:
MRSA/MSSA screening
guidance
Advice on chlorhexidine
allergies
New ways of establishing
buttonhole access
PD Peritonitis Pathway
and standard prescription
charts
Opioid patient information
leaflet
Line insertion pathways targeted
at MRSA/MSSA prevention
EMLA cream information for
patients
Parathyroidectomy leaflets
Fistula Bleeding packs for
patients
Fistula cleaning guidance
MRSA/MSSA prevention
PGD
Haemodialysis specific
prescription charts
Review of hypertension
management
Management of
hypoglycaemia in dialysis
patients
Living with Kidney Failure
Leaflet review
CONCLUSION: Over the last 18 months the developments group has continued to
work together and take forward changes to the renal service in a structured setting.
With some of the work we have started to introduce the concepts of quality
improvement using the Plan, Do, Study and Act (PDSA) methodology. Feedback from
all staff involved has been positive and the monthly meetings continue as a forum for
service improvement and development.