What about self care dialysis?
Self Care Methodology
• develop self-care scoring system
• survey staff and patients to find out:
• what are patients doing now?
• what are patients capable of doing?
• what are patients interested in doing?
• what can we do to support self-care?
14 point self-care scoring system
• take weight
• clean arm
• take blood pressure
• insert needles
• take temperature
• connect tubing to lines
• run fluids through
machine
• rectify machine alarms
• attach tubing and
dialyser
• prepare syringes
• set HD prescription
• remove needles
• strip and wash machine
• clean up table and chair
What is self-care?
• patients performing routine tasks when attending
dialysis:
• take weight and blood pressure
• line the machine
• set dialysis prescription
• needle fistula
• self-care is a subset of self-management
• a fully self-caring patient is able to dialyse without
assistance
Why support self-care?
• self-caring patients:
• feel more independent, confident and in control
• spend less time waiting
• have more flexibility around treatment type and
location
More than 70% self-care to some extent
(do at least one task)
CURRENT SELF-CARE SCORES
30%
25%
20%
15%
10%
5%
0%
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Half are interested in doing more
ARE YOU INTERESTED IN LEARNING TO DO MORE?
100%
90%
80%
70%
60%
No
50%
40%
30%
20%
10%
0%
ALL
GSTT
KCH
Yes
On average, patients are interested in
doing twice as much as they do now
AVERAGE SELF-CARE SCORES
14
12
10
Interested in
learning
8
6
Doing now
4
2
0
ALL
GSTT
KCH
Attributes for fully self-caring patients
• fixed:
• manual dexterity

• vision

• ability to understand and follow sequential
tasks

• variable:
• courage-confidence
• motivation
• self-care score of 5 or more = high self-carer
Do self-care levels and interest vary or
is it the staff?
AVERAGE SELF-CARE SCORES
14
12
10
Interested in
learning
8
6
4
Doing now
2
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ic
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y
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oo
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on
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id
U
ai
n
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nd
M
ge
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t
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om
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ng
's
Ki
es
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ill
or
Fo
r
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o
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h
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ul
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ich
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t fo
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Bo
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0
There is significant unrealised selfcare potential
• 15% of patients are high self-carers
• a further 30% are interested in being high selfcarers
• (at least) half of these are capable of becoming
high self-carers
Supporting self-care in interested
patients would significantly change the
patient profile
CURRENT & ASPIRATIONAL SELF-CARE SCORES
30%
25%
20%
Doing now
15%
Aspirational
10%
5%
0%
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Many barriers to self-care are within
our influence
Identified Barriers to Increased Self-Caring
Physical disability
70%
Poor vision
60%
50%
Frailty
40%
Lack of interest
30%
Language issues
20%
Learning difficulty
10%
Training
0%
UNIT 1
UNIT 2
UNIT 3
UNIT 4
UNIT 5
UNIT 6
Self-care levels and interest are
linked
AVERAGE ASPIRATIONAL SELF-CARE SCORES
14
ASPIRATIONAL SELF-CARE SCORE
13
12
11
10
9
8
7
6
5
4
3
2
1
0
0
1
2
3
4
5
6
7
8
9
CURRENT SELF-CARE SCORE
10
11
12
13
14
Realising the potential
• continue to promote understanding of self-care
• support staff and patients
• training material
• training goals and measurement
• peer support
• mainstream practices
Progress
50
40
30
20
10
0
New ly independent patients per
month
Month
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Cumulative independent patients
Jan
Number
Dialysing Independently
Dialysis Self-Care project progress
600
Patients approached for discussion
500
400
Completed SC
300
Currently undergoing SC training
200
Unable to SC
Declined SC
100
0
Jan
Mar
May
2006
Jul
Sep
Nov
Jan
Mar
2007
• Currently at 8% self-caring in dialysis units
• Target is 20%
• 1:4 nurse to patient ratio. Need to have at least 4 self-caring
patients on each shift to reduce grade of staff.
Why is this important?
• Quality for patients
• Identical capital cost
• Reduced nursing cost
Sample satellite dialysis costs:
£17,000 per patient per year (average)
SOURCES:
HEALTH TECHNOLOGY ASSESSMENT 2003 VOL. 7 NO. 2
GSTT ANNUAL REPORT 2004/2005
Premises
Consumables
Nursing
7143
6452
1250
Equipment
1117
261
720
Nursing is 38% of total cost
Patient transport
Water treatment
Good idea but is it goal too far?
This was for me!
The Lyon Experience
• Initial assessment
as whether patient is
for in patient dialysis
or autonomous
treatments
(PD,HHD, Self Care)
Autonomous unit
• 1 nurse for 8 patients.
• 1 for every 4 patients in ‘medicalised’
dialysis units.
• 73 new HD patients
– Tx 1
– Self 33
– Home 2
– Medicalised 37
Le programme REIN
http://www.agence-biomedecine.fr/article/142
Are there ways to enforce this?