O47
IMPROVING NURSING CARE AND SURVEILLANCE FOR HAEMODIALYSIS PATIENTS WITH
DIABETES
Cabada J, Fielding C, Muigai M, Taal, M
Renal Dialysis Unit, Derby Hospitals NHS Foundation Trust
PROBLEM: Dialysis patients with diabetes have considerably poorer outcomes in comparison to those dialysis
patients without diabetes. As well as the challenge of renal care, they have a number of ‘extra’ complications
related to their diabetes, as well as the complex effect of dialysis on diabetes management. The DOPPS study
(McIntyre et al, 2008) associated good surveillance practices with better mortality rates for dialysis patients with
diabetes. However, poor compliance with diabetes surveillance often occurs in dialysis patients. The burden of
both dialysis and diabetes treatments and the lack of flexibility of access to services, contributes towards this.
PURPOSE: We decided to clarify and review the care and complications our haemodialysis patients with
diabetes were experiencing, as we felt that our diabetes care could be improved. We developed a strategy, in
conjunction with the diabetes specialist team, which defined the desired the management of our dialysis patients
with diabetes.
DESIGN: Our strategy for diabetes management aimed to incorporate many of the surveillance aspects identified
in the DOPPS study (McIntyre et al, 2008), such as frequency of Hba1c monitoring and foot checks, as well as
other areas identified in the joint renal diabetes meetings. This strategy was implemented by a team of diabetic
link nurses within the haemodialysis unit nursing team. During the year of implementation, we audited the
frequency of Hba1c monitoring and the number of referrals to the diabetes team to monitor the impact of the
strategy.
FINDINGS: The results of the audit found that the identified frequency of 3 monthly Hba1c monitoring was
achieved in 88% (52/59) of patients during the implementation year (2011), compared to 51% (30/59) in the year
prior to implementation (2010). In the implementation year, we referred 11 patients to the foot clinic due to
identified foot problems; 10 patients to community diabetes teams to assist with glycaemic control; 30 patients to
the hospital specialist diabetes service to assist with glycaemic control. Some referrals facilitated the review of
these patients by the diabetes team whilst the patient was present for their haemodialysis treatment.
CONCLUSION: The improvement in the provision of nursing support for our haemodialysis patients with
diabetes has shown an improvement in their surveillance, leading to prompt and effective referral of these
patients. This has been provided in a way that has aimed to reduce the burden of treatment for our patients. This
strategy has since been expanded to support our peritoneal dialysis patients with diabetes.
RELEVANCE: This strategy, which outlines the management of dialysis patients with diabetes, aims to ensure
we detect complications early, allowing effective referral and treatment. This has led to better communication
between the diabetes and renal teams, as well as easier, better access for dialysis patients to diabetes services. This
ultimately hopes to improve outcomes for our dialysis patients with diabetes.
References: McIntyre N., Thumma J., Fluck R., Greenwood R., Rayner H., King J., Robinson B., Pisoni R., and
Ramirez S. ‘Haemodialysis Facility Failure to Deliver Optimal Diabetic Care to Diabetic Haemodialysis Patients
is Associated with Increased Mortality: An International Picture from DOPPS III’ in 37th. EDTNA/ERCA
International Conference: Improving the quality of renal care in Europe: building a bridge between theory and
practice: Abstract Book p.39 Abstract No. O28. 2008.