P86
IMPROVING THE CO-ORDINATION OF TRANSPLANT WORK-UP – A SINGLE CENTRE
EXPERIENCE
Fothergill, S, Bedford, M
Kent & Canterbury Hospital
Problem: Our renal unit serves a catchment area of 1.25 million supported by 1 central and 5 satellite dialysis units with the transplant centre situated 60 miles away. We are responsible for: transplant work-up forliving donor and cadaveric transplants, education and support of patients and activating patients on to the waiting list across all modalities (haemodialysis, peritoneal dialysis, pre-dialysis). Until 2 years ago this work was un-coordinated with the data being captured in different places, different ways (electronically, patients notes) and sometimes not at all. This caused major issues when patients were called for a transplant as all the information was not centralised. This highlighted the need to develop a central accurate collation of data to enable timely activation in accordance with UK
Renal Association Guidelines (2011).
Purpose :To develop a single electronic system collating data across all modalities to record, continually monitor and review the progress of patient’s transplant work-up. To ensure patients across all modalities who are suitable for transplantation have been considered and commenced work up in a timely manner. To further develop the role of
Transplant Link Nurses in all modalities. In particular, to participate in on-going monitoring and assist medical staff with prompts when tests need renewing or there are delays in the work-up process .
Design: A password protected access database was created using information from the existing electronic renal database which enabled us to identify all patients who were suitable for transplantation. This was piloted for a six month period in 2012 using information from the pre-dialysis population (272 patients). As the nurses working in this area have responsibility for their own groups of patients they populated the database accordingly.The database was designed to have reminder alerts when tests were due for renewal, with the ability to runreports to identify specific outstanding tests. In addition an education programme for the link nurses in all other areas was introduced focusing on the use and relevance of the database.
Findings: The pilot was reviewed after 6 months and showed an improvement in the quality & quantity of data recorded. However, it highlighted that further work was needed to activate patients in a timelier manner. The overall success of this pilot led to the transplant work up database being rolled out across all modalities. To date 584 patient records populate the database. A further review in 2014 of the pre-dialysis patients showed an improvement in the number of patients with a recorded transplant status and up to date tests.The transplant link nurses now take more responsibility for the work-up of the patients and can monitor their own patient groups more closely. They liaise with medical colleagues and communicate with patients regarding any relevant tests due.
Conclusion: The introduction of this system has increased awareness of staff in all areas for the need to keep transplant work up information up to date and recorded in a consistent and accessible manner. This has improved communication between the medical team, nurses, transplanting centre and patients being worked up for a transplant.
There has been a shift in emphasis of treatment to prioritise transplant work up and an improvement in the number of patients who have an up to date transplant status.
Relevance: We are now able to centrally record and effectively monitor how timely our transplant work up is for patients across all modalities. This change in practice has resulted in standardisation of our approach to transplant work up.
Reference http://www.renal.org/pages/pages/guidelines/current/rrt.php