P85
DEVELOPMENT OF A CKD PATIENT PATHWAY TO ENSURE ACCESS TO THE
RIGHT RENAL REPLACEMENT THERAPY (RRT) AT THE RIGHT TIME.
Beverley Worley, Rachel Anson, Diana Palmer, Pamela Dallyn, Buckfield Dialysis Unit, Royal
Sussex County Hospital, Toots Ansell, Baxter Healthcare.
The Renal Unit amalgamated their PD and HHD teams to form a Home Therapies (HT) team
during 2010. All CKD patients who opt for dialysis at home are managed by this team of
specialist nurses. It was decided to develop a new patient pathway which would ensure all
patients are given education in a timely manner with equal access to RRT dependent upon
suitability whilst incorporating the new structure.
It was proposed that the pathway would ensure all patients are educated initially by the
Advanced Kidney Care (AKC) team, counselled to choose between Home or Hospital then
further educated by the specialist nurses in their chosen area. It was considered important to
give patients who join at different junctures equal information and allow for patients who start
dialysis in an unplanned way. The pathway should be simple, flexible and accepted by the
multi-disciplinary team in order to enhance the patient experience along their journey.
A Project team was formed with two members of the AKC team, two members of the HT team
and support from the Clinical Consultant at Baxter. A literature search together with an email
request to other units produced a selection of pre-existing pathways for the Project team to
examine and decide the format that would work best within their unit. The team scrutinised the
NICE CKD pathway, NHS Kidney care commissioning pathway, NKF Home Dialysis
Manifesto and the Dialysis Specifications for commissioning from NHS England so that the
pathway conformed to best practice guidelines. A brainstorming session helped to identify
essential inclusions together with potential bottlenecks and barriers, and each team member
produced their “ideal” pathway.
It was identified that some decisions were being made regarding the patient based on
insufficient background psycho/social & economic information. The team decided to develop a
patient profile questionnaire that could be completed at the first AKC clinic appointment by the
patient and then discussed with the AKC nurse. This profile will work in partnership with the
pathway to ensure that value judgements are not made about the patients circumstances and to
give a valuable insight into the patients understanding of their condition and its implication.
The 4 versions of the pathway produced by the team had few variations making the formulation
of the final version straightforward. A 2nd pathway was developed for patients who had chosen
a home therapy to map their journey. This included a home visit from one of the HT nurses and
more education before a decision is made between the 2 therapies.
The final version of the pathways and patient profile were presented to the Renal RSCH Clinical
Governance committee for approval before being rolled out to the full multidisciplinary team.
Currently the units take on rate for incident patients to Home Therapies is approximately 25%
and the aim is to increase this by 10% to 35% by the end of 2014. The Project Team believe that
introduction of the pathway will result in improved patient outcomes, ensure that patients get
the right treatment at the right time, encourage growth in home therapies and reduce drop off
from therapy thus improving the patient experience.