P153
Improving Regional Paediatric Dietetic Care for Children with Chronic Kidney Disease
Trace, S, Inward, C
Bristol Royal Hospital for Children
Background: Following on from the Kennedy report, ‘Achieving Equity and Excellence for Children’ 2010
(1) , proposed that ‘In successful networks of care built around specialist children’s hospitals, children will receive the best possible quality of care as close to where they live as possible. ’ However, was a regional renal paediatric dietetic service equipped to deliver on relevant recommendations outlined in this report? Was access to appropriately trained dietitians indeed equitable and was knowledge sufficient to support shared care?
Method : A questionnaire was sent to paediatric dietitians in 11 regional shared care units within a large geographical area of the UK. Dietitians were asked to rate their confidence in assessing and advising children and carers on 8 different aspects of renal nutrition. 11 responses were received from dietitians in 9 units.
Using a score of 1-5, with 1 being least confident and 5 most confident, the average score was just 2.
Dietitians in 8/9 units did not feel adequately trained and 8/9 units had no paediatric specific renal resources.
Many were unaware of the outreach clinic in their unit and were not receiving local referrals. All were willing to take up training.
All children in Chronic Kidney Disease stage 3-5d should be seen by a dietitian (2) , ideally many children in
CKD 3-4 should have as much local care as possible. Therefore it was clear that action needed to be taken to meet recommendations in the Kennedy report (1) . Following on from the questionnaire results the regional specialist paediatric dietitian for Nephrology (SPDn) developed a project to create a renal paediatric dietetic training package, guidelines and patient resources. Eight nutrition guidelines covering assessment and renal diets were written to accompany a pre-existing guideline on growth monitoring. Accompanying patient information was developed. These formed the basis of the training pack. Resources were reviewed by multiprofessional colleagues both nationally and in the specialist centre and by parents or older children. To maximise uptake of training the SPDn travelled across the region to deliver short training sessions around the guidelines and effective networked care, resulting in 17 regional paediatric dietitans being trained and all specialist and general paediatric consultants being informed of the project. The training was evaluated and responses were received from 10/11 units. A post training questionnaire was given and again dietitians were asked to rate their confidence using the same self-assessed score. They were not only asked about their ability to assess and advise on renal diets but also their understanding around the regional network and effective shared care and where in the CKD 1-5 spectrum that their help would be most needed.
Results : The guidelines, resource and training package has improved dietitians self-assessed confidence and understanding by 30-250% (average 122%). Appropriate regional patient information is now available in
100% of units, which improves consistency for those patients being seen by different dietitians in both their local hospital and the specialist centre. The training has since been followed up by a regional dietetic study afternoon attended by 12 dietitians. There are plans to hold training updates annually and ensure competencies are maintained and to evaluate the long term effect on the package on care and quality for patients
References;
1.
Kennedy I, ‘Achieving Equity and Excellence for Children’ 2010. Department of Health. www.gov.uk/government/publications/achieving-equity-and-excellence-for-children .
2.
Improving the standard of care of children with kidney disease through paediatric nephrology networks
August 2011.Royal College of Paediatrics and Child Health and NHS Kidney care. www.rcpch.ac.uk/networks
With thanks to the British Kidney Patients Foundation for funding this project.