-1Hunter New England Health Service
Minutes of Renal Stream Meeting
DATE:
Thursday 6th June 2013
PRESENT:
Steve May, Jane Kerr, Catharine Death, Leanne O’Grady, Tina Straker, Peter Choi, Ginger Chu, Phil Way, John Landkauf,
Mary Allen, Tim Whyte, Merryl Finlayson, Karen Knutson, Phil Way
APOLOGIES:
Roz Everingham, Al Gillies, Julianne Oxley, Lorraine Thornton
TIME COMMENCED:
10.00am
TOPIC
2.1 Confirmation of
Previous Minutes
3.0 Matters Arising
from Previous
Meeting
3.1 Clinical Working
Party Update
TIME COMPLETED:
11.15am
MINUTES:
Belinda Cairns
DISCUSSION

RESPONSIBILITY
Previous minutes from April 2013 confirmed by John Landkauf.
Catherine Death – Reported that the Peritoneal Dialysis protocols had been updated with those tabled
today were ready for ratification.
6.1 Renal Peritoneal Dialysis Dialysate & System Collection
6.2 Renal Peritoneal Dialysis Extension Line change
6.3 Renal Peritoneal Dialysis Fresenius CAPD exchange (3 docs)
6.4 Renal Management of PD catheter extension line contamination
6.5 Renal Peritoneal Equilibration Test (PET) and 24 hour adequacy Test
6.6 Renal Fresenius Sleep Safe APD and temporary disconnection
6.7 Renal Specimen Collection of Peritoneal Dialysate Effluent
6.8 Renal Peritoneal Dialysis Catheter Acute post insertion exit site care
6.9 Renal Adding Medication to Peritoneal Dialysis Fluid
6.10 Renal Baxter Automated Peritoneal Dialysis and temporary disconnect
6.11 Renal Baxter Freeline Solo Continuous Ambulatory Peritoneal Dialysis
6.12 Renal Peritoneal Dialysis Catheter adapter replacement and management of a damaged catheter
6.13 Renal Peritoneal Dialysis Catheter Chronic Exit Site care
Renal Leadership agreed to ratify above protocols – will be sent for listing after discussion with
Sheryl Davis.
Catharine Death further discussed that three of the protocols were no longer required and could be
removed
HNEH GandP 10_03
HNEH GandP 10_07
HNEH GandP 10_12 (Will be turned into a local procedure for Tamworth)
Catharine Death also discussed three protocols needing further review by protocol group – these
include
K.Adams to liaise
with Sheryl Davis
1) Management of Exit site or tunnel Infection HNEH Gand10_38 – was missed in review process
2) Insertion of Medication Lock to a Peritoneal Dialysis Catheter HNEH GandP10_09
3) Management of Peritoneal Dialysis Related Peritonitis HNEH GandP10_36
Some discussion wether the north region required a separate protocol for peritonitis, Dr May felt that a
lot of doctors / staff in rural facilities may never have cared for a patient on peritoneal dialysis. General
discussion whether this could still be achieved in one protocol to avoid duplication
C. Death to
continue r/v and
present at next
meeting
Four other protocols were also tabled for stream ratification
6.14 Renal Virology screening for dialysis and plasmaphoresis patients
6.18 Renal Single Needle Double Pump
6.19 Renal Single Needle Click Clack
6.20 Renal: Hepatitis B Vaccination
Renal Leadership agreed to ratify above protocols – although Dr Choi asked for clarification on
available preparations for Hep B Vaccination which will be investigated and fed back to Dr Choi
prior to them being sent for listing on the intranet
New Working Party
Haemodialysis
Protocols
Kelly Adams will chair the Haemo Working Party. EOI were called for interested staff to nominate to be
part of group with a commitment to complete reviews within agreed timeframes. Good representation
from across the area from nursing staff. Mary Allen also nominated self at meeting to be part of same.
A sub group will also look at medication standing orders – Dr Choi volunteered to be part of same as
required.
3.2 Advanced Care
Planning Group
Update
Leanne O’Grady reported that the group had stalled and were awaiting the NSW renal group to
complete its work and subsequent recommendations before continuing. Dr Viliyar is working on this
party, Eswari will feedback to Leanne who will bring outcomes to the meeting as they become available
Leanne reported that Taree is trialling a flow chart as a quality project at Taree to see how it works.
Dr May reported that he was writing info in the Important decision tab on Transnet, K Adams reported
that this is also where it was recorded in her area.
3.3 Home Dialysis
Electrical Standards
Update
K Adams reported that Fresenius has come back and agreed to provide circuit breakers on APD
machines. Baxter have verbalised that they will but still awaiting official response -This brings in line
with part of management strategy for District for the electrical standard issue.
J Landkauf reported that the committee had been reconvened for the standard review but no further
information available
3.4 Inverell
Expansion
T Straker - Inverell has expanded from 4 to 6 stations. The next stage of expansion is to increase to a
second shift as this is needed due to patient numbers. Funding is the issue, however Armidale has
K.Adams to liaise
with Dr Choi
K.Adams to
provide update
L O’Grady to
report as updates
available
closed evening shift due to drop in numbers and Tina has proposed these funds could be redirected
Inverell to run the second required shift. Sharon Baker has escalated this at the beginning of this week
to Susan Heyman for discussion with relevant ELT members
Leadership group agreed that this was a good use of resources and while understanding reluctance of
hospitals to transfer budgets, felt that the above is the best solution. Agreed to send letter of support
from the Renal Stream Leadership group to Susan Heyman in support of the budget shift to Inverell.
K.Adams to draft
letter with T
Straker
3.5 Activity Based
Funding
No further activity. Kelly will feedback changes from the ACI meeting
3.6 Business
Continuity Plan
On hold till next meeting. Final versions will be tabled at next meeting
T Straker, C
Death, K Adams,
J Landkauf
3.7 Supportive Care
Evaluation
C. Death tabled evaluation report for the Supportive Care Pilot programme with St George – Project
was over last 3 years and funding has now come to an end. Sent to Ministry in April, no feedback as
yet. Tina to follow up with MOH to determine if further funding will be forthcoming
T Straker to report
next meeting
New Business
4.1 New member for
Renal Stream – Dr
Peter Choi.
Welcome to Dr Peter Choi, nominated by K Adams to join the Renal Leadership Group. Dr Choi joined
the JHH Nephrology team 6 months ago and has expressed a keen interest in joining the Renal Stream.
Leadership group agreed to nomination
4.2 Strategies for
caring for young
indigenous
persons.
Kaz Knutson – Was looking for strategies and to start a discussion on the care of our younger
indigenous renal patients. We seem to manage the older population well but struggle to maintain a
therapeutic relationship with younger patients e.g. Loose touch with Transplant and home dialysis
patients that become difficult to contact and miss appointments. Dr May discussed the Aboriginal liaison
officer role (Leanne Cutmore) and the benefit he gets from utilising the role, Catharine Death also
suggested the ICCAP committee to link in with programs that they offer. Kaz will invite Aboriginal
Liaison officer to the next renal team meeting in Taree. Recommended to invite the Aboriginal Liaison
Officer to meetings to discuss this.
4.3 EPO Micera
Funds
Steve May - Funding comes into hospital when prescribing Micera, Dr May has been in discussion with
Dr Trevillian in regards to same to look into utilising some of the funds for a clinical trials nurse. Dr May
ask that it is kept on the agenda.
4.4 Peritonitis
protocol
Discussed earlier in meeting
4.5 Transnet
Dr May - Issues with Transnet in regards to some areas where smart health was better, particularly with
the dialysis side i.e. prescription. Has been discussing same with Dr Trevillian who stated Transnet had
not been updated as requested, but were now coming to the table. Leave on the agenda.
4.6 Home Training
Tamworth
Dr May wanted to discuss why patients still required travel to a Metro hospital to be signed off for Home
Dialysis when the trainer in Tamworth had been ‘signed off’. Dr May stated that rural was being looked
at as incapable of training by the metro unit/staff and that this was not fair to the patients wanting to train
for home
K.Adams responded as the Manager for Home Training – a service level agreement was made to
establish an outreach home training unit at Tamworth utilising resources from the Wansey home training
unit, this was agreed to by all parties and one of the requirements was that the final week of training be
completed at the Wansey Centre. The main issue at the moment is the inexperience of the trainer at the
Tamworth unit where she has only trained one patient to this point in time and there were deficits
identified when this patient arrived at the Wansey Home training unit for his final week of training (that
even the patient identified). Home Haemodialysis is a high risk treatment with significant implications if
mistakes are made by the patient. The requirement for patients to attend the main unit is to benefit from
experienced staff evaluation and further training as required with patient safety being at the centre of
this decision. In response to metro versus rural and perception that rural is considered inferior - this has
never been an issue and K Adams tabled that the SLA was based on the SDC model which is used for
St George and Gosford units. Dr May agreed that safety should be at centre of process.
K. Adams stated in the future once the trainer has some broader experience then the model can be
revisited to utilise other options for those that can’t travel to Newcastle i.e. Telehealth /
videoconferencing.
T Whyte asked how this can be expedited so that patients don’t have to travel. K Adams responded that
the process won’t be rushed and will depend on assessment of the trainer’s skills and outcomes of
patient’s assessments at the main training unit when they are reviewed. At a minimum training of 5 or 6
patients over an 18 month to 2 year period when staff had more experience, however Kelly will not
commit to a golden number to achieve before changing model.
4.7 Clinical Lead –
Renal Stream
K Adams on behalf of Dr Gillies – Dr Gillies has asked that the group start thinking of a new Clinical
Leader as Dr Gillies is wanting to step down at the end of 2013. Phil Way stated that the process is that
the Exec Sponsor put out a formal EOI – group happy for Phil Way to follow this up with Susan and put
out in September.
5.1 Business
without notice
Jane Kerr
- Chronic Disease Network. Smoking cessation is main focus and progressing well with project looking
at education of staff. There will be greater access to smoking cessation services at least with greater
knowledge of what is available and better referral pathways. Feedback required in the future.
Phil Way to
organise formal
EOI
Phil Way
District has asked that any formal requests from the ACI for information, staff time for project work etc
must come through the CE and then fed down to network members if approved. Issues will be if the
requests don’t assist or not in line with the Districts strategic vision and/or meeting service agreement
with the MOH as that is what staff need to focus on during work time
th
Chronic disease network are required to present to the Acute GM meeting on the 24 June 2013. Jane
Kerr & Michael Hensley are representatives but the Renal Stream need to submit report. All agree that
Inverell would be a good thing to put forward to this meeting.
Catharine Death
New England have received funding from company to run a education day on indigenous health,
targeting management of indigenous people in the community, to be held at the end of July – will send
around a flyer for same
T Straker, K
Adams, C Death
to complete
C Death to send
flyer to other
areas
Leanne O’Grady
OT assessment - A pilot study was conducted for 3 months and they are hoping they will get funding for
an OT to come on board to cover LMNC renal service. Report was well written
John Landkauf
Vehicle for New England tech service – issue is for them to access an appropriate vehicle; J Landkauf
has been in discussion with the fleet Managers in Newcastle and New England to get an appropriate
vehicle in the fleet at Tamworth. JL has asked that a letter of support from the Stream will be helpful in
this issue. Stream agreed to write letter in support
Ginger Chu
Ginger attended an Area meeting Nursing and Midwifery Clinical Guidelines Reference Group and they
have asked to review procedures before we send them for upload. K Adams was unsure why they have
asked for this since the Renal Stream has delegated authority to approve own procedures but
suggested if they are to be involved, that they are consulted in the lead up to ratifying, as opposed to
after, to avoid hold ups and potential for need to be re tabled at the stream meeting
Merryl Finlayson
Gave a brief on the OT Home Assessment Tool utilised at Tamworth. The assessment tool originally
came from Newcastle and Merryl has further enhanced it with a manual. Merryl assesses all pre dialysis
patients and looks at what strengths and weaknesses that the patient has ~ Not a pass / fail system, but
how we can how assist / train the patient the best. Assessment has been shown to be indicative of who
will train well for PD and who will need longer training times and/or who will need more intense follow
up. Currently looking at trialling it with other units. Meryl stated that she is happy for others to utilise,
however emphasised the need for her to demonstrate prior to use, except for those Newcastle staff that
K Adams J
Landkauf to draft
letter
K Adams to follow
up with Sheryl
Davies
developed & utilised the original version.
Next Meeting
Date: 1st August, 2013
Time: 10.00 – 11.30
Venue: NBN Meeting Room 1, JHH
Tamworth Board Room, Tamworth Hospital
Taree Community Centre
Armidale Seminar Room 2, Armidale Hospital