Abstract: FR-PO952
Quality Improvement Pilot: A Novel, Personalised, Nurse Led Pathway for Patients Commencing Haemodialysis Shows Improved Outcomes
Session Information
- Patient Safety
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Patient Safety
- 1501 Patient Safety
Authors
- Ashworth, Vicky, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- Mccrudden, Alexandra C, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- Cole, Peter J, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- Sharma, Asheesh, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
Background
Commencing haemodialysis (HD) is a time of physical and psychological distress, with a high incidence of hospitalization. Despite good pre dialysis care many patients experience a suboptimal start to HD. Mortality is at its highest within the first 90 days of commencing dialysis.
Aim: To develop, test and evaluate the impact of a novel, personalised nurse led pathway for patients commencing HD on a range of patient centred process and outcome measures.
Methods
Sequential PDSA cycles were used to develop a personalised nurse led pathway for the first 6 sessions of HD (see fig). Patient distress was recorded at week 2, 4 and 8 using the validated Patient Distress Thermometer (Renal). Baseline control data were retrospectively collected for patients commencing HD from July 2015-June 2016.
Our prospective pilot recruits patients from July 2016-June 2017, and we report 90 day follow-up data.
Results
There were 78 patients in the historic control cohort (mean age 58.4y, 62% male, 45% diabetic). 90 day follow up data are available for 37 patients who started HD using the new pathway (mean age 56.2y, 51% male, 27% diabetic). All outcome measures have improved (see table). Patient distress score has dropped from 4.3 (week 2) to 2.4 (week 8). Patient and staff feedback has been strongly positive.
Conclusion
These data suggest improvements in patient experience and outcomes using this novel intervention.
Improvements in Patient Outcome Measures
| Historic control group | New patient pathway | |
| % listed for transplant or in work up at 90d | 21% | 31% |
| % definitive vascular access at 90d | 40% | 56% |
| % with home therapy plan at 90d | 8.5% | 20% |
| Days in hospital in first 90d | 12.2 days | 8.6 days |
| Unadjusted 90d mortality | 5.1% | 2.7% |
Components of nurse led pathway
Funding
- Private Foundation Support