Abstract: PO0950
Feasibility of a Staff-Assisted Peritoneal Dialysis Program in the United States: Results of a Pilot Study
Session Information
- Home Dialysis: Disparities and Modality Choice
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
- Bennett, Paul N., Satellite Healthcare, San Jose, California, United States
- Atwal, Jugjeet, Satellite Healthcare, San Jose, California, United States
- Legg, Veronica, Satellite Healthcare, San Jose, California, United States
- Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States
Background
Staff-assistance can support patients to utilize peritoneal dialysis (PD) and is available in many countries but not in the US. We report on the initial experience from a feasibility study for staff-assisted PD in the US.
Methods
An assisted PD program was initiated at one home dialysis center in Aug 2020, and expanded to a total of 6 centers by Feb 2021. Home assistance by non-registered nurse staff was offered to patients with barriers to self-care with the aim to support patients and families to become independent from staff assistance.
Results
Participating centers referred 33 patients (range: 0 – 16 referrals/center). 16 referrals were cancelled [admission from HD to the home program cancelled (3 referrals), transfer from PD to HD prior to starting staff assistance (5), resolution of the issue requiring assistance(7), and death (1)], 3 referrals are pending, and 14 patients received staff assistance at home.
Of those who received assistance, median age was 72 (range 43-87) years, and 8 were new to PD. Indications included: physical weakness (10 patients), cognition (8), and psychosocial issues (7). One prevalent PD patient required assistance following a PD peritonitis episode. Anxiety and lack of confidence were common among referred patients.
Staff member attending the patient’s home assisted with removal and replacement of PD bags (5 patients), machine setup (9), dressing of exit site (7), checking the blood pressure (2), and other requests (8) such as documentation. Assisting staff worked with patients to build problem-solving skills, gain self-confidence, and arrange a safer home environment.
Median length of time on the service was 17 (IQR: 6 – 23, range: 2 – 49) days, and median number of visits was 15 (range: 4 – 38, IQR: 5 – 26) visits/patient. Median visit duration was 64 (IQR: 55 – 90) minutes. Seven of the patients who finished are more than 90 days after starting assistance. Six of them remain on PD and one patient transferred to HD.
Conclusion
Staff-assistance can support patient transition to, and maintenance on, PD. Such programs are operationally feasible with non-RN staff in the US and should be supported by Medicare and regulatory agencies.