December News

Focus on…Dialysis at Home, Peritoneal Dialysis

There is good evidence that across London we do not support as many people as would like to dialyse at home, if given the support and opportunity to do so. Both peritoneal dialysis (PD) and home haemodialysis (HHD) are great treatments that avoid the need for hospital (in-centre) based haemodialysis. The LKN is working to ensure that everyone in London has equal access to high quality dialysis at home.

One of the challenges in some areas of London are access to peritoneal dialysis catheters, work on training healthcare teams in inserting percutaneous PD catheters is being led by Bhrigu Sood, to ensure that every unit has rapid access to PD catheters to help people start dialysis at home with the right dialysis access. As a network we are also working closely with manufacturers to ensure that there is a resilient supply chain for PD catheters over the next few years.

Katie Durman has developed with a Home Dialysis nurses from across London guidelines on Training for PD along with Nursing Workforce. Ensuring an appropriately skilled and resilient workforce are vital to support the growth of Home Dialysis programs across London. This work will extend to Home Haemodialysis as well as looking at variations in dietetic support across London in the next few months.

As healthcare teams we all want to ensure that our quality of care is good as it can be and we know that infection is one aspect that many people worry about with home dialysis. Peritonitis (abdominal infection relating to peritoneal dialysis) rates across London are now a central part of the LKN datapack, demonstrating that while in general we provide safe care, we need to work as a network to ensure we continue to do so as more people choose home dialysis treatments.

Finally, while currently most people doing dialysis at home do PD, Home Haemodialysis programs are growing. Bringing teams together around HHD, led by Suzanne Forbes, is starting to help share expertise to support continued growth and high-quality care in this area.

Meet the Team

In the October Newsletter, we introduced a ‘Meet the Team’ section. We met Lisa and Wendy, two AHPs who work with the LKN. This month, we chatted with Wendy and Lisa to hear why they love being nurses and why working with the LKN is important to them.

What skills do being a Nurse give you that allow you to fulfil your role in the LKN? My experience in the renal transplant field undoubtedly brings valuable insights and expertise which enable me to collaborate with colleagues across London. The confidence I have gained over the years allows me to share ideas effectively and contribute to a multidisciplinary approach. In the complex world of healthcare, where various specialties work together, excellent communication is a key factor in ensuring a coordinated and comprehensive approach.

What do you love about working with the LKN? Bringing together professionals from the multidisciplinary team to share ideas, learn, and support one another is a powerful way to enhance the overall effectiveness of healthcare initiatives. The exchange of ideas and shared experiences will hopefully lead to continuous improvement and advancements in transplant care and will foster a sense of unity and common purpose among the London Transplant centres. I especially enjoy working with patient focus groups.  Engaging with patients directly can bring valuable perspectives and insights to healthcare practices. Patient focus groups offer a unique opportunity for healthcare professionals to better understand the experiences, preferences, and needs of those they serve.

What’s your advice to other Nurses considering taking on a non-traditional role? Definitely consider it. Transitioning to a non-traditional role may seem daunting, but successfully navigating challenges can lead to personal and professional growth and  can open doors to new opportunities and advancement within your career. Exposure to new people, ideas, and approaches broadens your horizons. It helps you see your work from different perspectives, making you more adaptable and open-minded and breaks the monotony of a routine day to day job.

What skills do being a Nurse give you that allow you to fulfil your role in the LKN?
Good communication skills to enable links between healthcare providers and patients to establish joint working, develop engagement and improve long term patient experience. Ability to build a rapport and trust with others; colleagues, patients and community partners. 

What do you love about working with the LKN? 
The opportunity to work and collaborate with colleagues and patients across London, sharing good practice with the aim of improving care and reducing inequities for patients.  A collective voice and action is so much stronger than a silo effort. 

What’s your advice to other Nurses considering taking on a non-traditional role? 
It is an excellent opportunity to work and experience renal care outside your own setting. Also to work with brilliant colleagues across London who are all working towards the same goal – providing better to care for kidney patients in London  

An Introduction to QI

You may have completed an audit and identified an area of your service or practice that you wish to improve, but when and how do you start?

Step 1. Get some training and help
Contact your local QI team, ask about training in the principles of QI, ask if your organisation provides ‘QI coaches’. A coach is someone who has expertise in QI methodology and can help and guide you with your project.

Step 2. Who’s on the team?
Think about the key individuals that need to be engaged with the project to achieve a successful outcome. Also consider who might have particular insights or different perspective on the problem you want to tackle. Your team should have around 5 members. You will need a team leader, someone who will take overall responsibility for driving the project. You also need a sponsor. The sponsor is usually someone in a senior leadership position who can help overcome barriers and whom you can turn to for support if needed. It is not necessary for the sponsor to be part of the core improvement team, but they should check in on a regular basis and try to understand how they can help.

Step 3. Set an aim
In the model for improvement, the first task for your improvement team is to write
an aim statement – “What is it we want to accomplish?”. The aim statement communicates clearly to the whole team what you want to achieve. This is an exercise in goal setting. Decide what you want to achieve, how much you want to improve and by when. The key to setting and writing a good aim statement is to be SMART!

We will work through an example.
We want to increase the number of people receiving a kidney transplant.

S – you want to be specific. What is it that you are going to improve? Define the population that your improvement applies to.

With reference to our example, we decide to refine our aim to specifically increase the number of individuals receiving a pre emptive (before they need dialysis) kidney transplant. However, we also need to be more specific with regards to the scale of the improvement we are hoping to achieve so we revise our aim as follows:
 Increase by 25% the number of individuals receiving a pre-emptive kidney
transplant

M – your aim should be measurable; how will you assess your progress and know
when you have achieved your aim otherwise?
A poor example would be “improve the happiness of the workforce”. How do you measure happiness?, “Improve staff job satisfaction as determined in the NHS Picker staff survey by 25%” would be a better way of outlining the aim.

You must have baseline data from which you will judge your improvement, often this will have been identified in the course of a clinical audit.

Another important consideration is how you will measure. The less work involved in obtaining the measurement, the more likely your project will remain on target and ultimately result in successful improvement.

Some outcomes have a lead time which you will need to consider. In our example increasing the number of pre-emptive kidney transplants is going to be determined by a number of factors not least how long individuals are on the waiting list. You may even include multiple goals within the overall aim of your improvement project.

So our aim now is:
Increase the number of individuals receiving a pre-emptive kidney transplant by 25% through:

 Increasing the number of living donor transplants by 20%
 Optimising the referral pathway to increase the proportion of patients
activated on the national transplant waiting list when their eGFR is 15 ml/min
 Reducing the length of time taken to work-up for transplant listing from a
median of 200 days to 186 days or less

A – Achievable. It is important that your aim is realistic setting an unrealistic aim which you then do not achieve can be demoralising. For example setting the aim to achieve 100% compliance with a target may not be achievable. A good starting point is to consider a relative improvement e.g. 20-25% improvement from baseline Or achieve a particular goal for 95% of individuals.

R – Relevant, your aim should be relevant to you, your team and the organisation. It can be very difficult to achieve your aim if these are not aligned. Before embarking on your improvement project, you may need to spend sometime working to align your aims.

T – Timebound. Setting a time frame is an essential part of assessing your progress towards achieving your aim. Without a time horizon, it is easy to languish on your journey towards improvement. It is often better to specify a date rather than a time frame such as 12 months. As it is a much clearer deadline and less tempting to fudge.

Putting it all together our aim statement now reads as:

Increase the number of individuals receiving a pre-emptive kidney transplant by 25%
through:
 Increasing the number of living donor transplants by 20%
 Optimising the referral pathway to increase the proportion of patients
activated on the national transplant waiting list when their eGFR is 15 ml/min
 Reducing the length of time taken to work-up for transplant listing from a
median of 200 days to 186 days or less by 31 March 2025.

If you need help getting started, then e-mail Victoria on [email protected] to arrange a coaching session with me.

Celebrating the GOLD Team:

Leadership Forum

Our Annual Report, 2022-23

Events/Coming Soon

In this section, we share information about events and education opportunities either that we’re hosting, or that we think you might be interested in. If you’ve got an event you’d like to promote, contact us with the details and we’ll do our best to share it.

Supportive Care Audit half day, in-person at Royal London Hospital 15 December.

This half-day is specifically aimed at those working in renal units who have some responsibility for supportive care within their roles. Places are limited, so please sign up here if you’re interested in joining us: Sign Up

Empowering the Inbetweeners: Young Adult Kidney Care And Beyond.

Date: 14 December

This will be held at the Royal Society of Medicine and has been jointly organised by the LKN and several other partners.  You can find full details here https://www.rsm.ac.uk/events/nephrology/2023-24/nes01/ 

Kidney Care UK Carol Concert

Date: 15 December

Venue: Leadenhall Market. 

If you’re interested in buying tickets for KCUK’s first Carol Concert, you can find details here: Book tickets