November 2024 News

Welcome to our November 2024 newsletter.

This month we welcome Donna Morgan to the team and hear about her new role, we Focus On “Green Nephrology“, and you can learn about what’s new in Prevention/CKD Pathways for Primary Care. Find out what happened at the PREMS (Patient Reported Experience Measures) London meeting, there’s more from the Leadership Forum and to cap it all off we have news about Kidney Care UK’s “Bloody Amazing Kidneys“.

Meet the Team

Donna is the Matron for Renal Services at St George’s Hospital, and has recently joined the LKN team as Lead Nurse. She’ll be working across the LKN to support and advocate on Nursing related areas of practice across the kidney pathway. Donna will be supporting more nurses to get involved in the LKN’s work, and encouraging them to do so.

What do you enjoy about working with the LKN? I have recently joined in this role as the Lead Nurse. Since joining I have enjoyed the positivity within the team.  It is great to be part a team that are so passionate in improving the lives of our kidney patients.  I truly appreciate this opportunity to work collaboratively across London in bringing services together for the greater good of kidney patients.

What is your advice to other people who might be interested in taking on a non-traditional role? Honestly, I’m still new to this but I can quite confidently say the LKN team are so welcoming and supportive.  They are mindful first and foremost, that I am a nurse and create a flexible working environment.  This is a fabulous learning opportunity, at the same time as improving the lives of our patients – so come and get involved 😊

Focus on…Green Nephrology: In dialysis, Green Business, is Good Business!

Author: Gareth Murcutt, Royal Free London NHS Foundation Trust
Date: 24/10/2024 Version 1.2
Contact: [email protected]

Introduction:

There are many interventions within haemodialysis that save money and time as well as greenhouse gas emissions, without having any adverse impact on the quality or safety of the service provided.

There are numerous case studies and resources available at Resource library | Sustainable Healthcare Networks Hub but here the focus will be on just two examples.

Did you know that…

1. At the end of a standard dialysis treatment between a quarter and a third of every can of acid concentrate is thrown away?
2. Many dialysis machines are disinfected last thing at night and then again first thing in the morning?

All figures are based on a single 30-bed dialysis unit running 3 shifts per day, 6 days per week, or a total of 28,080 treatments per year. This figure has been chosen to be easily scalable to suit larger or smaller units or running fewer shifts.

1. Central Acid Delivery (CAD)

A central acid distribution system eliminates the wastage of acid concentrate, saving thousands of £££, hundreds of tonnes of staff lifting and staff time per annum (which can be used for patient care) [1]. Due mainly to the removal of plastic cannisters, it also saves about 1,000 kgs of greenhouse gas emissions per dialysis station every year [2]. This project requires pump-priming funding but is expected to repay the installation costs within 2-3 years.

Table 1: Central Acid Delivery – SusQI Triple bottom line reductions

2. Changing an early morning disinfection cycle to a rinse cycle

All dialysis machines require internal disinfection and appropriate external decontamination after every patient treatment. At the Royal Free London, our Fresenius 5008 machines were disinfected after the last patient shift (circa 11.30 pm) and then again before the morning shift started (circa 6.00 am). It became clear from colleagues that many UK units had replaced this morning disinfection and further enquires showed that this was supported by Fresenius. The 5008 manuals state [3]:

After a downtime of more than 72 hours, perform a disinfection before starting a treatment.

Confirmation was provided by FMC Regulatory Affairs … “In our analyses 72 hours have been validated and were proven to be safe.”

The RFL technical team also carried out some type-tests to confirm the safety of a 48 hr dwell period but out of an abundance of caution we are not leaving any machine for more than 24 hours without a disinfection. Now, on Tuesday-Saturday mornings the dialysis machines complete a rinse cycle rather than a disinfection (Monday morning would breach the current 24hr dwell rule).

In a 30=bed unit this equates to 30 (machines) x 5 (days/week) x 52 (weeks/yr) = 7800 cycles changed.

Table 2: Morning Disinfect to Rinse – SusQI Triple bottom line reductions

Discussion:

Whilst sustainability should be on the agenda at most dialysis business meetings there appears a tendency to ‘leave it till next time’. This is even though green interventions within haemodialysis always provide financial savings, some immediate and some medium term. If well- designed, they also reduce the workload for clinical and support staff. Sustainability improvements should be a central part of all business planning within dialysis – whether it be transport, consumables or current practice, they just offer too much of an opportunity to ignore.

Technical Notes:

These examples are based on using a Fresenius 5008H dialysis machine and associated consumables. 

Carbon Emission Factors used in calculations are taken from DEFRA/BEIS Database ghg-conversion-factors-2023-full-set: (Greenhouse gas reporting: conversion factors 2023 – GOV.UK) except [4] Citric acid from carboncloud.com (Citric acid, Europe. E330 · 31.25 kg CO₂e/kg | Verified by CarbonCloud)

Energy calculations have used the formula: Pt = 4.2*L*ΔT/3600 where Pt = the power consumed (kWh), L = volume of water to be heated (litres) and ΔT = the temperature rise (0C)

References:

[1] All workings, assumptions and calculations available on Tabs 2-4 of the following: Sustainability Impact Calculator – Central Acid Delivery GM v2.2.xlsx 
[2] Murcutt, G., Hillson, R., Goodlad, C. et al. Reducing the carbon footprint for a 30-bed haemodialysis unit by changing the delivery of acid concentrate supplied by individual 5 L containers to a central delivery system. J Nephrol (2024). https://doi.org/10.1007/s40620-024-02073-9
[3] Section 6.1: Fresenius Medical Care 5008 IFU-EN 15B-2019.
[4] Dialysis machine disinfection: Is it costing the Earth? G. Murcutt (currently unpublished)

LKN Prevention/CKD Pathways for Primary Care 

PREMS (Patient Reported Experience Measures) – London Regional Meeting

We were delighted to co-host a workshop with UK Kidney Association and Kidney Care UK focusing on the results of the 2023 PREMs survey. Patients and health care professionals from across London came together to review the key achievements and areas for improvement shown in the survey. Each ICB group worked together to think about what they could do to make changes that matter to kidney patients.

Similar meetings have been held across the country with UKKA and KCUK now leading national action learning meetings to agree plans to act on the survey results.

Thank you to everyone who joined us, and special thanks to Sarah Harwood (LKN Patient Experience and Engagement Lead) and Catherine Stannard and Leanne Lockley (Quality Improvement Programme Managers, KQIP UK Kidney Association) for the time, energy and effort they put into creating and running such a useful meeting.

PREMS 2024

The PREMS Survey for 2024 is open until Monday 11 November. You can find out more about why it is important patients complete the survey and how the information is used, here https://kidneycareuk.org/get-involved/kidney-patient-reported-experience-measure-prem/

Please encourage as many of your patients to complete it as possible.

Leadership Forum

In September, the LKN Transplant Collaborative led the Leadership Forum, discussing how mutual aid has made a difference to patients and staff in London. Mutual aid is the system which means that should a kidney be offered to a patient and their usual team cannot perform the operation that day, the operation can happen in another London transplanting centre. It was used successfully during COVID-19, during times of intense pressure at different sites, and was of critical value during the cyber-attack affecting South London this summer. We heard from the Team who needed support and from one of the Teams who offered support, as well details of how patient opinion has impacted on what information is given to people about Mutual Aid.

The Transplant Collaborative are about to finalise their up-dated mutual aid guidance, which will be on our website in due course.

Thank you to Sapna Shah, Rhana Zakri, Anana Muthusamy, and Lisa Silas for sharing their experiences and reflections.

Bloody Amazing Kidneys

Kidney Care UK launched their Bloody Amazing Kidneys champaign in October. They want to start a national conversation about the importance of kidney health and are urging people to use their online Kidney Health Checker to understand their risk and actions they can take.

Check your risk here https://kidneycareuk.org/kidney-health-checker/ and find out more about their campaign here https://kidneycareuk.org/news-from-kidney-care-uk/bloodyamazingkidneys/