A MULTIDISCIPLINARY TEAM APPROACH TO INCREASING AND MAINTAINING PERITONEAL DIALYSIS (PD) PATIENT NUMBERS
Collinson, H, Pyrah, C, Ward, P
Renal Service, Hull and East Yorkshire Hospitals NHS Trust
Nationally there has been a steady decline in Peritoneal dialysis (PD) patient numbers across the UK as per data from UK Renal Registry 2010.
In our unit we have engaged the whole Multidisciplinary Team in an approach to growing and maintaining our PD service. We have been able to demonstrate increase in PD numbers at the time when other units have noted a decline. Between April 2005 and September 2011 average patient numbers have increased from 60 to over 90. 1n 2009 22% of our dialysis population were on PD compared to 18% in UK overall (2010 Renal Registry report), although there is wide variability across renal units. Continuous ambulatory peritoneal dialysis, automated peritoneal dialysis (APD) and assisted APD can be offered.
The average age of our current PD patient population is 56years. At present the age range is from 20 to 87years. Our oldest patient has been 91 years.
The 2011 NICE guidelines for PD suggests PD as the initial treatment of choice for patients without significant co-morbid conditions. We have found this not to be the case in our patient population and many of our patients with multiple co-morbid conditions can do PD successfully.
Our approach is patient centred and patients are encouraged to be partners in their care. We aim for them to make an informed choice for dialysis modality.
Patients have been seen in a dedicated low clearance clinic with medical, specialist nursing and dietetic staff since 2003, initially in the main centre only. With an increase in staffing in 2005 (second specialist nurse) additional peripheral clinics held monthly, in others areas of our catchment population were able to commence (3 separate locations).
Part of the pre-dialysis education programme and assessment for PD involves a home visit at an early stage of information giving from a member of the PD staff.
Some PD patients have also been willing to talk to potential new PD patients about their experience of being on PD which these patients have found to be very beneficial.
All training in PD takes place in the patient’s home and PD patients subsequently have regular home visits from the PD staff.
Pre dialysis patients also have a chance to visit a haemodialysis (HD) facility aiming to give a balanced view of dialysis modalities. A number of patients who have previously been receiving HD have also chosen to transfer to PD with success.
Patients with failing renal transplants are also educated afresh about renal replacement options.
The process does require quite a high work load to maintain it, but the feedback from patients choosing PD is extremely positive and a key driver appears to be patients being able to have treatment away from the hospital, and being well supported for this by the dedicated PD team.
Refs: UK renal registry report 2010
CG125 Peritoneal dialysis NICE Guideline