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Programme Supported By

Welcome

“ALL HANDS TOGETHER” SHARED HAEMODIALYSIS CARE EVENT

22 JANUARY 2019 : The Marriott LEEDS

Today is about…

• Celebrate the SHAREHD programme achievements

• Understand the shared care “why”

• Hear & see different shared care experiences

• Review early SHAREHD results

• Explore the shared care broader renal context

• Acknowledge and thank all SHAREHD contributions

Please feel free to tweet as we go along @sharemydialysis

#sharehd #whyidosharedcare

Shared Haemodialysis Care

"The objective of Shared Haemodialysis Care is for all people who receive dialysis at centres to have the opportunity, choice and information to participate in aspects of their treatment and thereby improve their experience and their outcomes.

This requires a collaborative approach between health care professionals and patients :

“without patient involvement at every level it would be misdirected and irrelevant".

4

2

3

1

PAM Score 1-4

Small Steps (tasks) within shared care provides a framework to unlock potential

Which of the following dialysis related tasks would you like to try?

Blood pressure

Weight

Hand and access hygiene

Prepare pack

Set-up machine

Insert needles / Connect access

Program machine

Commence dialysis

Discontinue dialysis

Disconnect access / remove needles

Strip down machine and clear away

Problem solving

Administering medications

Lead Wave TRUST

Dr Sandip Mitra 2

Central Manchester

Dr Saeed Ahmed 1 Sunderland

Dr Praveen Jeevaratnam 1 E&N Hertfordshire

Dr Nicola Kumar 2 Guys & St Thomas

Dr Jyoti Baharani 2 Heart of England

Dr Elizabeth Garthwaite 2 Leeds

Dr Albert Power 2 North Bristol

Dr Alastair Ferraro 1 Nottingham

Dr Veena Reddy 1 Sheffield

Dr Babu Ramakrishna 1 Wolverhampton

Dr Mark Lambie 1 North Midlands

Dr Paul Laboi 2 York

Dr Asheesh Sharma 3 Liverpool

Dr Veshal Dey 3 Ayrshire & Arran

Dr Ying Kuan 3 Western Trust

Dr Jennifer Hanko 3 Belfast

Dr Phil Evans Salford Royal

Dr Didem Tez 3 South Tees

Dr Clara Day 3 QE Birmingham

Scaling Up to 19 trusts Shared Haemodialysis Care

Action Period Calls A Shared

Vision

Sharing resources

Co Production

Quality Improvement

Learning events

Teams of HCP and Patients

Toolkits and Roadmaps

Sustainability Plans

Patient focus Group

Team to Team

Support

“making Shared Care everyone’s responsibility”

“patients & staff working

together sharing ownership &

control”

“turning reflective learning into

action”

“real world co-production”

Collaborative Power

Transforming Participation in Chronic Kidney Disease – Report Findings

• HD patients significantly more likely to have lowest activation scores

• Patients living in deprived areas significantly more likely to have lower activation scores

• Workforce training needed to enable better support for low activation levels

Rachel Gair et al 2019

Patient reported Experience of Kidney Care in England and Wales 2017

• Analysis by age, sex, ethnicity, stage of disease showed no significant difference in experience based on those characteristics

Fiona Loud Policy Director Kidney Care UK

The NHS Long Term Plan

People will get more control over their own health and more personalised care when they need it

• better support for patients, carers and volunteers to enhance ‘supported self-management’ particularly of long-term health conditions

Stronger NHS action on health inequalities

• every local area across England will be required to set out specific measurable goals and mechanisms to narrow health inequalities over the next 5/10 years.

www.longtermplan.nhs.uk Jan 2019

http://www.longtermplan.nhs.uk/

Session 1 Why do Shared Haemodialysis Care ? Key Note Speech: “Why Bother with

Shared Care - Particularly in the Renal Unit ?”

The Joy of Supported independence

SHAREHD Research Findings so far ….

Expert Panel Discussion

Chair : Fiona Loud Donal O’Donoghue Tara Bashford Steve Ariss & James Fotheringham


“ALL HANDS TOGETHER”

SHARED HAEMODIALYSIS CARE EVENT

Why bother with shared care, particularly in the renal unit? Professor Donal O’Donoghue

Registrar, Royal College of Physicians

22 January 2019

Shana Alexander, LIFE magazine, 9 November 1962

FigureFigure 2: Description of PAM Levels

FFigure 3: Median PAM score by age

Figure 5: PAM levels by deprivation

Figure 6: PAM levels by symptoms (POS-S renal)

Figure 7: PAM levels by quality of life (EQ-5D-5L)

Figure 10: Haemoglobin by PAM level by Modality

Figure 4: PAM levels by treatment

Figure 8: Median PAM score by renal unit

Table 1: RAG assessment of participating units

Figure 1: Knowledge, skills and confidence cube

Figure 9: Overall distribution of the difference in PAM score between first and second PAM surveys

Patient Involvement: a Paradigm

Shift Old method New Method

What is performance? Outcomes!

VALUE = CLINICAL QUALITY (COMS)

FUNCTIONAL OUTCOME (PROMS)

PATIENT EXPERIENCE

(PREMS)

COST

• Clinical quality includes outcomes and safety • Functional outcome as measured by PROMs • Patient experience includes access and

satisfaction measures

The Joy of supported independence

Tara Bashford – Liverpool Royal

My dialysis journey

Why Shared Care?

Flexibility

Support

Confidence

Friendship

10 months of Shared care

SHAREHD Evaluation Findings

Please note some slides have been removed as they are subject to

further analysis in readiness for formal publication

Dr Steve Ariss & Dr James Fotheringham

Evaluation Work-packages

• Realist/Developmental Evaluation (Developing, refining and testing theories)

• Controlled Trial: Stepped wedge (Numbers of tasks & HHD)

• Principal Component Analysis (How patient characteristics relate to tasks)

• Linkage to HES data (Hospital service use)

• Health Economics (Cost per QALY, compare activity costs, cost for additional tasks/HHD)

Programme Theory

Trust

Main/ Acute unit

Satellite

No External Intervention

Shared Care

Some

Shared Care

Increased involvement

in Care

Wider range of patients

involved

More resilience

Staff

Patients

Share HD intervention

Learning events: QI methods, Networking, Peer support, Sharing ideas and materials, Discussing problems and solutions, Presenting experiences, Check-points & ways to measure progress Website: Sharing ideas and materials Action period calls: Discussing problems and solutions

Introduce Changes

Site-specific Changes have an effect on: working practices/ environment/

opportunities/ motivation/ capability/ organisational readiness etc.

Sustained

competency, opportunity

and motivation of staff

Consistent &

equal opportunities for patients

Ongoing

monitoring and

adjustment

Shared care is business as

usual/ has high profile

Variable & low volume

shared

care

Context: -Relationships between units -Leadership -Budget (training, equipment, materials) -Stability of staff -Patients’ needs/ circumstances -Service history -Built environment -Working processes

Satellite

Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis. BMC Nephrology: 10.1186/s12882-017-

0748-6

Your Health Survey

Tasks HHD

Interest

Quantitative Data: The Stepped Wedge Testing if the SHARE-HD Intervention works

Quantitative Data: Our Endpoint - 5 Tasks or more

Patient Preparation

Machine Preparation & Dialysis Initiation

During and after dialysis

Number of Tasks

Patients (n)

0 64

1 83

2 104

3 85

4 57

5-9 130

10-15 58

Overall 581

First four task are easy? Happen away from the dialysis space?

What did we learn about patients and tasks Some things you can’t change

Overall (n=581)

Less than 5 Tasks (n=188)

More than Five Tasks (393)

Mean Age (Years) 62.3 64.9 57.4 Male Sex (%) 61.7 62.4 60.3 Ethnicity (%)

White 81.3 81.3 81.3 Non-White 18.7 18.7 18.7

Dialysis Access (%)

AVF/AVG 73.2 67.2 84.1 Tunnelled Line 18.6 23.4 10.0

Self Needling (%) Doing 12.4 2.2 29.7

Maybe + 21.8 21.3 22.8 Health Literacy: Trouble with forms (%)

Quite Confident + 58.1 52.2 68.8

Interest In HHD (%) Yes 14.9 12.1 20.9 No 70.7 75.3 61.0 Unsure 14.4 12.6 18.1

EQ5D-5L QoL 0.698 0.669 0.751 Moderate Difficulty In Mobility (%) 35.3 43.2 27.8 Mean Tasks (N) 4.0 2.0 8.2

THE RELATIONSHIP BETWEEN PATIENT ACTIVATION LEVEL AND SELF-PERFORMED TREATMENT RELATED TASKS AMONG PATIENTS RECEIVING IN-CENTRE HAEMODIALYSIS: THE SHAREHD COHORT STUDY. UKKW 2018

Baseline Patient Activation and Tasks (cross-sectional)

Qualitative Analysis

Patient Activation

Developmental model of activation involving 4 stages:

1. believing the active patient role is important,

2. having the confidence and knowledge necessary to take action,

3. actually taking action to maintain and improve one's health, and

4. staying the course even under stress

(Hibbard et al, 2004)

Increase PAM through motivational interviewing and health coaching. Patients with lowest levels of activation make the most gains.

Patient Stages of Change

‘levels of motivational readiness’ 1. Pre-contemplation,

2. Contemplation,

3. Preparation,

4. Action, and

5. Maintenance/Relapse

(Prochaska et al, 2005)

N.B. Some patients are doing SHD but don’t consider this to be shared care(mostly basic tasks: handwashing, weight, BP, Temperature, compressing etc.) . When tasks become business as usual ‘motivational readiness’ becomes a redundant theory and social practice models more relevant, motivation becomes moral compliance with social norms.

Patient Involvement Models

Self care

No involvement

Training

Self care

Training

No involvement

HHD

1) All or Nothing

2) Route to HHD

3) Segre-gated

4) Transient

5) Integrated ‘doing

shared care’

6) Business as usual

7) Rehab approach

Shared care in separate bays

Training

No involvement

No involvement

Shared care on unit

Training in separate bays

Patients selected for

shared care on unit

Training

No involvement

(not selected)

Most patients facilitated to be as involved as

they want. Training is part

of culture performed by

all, on an ongoing basis

No involvement

Due to practical/

cognitive issues etc.

Most patients facilitated to be as involved as

they want. Training is part

of culture performed by

all, on an ongoing basis.

Range of approaches to

give opportunity for

involvement (translators,

vision aids etc.)

No involvement Due to issues

etc.

Staff Involvement Models

1) Lone Champion

2) Shared care leader 3) Small segregated team

4) Distributed team. Some nurses supporting shared care throughout the unit

5) All nurses involved to some extent

6) All nurses committed to supporting shared care

7) All staff committed to supporting shared care

8) Co-production. All staff committed to supporting shared care with service-users

Some key themes

• Spontaneous shared care: Some patients will tend to want to be more involved in their care with little or no encouragement or support (personality, past experiences, health reasons, lifestyle etc.)

• Shared care visibility: Awareness is the first main step towards equality of shared care (separate bays/sessions, staff discussing shared care, posters, leaflets, awareness raising events, peer support, pre-dialysis etc.)

“the more the programme is going on and we are getting more and more patients doing it and obviously they do see other patients, and say ‘what are you doing’? and then they will come and ask what it is all about”

• Start early: It can be more difficult to introduce shared care as a change to treatment. However, visibility helps; being aware of shared care can raise curiosity and lead to taking on more tasks

• Resilience: Don’t rely on a small number of people (or one person) to maintain shared care, co-production with patients can keep shared care as a priority




Refreshments & Marketplace Viewing

Resume at 11.30am

Session 2

Lessons from the Quality Improvement collaborative on delivering Shared Care. Its all about Partnership 15yrs of SHC – Riding Ebbs & Flows Peer Education and SHC Feed and water a SHC culture Expert Panel Discussion

Chair : Liz Hill Smith Sunderland Team Guys & St Thomas Salford Royal Team Heart of England Team

City Hospitals Sunderland

Excellence in Health putting People first

Department of Renal Medicine

Durham Satellite Unit – 60 Patients

Washington Satellite Unit – 54 Patients

Medical Renal Unit – 150 Patients

Home HD – 24 Patients


Shared Care 2014

CHS Pledge

“continue working in partnership together

to improve service options for dialysis patients”


Creating a ripple effect


CHS Renal Service Design and vision for Shared Care

Our Vision

• Increase flexibility for service for the user

• Safer treatments through education and understanding more

• Provide more treatment options and choice. Self-care, home haemodialysis

• Giving back control and ability to decide how, when and where …

• Developmental opportunities for the whole staff team

• Shared care is the norm for those who wish to be involved


Shared Care Partnerships

4 Partnerships of our Shared Care Journey


1.Staff Team Partnership

Planning / Continuity

Teamwork / Communication

Evaluation / PDSA


Staff team partnership Planning


2.Staff and Patient Partnership

Nurse and patients combine resources and

experience. Shared experiences.

Renal Information days.

Staff and patient collaborative in shared care

(Sheffield).

More recently – Northern shared care hub


Collaborative


Time and space to learn


3. Partnership with senior tier for service

design only possible through recognition of

shared care growth

New Unit with dedicated self-care space for

future out of hours service

Expansion of home dialysis service


Taking control


4. Partnership – Support from Charitable Organisations


Thank you for listening

15 years of Shared Care – Riding the Ebbs and Flows

15 years ago our journey started with these aims:

• For patients to reach their maximum self-care potential with 10% fully independent across all dialysis units

• To support staff to establish their own strategies for implementing shared care

• To increase take up of home HD

• To ensure long-term sustainability

Initial impact:

• Almost 10% of patients approached became fully self-caring

• A further 50% were self-caring to some degree

• Increased patient choice

Home HD

Nocturnal home HD

Designated self-care areas

• Culture change

Independence

Involvement

• Re configuration of future HD units

Sustainability 2008:

• Celebrate successes

• Support leadership

• Build effective teams

• ShareHD areas in satellite units

• Identify clear, patient centred, benefits (appointment times, waiting times, flexibility)

• Increase access to home HD – ShareHD pathway to home

• Cultural shift - ‘This is the way we do it here’

Over the next 10 years…..

Outcomes:

• Pockets of excellence

• Evidence of shared care in all 6 satellite units

• Home haemodialysis pathway – the majority of patients going home are ShareHd patients

Challenges:

• Staff turnover

• Competing priorities

• Patient dependency

• Demand / capacity

• Motivation (staff & patients)

Home HD 2008-18

31 30

35 34

41 43

47

53

49

45 43

0

10

20

30

40

50

60

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Home HD take up 2008-18 • 11 patients started

Home HD in 2018

of which 7 were

from the ShareHD

programme

ShareHD 2019

Our aims:

For people who receive dialysis at centres to have the opportunity and information to

participate in aspects of their treatment and thereby improve their experience and their

outcomes (ShareHD)

• For patients to reach their maximum ShareHD potential

• For patients to feel more involved in their care (measured via patient experience

surveys)

• To challenge the culture:

– Dependence to independence

– Passivity to activity

• To increase the take-up of home therapies

Our approach: • Baseline measures of 15 tasks

• Staff survey

• Staff workshop

– Present findings from above

– Discuss drivers and barriers; identify support required

– Agree strategy

– Involve:

• PDN

• home team

• consultants

• pre dialysis team

• patient champions, peer supporters and KPA

• Encourage the teams to take ownership

Motivation and Ownership • Encourage ownership by supporting teams to develop local strategies – one size does not fit all!

• Train the trainers

• Involve the whole MDT especially consultants

• Strengthen the link between shared care teams and home dialysis team

• Use patient feedback & patient stories to motivate other patients and staff

• Share and celebrate successes, even the small ones!

• Expect setbacks, don’t lose the momentum, just keep going….

Roll-out plan to all satellite units: – New Cross Gate

• Shared care bay

• Home HD successes

– Camberwell

• All patients doing some shared care in main unit with 4 patients dialysing independently in self-care room

– Borough

• Shared care bay with flexible appointment times

– Tunbridge

• Home HD training centre for Kent patients

– Sidcup

• Home HD successes via shared care pathway

– Lewisham (moving to new centre this year)

Our vision…..

• Increase access to home dialysis

– ANP to lead the team

– Closer liaison with satellite units / ShareHD teams

– Continue home dialysis roadshows

– More Peer Support and Patient Champions

• New starter area

– Seamless transition from low clearance to HD

– Focus on education and planning

– Involve all the MDT

– Promote involvement, shared care and home therapies

• Patient involvement

– For all patients to be actively involved in their care as far as possible and

to work in partnership with clinicians to improve their outcomes and

experience

Our latest initiative to support patient involvement:

Last year we made a series of 4 films:

• Living with early stage kidney disease

• Having dialysis (home HD, PD, ShareHD)

• Having a kidney transplant

• Supporting you to manage your kidney condition

Each film features clinicians talking about treatment options and patients telling their stories with an emphasis on partnership working and self care.

The films can be viewed on YouTube

Contact us: • Ros Tibbles, Service Improvement Nurse

[email protected]

• Kevin Evans, Satellite Dialysis Matron

[email protected]

• Nicky Kumar, Dialysis Lead Consultant

[email protected]

mailto:[email protected]



Salford Renal Unit Wigan Renal Unit Bolton Renal Unit

Emma Jenner – Salford Unit Matron

Daniel Clarke – Patient Volunteer

Our ShareHD Journey

Who we are

Launch Day

ShareHD poster

Collaborative working between Units

Empowerment of staff

Patient & Staff engagement board

Daniel Clarke – our patient volunteer

Test of change – Bay Working

Test of Change – Shared Care buddies

Who are we?

• 5 dialysis units across the north of Greater Manchester

• 396 ICHD patients

• Previously involved in shared care

• Enrolled in the ShareHD program starting from November 2017

Launch Day

• Planned launch day across all units – Monday 30th July

• Launched new bed allocations

• Started working through new handbook with current and new patients

• Establish patient learning styles

ShareHD poster for all

units

Collaborative working

between units

• Monthly meetings to share progress

• Combined database containing all patient trackers

• Element of competition between units

• Patient numbers tracked on a graph for all to see

Empowerment of Staff

• Completing the ShareHD course

• Attendance at ShareHD learning events

• Monthly staff goal

• Positive reinforcement for nurses towards the patients

Patient & staff engagement

board

Daniel – Our patient

volunteer

Test of change- Establishing Shared Care Bay Working

• Simple visual allocation

• Beds facing each other

• Roll out of bay working successfully

• Allows for 1:1 training

• Now established at all 3 units

Test of change - Shared Care

Buddies

• Competent patients

• Assist in teaching

• Positive feedback from other patients

• Currently have 2 shared care buddies at Salford

• Wigan & Bolton have identified prospective buddies

Patient feedback Stephen

Good idea to involve patients in their own care

Gives me greater knowledge about my

own condition Better social aspect – new group of friends, feel this is the most

important

Colin More community – very

personal, get to know the nurses better

More homely, better now it is in a bay

More knowledge around the dialysis

Better mental health since having new shared care

community

Maria Enjoy the experience Like getting to know

the people, don’t feel isolated, amongst

friends ‘like a little family’

Calmer environment

Audrey Like being in a bay

Enjoy helping other patients as a buddy – gives me a sense

of purpose Feel supported by

the nurses

Data - How are we measuring

progress?

Database established which is logging patient tracker numbers each month

Salford – 24% of ICHD patients participating in ShareHD Bolton - 19% of ICHD patients participating in ShareHD Wigan – 25% of ICHD patients participating in ShareHD

Any Questions?

Feeding and Watering a Shared Care Culture

Birmingham Heartlands Hospital @ UHB

Creating a strategy

• Involvement from Clinical Director to frontline staff

• Embedded in our Renal Pathway

• Sustainability Plan

Creating Sustainability- raising awareness

In house 2 Day S/C and Home Therapies Awareness workshop

• Self directed study

• Practical learning skills

• Group work sessions

• Topic included: accountability, barriers to overcome, communication, hints and tips, teaching cannulation, SMART and PDSA cycles, s/c to HHD

• Guest speakers

• Engaged staff to inform others on how they increase uptake in their unit.

• Group discussions

Road Shows

Patients have the strongest voice- Give them a platform to share their journey- coffee mornings and acknowledgment

Creating a Culture

How do we move to stage 4/5?

• Renal pathway

• Sustainability Report

• Discussed in MDT Meeting

• One to one teaching

• Handovers

• Posters

• Appraisals

• Auditing

• Whatsapp group

• Shared Care Focused Group

• Recognising outstanding contribution by staff

• Industry assisting in education

• Challenge (don’t be scared)

• Support

Organizational culture will eat strategy for breakfast lunch and dinner

Session 3

Interactive Workgroup Sessions A Implementing New Starter dialysis pathways B Early CKD education C Delivering Co-production D Dialysis in 10 years time – Blue Sky thinking E Getting started with Shared Care F Sustaining and growing Shared Care

Vicky Ashworth Nicky Thomas Andy Henwood Liz Pryde Tania Barnes Paul Laboi

A New Starter dialysis pathways B Early CKD education C Delivering Co-production D Blue Sky thinking E Getting started with Shared Care F Sustain and grow Shared Care

Session 3 : Interactive Workgroup Sessions

C B

A

D E F

Trevelyan (1st floor)




Lunch & Marketplace Viewing

Resume at 1.45pm

Marketplace

Lunch in the restaurant

Charity & Commercial Stands

Have your say Video - box

New Starter Dialysis Pathway

“All HANDS TOGETHER” SHARED HAEMODIAYSIS CARE EVENT

22nd JANUARY 2019

Asheesh Sharma Consultant Nephrologist

Maria Fraser Consultant Clinical psychologist (Renal)

Vicky Ashworth Advanced Nurse Practitioner

Susan Casey Haemodialysis Sister

• To explore where the opportunities to improve

patient experience and outcomes maybe in your

department

• To share our learning and experience from

Liverpool

• To discuss change ideas to take back to your own

places of work

Learning Objectives

Starting HD may feel like diving

into an abyss….

Patient Voice Frightened,

Scared, worried

Am I going to

die ? Inappropriate

dialysis time

Physical

Complications

Tired,

exhausted

No Clear Plan

Who do I

speak to about

my concerns

No timely

medical review

Renal Registry: Unadjusted 90d

survival

1 year following 90day survival

High early mortality observed in

USRDS

Cause of this early mortality?

Non-modifiable

Age>65

Age 40-64

Smoker

Previous CVE

CKD aetiology

• Hypertension/ischaemic

• Non-recovered ATN

• Diabetes

Opportunities for improvement?

Modifiable

Timing of dialysis initiation

Pre-dialysis care

High or low weekly dialysis dose

High SBP pre-HD

Low blood flow

HD via a line

• Think about how patients start

dialysis within your own units

• Is there any opportunity to

improve the patient

experience and enhance their

outcomes ?

• Are the any barriers to this ?

15 minutes discussion, 5 minute feedback

Delivery of care is multi-

disciplinary and complex

Patient Journey

Patient Journey: Reality

• Not patient-centered

• Unstructured

• Unreliable

• Prone to congestion

Apply QI methodology to develop

a novel nurse-led pathway to

improve coordination of

personalised multi-disciplinary

care

Reduce 90d mortality of incident

HD patients by 30%

To reduce patient distress on

starting HD

Our Vision in Liverpool

New Starters

Baseline Year 1 Year 2

Number of

patients

78

94

91

Mean Age

(SD)

58.4 (15.6)

60.4 (14.09)

59.7 (16.21)

% Male 62% 59% 59%

% Diabetic 45% 43% 46%

Mean eGFR

Starting HD

(SD)

8.6 (2.7)

7.7 (2.4)

8.0 (2.61)

• Screening for distress is clinically relevant in order to

provide interventions for those patients who are prone to

develop depression and psychosocial well being should be a

priority (Sfrykou, 2014)

• Research from cancer studies suggest that patients tend

not to spontaneously express emotional concerns –

patients need to be asked

• Implementing systematic distress screening should be done

routinely as a first step to offering patients appropriate

interventions (Goh & Griva, 2018)

The Importance of Screening

• Psychological distress is considered a risk

factor for developing mental health problems

• Prevalence of depression or anxiety in the

ESRD population is 4x higher than in the

general population

• Many patients find the transition to dialysis

frightening and traumatic (Combes et al,

2015)

• Untreated psychosocial problems are associated with

withdrawal from dialysis, poor medication and diet

compliance and reduced ability to engage in RRT education

and treatment choice (Taylor et al, 2016)

• Patients want improved lower level support, particularly in

the area of adjustment and coping, however their needs

tend to be ignored and frequently untreated (Tong et al,

2009)

• More than 1/3 of dialysis patients experienced emotional

difficulties during the transition to dialysis and early months

on dialysis (Combes et al, 2015)

Psychological Impact

• 25% of patients have been referred for

assessment as part of the pathway

• Individual assessment involves exploring areas

such as

Psychological Assessment

Mood Anxiety Adjustment/

Coping Lifestyle

Impact on relationships

Treatment Altered body

image Fatigue and

Sleep

Patient with Learning Difficulties and past mental health issues

who also has diabetes

Distress Score = 10.

Very anxious and worried about how she will cope on dialysis

with all the new people and the change to her routine.

Saw for a few sessions to explore concerns and normalise

some of the issues raised. Liaised with nursing staff.

She then managed well for a number of months but needed to

be referred back when she tried to pull her neckline out. As

she

had already seen patient was able to address recent issues

more easily with her.

Case Study

Care takes time

Improved Process


% with a documented transplant

status at 90 days

61% 95.5% 96.5%

% with definitive vascular access

plan at 90 days

89% 95% 98%

% with defined dry weight at 2

weeks

58% 99% 99%

Time interval to first clinic 98 DAYS 42 DAYS 52 DAYS

Improvements:


% with definitive vascular access at

90 days

40% 52% 51%

% with a plan for a home therapy at

90 days

8.5% 24% 16%

Days spent in hospital in the first 90

days

12.2 days 9.5 days 10 days

Unadjusted 90 day mortality 5.1% 2.1% 1.1%

Inpatient stays estimated saving 144K per year

Improved Experience: PREM questionnaire

and distress thermometer

Patient distress diminished from a score of 4.3 (week 2) to 2.4 (week 8)

Patient feedback has been strongly positive

• Thinking about what has been

implemented in Liverpool

• Have you any ideas of how

things may be improved at

your units ?

• Are the any barriers to this ?

15 minutes discussion, 5 minute feedback

• Key elements of intervention seem to be

reproducible at other sites although changes

are needed to suit individualised area

• Consider a cluster randomised or step

wedge trial design to evaluate more widely

• Significant potential gains at scale

Next steps….

Thank you.




Refreshments & Marketplace Viewing

Resume at 3.15pm

Session 4

15:15 All Hands Together What Shared Care means to

Commercial Partners Shared Care Experiences

Chair : Michael Nation Commercial Partners Video

16:00 Concluding Remarks Martin Wilkie

What Shared Care Means to our Commercial Partners

Question 1

As a company why do we think shared haemodialysis care is important

(is there evidence)?

Question 2

What can we do as a company to further the objectives of shared haemodialysis care?

Question 3

Why do we think that a positive patient experience has been squeezed out of in centre

dialysis over the last few decades?

Commercial Charter

As commercial partners we support the Shared Haemodialysis Care vision and agree to help

maintain and grow the movement.

Patient and Staff

Shared Care Experiences

Shared care is a gift. We didn’t realise just how valuable it was until we

unwrapped it!

The Shared Care Movement

FUTURE

Closing the Gap (Y&H)

SHC Course

SHAREHD

MANY INDIVIDUAL INITATIVES

• Manchester 1-4 levels • Guys & St Thomas Self Care

• Wales self care • Nottingham SYD (Share your Dialysis)

Continual development

and collaboration to share, teach,

support and report

LEARNING and COLLABORATION

• 19 trusts involved • Individual contexts embraced

• Collaborative

BUILDING ON A CONSISTENT

FRAMEWORK

255 staff – Closing the Gap & 3 Trusts

42 staff & 2 Trusts

23 staff & 1 Trust

15 staff & 1 Trust

19 staff & 1 Trust

1

22 staff

Over 518 staff trained via nurses course

1 staff & 1 Trust

9 staff + 2 trusts

2 staff & 3 Trusts 19 trusts involved in

32 staff & 3 Trusts

90 staff & 3 Trusts

8 staff & 2 Trusts

Canada

Denmark / Sweeden

• Its Not about mandating

• It is all about Collaboration

– Patient co-production

– Taking, Sharing and learning with & from each other

– Changing the culture

Key Learning Points

from Learning Event feedback that Teams

say will make a different to scaling up their

Shared Care programmes

Engage your Staff and Listen to the Patients

Use the website tools, roadmap and ideas from others

Go back and regularly measure to check where you are

Start small, feed and water

Learning event objectives, agendas, measures , lessons and collateral can be made available to use locally - contact [email protected]

Some key points

from todays meeting • Your outcome is influenced by the house you are

born in - Donal • Patient partnership makes a big difference –

Emma & Daniel • ShareHD is individualised – not everyone want to

go home – Tara • Learning dialysis related tasks does increase PAM

– James • Co-production – all staff committed to supporting

ShareHD – Steve, Laura, Ros, Joyti

https://www.shareddialysis-care.org.uk

https://www.shareddialysis-care.org.uk/



Poster Award

Thankyou to our Patients

THANK YOU

welcome []xokqpppi/files/... · 2019. 1. 25. · dr sandip mitra 2 central manchester dr saeed...

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