{"id":7857,"date":"2020-08-05T12:45:47","date_gmt":"2020-08-05T11:45:47","guid":{"rendered":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/?page_id=7857"},"modified":"2020-09-04T13:36:42","modified_gmt":"2020-09-04T12:36:42","slug":"birmingham-peritoneal-dialysis","status":"publish","type":"page","link":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/birmingham-peritoneal-dialysis\/","title":{"rendered":"Peritoneal dialysis"},"content":{"rendered":"\n

Learning from one renal unit\u2019s transformation in response to COVID-19<\/h2>\n\n\n\n
\"\"<\/figure>\n\n\n\n

Authors<\/h2>\n\n\n\n

Lavanya Kamesh, Clare Pattenden and Alison Moore <\/em><\/p>\n\n\n\n

Summary of beneficial changes<\/h2>\n\n\n\n
\n
  1. Video education to provide information on PD for pre-dialysis patients, or information on reducing risk of infections for patients established on PD <\/li>
  2. 1:1 training either in the PD unit or at home aided by the assisted APD team <\/li>
  3. Use of Baxter sharesource (on line platform) to manage patients on automated peritoneal dialysis, allowing us to address problems and change dialysis prescriptions remotely<\/li>
  4. Sharesource coupled with video\/telephone clinics helped us manage patients when they were self-caring in the community<\/li>
  5. In-house assisted APD (AAPD) team helped with training and managing peritonitis in the community. They have also been doing phlebotomy rounds to help monitor blood tests.  We would like to augment the AAPD team to include the training component.<\/li><\/ol>\n<\/div><\/div>\n\n\n\n

    Patient Education<\/h3>\n\n\n\n

    Pre-covid all patient education (information on PD for\npre-dialysis patients, or on reducing risk of infections in patients\nestablished on PD) was offered in the unit as 1:1 or group education. During\nthe covid crisis all routine education was stopped. In the recovery phase we\nare doing video consultations to provide information for pre-dialysis patients\nand send links to Baxter\/Fresenius websites to watch information videos. We\nplan to re-start information days on reducing risk of infection via video.<\/p>\n\n\n\n

    Challenges <\/h4>\n\n\n\n

    The video format is not suitable for everybody and the face\nto face contact is so important to reassure patients when they start on new\ntreatment.<\/p>\n\n\n\n

    Future<\/h4>\n\n\n\n

    Some parts of video education will be retained in selected\ngroup. We do want to re-start face to face education when the situation\nsettles.<\/p>\n\n\n\n

    PD catheter insertion<\/h3>\n\n\n\n

    Pre-covid all PD catheter insertions were done at QE\nHospital. We had access to regular lists and a dedicated surgeon who leads the\nlists.  During the covid crisis our\ncatheter insertions dropped from 6-8 per month to 2-5 per month (April and\nMay). We were able to secure catheter insertion lists in a private hospital. In\nthe recovery phase we are now re-building our capacity in QEH and the lists at\nprivate hospital will stop in July.<\/p>\n\n\n\n

    Challenges<\/h4>\n\n\n\n

    We could not do some of the complex cases in the private\nsetting. They had to be accommodated in the Emergency lists. <\/p>\n\n\n\n

    Future<\/h4>\n\n\n\n

    We are relieved that we are getting our dedicated sessions\nback at QEH.<\/p>\n\n\n\n

    Training<\/h3>\n\n\n\n

    Pre-covid around two patients were trained together by one\nnurse in the PD unit and the training generally lasted for 3-5 days. Some\npatients were trained at home by assisted APD team or by Baxter nurse. During\nthe covid crisis we commenced 1:1 training either in the PD unit or at home aided\nby the assisted APD team. During the recovery phase we are continuing in the\nsame pattern as above. Baxter nurses have re-started helping out with training\nat home especially for patients who live far away from the hospital.<\/p>\n\n\n\n

    Challenges<\/h4>\n\n\n\n

    We now have 8- 10 new starters this month. Training them\nsafely and in time is a challenge as we are training the patients on a 1:1\nbasis.<\/p>\n\n\n\n

    Future<\/h4>\n\n\n\n

    It is likely to continue in the same fashion. We will be\nrelying heavily on the assisted APD team to provide training and this need to\nbe considered in staffing numbers.<\/p>\n\n\n\n

    Follow up clinic appointments<\/h3>\n\n\n\n

    Pre-covid there were five consultant led clinics every month\nworking alongside trainees to review patients established on PD. In addition\nthere were nurse led clinics that provided the support, reassurance and\nexpertise for this group of patients managing self-care of dialysis. During the\ncovid crisis all clinic appointments were switched to telephone clinics and\nlead by the nursing team. Only urgent cases were reviewed in the PD unit. In\nthe recovery phase we have recovered some face to face clinic appointments, but\nthese are severely restricted due to social distancing rules. We are using a\nmixture of telephone and face to face clinics to review patients.<\/p>\n\n\n\n

    Challenges<\/h4>\n\n\n\n

    Some of the patients suffer from significant anxiety and\nwant to avoid coming in to hospital. We are encouraging patients not to ignore\ntheir symptoms and to seek medical help. The telephone conversations help in\neasing anxiety.<\/p>\n\n\n\n

    Future<\/h4>\n\n\n\n

    Telephone\/ video clinics are here to stay and will be\nembedded in our pathways.<\/p>\n\n\n\n

    Special mention<\/h3>\n\n\n\n

    Baxter Sharesource<\/h4>\n\n\n\n

    In the last three years, the trust has been using Baxter\nsharesource (on line platform) to manage patients on automated peritoneal\ndialysis. This allowed us to address problems (eg fluid overload) and change\ndialysis prescriptions remotely without the patient needing to come to the PD\nunit. This coupled with video\/telephone clinics certainly helped us to manage\npatients when they were self-caring in the community.<\/p>\n\n\n\n

    Assisted APD<\/h3>\n\n\n\n

    We have our in house assisted APD service that provides care\nfor 20-22 patients. During the pandemic, they have been crucial in patient\nmanagement. In addition to taking on new patients, the team has helped with\ntraining and managing peritonitis in the community. They have also been doing\n\u201cphlebotomy rounds\u201d to help monitor blood tests.<\/p>\n\n\n\n

    Going forward, we would like to augment the AAPD team to\ninclude the training component. <\/p>\n\n\n\n

    Key messages<\/h3>\n\n\n\n